Abstract
OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil.METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis.RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions.CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.
Highlights
Unsafe abortion is defined as the interruption of a pregnancy performed by persons/professionals without the necessary technical abilities and/or in environments without adequate sanitary standards.a On the other hand, abortion that is considered safe is that which performed in situations set forth in law, making it possible to provide women with the necessary and qualified treatment on behalf of structured health services
The methodology of Alan Guttmacher[2] was used, based on the following formula: NAI = (5)*(1.125)*(0.75) NIH. This methodology estimates the number of unsafe abortions, considering: 20.0% of hospital admissions due to abortion complications; parameter of 12.5% as an estimate of underreporting and a discount of 25.0% of abortions due to spontaneous causes.[17,18]
The highest proportion of cases of hospital admissions and unsafe abortions was recorded in the Southeast region (39.2%), especially in the state of Sao Paulo (19.0%)
Summary
Unsafe abortion represents a controversial and challenging question, which incorporates social justice aspects in low and middle income countries,[7] involving a complex network of legal, economic, social, and psychological factors.[7,17] Unsafe abortion is defined as the interruption of a pregnancy performed by persons/professionals without the necessary technical abilities and/or in environments without adequate sanitary standards.a On the other hand, abortion that is considered safe is that which performed in situations set forth in law, making it possible to provide women with the necessary and qualified treatment on behalf of structured health services.
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