Abstract
In Côte d'Ivoire, induced abortion is legally restricted unless a pregnancy threatens a woman's life. Yet the limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country's high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Côte d'Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion. In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Côte d'Ivoire. Women reported their own abortion experiences and those of their closest female confidante. We estimated the one-year incidence of induced abortion, and the safety of the abortions women experienced. Using bivariate and multivariate regression, we separately assessed sociodemographic characteristics associated with having had a recent abortion or an unsafe abortion. Overall, 2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend. Based on respondent data, the one-year incidence of induced abortion was 27.9 (95% CI 18.6-37.1) per 1,000 women of reproductive age, while the confidante incidence was higher at 40.7 (95% CI 33.3-48.1) per 1,000. Among respondents, 62.4% of abortions were most unsafe, while 78.5% of confidante abortions were most unsafe. Adolescents, less educated women, and the poorest women had the most unsafe abortions. This study provides the first national estimates of induced abortion incidence and safety in Côte d'Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion. Consistent with other research, our results suggest that legal restrictions on abortion in Côte d'Ivoire are not preventing women from having abortions, but rather pushing women to use unsafe, potentially dangerous abortion methods. Efforts to reduce the harms of unsafe abortion are urgently needed.
Highlights
The West African country of Cote d’Ivoire has a relatively young population and a fast-growing economy; a decade of conflict and instability that destroyed 42% of health facilities weakened the health system and has contributed to poor population health indicators [1]
2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend
This study provides the first national estimates of induced abortion incidence and safety in Cote d’Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion
Summary
The West African country of Cote d’Ivoire has a relatively young population and a fast-growing economy; a decade of conflict and instability that destroyed 42% of health facilities weakened the health system and has contributed to poor population health indicators [1]. The country has one of the highest maternal mortality rates in the region, with estimates ranging from 502 to 944 deaths per 100,000 live births [4, 5]. These deaths are in large part a result of limited emergency obstetric care, but unsafe abortion is a significant contributor. There are no national estimates of the abortion rate in Cote d’Ivoire, available evidence suggests that abortion, unsafe abortion, is common. The limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country’s high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Cote d’Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion
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