Morbidity and Mortality from Induced Abortion in Selected Foreign Countries


Zambia

A community study in four districts of Western Province in Zambia identified 298 women who died after an induced abortion between 1980-1993. Of the women who were identified, 171 (57%) were schoolgirls, 111 (37%) were single, and 15 (5%) were married. About half of the abortion-related deaths were reportedly caused by an overdose of modern medicine, usually chloroquine.

The deaths occurred in an area where the social norms taught that a girl should be a virgin at marriage. However, it was determined that more than one-half of the secondary schoolgirls reported sexual contact, and 58% of the girls in grades 10-12 had had sex. Generally their sexual partners were not schoolboys, but workers, teachers, businessmen, and drivers who could provide money, transportation, or high marks in school. Most contacts were regular. One-fifth of the sexually active girls had casual partners as well. These were one night stands for pleasure or money.

The food in the boarding schools where many girls attended is poor and students have little or no pocket money to supplement their poor diet or buy a soft drink, soap, or other small items. Boarders lack the protection of their extended family and most of the girls depend upon their peer group and teachers for social contact. Most of the boarding schools tend to be far from the market and towns. Men in cars were observed waiting for the end of classes when they would offer schoolgirls a ride to wherever they were going. In exchange for sex they provide money, food, and transportation. Schoolgirls may use condoms which are usually provided by their partner. Since many of the partners are married, their relationship must be kept secret and pregnancy would reveal the secret.

It was reported that most pregnancies are unwanted by the schoolgirls. Girls often decided to abort before being discovered and possibly expelled from school. The girls anticipated a harsh reaction from parents at home if they disclosed their pregnancy. However, if the parents were informed, they would be upset initially but would accept the baby into their home. About one-third of the girls attempted abortion alone using a variety of methods. One-quarter of the attempted abortions were unsuccessful, resulting in childbirth. It was estimated that 1% of the secondary schoolgirls died of abortion complications despite the fact that Zambia has one of the most liberal abortion laws in sub-Saharan Africa. Other African studies cited in the article also found that unmarried schoolgirls in other countries, including Gambia, are a most likely group to undergo abortion.40 A Cuban study also reported that young women who were students had a risk of aborting which was 10 times higher than that of housewives and 7 times that of employed women of the same age with students in coeducational boarding schools being at the highest risk.41

Isolation of the young woman from a network of support appears to be a particular risk factor for pregnancyrelated morbidity or mortality. Another type of young woman which appears to be in this category is a maid in domestic service. A Brazilian study of women with postabortion complications found that women under age 20 who were maritally unstable were frequently working in domestic service as maids. The authors noted that these women often had no recognized employment status, live in poor conditions, experience less job stability, all of which which might lead to an abortion if pregnancy occurs.42 Students or women in Ethiopia who were maids or janitresses have also been found to be much more likely to die in childbirth compared with women who survive childbirth.43

Footnotes

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5.  Sex-Selection Abortions in India on the Rise, Australian Broadcasting Company, quoting Dr. Prem Aggarwal, The Pro-Life Infonet, August 3, 1999 [Back]

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11.  The Incidence of Abortion Worldwide, SK Henshaw et al, Int'l Family Planning Perspectives 25 (Suppl): [Back]

12.  Analysis of lifestyle data and cytologic findings in a pilot cervical screening project in rural Vietnam, ME Boon et al, Acta Cytol 43(5):786, 1999 [Back]

13.  Abortion in Vietnam: Measurements, Puzzles, and Concerns, D Goodkind, Studies in Family Planning 25(6):342, 1994 [Back]

14.  Husbands' Involvement in Abortion in Vietnam, A Johansson, et al, Studies in Family Planning 29(4):400, 1998 [Back]

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16.  Abortion in Turkey: A Matter of State, Family or Individual Decision, A Gursoy, Social Science and Medicine 42 (4): 531, 1996; Biomedical regulations in Turkey, E Aydin, Journal of Medical Ethics 25:404,1999 [Back]

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19.  Induced abortion: a method for birth control?, D Guidal, D and S Semin, Adv Contracept 15(1): 49, 1999 (Abstract) [Back]

20.  Demographic and reproductive factors for high seroprevalence of Chlamydia trachomatis among pregnant women in Japan, Y Kusano et al, Tohoku J Exp Med 190 (1):1, 2000 (Abstract) [Back]

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22.  Postabortal Endometritis and Isolation of Chlamydia trachomatis, MB Barbacci et al, Obstet Gynecol 68:686,1986; Chlamydial infection among females attending an abortion clinic, P Levallois et al, Canadian Medical Association Journal 137:33, 1987; A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion, JL Sorensen and I Thronov, Br J. Obstet and Gynaecol 99:434,1992; There is more to a test than technology evaluation of testing for chlamydia infection in a charitable sector termination service, J Hopwood, Br J. Family Planning 23:116,1998 [Back]

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25.  HIV+ adolescents: factors linked to transmission and prevention, D Futterman et al, Int Conf AIDS 9(2):725, Abstract No. PO-C 19-3049, 1993 (Abstract) [Back]

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27.  HIV/AIDS prevention and Multiple Risk Behaviors of Gay Male and Runaway Adolescents, C Haignere et al Int Conf AIDS 6(3): 234 (Abstract No. S.C. 581), 1990 [Back]

28.  What have we learned from adolescent prostitutes in the Caribbean that adult prostitutes did not tell us:, M Alegria et al, Int Conf AIDS 9(1):89 ( Abstract No. WS-C08-2), 1993 (Abstract) [Back]

29.  Single and repeat elective abortions in Japan: a psychosocial study, T Kitamura et al, JPsychosom Obstet Gynaecol 19(3): 126, 1998 [Back]

30.  The First Abortion and the Last? A Study of the Personality Factors Underlying Failure of Contraception, P Niemela et al, Int'l J Gynaecol Obstet 19:193, 1981 [Back]

31. Reflections on repeated abortions: The meanings and motivations, Susan Fisher, Journal of Social Work Practice 2(2):70, 1986 [Back]

32. Unsafe Abortions: Methods Used and Characteristics of Patients Attending Hospitals in Nairobi, Lima, and Manila, A Ankomah et al, Health Care for Women Int'l 18:43, 1997 [Back]

33.  Abortion in the Philippines: A Study of Clients and Practitioners, Moria Gallen, Studies in Family Planning 13 (2):35, 1982 [Back]

34.  Induced Abortion in Rural Villages of Cavite, the Philippines: Knowledge Attitudes, and Practice, JM Flavier and CHC Chen, Studies in Family Planning 11 (2): 65, 1980 [Back]

35.  Pregnancy-associated deaths in Finland 1987- 1994- definition problems and benefits of record linkage, M Gissler et al, Acta Obstet Gynecol Scand 76:651, 1997 [Back]

36.  Suicides after pregnancy in Finland, 1987-94: register linkage study,M Gissler et al, British Medical Journal 313:1431, 1996a [Back]

37.  Declining induced abortion rate in Finland: data quality of the Finnish abortion register, M Gissler et al, Int'l J Epidemiol 25(2) 376, 1996b [Back]

38.  Frequency of admissions (rate per 1000 population) for attempted suicide by pregnancy event in women aged 15-49 during 1991-95, C Morgan et al, British Medical Journal 314: 902, 1997 [Back]

39.  Childbirth as Protective of the Health of Women in Contrast to Induced Abortion-II. Smoking, Alcohol and Drug Use, T Strahan, Association for InterdisciDlinarv Research in Values and Social CXanae Research Bulletin 12 (3): 1, 1998, Ch~ldbirth as Protective of the Health of Women in Contrast to Induced Abortion-III. Mental Health and WellBeing, T Strahan, Association for Interdisciplinary Research in Values and Social Chanue Research Bulletin 12 (4): 1, 1998 [Back]

40.  Why Resort to Illegal Abortion in Zambia? Findings of a Community Based Study in Western Province, W Koster Oyekan, Social Science and Medicine 46 (10): 1303, 1998 citing other authorities [Back]

41.  Abortion in the Americas, HP David and S Pick de Weiss in Reproductive Health in the Americas, Ed. AR Omran et al, Pan American Health Organization PAHO/WHO, 1992, 334 citing Abortion in Cuba, 1989, M Soza et al, Paper Presented at the Population Council Workshop, Toronto: May 2, 1989 [Back]

42.  Abortion and Adolescence: Relation Between the Menarche and Sexual Activity, N Schor, Int'l Journal of Adolescent Medicine and Health 6(34):225, 1993 [Back]

43.  Factors Associated with Maternal Mortality in Addis Ababa, Ethiopia, B Kwast and JM Liff, Int'l J Epidemiology 17 (10):115,1988 [Back]

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