Suzanne O Bell1, Grace Sheehy1, Andoh Kouakou Hyacinthe2, Georges Guiella3, Caroline Moreau1,4. 1. Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. 2. Programme National de Santé de la Mère et de l'Enfant (PNSME), Abidjan, Côte d'Ivoire. 3. Institut Supérieur des Sciences de la Population (ISSP), Université of Ouagadougou, Ouagadougou, Burkina Faso. 4. Soins Primaires et Prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, Villejuif, France.
Abstract
BACKGROUND: In Côte d'Ivoire, induced abortion is legally restricted unless a pregnancy threatens a woman's life. Yet the limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country's high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Côte d'Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion. METHODS: In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Côte d'Ivoire. Women reported their own abortion experiences and those of their closest female confidante. We estimated the one-year incidence of induced abortion, and the safety of the abortions women experienced. Using bivariate and multivariate regression, we separately assessed sociodemographic characteristics associated with having had a recent abortion or an unsafe abortion. RESULTS: Overall, 2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend. Based on respondent data, the one-year incidence of induced abortion was 27.9 (95% CI 18.6-37.1) per 1,000 women of reproductive age, while the confidante incidence was higher at 40.7 (95% CI 33.3-48.1) per 1,000. Among respondents, 62.4% of abortions were most unsafe, while 78.5% of confidante abortions were most unsafe. Adolescents, less educated women, and the poorest women had the most unsafe abortions. CONCLUSION: This study provides the first national estimates of induced abortion incidence and safety in Côte d'Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion. Consistent with other research, our results suggest that legal restrictions on abortion in Côte d'Ivoire are not preventing women from having abortions, but rather pushing women to use unsafe, potentially dangerous abortion methods. Efforts to reduce the harms of unsafe abortion are urgently needed.
BACKGROUND: In Côte d'Ivoire, induced abortion is legally restricted unless a pregnancy threatens a woman's life. Yet the limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country's high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Côte d'Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion. METHODS: In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Côte d'Ivoire. Women reported their own abortion experiences and those of their closest female confidante. We estimated the one-year incidence of induced abortion, and the safety of the abortions women experienced. Using bivariate and multivariate regression, we separately assessed sociodemographic characteristics associated with having had a recent abortion or an unsafe abortion. RESULTS: Overall, 2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend. Based on respondent data, the one-year incidence of induced abortion was 27.9 (95% CI 18.6-37.1) per 1,000 women of reproductive age, while the confidante incidence was higher at 40.7 (95% CI 33.3-48.1) per 1,000. Among respondents, 62.4% of abortions were most unsafe, while 78.5% of confidante abortions were most unsafe. Adolescents, less educated women, and the poorest women had the most unsafe abortions. CONCLUSION: This study provides the first national estimates of induced abortion incidence and safety in Côte d'Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion. Consistent with other research, our results suggest that legal restrictions on abortion in Côte d'Ivoire are not preventing women from having abortions, but rather pushing women to use unsafe, potentially dangerous abortion methods. Efforts to reduce the harms of unsafe abortion are urgently needed.
Authors: Annet Nanvubya; Francis Matovu; Andrew Abaasa; Yunia Mayanja; Teddy Nakaweesa; Juliet Mpendo; Barbarah Kawoozo; Kundai Chinyenze; Matt A Price; Rhoda Wanyenze; Jean Pierre Van Geertruyden Journal: J Family Med Prim Care Date: 2021-11-29
Authors: Grace Sheehy; Elizabeth Omoluabi; Funmilola M OlaOlorun; Rosine Mosso; Fiacre Bazié; Caroline Moreau; Suzanne O Bell Journal: Reprod Health Date: 2021-12-20 Impact factor: 3.223
Authors: Laura Hinson; Anam M Bhatti; Meroji Sebany; Suzanne O Bell; Mara Steinhaus; Claire Twose; Chimaraoke Izugbara Journal: BMC Womens Health Date: 2022-10-10 Impact factor: 2.742
Authors: Suzanne O Bell; Mridula Shankar; Saifuddin Ahmed; Funmilola OlaOlorun; Elizabeth Omoluabi; Georges Guiella; Caroline Moreau Journal: Health Policy Plan Date: 2021-08-12 Impact factor: 3.547