Abstract
BackgroundLiterature shows that choice for unsafe abortion is often driven by poverty. However, factors related to the family formation behaviour of women are also implied as determinants of this decision. This study assessed which family formation characteristics of women are associated with the risk of unsafe abortion, without being confounded by their low socio-economic status among Sri Lankan women admitted to hospital following post-abortion complications.MethodsAn unmatched case–control study was conducted in nine hospitals in eight districts in Sri Lanka among 171 women with post-abortion complications following unsafe abortion (Cases) and 600 postpartum mothers admitted to same hospitals during the same period for delivery of term unintended pregnancies (Controls). Interviewer-administered-questionnaires obtained demographic, socio-economic and family formation related characteristics. Risk factors of abortion were assessed by odds-ratio (OR), adjusted for their socio-economic status in logistic regression analysis.ResultsLow socio-economic status, characterised by low-education (adjusted OR = 1.5; 95 % CI = 1.1–2.4) and less/unskilled occupations (2.3; 1.4–3.6) was a significant risk factor for unsafe abortion. Independent of this risk, being unmarried (9.3; 4.0–21.6), failure in informed decisions about desired family size (2.2; 1.4–3.5), not having a girl–child (2.2; 1.4–3.4) and longer average birth intervals (0.7 years; 0.6–0.8) signified the vulnerability of women for unsafe abortion. Cases were as fast as the controls in their family completion (4.3 versus 4.5 years; p = 0.4), but were at increased risk for abortion, if their average birth intervals (including the last one) were longer. Previous contraceptive use, age at reproductive events or partners’ characteristics did not impart any risk for abortion.ConclusionsLow socio-economic status is not the most influencing risk factor for unsafe abortions leading to complications, but many other factors in relation to their family formation characteristics that are independent of their low socio-economic status.
Highlights
Literature shows that choice for unsafe abortion is often driven by poverty
The majority of women were of Sinhalese ethnicity (67.1 %), married at the time of unintended pregnancy (94.7 %), poor education (58.2 %) and unemployment status (71.7 %)
Our study highlights that low socio-economic status, characterised by poor education and being employed in unskilled/less-skilled occupations is an independent risk factor for unsafe abortion. It is not the most influencing factor for unsafe abortions leading to complications, but many other aspects in relation to their family formation characteristics that are not confounded by their low socio-economic status, but act as independent risk factors for unsafe abortion
Summary
Literature shows that choice for unsafe abortion is often driven by poverty. factors related to the family formation behaviour of women are implied as determinants of this decision. This study assessed which family formation characteristics of women are associated with the risk of unsafe abortion, without being confounded by their low socio-economic status among Sri Lankan women admitted to hospital following post-abortion complications. Induced abortion is termination of an unintended pregnancy through deliberate intervention. 47,000 die of complications following unsafe abortions each year, giving a case fatality rate of 220 deaths per 100,000 unsafe abortions. This rate is nearly 350 times higher than that associated with legal induced abortion [2, 3]. Septic abortion, occurring as a direct result of unsafe abortion has remained a significant contributor to both maternal morbidity and mortality in Sri Lanka, with no declining trend over the past few years [5, 7, 8]
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