Determinants of unsafe abortion in three squatter settlement of Karachi
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
The World Health Organization estimates that about 20 million unsafe abortions occur each year, the vast majority in South and Southeast Asia, Sub-Saharan Africa, Latin America and the Caribbean. As a result of these abortions, estimated 60,000 maternal deaths occur each year. Abortion is prohibited by law in Pakistan except to save the life of the mother, as a result of which clandestine abortions occur. Information on unsafe abortion from Pakistan is mostly facility-based. Data from obstetrics and gynecology departments of large government and non-government hospitals has estimated 4.5 - $ percent of hospital-mortality amongst the admitted cases as being due to unsafe abortion. Community-based data from squatter settlements of Karachi reveals that 8.8 % of all maternal deaths are due to induced abortions. Another community-based study from squatter settlements of Karachi estimates that out of a total of reported 282 pregnancies, 11% ended as a result of induced abortion. We conducted interviews on 1,2I4 ever married women belonging to reproductive age group (15-49) with history of at-least one pregnancy. One hundred women reported resorting to at-least one abortion in their reproductive life. Abortion rate reported for last year was 25.5 per 1000 women of reproductive age group. Total abortion rate estimated for last year was 0.86. Women who reported an induced abortion in past three years were two times more likely to be educated (OR = 2.0;95%oCI1.2- 3.8), in age group 26-35, (OR = 3.0, CI, 1.4 - 6.3) and nearly four times more likely to have more than four pregnancies (OR 3.9, 95% CI 1.9,8.2) in their entire reproductive life. The major reasons for terminating a pregnancy were short spacing, too many children and ill-health of mother. The main reasons for conceiving an unplanned pregnancy were either couple or husband unwilling to use a contraceptive method or method failure. Health care providers who conducted such clandestine abortions ranged from traditional birth attendants to doctors, though doctors were most commonly sought. Dilatation and curettage was the most commonly sought and most successful method identified. Fever and high vaginal bleeding were the most common post abortion complications reported by the 100 women who reported resorting to induced abortion. We recommend raising awareness amongst policy makers and health planners regarding the high induced abortion rate, and high risk of post-abortion complications. We further recommend appropriate counseling for modern family planning methods to women who have resorted to induced abortions. Additionally IEC campaigns on the adverse health consequences of clandestine abortions should be developed and implemented.
Saleem, S. (1998). Determinants of unsafe abortion in three squatter settlement of Karachi (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.