New York — The first national estimates of abortion incidence in Rwanda show that one in 40 women aged 15-44 had an abortion in 2009 and that virtually all of these abortions were clandestine procedures that are highly likely to be unsafe.
The study, conducted by the National University of Rwanda's School of Public Health and the U.S.-based Guttmacher Institute, in collaboration with the Ministry of Health, found that an estimated 60,000 induced abortions occurred that year, which translates to a national rate of 25 abortions per 1,000 women of reproductive age.
This is lower than the abortion rate for Sub-Saharan Africa as a whole (31 per 1,000) and for Eastern Africa (36 per 1,000).
The researchers, who gathered data from a nationally representative sample of health facilities and knowledgeable key informants, found that 25,000 women--more than 40% of women who had an abortion--suffered complications that required medical treatment. However, 30% of these women did not receive the medical care they required, indicating a greater need for postabortion care than is currently being provided.
A substantial proportion of abortion complications are likely due to the actions of untrained providers, such as traditional healers, lay practitioners, pharmacists, or pregnant women themselves. Such procedures may involve ingesting dangerous substances or inserting sharp objects into the body to end a pregnancy.
"Reducing maternal mortality and ill-health is a priority for Rwanda.
These important findings will help us better address the issue and improve the health and well-being of Rwandan women and their families," said Dr. Agnes Binagwaho, Rwanda's Minister of Health. "The fact that so many women are suffering complications from unsafe abortion and that so many are not receiving the care they need is very concerning. It is clearly an issue we must address."
Approximately 20% of Rwandan women will require treatment for complications from an unsafe abortion at some point in their lifetime.
The study found that the quality of postabortion care was poor throughout the health system. While 92% of health facilities in the country provide some form of treatment for abortion complications, the majority do not use techniques recommended by the World Health Organization.
Though the number of women who die from unsafe abortions in Rwanda is not known, the World Health Organization estimates unsafe abortion accounts for 17% of all maternal deaths in Eastern Africa.
The researchers also found that despite growing modern contraceptive use in Rwanda, 47% of all pregnancies in the country are unintended.
"Unintended pregnancy is the root cause of the vast majority of abortions," notes Dr. Fidel Ngabo, Director of maternal and Child Health Unit, Ministry of Health, Rwanda and coauthor to the study. "Addressing the unmet need for modern contraception is critical in order to reduce unintended pregnancy and unsafe abortions in Rwanda."
The authors recommend that Rwanda improve its family planning policies and programs to meet the need for modern contraception as a way to reduce unsafe abortion. In addition, postabortion care needs to be expanded and improved so all women have access to the high quality services they need. Furthermore, the authors note, because most Rwandans believe abortion is illegal under all circumstances, programs to educate women and couples about the criteria under which abortion is legally permitted is needed.
KEY FACTS ON ABORTION IN RWANDA
- There are approximately 60,000 abortions performed each year in Rwanda.
- The national abortion rate is 25 abortions per 1,000 women aged 15-44.
- This is lower than the overall rate of 36 per 1,000 for Eastern Africa.
- Unsafe abortion endangers women's health in Rwanda. An estimated 40% of abortions lead to complications requiring treatment. However, one-third of women who suffer complications do not receive needed treatment in a health care facility.
- Unsafe abortion is also a substantial drain on the health care system.
- In 2009, 16,700 women received care for complications resulting from unsafe abortions at health care facilities.
- Unsafe abortions carry a high risk of complications because they are performed by untrained providers such as traditional healers, lay practitioners or pharmacists using dangerous methods; induced by the pregnant woman herself; or performed by trained providers in unhygienic conditions.
- Nationally, seven women are hospitalized for treatment of abortion complications per every 1,000 women of reproductive age. This means that 21% of women will require treatment for abortion complications over their lifetimes.
- While the majority of hospitals are equipped to surgically treat abortion complications, most do not use manual vacuum aspiration (MVA), the technique recommended by the World Health Organization (WHO) because it is safe and easy to perform.
- The level of abortion-related mortality in Rwanda is unknown, but WHO estimates that unsafe abortion accounts for one in six maternal deaths in Eastern Africa.
- Behind nearly every abortion is an unintended pregnancy. According to the most recent data available, 47% of all pregnancies in Rwanda are unintended.
- Some 19% of married Rwandan women have an unmet need for contraception, meaning they want to delay becoming pregnant or want no more children but are not using a modern method.
- In order to reduce the number of unsafe abortions in Rwanda, family planning policies and programs need to be strengthened further so that women and couples can better control the timing and spacing of their pregnancies. In addition, postabortion care needs to be expanded and improved so all women have access to high-quality services.