Higher Levels of Education Associated With Greater Access to Safe Abortion in Brazil

Abstract

In Brazil, women with higher levels of education are more likely to terminate a and less likely to experience complications after the termination, than those with less education, according to a cross-sectional study conducted among female and male civil servants in Campinas, Sao Paulo. (1) Despite the country's strict abortion laws, more than half of respondents who had had (or whose partner had had) unwanted pregnancy reported that the pregnancy ended in abortion. The only measured characteristic associated with opting to terminate unwanted pregnancy was education level: Respondents with at least some college education were more likely than others to say that unwanted pregnancy had resulted in abortion (prevalence ratio, 1.6). After abortion, women with some college education were less likely than those with lower levels of education to need medical care (13% vs. 38%) and hospitalization (8% vs. 28%). Although abortion is restricted to women who were raped or whose life is endangered by their pregnancy (and, since 2012, in cases of fetal anencephaly), estimated one million induced abortions occur in Brazil each year; only a small proportion can be classified as legal. And, despite scant data, it is generally believed that women's risk of complications from unsafe abortion increases as socioeconomic level decreases. Using education level as a proxy for socioeconomic status, the researchers sought to assess the association between education level and induced abortion, and to examine women's access to physician-performed abortions and their risk of complications. In January 2010, the researchers sent self-administered questionnaires to 15,800 male and female civil servants; the survey was resent after a month to increase the response rate. In all, 1,660 questionnaires were returned (response rate, 11%). Women were asked if they had ever had an absolutely unwanted pregnancy, whether they had felt the need to terminate the pregnancy and, if so, what they had done; men were asked the same questions about their female partners. The survey also collected social and demographic information that referred to the time of the unwanted including age, number of children, marital status, education level and contraceptive use. The researchers used chi-square tests to assess differences in reports of unwanted pregnancy and induced abortion by social and demographic characteristics; multivariate Poisson regression models were constructed to assess associations between demographic variables and induced abortion, the need for medical care and the need for hospitalization. Nearly three-quarters of participants (73%) were women. Overall, 18% of respondents reported that they or a partner had had unwanted pregnancy; the proportion was even higher (24%) among respondents who had not attended college. At the time of their unwanted almost half of participants were aged 18-24, nearly three-fourths had no children and a similar proportion were not in a stable union; 45% had at least some college education. Thirty-three percent of respondents had not been using contraceptives, while 23% had been using a hormonal or surgical method or IUD, and 45% had been using a barrier method, a behavioral method (rhythm or withdrawal) or both. …