Abstract
Estimates of number of women who have undergone induced abortion in jurisdictions with restrictive abortion laws are still scarce in the scientific literature, and the disparate estimates from currently used methods call for the application of innovative estimation techniques such as new indirect methods. This need is especially acute in more densely populated areas, such as Brazil's state capitals, given the magnitude of unsafe abortions and the resulting risks and harms. The article aims to estimate the number of women who had induced abortions in the city of Rio de Janeiro in 2011, based on a Bayesian hierarchical model. The model was applied to data from a household survey that supported the use of the network scale-up method in the city of Rio de Janeiro, a Bayesian hierarchical model using indirect information based on the contact networks of randomly selected participants from the general population. Among the 1,758,145 women 15-49 years of age living in the city of Rio de Janeiro, 13,025 women (95%CrI: 10,635; 15,748) had induced abortions in 2011, resulting in a mean cumulative incidence of 7.41 (95%CrI: 6.05; 8.96) for every 1,000 women 15-49 years of age. The model's self-validation process identified patterns of underestimation in stigmatized subpopulations with low social visibility, such as women who have undergone induced abortion. Induced abortion is a common practice among women in the city of Rio de Janeiro. New indirect estimation methods can contribute to more precise measurement of this event, considering the context of illegality, and thereby contribute to appropriate health policies.
Highlights
The high incidence of induced and often unsafe abortions is still a public health problem and one of the principal indices in reproductive health
This study is a subproject of a broad national survey concluded in 2012, entitled Profile of Crack Cocaine Users in the 26 State Capitals, Federal District, 9 Metropolitan Areas, and Brazil, developed by the Oswaldo Cruz Foundation (Fiocruz), whose main objective was to estimate crack cocaine consumption and which covered a series of other public health issues, such as induced abortion, illegal drug use in general, and female sex work, among others
The data collected in the national household survey on the Profile of Crack Cocaine Users in the 26 State Capitals, Federal District, 9 Metropolitan Areas, and Brazil allow estimating the size of hard-to-reach populations, for example women who have undergone induced abortion in the city of Rio de Janeiro in the year prior to the interview, using the network scale-up method (NSUM) 17
Summary
The high incidence of induced and often unsafe abortions is still a public health problem and one of the principal indices in reproductive health. The global rate of unintended pregnancy was 62 (90% credible interval or 90%CrI: 59; 72) per 1,000 women 15 to 44 years of age from 2010 to 2014, and 56% (90%CrI: 53; 60) of all unintended pregnancies ended in abortion during the same period 1. According to Bearak et al 1, during the same period, developing (low and middle-income) countries reported a higher unintended pregnancy rate (mean of 65 per 1,000 women [15-44] years of age; 90%CrI: 62; 76) than developed (high-income) countries (mean of 42 per 1,000 women [15-44] years of age; 90%CrI: 38; 56). There was no significant difference at 90% credibility level in the percentage of unintended pregnancies that ended in abortion in developing (55%; 90%CrI: 52; 60) versus developed countries (59%; 90%CrI: 54; 65). Induced abortions are often performed by persons without the minimum necessary skills or in locations that fail to comply with the most basic medical and hygienic standards, or both, characterizing unsafe abortions and posing avoidable risks to the woman’s health and life 3
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