The Likelihood of Induced Abortion Among Women Hospitalized for Abortion Complications in Four Latin American Countries Author(s): Susheela Singh and Deirdre Wulf Source: International Family Planning Perspectives, Vol. 19, No. 4 (Dec., 1993), pp. 134-141 Published by: Guttmacher Institute Stable URL: http://www.jstor.org/stable/2133497 Accessed: 17-08-2015 14:35 UTC
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The Likelihood of Induced AbortionAmongWomen Hospitalized forAbortionComplicationsin Four Latin AmericanCountries BySusheelaSinghand DeirdreWulf based on actual todataon thesenationalstatistics, Application oftheWorld HealthOrganization (WHO)method ofclassifying abortions records hospitalstays(forwhichdischarge inBolivia, PeruandVenezuela arepreparedwithinthemedicalsystem), 8,589women hospitalized forabortion complications Colombia, as theresult of aresubjecttomisreporting revealsthat67%ofallsuchwomen mayhaveexperienced their complications ofthecauseof hospitalization. toWHOcriteria, an inducedabortion, compared with 9% reported bythewomen. According In countrieswhere'induced abortion inthesefour 6%prob13%ofthewomen countries arecertain tohavehadaninduced abortion, mightincurlegaland socialsanctionsfor more boththewomanandherpractitioner, havehadone.Unmarried women aresignificantly ablyhavehadoneand49%possibly many (24%vs. womenhospitalizedforinducedabortion likely thanmarried womentobe classified as certain tohavehadan induced abortion say thattheysoughttreatthosewho complications 10%).Compared with womenwhoarelikely tohavehada spontaneous abortion, mentfora spontaneousabortion.Moretohavehadaninduced arelikely abortion tendtohavemorechildren (16%vs.2% hadhadfive over,doctorsand hospitalsreportalmost ormorelivebirths) women like- all patientstreatedforabortioncomplicaandtobe older(39% vs.22% wereaged30 orolder).Among lytohavebeenhospitalized forinducedabortion complications, 40% hadbeenusinga con- tionsas havinghad a spontaneousorunspecifiedabortion,evenwhena cleardimethod traceptive at thetimeofconception and31%saidtheyhadhadatleastoneprevious complications agnosisofinducedabortion tohavehadan induced abortion. 23% ofwomenwhoarelikely abortion hada septicin- mightbe made.Doctorsalso reportthatin About ofcases,thesymptoms fortwo a largeproportion 31% wereat 13weeksormoregestation andabout50%stayedinthehospital fection, two of types ofpatientsaretoosimthese (International 19:134-141, 1993) daysormore. Family Planning Perspectives, ilartodiagnosewhethertheabortionwas spontaneousorinduced. Because the classificationof patients andmisreportingels are also necessaryto understandthe nderreporting dynamicsofa population.3 hospitalizedforabortioncomplications ofabortionin surveysand health broadfertility statistics arewidespreadthrough- Abortionis illegalin almostall Latin obtainedfromhospitaldischargerecords and theonlysource cannotbe takenat facevalue,researchers outtheworld,especiallywhereinduced Americancountries, and reasonablycomplete have devisedmethodsofdistinguishing As a ofquantifiable abortionis illegalinmostinstances.1 result,theincidenceofabortionin these data aboutabortionat thenationallevel betweenspontaneousabortionsand inindependentoftheoffitomeasure.Re- is thedischargerecordsofwomenhospi- ducedabortions, countriesis verydifficult Despite cialclassification. Onehighly complications. liable measures of the incidenceof in- talizedforabortion plausibleand thesedata mustbe widelyendorsedmethodis thetypology ducedabortionareneededtoevaluatethe manyimperfections, and testedbya taskforcecreimpactoffamilyplanningefforts, as well used to obtainindicatorsof thelevel of introduced as to understandcontraceptivefailure inducedabortion.In countrieswherein- atedinthe1980sbytheWorldHealthOrwomen ganization is illegal,however, ratesina givensetting. Contraceptive fail- ducedabortion (WHO) tostudythehealthconfromspon- sequences of clandestineabortion.This resulting ureis usuallyassociatedwithan increase withcomplications criin unintendedbirths,but ifresearchers taneousabortionareincludedwiththose taskforceestablisheda setofuniform ofinduced teriatoreclassify theabortioncases treatoverlooktheuse ofillegalabortiontoend hospitalizedforcomplications whenusinghospital ed in hospitals,and testedthefeasibility unintendedpregnancies,theywill un- abortion.Therefore, toabortioncomas- dischargedata to estimatethe level of ofapplyingthesecriteria derestimate thenumberofpregnancies mustfirst eliminate plicationcasestreatedathealthcentersin researchers sociatedwithcontraceptive failure.2 More abortion, andVenezuela.4 ofinducedabortionlev- spontaneousabortioncases.Becauseitis Malaysia,Nigeria,Turkey preciseestimates difficult to distinguishbetweensponta- Anothermethod,utilizingan indirectesSusheela Singh is associate directorof research and neous and inducedabortionon thebasis timationtechniquebased on thebiologiDeirdreWulfis coordinator ofspecialprojectsat TheAlan ofspontaneouspregnancy ofreporteddiagnosesalone,researchers cal probability GuttmacherInstitute.This analysis was fundedby the methods. loss by durationof gestationand on asJohnD. and CatherineT. MacArthurFoundation,with mustuse indirect Most LatinAmericancountriesuse a sumptionsaboutthelikelihoodofhospiadditional fundingfromtheJessieSmithNoyes Foundation. Funding forthesurveyby theFederaci6nLatinationalsystemofdiagnosesdetailedin talizationamong women experiencing noamericanade Sociedades de Obstetriciay Ginecologia has also beenapthe ninthrevisionof the International spontaneousabortions, was providedbytheJessieSmithNoyes Foundation.The datainthreecounofDiseases (ICD-9) to col- pliedtohospitalization Classification authorsare gratefulto thecoordinatorsofthesurveyOthersurveyshave The triesinLatinAmerica.5 lectinformation abouthospitalization. JoseLarreain Bolivia,GermanUriza in Colombia, Luis Tang in Peru,Orlando Gutierrezin Venezuela-and to with ofinformation thecauseofhospitalization about identified comprehensiveness Villarealforpermissiontoanalyze studyconsultantJorge hospitalized abortion cases varies by somesuccessthroughcarefuland extenthedata. The authorsalso thankSarah H. Costa,Jacquetothe siveinterviewing ofthewomeninvolved.6 butmisreporting according country, lineDarrochForrest, StanleyHenshaw,JorgeVillarealand of octhisstudyis toapplythe standard ICD-9 The purpose categories diagnosis two anonymouspeer reviewersforcommentson thearinducedaborcurs in almostall countries.Thus even WHO methodofseparating ticle,and EthelBrooksforassistancewithtabulations.
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A hospital was seof patients hospitalized withcomlectedifoneormoreob- Table 1. Percentage distribution plications attributableto abortion,by the likelihoodof having had stetrician-gynecologists an induced abortion, according to selected characteristics, Fedagreed to participate eracion Latinoamericana de Sociedades de Obstetricia y Gineand were able to con- cologia (FLASOG), 1990 duct thestudyin their Characteristic N Likelihoodofinducedabortion hospital;thus,thesamCertain Probable Possible UnlikelyTotal ple of hospitalsis nei100.0 32.7 49.3 5.5 12.5 8,589 therrandomnorrepre- All women sentativeofhospitalsin Country 100.0 29.3 53.4 3.6 13.7 758 Bolivia Thenum- Colombia eachcountry. 100.0 33.4 46.8 7.0 12.9 4,046 100.0 30.5 47.3 2.8 19.4 1,930 berofabortionpatients Peru 100.0 34.6 55.3 6.0 4.2 1,855 per surveyedhospital Venezuela during the six-month Age-group 100.0 42.4 38.1 5.2 14.4 1,195
