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Access to safe abortions in low-income and middle-income countries is still a major struggle — thanks to socioeconomic factors, lack of skilled healthcare workers, and patriarchal norms that restrict women’s bodily autonomy, among other barriers. Globally, 45% of all abortions are unsafe and a whopping 97% of them take place in developing countries.
A new study published in the journal PLOS One has highlighted that married women were far more likely to undergo abortions in low-income and middle-income countries. Especially those who had more than four children or were above the age of 30 and highly educated.
According to the World Health Organization (WHO), an unsafe abortion occurs when it is conducted by people with little to no medical expertise and know-how without any adherence to medical standards. “In low and middle-income countries, most abortions tend to be done clandestinely and unsafely by unskilled individuals that result in higher risk of complications such as hemorrhage, infection, uterine perforation, incomplete abortion, maternal deaths and morbidities,” the researchers wrote in their study.
In high-income countries, every year the rate of abortions is 15 per 1000 women who are between the ages of 15-49 years old. Whereas in middle-income countries, the rate is 44 abortions per 1000 women and 38 abortions for every 1000 women in low-income countries.
“To accommodate strategies to reduce pregnancy termination among women of childbearing age in low and middle-income countries, it is crucial to fully understand regional and country-specific variations in the prevalence of pregnancy termination and associated factors,” the researchers explained. “Such knowledge will guide the prioritization of intervention strategies to the most at-risk countries in low and middle-income countries and assist healthcare professionals and stakeholders to adequately identify potential reasons for the high prevalence of pregnancy termination.”
To analyze abortion trends in 36 countries across Africa and Asia, the team used data that included 1.2 million women who were 15 to 49 years old and were a part of the Integrated Public Use Microdata Series (IPUMS) Demographic and Health Surveys (DHS). Most of them (53%) were between ages 15 to 29 years and 72% of them were married but only 20% of them were breastfeeding during the study’s duration. More than half of them or 65% were not using any form of contraceptives and had at least one child up to a maximum of four. The women were asked to reveal if they had undergone an abortion and also consented to disclosing their additional health and socioeconomic data.
The researchers observed that while the prevalence of abortions were lowest in Namibia at 7.8%, the highest prevalence was in Pakistan at 33.4%. “Women with no education, primary education, married, living in the urban areas, not reading newspapers/magazines, listening to radio and watching television less than once a week, having more than four children, currently breastfeeding had the highest prevalence of pregnancy termination in these 36 low-income and middle-income countries,” they noted.
“The positive association between married women and the higher odds of pregnancy termination could be attributed to the lack of contraceptive use or contraceptives’ failure Married women from low socio-economic status may not have the financial means to pay for contraceptives, which may result in an increased likelihood of unintended pregnancies and maternal mortality rates due to unsafe abortions,” they added. “A plausible explanation could be due to the fact that educated women, especially in low resource settings, may have pregnancies that could hinder with their education and therefore may decide to terminate those pregnancies.”
