Abstract
BackgroundIn the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion.ObjectivesOur study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa.MethodsWe applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility.ResultsIn 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49.ConclusionsIncreasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.
Highlights
The Democratic Republic of Congo (DRC) is slowly emerging from decades of armed conflict that has stunted national development and produced disastrous consequences for the health of its citizenry
We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities
Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion
Summary
The Democratic Republic of Congo (DRC) is slowly emerging from decades of armed conflict that has stunted national development and produced disastrous consequences for the health of its citizenry. Use of modern contraceptives remains very low in the country (8% among married women) [4]. Even in Kinshasa, the capital of the DRC and the second most populous city in Sub-Saharan Africa [5], modern contraceptive prevalence is low (23% among married women) [4]. At the low level of contraceptive use, Kinshasa women have only slightly more than four children on average—total fertility rate (TFR) is 4.2 [4]. This strongly suggests that many women are regulating their fertility through recourse to abortion, many of which are likely unsafe given the restrictive legal and social context. To date, there are no official statistics or reliable data to support this assertion.
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