Social determinants of health: from the concept to the practice in outcomes of unintended pregnancies which result in induced abortion

Abstract

The present research is a continuation of another one previously developed about unsafe abortion, associated socio-demographic characteristics and morbidity, and goes further in its analysis of the social determinants of health that influence this occurrence, generating inequities in health. This study compared data of three groups of 51 women (total of 153) submitted to induced abortion, as per situation and site of the procedure: one with “unsafe abortion” (Slum), one with “legal and safe” induced abortion (Public hospital) and a third group with “illegal and safe” induced abortion (Private clinics with appropriate standard of care). Univariate and multiple analyses of multiple multinomial logistic regression analyses were performed for the three categories with Private as reference. In the final model, the variables that proved to have a statistically significant association with induced abortion (CI=95%; p<0.05) were: income, level of schooling, ethnicity/color and place of birth for Slum and, for the Hospital location, the variable ethnicity lost significance. Morbidity, resulting from the outcome, showed a highly significant discrepancy between the first sample (Slum), with 94.12% of women who reported post-abortion complications, and the other two samples (Hospital and Private) in which no case of complication was identified or reported. A critical analysis was also made on the influence of the social determinants of health implied in abortion in all samples, and on the degree of inequity generated in each one (intra-group) and among them. We aimed to better understand social determinants of health concepts in practice. Proposals of action/intervention related to the “entry points” and findings were also suggested.