Abstract
BackgroundUnsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative.MethodsBy estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios) and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term.ResultsThousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia). Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates.ConclusionsThis is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.
Highlights
In June 2009, the UN Human Rights Council passed a landmark resolution recognizing preventable maternal mortality and morbidity as a pressing human-rights issue that violates a woman’s rights to health, life, education, dignity, and information
Ethiopia and Tanzania were chosen for their high maternal mortality ratios (MMRatio), unsafe abortion case-fatality rates and proportions of maternal mortality attributable to unsafe abortion
Assuming that many unwanted/mistimed pregnancies that would have gone to term may be terminated through medical abortion saves thousands more women’s lives per year than assuming an impact on unsafe abortion users only (1093 and 1587 more lives saved/year for Tanzania and Ethiopia respectively (2122 and 2551 saved in total), with coverage assumed at family planning service coverage levels: 56% and 31% respectively)
Summary
In June 2009, the UN Human Rights Council passed a landmark resolution recognizing preventable maternal mortality and morbidity as a pressing human-rights issue that violates a woman’s rights to health, life, education, dignity, and information. Sub-Saharan Africa has the world’s highest maternal mortality ratios (MMRatio) [5] In this region, 3.9% (range 0.0–23.8%) of maternal deaths are due to induced abortion [6] arising from an estimated 19 million unsafe abortions performed annually [7]. The estimated proportion of all pregnancies terminated by induced abortion in Africa is only 15%, the lowest for any continent [9]. This is partly due to strict sanctions against abortion in most African countries, and from a desire for larger families than the rest of the world [9].
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