Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003

Elena Prada, Lynn M Atuyambe, Nakeisha M Blades, Justine N Bukenya, Christopher Garimoi Orach, Akinrinola Bankole, Elena Prada, Lynn M Atuyambe, Nakeisha M Blades, Justine N Bukenya, Christopher Garimoi Orach, Akinrinola Bankole

Abstract

Background: In Uganda, abortion is permitted only when the life of a woman is in danger. This restriction compels the perpetuation of the practice in secrecy and often under unsafe conditions. In 2003, 294,000 induced abortions were estimated to occur each year in Uganda. Since then, no other research on abortion incidence has been conducted in the country.

Methods: Data from 418 health facilities were used to estimate the number and rate of induced abortion in 2013. An indirect estimation methodology was used to calculate the annual incidence of induced abortions ─ nationally and by major regions. The use of a comparable methodology in an earlier study permits assessment of trends between 2003 and 2013.

Results: In 2013, an estimated 128,682 women were treated for abortion complications and an estimated 314,304 induced abortions occurred, both slightly up from 110,000 and 294,000 in 2003, respectively. The national abortion rate was 39 abortions per 1,000 women aged 15-49, down from 51 in 2003. Regional variation in abortion rates is very large, from as high as an estimated 77 per 1,000 women 15-49 in Kampala region, to as low as 18 per 1,000 women in Western region. The overall pregnancy rate also declined from 326 to 288; however the proportion of pregnancies that were unintended increased slightly, from 49% to 52%.

Conclusion: Unsafe abortion remains a major problem confronting Ugandan women. Although the overall pregnancy rate and the abortion rate declined in the past decade, the majority of pregnancies to Ugandan women are still unintended. These findings reflect the increase in the use of modern contraception but also suggest that a large proportion of women are still having difficulty practicing contraception effectively. Improved access to contraceptive services and abortion-related care are still needed.

Conflict of interest statement

We have the following interests. Elena Prada is an independent consultant. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

References

    1. Center for Health, Human Rights and Development, Center for Reproductive Rights. Facing Uganda's Law on Abortion: Experiences from Women and Service Providers. Kampala, Uganda: Center for Health, Human Rights and Development; 2016.
    1. United Nations, Department of Economic and Social Affairs, Population Division. World population policies 2009. New York, NY: United Nations; 2010. Report No.: ST/ESA/SER.A/293.
    1. United Nations, Department of Economic and Social Affairs, Population Division. Abortion policies and reproductive health around the world New York, NY: United Nations; 2014.
    1. Center for Reproductive Rights. Fact Sheet: 10 Key points about Ugandan's law and policies on termination of pregnancy New York, NY: Center for Reproductive Rights; 2011.
    1. Singh S, Prada E, Mirembe F, Kiggundu C. The incidence of induced abortion in Uganda. International Family Planning Perspectives. 2005;31(4):183–91. 10.1363/ifpp.31.183.05
    1. Uganda Ministry of Health. Roadmap for accelerating the reduction of maternal and neonatal mortality and morbidity in Uganda Kampala, Uganda: Ministry of Health; 2007.
    1. Mbonye A, Asimwe J, Kabarangira J, Nanda G, Orinda V. Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda. International Journal of Gynecology and Obstetrics. 2007;96(3):220–5. 10.1016/j.ijgo.2006.12.017
    1. Uganda Ministry of Health. Health sector strategic plan III: 2010/11-2014/15. Kampala, Uganda: Ministry of Health; 2010.
    1. Haddad LB, Nour NM. Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics & Gynecology. 2009;2(2):122–6.
    1. World Health Organization; Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 Geneva, Switzerland: World Health Organization; 2011. Report No.: 6th Edition.
    1. Jagwe-Wadda G, Moore AM, Woog V. Abortion Morbidity in Uganda: Evidence from Two Communities New York: Guttmacher Institute; 2006. Report No.: 26.
    1. Prada E, Mirembe F, Ahmed FH, Nalwadda R, Kiggundu C. Abortion and postabortion care in Uganda: a report from health care professionals and health facilities. Occasional Report. 2005;17.
    1. Vlassoff M, Mugisha F, Sundaram A, Bankole A, Singh S, Amanya L, et al. The health system cost of post-abortion care in Uganda. Health Policy and Planning. 2012;29(1):56–66. 10.1093/heapol/czs133
    1. Hussain R. Unintended pregnancy and abortion in Uganda. New York, NY: Guttmacher Institute; 2013. Report No.: 2.
    1. Uganda Bureau of Statistics, ICF International, Inc. Uganda demographic and health survey 2011. Kampala, Uganda; Calverton, Maryland: Uganda Bureau of Statistics; ICF International, Inc; 2012.
    1. United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive patterns 2013 [New York, NY: United Nations; 2013. Accessed 2015 Jul 2. Available: .
    1. Singh S, Prada E, Juarez F. The abortion incidence complications method: A quantitative technique In: Singh S, Remez L, Tartaglione A, editors. Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity: A Review.New York, NY: Guttmacher Institute; 2010. p. 71–97.
    1. Uganda Bureau of Statistics, ORC Macro. Uganda demographic and health survey 2000–2001. Entebbe, Uganda; Calverton Maryland: Uganda Bureau of Statistics; ORC Macro; 2001.
    1. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: The 2015 revision, custom data acquired via website. Accessed 2016 Oct 6. Available:
    1. Harlap S, Shiono P, Ramcharan S. A life table of spontaneous abortions and the effects of age, parity and other variables In: Porter I, Hook E, editors. Human Embryonic and Fetal Death.New York, NY: Academic Press; 1980. p. 145–58.
    1. Bongaarts J, Potter R. Fertility, biology, and behavior: An analysis of the proximate determinants New York: Academic Press; 1983.
    1. Uganda Bureau of Statistics, Macro International Inc. Uganda Demographic and Health Survey 2006. Kampala, Uganda; Calverton, Maryland: Uganda Bureau of Statistics; Macro International Inc.; 2007.
    1. Leridon H. Human fertility: The basic components. Chicago, IL: University of Chicago Press; 1977.
    1. Lakwo A, Cwinyaai W, Abdallay O. West Nile profiling report, 2008 Nebbi, Uganda: Agency for Accelerated Regional Development; 2008.
    1. Prada E, Biddlecom A, Singh S. Induced abortion in Colombia: New estimates and change between 1989 and 2008. International Perspectives on Sexual and Reproductive Health. 2011;37(3):114–24. 10.1363/3711411
    1. Basinga P, Moore AM, Singh SD, Remez L, Birungi F, Nyirazinyoye L. Unintended pregnancy and induced abortion in Rwanda: Causes and consequences New York, NY: Guttmacher Institute; 2012.
    1. Bankole A, Oye-Adeniran BA, Singh S, Adewole IF, Wulf D, Sedgh G, et al. Unwanted pregnancy and induced abortion in Nigeria: Causes and consequences New York, NY: Guttmacher Institute; 2006.
    1. Sundaram A, Vlassoff M, Mugisha F, Bankole A, Singh S, Amanya L, et al. Documenting the individual and household level cost of unsafe abortion in Uganda. International Perspectives on Sexual and Reproductive Health. 2013;39(4):174–84. 10.1363/3917413
    1. Uganda Ministry of Health, World Health Organization. Service availability mapping in Uganda. Geneva, Switzerland: World Health Organization; 2006.
    1. Prada E, Mirembe F, Ahmed FH, Nalwadda R, Kiggundu C. Abortion and postabortion care in Uganda: A report from health care professionals and health facilities New York, NY: Guttmacher Institute; 2005. Report No.: 17.
    1. Atukunda EC, Brhlikova P, Agaba AG, Pollock AM. Civil Society Organizations and medicines policy change: A case study of registration, procurement, distribution and use of misoprostol in Uganda. Social Science & Medicine. 2015;130:242–9.
    1. Uganda Ministry of Finance Planning and Economic Development. Millennium development goals report for Uganda 2010—Special theme: Accelerating progress towards improving maternal health. Kampala, Uganda: Ministry of Finance, Planning and Economic Development; 2010.
    1. Kiggundu C, Nakimuli A, Lukoda R. Uganda: Abortion situational analysis report. Geneva, Switzerland: International Federation of Obstetrics and Gynecology; 2008.
    1. United Nation Children's Fund. Uganda UNICEF humanitarian situation report—External September 2007. Kampala, Uganda: UNICEF Uganda; 2007.
    1. International Organization for Migration. HIV hot spot mapping and situational analysis along the Kampala-Juba transport route Kampala, Uganda: International Organization for Migration; 2008.
    1. Morris C, Morris S, Ferguson A. Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: The continuing role for prevention in high risk groups. Sexually Transmitted Diseases. 2006;82:368–71.
    1. Marlow H, Shellenberg K, Yegon E. Abortion services for sex workers in Uganda: Successful strategies in an urban clinic. Culture, Health & Sexuality. 2014;16(8):931–43.
    1. Scorgie F, Nakato D, Harper E, Richter M, Maseko S, Nare P, et al. 'We are despised in the hospitals:' sex workers' experiences of accessing health care in four African countries. Culture, Health & Sexuality. 2013;15(4):450–65.
    1. Singh S, Sedgh G, Hussain R. Unintended pregnancy: Worldwide levels, trends, and outcomes. Studies in Family Planning. 2010;41(4):241–50.
    1. Westoff C. Unmet need for modern contraceptive methods. Calverton, MD: ICF International; 2012. Report No.: 28.
    1. Singh S, Fetters T, Gebreselassie H, Gebrehiwot Y, Kumbi S, Audam S. The estimated incidence of induced abortion in Ethiopia, 2008. International Perspectives on Sexual and Reproductive Health. 2010;36(1):16–25. 10.1363/ipsrh.36.016.10
    1. Basinga P, Moore AM, Singh SD, Carlin EE, Birungi F, Ngabo F. Abortion incidence and postabortion care in Rwanda. Studies in Family Planning. 2012;43(1):11–20.
    1. Trussell J. Contraceptive failure in the United States. Contraception. 2011. May;83(5):397–404. 10.1016/j.contraception.2011.01.021
    1. Week A, Alia G, Blum J, Winikoff B, Ekwaru P, Durocher J, et al. A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion. Obstetrics & Gynecology. 2005;106:540–7.
    1. Singh S, Darroch JE, Ashford LS. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014 New York, NY: Guttmacher Institute; 2014.
    1. Bellizzi S, Sobel HL, Obara H, Temmerman M. Underuse of modern methods of contraception: underlying causes and consequent undesired pregnancies in 35 low- and middle-income countries. Human Reproduction. 2015;30(4):973–86. 10.1093/humrep/deu348
    1. Anguzu R, Tweheyo R, Sekandi JN, Zalwango V, Muhumuza C, Tusiime S, et al. Knowledge and attitudes towards use of long acting reversible contraceptives among women of reproductive age in Lubaga division, Kampala district, Uganda. BMC research notes. 2014;7(1):1.
    1. Kakaire O, Nakiggude J, Lule JC, Byamugisha JK. Post Abortion Women’s Perceptions of Utilizing Long Acting Reversible Contraceptive Methods in Uganda. A Qualitative Study. Open Journal of Obstetrics and Gynecology. 2014;4(16):1087.
    1. Bryce E, Budongo S, Baganizi M, Paccione G, Kahn C. Barriers to long-acting reversible contraception use in Kisoro, Uganda. Annals of Global Health. 2016;82(3):380.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit