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Estimating the Level of Abortion In the Philippines and Bangladesh

Authors:

Abstract

In countries where data on induced abortion are underreported or nonexistent—such as the Philippines and Bangladesh—indirect estimation techniques may be used to approximate the level of abortion. The collection of data about women hospitalized for abortion complications and the use of such indirect estimation techniques indicates that the abortion rate in the Philip- pines is within the range of 20-30 induced abortions per 1,000 women aged 15-49, and the rate in Bangladesh ranges between 26 and 30 per 1,000. About 400,000 abortions are esti- mated to occur each year in the Philippines, while the number in Bangladesh is calculated to be about 730,000. Some 80,000 women per year are estimated to be treated in hospitals in the Philippines for complications of induced abortion; in Bangladesh, about 52,000 women are treat- ed for such complications, and another 19,000 are treated for complications resulting from men- strual regulation procedures. The probability that a woman will be hospitalized for abortion com- plications in the Philippines is twice that in Bangladesh, probably because menstrual regulation procedures by trained providers account for about two-thirds of all voluntary pregnancy termi- nations in Bangladesh. (International Family Planning Perspectives, 23:100-107 & 144, 1997)
100 International Family Planning Perspectives
tion is extremely difficult to obtain in
many parts of the developing world.1Al-
though the problem is most severe where
the procedure is highly restricted by law,
there are a number of reasons why the pro-
cedure is often underreported, even in
countries where abortion is legally per-
mitted under broad conditions. Providers
may not report all of the procedures they
perform, an official system for recording
abortions may not exist or may be in-
complete, and women may not always ac-
knowledge an abortion.
The countries of South Central and
Southeast Asia are no different from the
rest of the developing world in this regard,
and most lack accurate information on
abortion. These countries span a wide
range of situations regarding the legal sta-
tus and safety of abortion provision. The
Philippines and Bangladesh are at very
different points along the continuums of
legality, access and safety. Although we
focus on these countries partly to portray
the variation that exists in Asia, other,
equally important factors that influenced
the choice of these two countries include
the high level of concern about the con-
Susheela Singh is director of research at The Alan
Guttmacher Institute, New York. Josefina V. Cabigon is
professor at and Aurora E. Perez is director of the Pop-
ulation Institute of the University of the Philippines,
Manila; Altaf Hossain is research coordinator and
Haidary Kamal is director of the Bangladesh Associa-
tion for Prevention of Septic Abortion (BAPSA), Dhaka.
The authors would like to thank the following individ-
uals for their invaluable contribution to the collection,
processing and analysis of data: in the Philippines, Cora-
zon Raymundo (both for comments and for special tab-
ulations), Zenaida E. Quiray, Florio Arguillas and Jose-
fa Zafra, all of the University of Philippines Population
Institute; Benjamin Marte and Vidal Pantillano, Jr., De-
partment of Health, Manila; and in Bangladesh, Reena
Yasmin and Purabi Ahmed, who are quality control of-
ficers, and Abu Taher, Hedayeat Bhuiyan, Lutful Man-
nan and Tariful Prodhan, who are interviewers, all at
BAPSA. The authors also thank Heidi Jones and Reina
Nuñez at AGI for research assistance and Jacqueline E.
Darroch, Adrienne Germain, Stanley Henshaw, Roger
Rochat and Deirdre Wulf for reviewing drafts of this ar-
ticle. The research on which this article is based was sup-
ported by The World Bank. The findings and conclusions
expressed are entirely those of the authors, however, and
do not necessarily represent the views of The World Bank.
Estimating the Level of Abortion
In the Philippines and Bangladesh
By Susheela Singh, Josefina V. Cabigon, Altaf Hossain, Haidary Kamal and Aurora E. Perez
Regardless of the legal status, acces-
sibility or safety of induced abor-
tion, information about it is essen-
tial if health planners are to ensure that
women’s reproductive health is protect-
ed. However, reliable information on abor-
sequences of unsafe abortion,2the possi-
bility of collecting data that would allow
us to estimate the level of abortion, the
availability of collaborators who had ex-
perience with research on the subject of
abortion and resource limitations that re-
stricted the research to only two countries
of moderate size.
The Philippines and Bangladesh have
very different official policies on abortion.
The Philippine penal code contains a gen-
eral prohibition on abortion, but while no
exceptions are specified, it may be inter-
preted to permit abortion to save the life
of a pregnant woman.3Despite the law’s
severity, abortion appears to be widely
practiced, however, judging from studies
carried out over the past few decades.4A
recent survey of health professionals in the
Philippines suggests that about one-third
of women seeking an abortion obtain it
from a doctor or nurse; the majority of
women consult traditional practitioners
or attempt to induce the abortion them-
selves—increasingly, through the use of
prostaglandins like misoprostol.5
In Bangladesh, the penal code permits
induced abortion only to save a woman’s
life. However, menstrual regulation by
vacuum aspiration is not regulated by the
code and is considered to be an “interim
method for establishing nonpregnancy.”6
The procedure is allowed up to 10 weeks
since the last menstrual period, but in
practice, it is sometimes provided up to
12 weeks.7About 12,000 doctors and para-
medical providers have received formal
training in menstrual regulation,8al-
though many other practitioners with
only informal training are also believed
to provide it. However, many women do
not know that menstrual regulation is
available, do not know of a provider or are
unaware of time limits. In addition, access
to legal menstrual regulation services is
poorer in rural areas than in urban areas.
As a result, in both urban and rural areas,
In countries where data on induced abortion are underreported or nonexistent—such as the
Philippines and Bangladesh—indirect estimation techniques may be used to approximate the
level of abortion. The collection of data about women hospitalized for abortion complications
and the use of such indirect estimation techniques indicates that the abortion rate in the Philip-
pines is within the range of 20–30 induced abortions per 1,000 women aged 15–49, and the
rate in Bangladesh ranges between 26 and 30 per 1,000. About 400,000 abortions are esti-
mated to occur each year in the Philippines, while the number in Bangladesh is calculated to
be about 730,000. Some 80,000 women per year are estimated to be treated in hospitals in the
Philippines for complications of induced abortion; in Bangladesh, about 52,000 women are treat-
ed for such complications, and another 19,000 are treated for complications resulting from men-
strual regulation procedures. The probability that a woman will be hospitalized for abortion com-
plications in the Philippines is twice that in Bangladesh, probably because menstrual regulation
procedures by trained providers account for about two-thirds of all voluntary pregnancy termi-
nations in Bangladesh. (International Family Planning Perspectives, 23:100–107 & 144, 1997)
ARTICLES
101Volume 23, Number 3, September 1997
project described in this article, all avail-
able forms for 1993, 1994 and 1995 were
collected in early 1996 from each region-
al Department of Health office.
Because some hospitals do not submit
a reporting form, we assembled a com-
prehensive list of Philippine hospitals, to
place in context the information obtained
from hospitals with forms. Existing lists of
all known private and public hospitals
were compiled, and hospitals that were not
on these lists but that were identified
through the reporting forms they had sub-
mitted were added. We identified a total
of 1,863 hospitals from all sources. (By com-
parison, government statistics for 1992 in-
dicated that there were 1,663 hospitals.14)
Using information from existing hospi-
tal lists or from reporting forms, we creat-
ed a data file of basic descriptive charac-
teristics for all hospitals, including
ownership, type and level of hospital, and
number of beds. For hospitals that had
submitted a form, other selected informa-
tion was added to the data file, including
the number of abortion complication cases
treated (in hospitals where abortion was
among the top 10 causes of admission) or
the number of patients treated for the 10th
most common cause of admission (in hos-
pitals where abortion was not among the
top 10 reasons for admission).
Calculating the total number of hospitalized
abortion patients. Of the 1,863 hospitals
identified in the Philippines, we obtained
usable reporting forms for 1,121.We then
made two basic adjustments to the data:
If reporting forms were available for more
than one year, the data were averaged; if
the form covered only part of a year, the
number of patients was adjusted to cre-
ate an annual estimate, proportional to the
number of months covered by the form.§
Overall, in 345 hospitals, abortion was
one of the 10 main causes of admission and
a direct count of the number of women
hospitalized for abortion complications
was available. For the remaining 776, we
used the number of patients admitted for
the 10th most common cause of hospital-
ization as part of our estimation process.
We developed a three-step method-
ology to estimate the number of women
hospitalized because of abortion in all hos-
pitals, including those for which the num-
ber was not directly available. First, there
were almost 51,000 hospitalizations be-
cause of abortion in the 345 hospitals in
which abortion complications were
among the 10 leading causes of admission
and for which a direct count of such ad-
missions was available; this information
needed no further adjustment.
a substantial proportion of women are be-
lieved to obtain abortions from tradition-
al midwives or attempt to perform the
abortion themselves.9
Despite the policy differences, both
countries face serious health and health
service problems related to the wide-
spread practice of abortion. In both, ma-
ternal mortality resulting from unsafe
abortion and a heavy demand for hospi-
tal services to treat abortion complications
are serious public health problems.10 The
maternal mortality ratio is estimated to be
much higher in Bangladesh (480 maternal
deaths per 100,000 births) than in the
Philippines (100 per 100,000).11 A survey
of health workers in Bangladesh in the late
1970s indicated that as many as 26% of
maternal deaths were due to abortion;12
Philippine government statistics indicate
that about 10% of recorded maternal
deaths were classified as due to abortion.13
This article presents estimates of levels
of induced abortion in the Philippines and
Bangladesh in the mid-1990s, based on an
indirect estimation methodology. How-
ever, the data collection efforts differ for
each country, reflecting variations both in
the availability of the relevant data and in
the provision of abortion services.
The Philippines
Estimating the level of abortion in the
Philippines involved several steps: col-
lecting information on the number of
women hospitalized due to abortion com-
plications; adjusting this number for in-
completeness; separating out women
treated for complications of spontaneous
abortion; and calculating the total num-
ber of women having an induced abor-
tion, safe or unsafe, based on the number
of women hospitalized and on assump-
tions concerning the ratio of the total to the
number hospitalized. We arrived at these
assumptions after considering all avail-
able information concerning the safety of
abortion practice and access to hospitals.
These data were then used to estimate the
abortion rate and the abortion ratio.
Methodology
Data availability and data collection. As part
of licensing regulations, all hospitals in the
Philippines are required each year to com-
plete and submit to their regional De-
partment of Health office a form report-
ing on their facilities and on services
provided, including the number of pa-
tients treated for each of the top 10 caus-
es of hospital admission. However, these
forms are not compiled, processed or tab-
ulated for the country as a whole.* For the
For the remaining 776 hospitals, we as-
sumed that admissions for abortion com-
plications would account for about half as
many patients as the number hospitalized
for the lowest-ranking or the 10th-rank-
ing cause.** This yielded an additional
count of about 18,500 abortion complica-
tion cases per year from these 776 hospi-
tals, for a combined total from the 1,121
hospitals with reporting forms of about
69,500 abortion-complication patients.
The third step was to estimate the like-
ly annual number of abortion complica-
tions treated in the 742 hospitals for which
there were no reporting forms. We used a
regression equation in which the number
of abortion patients was the dependent
variable and hospital characteristics con-
sidered to be important determinants of
the intake of abortion complication cases
were analyzed. These characteristics were
ownership (public vs. private), hospital
level (primary, secondary or tertiary), hos-
pital size (number of beds) and region.
The regression equation was based on the
1,121 hospitals with information on the
number of abortion patients, whether di-
rectly reported or estimated.
One interaction, between ownership and
size, was significant and was included in
the final regression equation. We estimat-
ed that these 742 hospitals treated about
30,100 women for abortion-related com-
plications per year, making a total of 99,600
women hospitalized for abortion in all hos-
pitals in the Philippines in 1994 (the cen-
*Nevertheless, these data have been used in special pro-
jects: For example, the LUCENA system has collected and
processed admissions statistics from 21 hospitals since
1993, and in a pilot project in Northern Mindanao, a cod-
ing and tabulation program was developed to utilize the
data from hospital reporting forms. Both of these projects
were developed by the Health and Management Infor-
mation System of the Philippine Department of Health.
†A letter of authorization was obtained in 1996 from Sec-
retary of Health H. J. Ramiro to facilitate data collection,
and both central and regional staff from the Department
of Health assisted with the fieldwork. Data for Northern
Mindanao were obtained directly from the Department
of Health, which had already processed that region’s
records in their pilot study.
‡Forms were obtained for 80 additional hospitals, but
these lacked some information that was essential to this
analysis, and could not be used. Nonobstetric specialty
hospitals were also excluded.
§Of the 1,121 hospitals with usable reporting forms, 221
had data for three years, 347 had data for two years, 383
had information for one year and 170 had information
for part of a year only.
**Additional information for Northern Mindanao sup-
ports this assumption: For six hospitals where abortion
ranked below the 10th cause and for which data were
available on both the 10th cause and the number of abor-
tion patients, abortion complications accounted for about
60% of the total number of patients hospitalized for the
10th-ranking diagnosis.
1993 National Demographic Survey show
that nationally, 28% of women delivered at
a health facility, but this proportion ranges
from 11% in the Cagayan Valley region to
68% in metropolitan Manila.17
Thus, by applying 3.41% to the number
of live births18 and by multiplying the re-
sulting number by the proportion likely to
obtain hospital care, we can estimate the
number of women likely to be hospitalized
for a late spontaneous abortion separate-
ly for each of the 16 regions; by combining
regions, we obtain values for the four
major areas of the country. The resulting
estimated annual number of women hos-
pitalized because of spontaneous abortion
is just under 20,000, or about 20% of all
women hospitalized each year for all abor-
tions. The remainder, about 80,000, are con-
sidered to be women hospitalized for com-
plications of induced abortion.
Estimating the total number of induced abor-
tions. Our next step was to derive a mul-
tiplier, or inflation factor, with which to es-
timate the number of women who have an
abortion but who do not need or do not
obtain treatment at a hospital. This in-
cludes women who die before obtaining
hospital care, those who have a compli-
cation but do not obtain hospital care
(whether due to poor access to hospitals
or to a reluctance to seek treatment), those
who obtain care from a private doctor and
those who have an uncomplicated abor-
tion. For example, if 20% of women hav-
ing an abortion are hospitalized for com-
plications (i.e., one out of every five
women having an abortion), then the in-
flation factor would be five, and multi-
plying the number of women hospitalized
as a result of an induced abortion by five
would yield the total number of abortions
occurring in the reference period.
In general, the safer abortion services
are, the higher the multiplier that is need-
ed, because for every woman hospitalized,
many have abortions that do not result in
complications or hospitalizations. Con-
comitantly, the poorer and less safe abor-
tion services are in a given setting, the
lower the multiplier will be, because a
higher proportion of women have serious
complications.
Safety is not the only consideration,
however. The multiplier is also a function
of the general availability of hospital ser-
vices. Where such services are easily ac-
cessible, the proportion of women with
complications who receive hospital treat-
ment will be higher. In poor regions or in
underdeveloped rural areas, on the other
hand, where hospitals are few, even the
most seriously affected woman is unlike-
tral year of the period covered, 1993–1995).
Estimating the number of women requiring
hospitalization exclusively for induced abortion.
Some hospitalized abortion patients are
treated for the complications of a sponta-
neous pregnancy loss rather than of an in-
duced abortion. However, in settings in
which induced abortion is illegal, as in the
Philippines, hospital records typically do not
distinguish between induced and sponta-
neous abortions, because of the possible
legal consequences. An essential step, there-
fore, is to separate out the number of patients
hospitalized for treatment of the complica-
tions of spontaneous abortion.
Because it has the advantage of being
comparable across areas, an indirect meth-
od of estimating the number of women
hospitalized for spontaneous miscarriages
was used. In the absence of induced abor-
tion, both the distribution of pregnancy
loss by gestation and the proportion of live
births among all pregnancies are fairly
constant across populations. Such data are
available both historically and from recent
clinic-based studies in the United States
and other countries.15
In clinic studies, estimates of pregnan-
cy loss by gestation are based on all preg-
nancies recognized at an early point in
gestation (e.g., at five weeks). We assume
that late miscarriages (those at 13–22
weeks) are likely to be accompanied by
complications that require hospital care.*
Miscarriages at 13–22 weeks account for
about 2.89% of all recognized pregnancies,
although since live births are 84.8% of all
recognized pregnancies, such miscar-
riages are equal to 3.41% of all live births.
Since the number of live births is known,
this proportion can be used to estimate the
number of women having late miscar-
riages.16 We applied this proportion to the
number of annual births in the Philippines
to estimate the number of late sponta-
neous abortions there.
However, a further adjustment is need-
ed to obtain the number of women likely
to be hospitalized because of a late sponta-
neous abortion. Since not all women who
need hospital care for the treatment of late
spontaneous abortion have access to a hos-
pital, we assumed that the proportion of
women having a late spontaneous abortion
who are likely to be hospitalized is the same
as the proportion of women giving birth
who deliver in a hospital. Data from the
ly to get the treatment she needs for med-
ical problems related to abortion.
Unfortunately, there have been no large-
scale, community-based surveys of women
that might provide a reasonable estimate of
the proportion of all women having induced
abortions who become hospitalized. After
reviewing all available information, we con-
cluded that this proportion most likely
ranges between one in four and one in five
nationally, but that in regions with greater
access to safe abortion—or with poorer ac-
cess to hospitals—it may be one in six. Thus,
the multiplier appropriate for the Philip-
pines would range between four and six.
Data from a number of studies provid-
ed the basis for this estimate:
•Two Philippine community surveys pro-
duced relevant information. One, a 1978
community survey in Cavite province,
found that 12% of women (or about one in
eight) who reported having one or more
abortions had been hospitalized for com-
plications.19 The other, conducted in 1994,
found that among 170 women in metro-
politan Manila who reported ever having
had an abortion, about 36% (or one in three)
had been hospitalized for complications.20
Neither of these studies may be gener-
alizable to the whole country in the 1990s,
though. The proportion of women hospi-
talized in a rural area such as Cavite, and
in other rural areas, may have been high-
er in the mid-1990s than it was in 1978. On
the other hand, the estimate for Manila
was based on a small number of cases and
had a large sample error. In addition, it is
difficult to generalize to the rest of the
Philippines from Manila, a large urban
area with better access both to hospital
care and to safe abortion services.
•Philippine health professionals knowl-
edgeable about abortion believe that about
one in four women (27%) who had an in-
duced abortion would be hospitalized for
complications.21 Over the last two decades,
the safety of abortion services has im-
proved, as abortions have increasingly
been provided by medical and paramed-
ical personnel, reducing the proportion
needing hospitalization among all women
obtaining an abortion. The 1996 health pro-
fessionals survey found that while un-
trained abortion practitioners in the Philip-
pines are still thought to frequently use
traditional methods, such as abdominal
massage, these providers are also believed
to have increased their use of hormones
and modern drugs.22 The health profes-
sionals also estimated that about half of
nonpoor urban women seeking an abor-
tion would obtain it from a physician, a
nurse or a midwife, and that even among
102 International Family Planning Perspectives
Estimating Abortions in the Philippines and Bangladesh
*Although some women with miscarriages at gestations
of less than 12 weeks may seek medical care, many are
likely to do so on an outpatient basis, and relatively few
will be hospitalized. Pregnancy losses at 22 or more weeks
are not considered because they are usually not classi-
fied as abortions, but as fetal deaths.
103Volume 23, Number 3, September 1997
were based on the assumption that the
number of abortion providers might range
from as few as 1,000 to as many as 5,000
and on estimates of the average number
of abortions performed each year, based
on interviews with providers.
The medium-level national abortion
rate derived from our analysis (based on
a multiplier of five) is 25 induced abor-
tions per 1,000 women aged 15–44 (Table
2). The low estimate is 20 per 1,000 and the
high estimate is 30 per 1,000. The abortion
ratio (the number of abortions per 100
pregnancies) would be 16 per 100 if the
multiplier were five and would fall be-
tween 13 and 19 per 100 if the multiplier
were either four or six.
Regional variations in the estimated
abortion rate are large. The two most
urban regions of the country have high
rates: The medium estimate for metro-
politan Manila (41 per 1,000) is the high-
est, and that for the rest of Luzon is mod-
erately high (30 per 1,000). A relatively low
rate is found in the Mindanaos (18 per
1,000), although it is somewhat higher in
some parts of this island grouping (e.g.,
23–24 per 1,000 in Southern and Western
Mindanao and 29 per 1,000 in Central Min-
danao). Very low levels of abortion are
found in the Visayas (11 per 1,000).
We converted the number of women
hospitalized into annual rates to measure
the incidence of hospitalization for treat-
ment of abortion complications per 1,000
women of reproductive age. The estimat-
ed rates indicate clear regional differences
in the likelihood that a woman would be
hospitalized in any given year for the treat-
ment of complications from induced abor-
tion. The rate of hospitalization is highest
for women living in metropolitan Mani-
la—eight per 1,000 women aged 15–44. It
is lowest in the Visayas (two per 1,000) and
intermediate (five per 1,000—around the
national average) in the remaining two
major areas, Luzon and the Mindanaos.
poor urban and rural women, between
one-quarter and one-third would do so.
•One of the highest documented hospi-
talization levels was that found in Chile
in the 1960s, when abortion provision was
highly unsafe: Community surveys
showed that about one in three women
having an abortion were hospitalized.23
Across the Philippines, there evidently
are large differences in the types of abor-
tion methods used, in the safety of the pro-
cedure and in the probability of compli-
cations, according to a woman’s income
level, social class and area of residence.
However, it seems highly unlikely that by
the early 1990s, the multiplier for the
Philippines would be as low as three. To
provide a range within which the true
level is likely to fall, therefore, we made
three estimates, based on multipliers of
four, five and six.
Results
Nationally, according to the moderate es-
timate (a multiplier of five), the annual
number of induced abortions in the Philip-
pines in 1994 was about 400,000 (Table 1).
If the multiplier were four, the total would
be 320,000, while if it were six, the total
would be about 480,000. In comparison,
an earlier study estimated that the annu-
al number of induced abortions in the
Philippines in 1982 was in the range of
155,000 to 750,000.24 That study’s estimates
Bangladesh
The process of estimating the level of abor-
tion in Bangladesh differs from that for the
Philippines because there are two com-
ponents to be considered: clandestine, un-
safe induced abortion, and menstrual reg-
ulation performed by vacuum aspiration.
We combined separate estimates of the
total number of women having induced
abortions other than menstrual regula-
tions and the total number of menstrual
regulation procedures, to produce an
overall estimate of the number of volun-
tary pregnancy terminations occurring in
Bangladesh.
The estimation process for the first com-
ponent was similar to that used in the
Philippines, except that Bangladeshi hos-
pitals have no standardized reporting of
abortions or of any other statistics (al-
though a few very large teaching hospi-
tals produce annual statistical reports).
Thus, we obtained the total number of
women hospitalized for abortion compli-
cations by carrying out a sample survey
of hospitals. To derive an estimate of the
total number of menstrual regulations, we
began with official statistics on menstru-
al regulation and then estimated the level
of underreporting of these procedures.
Number of Induced Abortions
Survey of Bangladesh hospitals. In 1996, to
estimate the number of women hospital-
ized each year for complications of in-
duced abortion, we carried out a sample
survey of 110 hospitals (about one-seventh
of all facilities).* A 1978–1979 study had
found large variations by area in the level
of maternal mortality attributed to abor-
tion,25 suggesting that variation in the
level of abortion complications and of
abortion itself may still be substantial. We
expected that a survey of this many hos-
pitals, based on a systematic area sample
drawn with a random start, would cap-
ture the range of variation.
A senior medical officer in each sam-
pled facility was interviewed using a
structured questionnaire.Two sets of
questions were asked on the number of
patients treated for abortion complica-
tions, allowing us to create and compare
Table 1. Measures related to calculating the number of women hospitalized for induced abor-
tion complications, and estimated total number of induced abortions, by multiplier to account
for women not hospitalized, according to major area, the Phillippines, 1994
Area* Total No. of hos- All No. of women Total no. of induced abortions
no. of pitals with hospita- hospitalized 456
hospitals reporting lizations for induced
forms for abortion abortion†
Philippines 1,863 1,121 99,601 80,103 320,413 400,515 480,618
Metro Manila 166 108 25,951 20,917 83,668 104,585 125,502
Rest of Luzon 871 478 45,938 38,899 155,596 194,495 233,394
Visayas 278 181 10,831 6,895 27,580 34,475 41,370
Mindanaos 548 354 16,881 13,392 53,568 66,960 80,352
*The four major areas are: metropolitan Manila; the rest of Luzon, which is comprised of Ilocos Region, Cagayan Valley, Central Luzon,
Southern Tagalog, Bicol and Cordillera Autonomous Region; the Visayas, which are comprised of Western Visayas, Central Visayas
and Eastern Visayas; and the Mindanaos, which are comprised of Western Mindanao, Northern Mindanao, Southern Mindanao, Cen-
tral Mindanao, the Autonomous Region Muslim Mindanao and Caraga. Calculations were done separately for each of the 16 regions,
and then summed to obtain results for the four major areas. †After the number hospitalized for spontaneous abor tion was subtracted.
Table 2. Estimated annual abor tion rate and abor-
tion ratio, by major area, according to multiplier
Area Abor tion rate Abortion ratio
45 6 456
Philippines 20 25 30 13 16 19
Metro Manila 33 41 50 28 33 37
Rest of Luzon 24 30 36 15 18 21
Visayas 9 11 13 6 7 8
Mindanaos 14 18 21 9 11 13
Note: Abortion rate is the number of abortions per 1,000 women aged
15–44; abortion ratio is the number of abortions per 100 pregnancies.
*The universe of facilities represented by this sample is
all hospitals and clinics that treat inpatients. The sample
does not represent the large number of clinics without
beds, some of which may treat women with abortion
complications on an outpatient basis.
†The Bangladesh Association for Prevention of Septic
Abortion (BAPSA) fielded the survey. In larger hospi-
tals, the person interviewed was the consultant, medical
officer or chief of the department of obstetrics and gy-
necology; in smaller facilities, the local health officer or
family planning officer was interviewed.
teaching hospitals, about 59 district hos-
pitals, 372 hospitals at the thana level (a
thana is the next smaller administrative
area below a district) and approximately
333 nongovernmental hospitals.* All 13
teaching hospitals—the largest facilities in
the country—were included in the survey.
To obtain representative coverage of all
other hospitals, we drew a systematic area
sample with a random start, selecting 16
of the 64 districts in the country and 55 of
the 88 thanas in the selected districts. (Al-
most all districts have one district-level
hospital, and about 75% of the 486 thanas
have a thana-level facility. In addition,
nongovernmental or voluntary facilities
also operate in many thanas.) The sample
included the district hospital in each se-
lected district and the thana hospital in
each selected thana, as well as at least one
voluntary facility in each selected district.
Interviews were completed in all 13
teaching hospitals, in 17 district hospitals,
in 55 thana hospitals and in 25 voluntary fa-
cilities (nine more than expected). The sam-
ple was weighted by type of facility and by
division: Within each of the five adminis-
trative divisions, weights for district and
thana hospitals were calculated based on
the proportion of beds in the sampled fa-
cilities; for private or voluntary hospitals,
weights were based on the proportion of fa-
cilities that were sampled, because detailed
information on number of beds in each fa-
cility was unavailable. (No weighting was
needed for teaching hospitals, because all
were surveyed.) The sample was designed
to permit estimates at the division level.
The 110 hospitals sampled reported a
total of nearly 24,400 hospitalized abortion
patients. After applying sample weights,
we found that the total estimated number
of hospitalized abortion patients in
Bangladesh in 1996 was about 90,800 (see
Table 3), of whom almost 14,000 were
treated in teaching hospitals, 13,800 in dis-
trict hospitals, 33,200 in thana hospitals
and 29,800 in voluntary facilities. Nation-
ally, 21,000 (about 23%) are estimated to
two estimates. The first was based on di-
rect questions about the monthly number
of patients treated for any abortion com-
plications, separately for outpatients and
inpatients. The second, an indirect ap-
proach, used questions about the average
weekly number of all patients treated (sep-
arately for each ward in which abortion
patients are treated), and the proportion
of patients on each ward who are hospi-
talized for abortion complications. We ex-
amined the consistency of answers to
these two sets of questions, as well as their
consistency with other data (e.g., the num-
ber of beds in the wards, the total number
of patients treated and the number of de-
liveries at that hospital).
As an external consistency check, we
also compared the number of women hos-
pitalized for abortion complications at
three large hospitals (according to their an-
nual hospital reports) with our survey re-
sults. This comparison confirmed that the
survey data were of acceptable quality.26
The sample was selected to represent all
hospitals in the country that receive abor-
tion cases, as well as to maximize cover-
age of large hospitals. Bangladesh has 13
have been treated as outpatients, while the
remainder were treated as inpatients.
Estimating the number of patients hospital-
ized for induced abortion complications. To ob-
tain the number of women hospitalized for
complications from induced abortion, we
had to separate out and subtract two types
of abortion patients: women admitted to
a hospital due to a spontaneous abortion,
and those hospitalized for a complication
resulting from menstrual regulation.
To identify the first group, we examined
responses to a direct question on the 1996
hospital survey. In it, respondents esti-
mated that slightly more than 19,000
women (or 21% of all hospitalized abor-
tion patients) were treated for complica-
tions related to a spontaneous abortion.
The 1996 hospital survey also showed
that about 19,300 of all women hospitalized
for abortion nationwide were treated for
complications of menstrual regulation. If
these patients are subtracted from the total
number hospitalized for induced abortion,
we can conclude that over a year, an esti-
mated 52,400 women in Bangladesh are
treated for complications of induced abor-
tions other than menstrual regulations.
Estimating the total number of induced abor-
tions other than menstrual regulations. As
with the Philippines, in order to estimate
the total number of women having an in-
duced abortion, we must use a multipli-
er representing the ratio of women who
had an induced abortion but were are not
hospitalized for complications to women
who were hospitalized. No existing
Bangladeshi community surveys provide
an estimate of this proportion, but we can
use other available information to arrive
at such an estimate.
Two factors must be taken into account:
women’s likelihood of experiencing a com-
plication that requires hospitalization, and
their likelihood of being treated in a hos-
pital when they experience complications.
Bangladeshi respondents to a survey of
health professionals knowledgeable about
abortion services estimated that 40% of
104 International Family Planning Perspectives
Estimating Abortions in the Philippines and Bangladesh
Table 3. Sample information; estimated number of women hospitalized for complications of abortions, by type of abortion; estimated total num-
ber of induced abortions, by multiplier; and total number of menstrual regulations; all according to division, Bangladesh, 1995
Division No. of Sample No. of women hospitalized for Total no. of induced abortions Total no. of
hospitals hospita- All Spontaneous Menstrual Induced 4 5 6 menstrual
in sample lizations abortions abortions regulations abor tions* regulations
for abortion
Bangladesh 110 24,377 90,766 18,973 19,367 52,426 209,704 262,130 314,556 468,299
Dhaka 29 7,163 32,747 7,126 7,155 18,466 73,864 92,330 110,796 229,689
Rajshahi 27 5,160 18,904 3,822 4,380 10,702 42,808 53,510 64,212 81,911
Khulna 15 3,144 14,308 3,470 3,632 7,206 28,824 36,030 43,236 31,235
Barisal 10 1,458 3,375 112 1,320 1,943 7,772 9,715 11,658 42,055
Chittagong 29 7,452 21,432 4,443 2,880 14,109 56,436 70,545 84,654 83,409
*After subtracting the number hospitalized with complications due to spontaneous abortion or menstrual regulation.
*An additional 174 government facilities, specialized ac-
cording to purpose (e.g., infectious diseases or tubercu-
losis, among others) or organization (the Population Con-
trol Division’s maternity hospitals, for example, or police
and jail hospitals) were not included, because they were
not considered likely to receive women with abortion
complications.
†Applying the same indirect methodology used for the
Philippines to estimate the number of women likely to
have a late miscarriage each year would produce a much
lower estimate—about 4.5% of all hospitalized abortion
complication cases. A 1988 study carried out in eight hos-
pitals of varying types applied the World Health Orga-
nization classification and estimated that 32% of 1,262 hos-
pitalized abortion patients interviewed were being
treated for spontaneous pregnancy losses (see: S.F.
Begum et al., 1991, reference 10). However, the symptoms
of spontaneous and induced abortion are very similar;
in addition, a substantial proportion (about one-third)
of abortions classified as spontaneous were at low ges-
tations (10 weeks or less), when women experiencing a
miscarriage are unlikely to be hospitalized. It is possible
that some of these women may have had an induced
abortion, and that spontaneous abortions represented a
somewhat lower proportion than was estimated.
105Volume 23, Number 3, September 1997
ever, such statistics suffer from a very high
level of underreporting: A 1985–1986 sur-
vey of menstrual regulation providers
found that recorded menstrual regulations
represented only 29% of the number of
procedures that surveyed providers said
they had actually performed.30 Thus, we
chose to use indirect methods to estimate
the number of menstrual regulation pro-
cedures performed in 1995.
We combined estimates from the
1985–1986 study of the annual number of
menstrual regulations performed in the
mid-1980s with information on the rate of
increase in the number of trained providers
to project the number of menstrual regu-
lations in the mid-1990s. From BAPSA
records of the number of formally trained
providers—both doctors and family wel-
fare visitors—it is clear that this number al-
most doubled between 1985–1986 and
1995, from 6,158 to 11,944.31
The 1985–1986 survey drew sampled
providers from existing lists of formally
trained providers and included informally
trained providers reported by formally
trained health professionals; an estimated
241,400 menstrual regulations were per-
formed annually at that time. Given that the
number of providers has nearly doubled
since then, we might expect a correspond-
ing increase in the number of procedures
carried out—that is, about 468,000 menstrual
regulation procedures in 1995 (Table 3).
Results
Combining the estimated numbers of in-
duced abortions and of menstrual regu-
lations yields three alternative estimates
of the annual number of pregnancy ter-
minations in Bangladesh in the mid-1990s
(Table 3). Rounded to the nearest thou-
sand, the national totals derived from
these three alternative approaches come
to 678,000, 730,000 and 783,000.
At the national level, the three estimates
of the number of abortions in Bangladesh
produce a range of estimated abortion
rates for 1995—annual rates of 26, 28 and
30 abortions per 1,000 women aged 15–44
(Table 4). These rates are moderate com-
pared to levels worldwide. Dhaka divi-
sion, which contains the large Dhaka met-
ropolitan area, has the highest incidence,
a rate of 40 per 1,000 women (the medium
estimate); estimated rates in all other di-
visions are much lower. Rajshahi and
Khulna have similar, relatively low rates
(20 per 1,000 women per year), while
Barisal and Chittagong have slightly high-
er rates (28 and 24 per 1,000, respectively).
A recent review concluded that at least
450,000 menstrual regulations and in-
women obtaining an abortion have a seri-
ous medical complication, and that about
half of these would be hospitalized.27
Those interviewed in the hospital survey
also estimated that about 50% of women
requiring hospitalization for an abortion
complication would obtain such care.
These results suggest that about one in
five women who have an induced abor-
tion will both need and obtain hospital
care, producing a multiplier of five. Con-
sidering the very high ratio of population
to hospital beds in Bangladesh (there are
about 3,189 persons per hospital bed in
Bangladesh, compared to 647 persons per
bed in the Philippines),28 it seems realis-
tic to expect that a lower proportion of
women needing care would obtain it; if so,
the multiplier would be higher. Howev-
er, since we lacked any additional infor-
mation that might provide the basis for a
more likely multiplier than five, we chose
to apply a range around it (four, five and
six). These three multipliers were applied
to the number of women estimated to be
hospitalized for induced abortion each
year in Bangladesh—52,400—to obtain a
range of estimates of the total number of
induced abortions (other than menstrual
regulations) occurring each year—from
210,000 to 314,000 (Table 3).
Number of Menstrual Regulations
The legal provision of menstrual regula-
tion was initiated in Bangladesh in 1975,
and is administered by the government
under the division of family planning. Pro-
grams to train medical personnel in men-
strual regulation, started in the late 1970s,
have expanded over the years and now in-
clude several government centers, as well
as centers operated by nongovernmental
organizations such as the Bangladesh
Women’s Health Coalition, the Bangladesh
Association for Prevention of Septic Abor-
tion (BAPSA) and the Menstrual Regula-
tion Training and Services Program.
Formal training courses, typically of 2–3
weeks’ duration, are given to physicians
and family welfare visitors.* Some trained
providers may informally train others,
mainly by allowing them to observe, assist
in and, in some cases, practice the proce-
dure under observation. These informally
trained providers include physicians, fam-
ily welfare visitors, medical assistants,
nurses and traditional birth attendants.29
Some private doctors, family welfare
visitors and nongovernmental facilities re-
port the procedures they have performed
to the government's management infor-
mation system, and BAPSA publishes
these statistics on a regular basis. How-
duced abortions were performed annually
in Bangladesh in the early 1990s.32 Our
lowest annual total—678,000—is sub-
stantially higher than that estimate, be-
cause our approach produces higher es-
timates both of the number of menstrual
regulations and of the number of induced
abortions.
Are these estimates exaggerated? Almost
20 years ago, a 1978–1979 study conclud-
ed that nationally in Bangladesh, there
were 780,000 abortions per year,33 a figure
that some analysts considered too high.34
Yet an estimate of even half that level for
the late 1970s (365,000 abortions) would
imply an annual abortion rate of 24 per
1,000 women aged 15–44 in 1978. It seems
unlikely that a rate twice that level (48 per
1,000) would have prevailed in the late
1970s; it is more likely that the level pre-
vailing in the late 1970s would be similar
to that currently estimated for 1995, or even
lower. In light of the tremendous amount
of social change in Bangladesh since 1978—
not least of which are the increased desire
of women and couples to control their fam-
ily size, a concomitant decline in family
size, a large increase in contraceptive use
and the expansion of menstrual regulation
services—it seems highly likely that the
abortion rate would have at least remained
at its earlier level, if not increased.
The overall rate of hospitalization due
to complications of induced abortion is 2.4
per 1,000 women per year. Most of these
complications (about 75%) are due to un-
*Family welfare visitors are women who have complet-
ed a high school education and who have obtained two
years of paramedical training; they represent the major-
ity of menstrual regulation providers in rural areas.
†An alternative, plausible approach could be to use es-
timates of the 1985–1986 average annual number of men-
strual regulations performed by each of the two main
types of providers (82 by physicians and 46 by female
welfare visitors) and of the number of active providers
in 1995 (the total number trained, reduced by the 42% of
physicians and 27% of female welfare visitors thought
in 1985–1986 to be no longer active in providing men-
strual regulations), and then adjust these to allow for the
proportion of menstrual regulations done by informal-
ly trained providers. This approach produces a much
higher annual total number of menstrual regulation pro-
cedures (722,000). Such an estimate suggests that the rates
presented in this article may be conservative.
Table 4. Estimated annual abortion rate and abor-
tion ratio, by division, according to multiplier
Division Abortion rate Abor tion ratio
456456
Bangladesh 26 28 30 17 18 19
Dhaka 38 40 42 22 23 24
Rajshahi 18 20 22 13 14 15
Khulna 18 20 23 13 15 16
Barisal 27 28 29 17 17 18
Chittagong 22 24 27 13 14 16
in both countries, al-
though it is somewhat
higher in the Philippines
(26%) than in Bang-
ladesh (19%). Yet contra-
ceptive use has greatly
increased over the past
10–15 years, especially
in Bangladesh, where
about 45% of currently
married women were
practicing contraception
in the early 1990s. In the
Philippines, this propor-
tion was slightly lower
(40%), but reliance on
less effective, traditional
methods was much
higher. Moreover, re-
search in the Philippines
points to an additional
barrier—the frequent ob-
jection of the male part-
ner to contraceptive practice.37
Considering that contraceptive use is
somewhat lower in the Philippines, that
traditional methods with high failure rates
are more commonly used and that societal
support for family planning is less strong
than in Bangladesh, we would expect to
find a higher level of abortion there than
in Bangladesh. However, estimated levels
of abortion for the two countries are sim-
ilar: according to the medium-level esti-
mates (a multiplier of five), annual rates
of 25 abortions per 1,000 women of repro-
ductive age in the Philippines and 28 per
1,000 in Bangladesh. Such factors as greater
social conservatism, ambivalence about so-
cial values and about attitudes concerning
family planning services (and fertility con-
trol in general), strong public opposition
to abortion and poorer access to safe abor-
tion services in the Philippines may ac-
count for this seeming discrepancy.
Because of the high level of reliance on
menstrual regulation in Bangladesh, hos-
pitalization of women with complications
of abortion is much lower there than in the
Philippines. The number of women hos-
pitalized each year for treatment of com-
plications of induced abortion is somewhat
higher in the Philippines—about 80,000,
compared with 72,000 in Bangladesh.
Given that the Filipino population is ap-
proximately 60% that of Bangladesh, the
rate of hospitalization due to unsafe abor-
tion is much higher in the Philippines than
in Bangladesh: 5.0 hospitalizations per
1,000 women per year vs. 2.7 per 1,000.
Government provision of family plan-
ning services is emphasized in both coun-
tries. However, one commonly accepted
safe induced abortions, and the remainder
are estimated to result from menstrual reg-
ulation. The annual estimated number of
complications requiring hospitalization
that result from menstrual regulation
(19,300) represents about 4% of the ap-
proximately 468,000 menstrual regulation
procedures performed annually. This is a
very low level of hospitalization, consid-
ering that it reflects care by some providers
who are informally trained. In comparison,
induced abortions other than menstrual
regulations are estimated to have a com-
plication rate of about 40% and a hospi-
talization rate of about 20%.35
Discussion
Recent national fertility surveys reveal
that unplanned births are still common in
both Bangladesh and the Philippines.36 In
Bangladesh, about one-third of all recent
births were reported as unplanned—13%
unwanted and 20% mistimed. In the
Philippines, the equivalent proportions
were 44%—16% unwanted and 28% mis-
timed. When the annual number of abor-
tions estimated here is added to the annual
number of live births, we conclude that
each year, 45% of pregnancies in
Bangladesh and 53% in the Philippines are
unplanned. (An estimated 18% of preg-
nancies in Bangladesh and 16% in the
Philippines are resolved as abortions.)
These high levels of unplanned preg-
nancy are probably a result of the strong
motivation of women and couples in both
countries to control their family size and to
space their births, combined with still high
levels of nonuse or poor use of contracep-
tives. Table 5 shows that unmet need is high
summary index suggests that family plan-
ning program strength is greater in
Bangladesh than in the Philippines.38 Since
the 1970s, the family planning program
has been a priority for the Bangladeshi
government, and service delivery has
taken a multisectoral, broad-based ap-
proach, with activities including the ex-
tensive training of fieldworkers (empha-
sizing the use of female staff to meet the
cultural need for women to be served by
women), the establishment of information
and education services, the use of mobile
sterilization teams, the setting up of local-
level clinics, a focus on the extension of
services into rural areas and an attempt to
increase limited maternal and child health
services. Nevertheless, to maintain its mo-
mentum and effectiveness, critics say that
the program must address many contin-
uing challenges.39
The Philippine family planning pro-
gram has been in place since the 1970s, but
it suffered a setback during the Aquino ad-
ministration (1986–1992), when political
and financial support was weakened as a
result of the strong influence of the
Catholic Church. In addition, as a result
of the devolution of health services to local
government bodies in 1993, local govern-
ment now assumes the primary respon-
sibility for the provision of family plan-
ning services. Thus, the national program
now focuses mainly on technical assis-
tance and policy issues. Although devo-
lution does not yet seem to have had a
negative impact on numbers of contra-
ceptive users (as contraceptive use among
married women aged 15–44 increased
from 42% in 1993 to 48% in 1996), com-
munity influence is likely to become
greater, and in some areas, opposition to
the provision of family planning services
may be stronger than when policy was
more centrally established and directed.40
Bangladesh and the Philippines face
somewhat different policy options to ad-
dress their induced abortion problems. In
Bangladesh, where menstrual regulation
is legally allowed, improved menstrual reg-
ulation services (increased availability in
rural areas, better access for all women—
including the unmarried and those having
a first pregnancy—and intensive efforts to
educate women about the legality of men-
strual regulation, where to obtain services
and gestational limits) could substantial-
ly reduce resort to unsafe abortion. In the
Philippines, where abortion is legally re-
stricted, and in Bangladesh as well, con-
traceptive counseling and referrals for
women being treated for complications of
abortion are both greatly needed.
106 International Family Planning Perspectives
Estimating Abortions in the Philippines and Bangladesh
Table 5. Fertility-related measures that may contribute to levels
of induced abortion, the Phillippines and Bangladesh, mid-1990s
Measure Philippines Bangladesh
(1993) (1993–1994)
Annual abortion rate* 25 28
Total fertility rate† 4.1 3.4
% of pregnancies that are unplanned 53 46
% of recent births that are unwanted 16 13
% of recent births that are mistimed 28 20
% who ever used any method‡ 61 66
% who currently use any method‡ 40 45
Sterilization 12 9
IUD 3 2
Pill 9 22
Other modern methods§ 1 3
Traditional methods** 15 9
% who discontinued using pill
due to health-related side effects†† 31 52
First-year discontinuation rate for pill‡‡ 33 38
% with unmet need§§ 26 19
*Medium estimate. †Derived from respective Demographic and Health Surveys (DHS) for the
three-year period preceding the survey date. ‡Among currently married women aged 15–49.
§Condom, diaphragm, foam and jelly. **Periodic abstinence and withdrawal. ††Among all dis-
continuations during the past five years. ‡‡Excluding those who stopped to become pregnant.
§§DHS definition. Sources: Bangladesh—see S.N. Mitra et al., 1994, reference 36; Philip-
pines—see reference 17.
107Volume 23, Number 3, September 1997
USA, 1988, p. 37.
7. Ibid.; and Bangladesh Association for Prevention of
Septic Abortion (BAPSA), MR Newsletter, Mar. 1996.
8. BAPSA, 1996, op. cit. (see reference 7).
9. S. F. Begum, H. Kamal and G. M. Kamal, “A Study on
Menstrual Regulation Providers in Bangladesh,” BAPSA,
Dhaka, 1984; and S. Singh, D. Wulf and H. Jones, 1997,
op. cit. (see reference 5).
10. A. B. Marcelo and Project Management Team, “At-
titudes and Perceptions Towards Induced Abortion: The
Women, Professionals and the Public,” paper presented
at 1991 conference on Attitudes and Perceptions Towards
Induced Abortion, Institute for Social Studies and Ac-
tion, Quezon City, Philippines, Mar. 15, 1991; N. J. Ford
and A. B. Manlagnit, “Social Factors Associated with
Abortion-Related Morbidity in the Philippines,” British
Journal of Family Planning, 20:92–95, 1994; A. R. Khan et
al., “Induced Abortion in a Rural Area of Bangladesh,”
Studies in Family Planning, 17:95–99, 1986; and S. F. Begum
et al., “Hospital-Based Descriptive Study of Illegally In-
duced Abortion-Related Mortality and Morbidity, and
Its Cost on Health Services,” Publication No. 5, BAPSA,
Dhaka, 1991.
11. UN, The World’s Women, 1995: Trends and Statistics,
New York, 1995, Table 6, pp. 84–88.
12. R. W. Rochat et al., “Maternal and Abortion-Related
Deaths in Bangladesh, 1978–1979,” International Journal
of Gynecology and Obstetrics, 19:155–164, 1981.
13. Health Intelligence Services, 1991 Philippine Health
Statistics, Department of Health, Manila, 1994, p. 195.
14. National Statistics Office (NSO), Annual Statistical
Report of the Philippines, 1992, Manila, 1994, Table 9.15, pp.
9–29.
15. J. Bongaarts and R. Potter, Fertility, Biology and Be-
havior, Academic Press, New York, 1983; S. Harlap, P. H.
Shiono and S. Ramcharan, “A Life Table of Spontaneous
Abortions and the Effects of Age, Parity and Other Vari-
ables,” in E. B. Hook and I. Porter, eds., Human Embry-
onic and Fetal Death, Academic Press, New York, 1980,
Table 1, pp. 148 & 157.
16. World Health Organization (WHO), Abortion: A Tab-
ulation of Available Data on the Frequency and Mortality of
Unsafe Abortion, Geneva, 1994; and S. Singh and D. Wulf,
“Estimated Levels of Induced Abortion in Six Latin
American Countries,” International Family Planning Per-
spectives, 20:4–13, 1994.
17. NSO and Macro International, Philippines: National
Demographic Survey 1993, Manila, the Philippines, and
Calverton, Md., USA, 1994.
18. NSO, unpublished estimates of the number of live
births in each region for 1994.
19. J. M. Flavier and C.H. C. Chen, “Induced Abortion
in Rural Villages of Cavite, the Philippines: Knowledge,
Attitudes and Practice,” Studies in Family Planning,
11:65–71, 1980.
20. J. Cabigon, University of the Philippines, Population
Institute, special tabulations of 1994 Community Survey
of Women in Metro Manila, Dec. 1996.
21. S. Singh, D. Wulf and H. Jones, 1997, op. cit. (see ref-
erence 5).
22. Ibid.
23. R. Armijo and T. Monreal, “The Problem of Induced
Abortion in Chile,” Milbank Memorial Fund Quarterly,
43:263–280, 1965.
24. M. J. De la Rosa, “Induced Abortion: Is It Really a
Problem?” Philippines Journal of Obstetrics and Gynecolo-
At the same time, both countries would
also benefit from some similar policy and
service measures. Improvements in any
aspect of contraceptive services would
help in reducing levels of unplanned preg-
nancy and abortion. These might include
extending the network of family planning
services (thereby expanding the range of
contraceptive methods offered), improv-
ing the quality of services (especially with
the goal of counseling women and couples
about the proper use of methods and
about alternative choices if a method is un-
satisfactory), including husbands in the
process of family planning decision-mak-
ing, and improving communication be-
tween spouses.
However, the practice of abortion always
reflects wider influences than simply that
of a country’s family planning program. A
range of cultural, social, religious and eco-
nomic factors contribute to women’s need
for abortion, to the type of services avail-
able and to the level of induced abortion.
Consequently, governments may use many
different approaches to address the prob-
lem. However, they are unlikely to be able
to act on all fronts simultaneously.
The Philippines and Bangladesh face a
number of difficult decisions about where
and how to invest their scarce health re-
sources most cost-effectively. Moreover,
these decisions and choices will have to be
made within widely differing political and
cultural contexts. These variables include
religion (Catholicism vs. Islam), the rate of
urbanization and modernization, current
and changing roles of women, the avail-
ability of resources and political feasibility.
References
1. T. Barreto et al., “Investigating Induced Abortion in
Developing Countries: Methods and Problems,” Studies
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2. F.M. Tadiar with M. Omictin-Diaz, “The Problem of
Abortion: The Philippines Case,” in International Planned
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3. United Nations (UN) Department of Economic and
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4. F.M. Tadiar with M. Omictin-Diaz, 1993, op. cit. (see
reference 2).
5. S. Singh, D. Wulf and H. Jones, “Induced Abortion in
South Central and Southeast Asia: Results of a Survey
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6. H. H. Akhter, “Bangladesh,” in P. Sachdev, ed., Inter-
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25. R. W. Rochat et al., 1981, op. cit. (see reference 12).
26. Dhaka Medical College, “Activities of Obstetrics and
Gynecology Department,” unpublished reports for 1993
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erence 5).
28. The World Bank, Social Indicators of Development, 1995:
A World Bank Book, Washington, D. C., 1995.
29. S. F. Begum, H. Kamal and G. M. Kamal, “Evaluation
of MR services in Bangladesh,” BAPSA, Dhaka, 1987, pp.
1–2 & 11.
30. Ibid., Table 7.3, p. 45.
31. Ibid., Table 2.1B, p. 6, and Table 5.6, p. 25.
32. H. Kamal et al., Prospects of Menstrual Regulation Ser-
vices in Bangladesh, Publication No. 9, BAPSA, Dhaka, 1993,
pp. 36–38.
33. A. R. Measham et al., “Complications from Induced
Abortion in Bangladesh Related to Types of Practition-
er and Methods, and Impact on Mortality,” Lancet,
I:199–202, 1981; and R.W. Rochat et al., 1981, op. cit. (see
reference 12).
34. H. Kamal et al., 1993, op. cit. (see reference 32).
35. S. Singh, D. Wulf and H. Jones, 1997, op. cit. (see ref-
erence 5).
36. NSO and Macro International, 1994, op. cit. (see ref-
erence 17); and S. N. Mitra et al., Bangladesh Demograph-
ic and Health Survey, 1993–1994, National Institute of Pop-
ulation Research and Training, Dhaka, Bangladesh, and
Macro International, Calverton, Md., USA, 1994.
37. J. B. Casterline, A. E. Perez and A. E. Biddlecom, Fac-
tors Underlying Unmet Need for Family Planning in the
Philippines, Research Division Working Paper No. 84, The
Population Council, New York, 1996.
38. W.P. Mauldin and J. Ross, “Family Planning Pro-
grams Efforts and Results, 1982–1989,” Studies in Family
Planning, 22:350–367, 1991.
39. Barkat-e-Khuda and A. Barkat, The Bangladesh Fam-
ily Planning Program: Key Programmatic Challenges and Pri-
ority Action Areas, University Research Corporation,
Dhaka, Bangladesh, n.d.
40. Department of Health, National Family Planning and
Maternal and Child Health Status Report, July 1994–June
1995, Manila, Philippines, 1995.
Resumen
En los países en que no existen o se registran
en forma deficiente los datos sobre el aborto in-
ducido—tales como las Filipinas y Bangla-
desh—se pueden utilizar técnicas de estima-
ción indirecta para realizar un cálculo
aproximado del nivel de aborto. La recopila-
ción de datos de mujeres hospitalizadas debi-
do a complicaciones del aborto y el uso de téc-
nicas de estimación indirecta indican que la
tasa de aborto en las Filipinas se encuentra en
un margen de 20–30 abortos inducidos por
cada 1.000 mujeres de entre 15 y 49 años, y la
(continued on page 144)
144 International Family Planning Perspectives
Estimating Abortions in the Philippines and Bangladesh
trual realizados por personas capacitadas al-
canzan a aproximadamente los dos tercios de
todas las terminaciones voluntarias de emba-
razo que ocurren en Bangladesh.
Résumé
Dans les pays où les données sur les avorte-
ments provoqués sont sous-déclarées ou n'ex-
istent pas—comme aux Philippines ou au
Bangladesh—on peut avoir recours à des tech-
niques indirectes d'estimation pour appréci-
er le niveau d'avortement. La collecte de don-
nées au sujet des femmes hospitalisées pour
complications de l'avortement et l'utilisation
de ces techniques indirectes d'estimation in-
diquent que le taux d'avortement aux Philip-
pines se situe dans la plage de 20 à 30 avorte-
ments provoqués pour 1.000 femmes âgées de
15 à 49 ans, et le taux au Bangladesh varie
Estimating Abortions…
(continued from page 107)
tasa en Bangladesh se sitúa entre 26 y 30 por
1.000. Cada año se realizan aproximadamen-
te 400.000 abortos en las Filipinas y esta esti-
mación alcanza a aproximadamente 730.000
en Bangladesh. Se calcula que unas 80.000
mujeres reciben atención hospitalaria en las
Filipinas debido a complicaciones del aborto
inducido, y en Bangladesh, aproximadamen-
te 52.000 mujeres se tratan por el mismo tipo
de complicaciones, y otras 19.000 son trata-
das debido a complicaciones resultantes de los
procedimientos para regular la menstruación.
La probabilidad de que una mujer sea hospi-
talizada en las Filipinas debido a complicacio-
nes causadas por un aborto llega al doble de la
registrada en Bangladesh, probablemente por-
que los procedimientos de regulación mens-
entre 26 et 30 pour 1.000. On estime à 400.000
le nombre approximatif d'avortements pra-
tiqués chaque année aux Philippines, tandis
que ce même nombre au Bangladesh est établi
à environ 730.000. On estime qu'environ
80.000 femmes par an sont traitées dans les
hôpitaux des Philippines pour complications
de l'avortement provoqué; au Bangladesh, en-
viron 52.000 femmes sont traitées pour ces
complications, et 19.000 autres sont traitées
pour des complications résultant de procédures
de régulation des menstruations. La probabilité
qu'une femme soit hospitalisée pour compli-
cations de l'avortement aux Philippines est le
double de celle au Bangladesh, probablement
parce que les procédures de régulation des men-
struations par des travailleurs formés représen-
tent environ les deux tiers de tous les avorte-
ments volontaires au Bangladesh.
... In Bangladesh, hospitalizations for abortion related complications are very common. Methods for unsafe abortion range from insertion of objects into the reproductive tract, to ingestion of pharmaceutical and homeopathic medications, to use of vacuum aspiration or D&C equipment by informally trained providers 5,[11][12][13] . Approximately 70,000 women annually are estimated to present to hospitals and clinics with abortion related complications 5,11,12 . ...
... Methods for unsafe abortion range from insertion of objects into the reproductive tract, to ingestion of pharmaceutical and homeopathic medications, to use of vacuum aspiration or D&C equipment by informally trained providers 5,[11][12][13] . Approximately 70,000 women annually are estimated to present to hospitals and clinics with abortion related complications 5,11,12 . A recent study from Bangladesh suggested that providing women with life-saving treatment for abortion related complications costs the health sector 1.6 million US dollars annually in incremental costs alone 11 . ...
... Approximately 70,000 women annually are estimated to present to hospitals and clinics with abortion related complications 5,11,12 . A recent study from Bangladesh suggested that providing women with life-saving treatment for abortion related complications costs the health sector 1.6 million US dollars annually in incremental costs alone 11 . The analysis also showed wide variations in incremental health system costs of providing care for moderate abortion complications, referring to those requiring uterine evacuation but no other surgical care from US $10 at the primary care level to US $50 at the tertiary care level 11 . ...
Article
Full-text available
Background: Misoprostol, a synthetic prostaglandin E1 analogue, may workas an alternative to manual vacuum aspiration (MVA) in incomplete abortion, which is easy to administer orally, andhelps to increase access to post abortion care.Objective: To compare the effectiveness, safety and acceptability by the patients of using oral misoprostol therapy and manual vacuum aspiration technique for the treatment of incomplete abortion in the first trimester of pregnancy.Methods: This cross-sectional study was conducted in Department of Obstetrics & Gynaecology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh, between January and July of 2016. A total of 200 patients (women with incomplete abortion ≤12weeks) were enrolled in the study. 100 Patients were randomly selected and treated with oral misoprostol 600mcg (group I), while the other 100 were treated with manual vacuum aspiration (MVA) (group II). They were followed up for 1-3 days before discharge. Participants were asked to return to the clinic for follow-up after 1 week. In follow-up visit, if abortion was not found complete, an immediate surgical evacuation was performed.Results: The mean age of the participants were 28.59±10.44 and 28.24±9.40 in group I and II respectively. In group I, 94% had complete abortion, while 6% had incomplete abortion or continued pregnancy. However, in group II, 100% had complete abortion (P>0.05). Per vaginal normal and heavy bleeding were 35% and 12% in group I, while 9% and 1% in group II respectively (P<0.001). Pain, nausea, vomiting and gastrointestinal issues were more observed in group I than that of group II (P<0.001). However, incidence of fever, headache and vertigo were similar in both groups (P<0.001). In group I, 98% stated that the treatment was ‘satisfactory/very satisfactory’, while in group II, 99% found the procedure ‘satisfactory/very satisfactory’. The difference between the groups is not statistically significant (P>0.05). In group I, 98% stated that they would select this method again, if needed and recommend it to a friend or relative, while in group II, 88% stated that they would choose this method again and 86% would like to recommend to a friend or relative. The difference between the groups is statistically significant (P<0.001).Conclusion: Our data suggest that oral misoprostol therapy can be used effectively ensuring safety and patients’ satisfaction for treatment of incomplete abortion in the first trimester as compared to manual vacuum aspiration technique.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 173-177
... A significant number of unmarried abortion seekers reported to have conceived in forced sexual happenstances (WHO, 1993). Around 80,000 women per year were estimated to be hospitalized in Philippines for complications of abortion (Singh et al., 1997). A similar study in Bangladesh had reported treatment of 52,000 women who had complications of abortion (Singh et al., 1997). ...
... Around 80,000 women per year were estimated to be hospitalized in Philippines for complications of abortion (Singh et al., 1997). A similar study in Bangladesh had reported treatment of 52,000 women who had complications of abortion (Singh et al., 1997). Lack of quality in family planning services and awareness on contaceptives is a contributor for abortions in less developed countries as a desire to limit family size (Rahman et al., 2001). ...
Article
Full-text available
The present study identifies the prevalence, pattern & geographical distribution of pregnancy loss and its various determinants. The choropleth equal interval maps and local indicators of spatial association maps were used to investigate the locations requiring attention. Spatial regression techniques were used to investigate the factors associated with pregnancy losses across India using data derived from the fourth round of National Family Health Survey. A decision tree was constructed to investigate the interaction effect of the significant factors.The percentage of pregnancy loss in India is noted to be 14.3% (95% BCa confidence interval: 13.47, 14.79). The spatial autocorrelation coefficient (ρ=0.61,p<0.001\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\rho = 0.61,~p < 0.001$$\end{document}) indicated the spatial dependence in the data. Hotspots of response variable were observed in districts of Uttar Pradesh, Manipur, and Odisha. Locations, with high percentage of women who have attained education upto high school and above, women who did not want the pregnancy, and women whose family did not want more child, were likely to have increased percentage of pregnancy loss. Struggles in a womens life, family’s pressure and own desire to have child coupled with their education status are related to the pregnancy loss. Preventing the unplanned pregnancies will play a pivotal role in decreasing the pregnancy loss which further prevents maternal mortality and morbidity. Timely and adequate supplies of contraception in public health institutions particulary sub-centre, primary health centre should be ensured.
... Although MR is allowed up to eight weeks after LMP when performed by FWVs and paramedics, and up to 10 weeks after LMP when implemented by a physician, providers occasionally perform the procedure later as well [20][21][22][23][24][25][26][27][28]. Currently MR is widely practiced throughout the country and is available at all tiers, from district and ...
... Currently, many women who would want to get an MR face barriers to obtaining one; many of them resort to unsafe abortion as a result.Because induced abortions are legally regulated in Bangladesh, they are often practiced clandestinely in unhygienic settings, performed by untrained providers, or both. By avoiding unsafe abortions and their associated health complications, MR could have a positive impact on women's health and survival[20]. ...
... Despite the fact that MR services in Bangladesh are provided free of charge or for a subsidized charge through the public sector and various non-profit organizations (NGOs), a number of studies have found that many women face barriers in accessing safe, affordable MR and post-MR care. Singh et al. in 1997 estimated that 33% of all births in Bangladesh are unplanned, and 45% of these unplanned pregnancies end in either menstrual regulation or unsafe abortions [8]. Furthermore, as many as 25% of all clients who present at MR clinics are refused services for various reasons [9]. ...
... Despite the fact that MR services in Bangladesh are provided free of charge or for a subsidized charge through the public sector and various non-profit organizations (NGOs), a number of studies have found that many women face barriers in accessing safe, affordable MR and post-MR care. Singh et al. in 1997 estimated that 33% of all births in Bangladesh are unplanned, and 45% of these unplanned pregnancies end in either menstrual regulation or unsafe abortions [8]. Furthermore, as many as 25% of all clients who present at MR clinics are refused services for various reasons [9]. ...
Article
Full-text available
Background: As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods: A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results: Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare.
... In Bangladesh approximately half of the admissions of major urban hospitals are due to complications of abortion [3]. In our country the abortion related death was found to be 21% of total maternal death [4]. In years 1992-94 abortion related death was 14.8% in our country [5]. ...
Article
In this study attempts made to show the types of abortion and their consequences admitted in Mymensingh Medical College Hospital (MMCH) in the year 2019. For this study 100 patients of abortion were selected on a random pattern. Special importance has been given on finding out the incidence and prevalence of abortion with respect to their age, socio­ economic status, and parity. Then attempts have been made to find out aetiology. Some suggestions have been given as to what could be done to reduce the incidence of abortion. Some reflection of the effect of abortion on mortality has also been highlighted. The mode of management of abortion patients in MMCH has also been analysed with their outcome. In this study it has been seen that around 47.8% of gynaeclogy patient are of abortion. Though majority is of spontaneous abortion, septic abortion patients are the most critical ones. The majority of cross section of patients is illiterate and very poor. These are the patients who come to the hospital after complications have taken place. All these can be saved by improving socio economic condition, education, finally planning and modernization of existing laws of the land relating to abortion.
... Where abortion laws are restricted or safe abortion services are not widely accessible or are of poor quality, women resort to unskilled providers, risking serious consequences to their health and well-being. [1,2] It is estimated that of the 210 million pregnancies that occur each year, some 80 million are unintended. In 2008, 21.6 million unsafe abortions were estimated to have occurred, causing the deaths of 47,000 women. ...
Article
Full-text available
The present research addressed the pineapple (Ananas comosus) residue (peel, crown, and bran) and its impact on the apparent digestibility, productive performance, carcass yield, liver status, and immune system of Oreochromis niloticus fry (initial weight: 2.16 ± 0.04 g). In a 14- week trial, fish were fed on 1% and 2% of each pineapple additive, starting from June 16 till September 23, 2020. Results showed a promising enhancement of fish growth performance and feed utilization. The tilapia, fed the pineapple crown, bran, and peel powder at level 2%, showed improvements in fish flesh, liver health, and apparent protein digestibility, followed by those fed the level 1% (p<0.05, compared to the control group). The data of the current study indicate the possibility of reusing the pineapple fruit residue as additives to the tilapia feed to sustain fish production with good quality. More studies on fruit residues are required for the sake of fish production and health quality enhancement. This would, in turn, reduce the aquaculture feed cost and solve the environmental problem of accumulating residues.
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Full-text available
This cross sectional type of descriptive study was carried out with a view to find out the situation of incomplete abortion and associated risk factors of the patients admitted in Rajshahi Medical College Hospital. The sample size was 150 which were selected purposively. This study showed that 37.3% of the respondents were in the age group of 25-29 years. The mean age of the respondents was 25.14 ± 4.95 years. Majority (75.3%) had history of contraceptive use. It was observed that 30.0% had hemoglobin level of 15 gm/dl followed by 22.7% and 20.0% constituting hemoglobin level of 14 gm/dl and 13 gm/dl respectively. Most (67.3%) respondents had history of previous history of abortion and 65.3% of the respondents had chronic vaginal bleeding. Uses of oral contraceptive pill, history of previous abortion were found the associated risk factors of abortion in this study. Intensifying reproductive health education would assist in the reduction of complications of abortions.
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Abortion is a fertility regulation practice that women use in the absence of contraception or when contraceptives fail. Laws regulating this practice in different countries range from allowing it on request to restrictive access and even total prohibition. Where the right to abortion is established, it is frequently challenged. Debates around legalization are centred on the rights of women, the rights of the embryo, and the health consequences of unsafe abortions. But whether abortion is legal or prohibited, women around the world resort to it, with great disparities in the intensity of the practice and its health and social consequences. Levels of safety of abortions varies widely between countries and regions (safe, less safe, and least safe). They have improved with the spread of medical abortion, particularly in countries with legal limits on access, where they replace riskier methods. The available data are highly heterogeneous: From healthcare statistics in countries where abortion is legal, to survey data of varying levels of completeness, and including the use of sophisticated methods to estimate levels in countries where legal access is restricted.
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In many countries particularly in the less developed world abortion remains illegal yet many women still seek to terminate unwanted pregnancies by clandestine methods. Such abortions are often unsafe and contribute significantly to maternal mortality and morbidity in such settings. This paper reports on findings from a study which investigated the social factors associated with abortion-related morbidity in Manila, in the Philippines. The study involved a comparison of the characteristics and experience of 200 women being treated in hospitals for complications of abortion with 250 hospital, and 250 community controls who had no history of abortion or miscarriage. Data collection combined a quantitative schedule structured survey and qualitative focus group discussions. The study investigated the women's fertility and contraceptive history, family and marital situation and attitudes and feelings concerning contraception and abortion. Particular aspects of relations between spouses were found to be especially strongly associated with abortion related morbidity.
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Interest in abortion research is reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to maternal mortality in developing countries. Information is lacking on all aspects of induced abortion, particularly methodological issues. This article reviews the methodological dilemmas encountered in previous studies, which provide useful lessons for future research on induced abortion and its complications, including related deaths. Adverse health outcomes of induced abortion are emphasized, because these are largely avoidable with access to safe abortion services. The main sources of information are examined, and their relevance for assessing rates of induced abortion, complications, and mortality is addressed. Two of the major topics are the problems of identifying cases of induced abortion, abortion complications, and related deaths, and the difficulties of selecting a valid and representative sample of women having the outcome of interest, with an appropriate comparison group. The article concludes with a discussion of approaches for improving the accuracy, completeness, and representativeness of information on induced abortion. Although the prospects for high-quality information seem daunting, it is essential that methodological advances accompany program efforts to alleviate this important public health problem.
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According to a set of 30 indices that assess the strength of large-scale family planning programs in developing countries, a strong upward shift in effort scores occurred between 1982 and 1989. During that period, many countries established or augmented their family planning programs, and effort scores improved in all developing regions and in all four dimensions of effort--policies and stage-setting activities, service and service-related activities, record keeping and evaluation, and availability of contraceptive methods. By region, the sharpest improvement was not in East Asia, where levels were already high, but in sub-Saharan Africa, where the movement was clearly upward, from a low base. Earlier associations between program effort and fertility declines are reaffirmed, additive to the contribution of socioeconomic improvements. In order to compute scores ranging from zero to 30 for each of the 30 indices, a detailed questionnaire was sent to 4-6 respondents in each of 103 developing countries having more than one million population. Respondents included program staff, donor agency personnel, local observers, and knowledgeable foreigners. The scores indicate that developing countries are continuing to move toward more favorable policy positions and stronger implementation of action programs, with consequent fertility effects. For the fertility decline to match the medium population projections of the United Nations, however, a substantial enlargement in the number of contraceptive users is necessary, not only to compensate for the enlarging base of couples, but also to increase the proportion who use contraceptives.
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Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.
Article
Health-workers in 795 health centres in Bangladesh were interviewed about complications arising from induced abortion in rural Bangladesh. 1590 cases of complications from abortion were reported. Dais (traditional birth attendants) and traditional practitioners were the larger groups of operators (42.1% and 18.1%, respectively). Menstrual regulation or dilatation and curettage (the medically approved procedures) were used 9.1% of the time. Nearly half the complicated abortions were induced by inserting a foreign object, such as a stick or root (sometimes treated with an herb), into the uterus and leaving it until either abortion or complications ensued. 498 abortion-related deaths were reported. The proportion of complicated abortions resulting in death was lowest for medically approved procedures (4.9%) and highest for vigorous physical activity (100%) and abdominal pressure (66.7%), although the last two together accounted for only 2.3% of abortion procedures. Women who died after abortion were more likely than were women who survived to be further along in their pregnancies. An extrapolation from these results gives a figure of 780000 abortions in Bangladesh in 1978 and 7800 deaths that year from abortion complications. Many of these deaths might have been prevented if a means of safe, affordable termination of unwanted pregnancy had been available.
Article
The incidence and causes of pregnancy-related deaths are unknown for most of Asia; only local area studies have been done for Bangladesh. Between December 1978 and May 1979, we interviewed 118 health workers in 63 hospitals and 732 non-hospital facilities to identify case reports of maternal and abortion-related deaths in Bangladesh. Of 1933 pregnancy-related deaths identified, 498 (25.8%) were due to induced abortion. Abortion mortality rates varied significantly in the 18 administrative districts; the highest were in Dinajpur and Chittagong, the most northern and southern districts, and the lowest in Comilla and Noakhali. We used an earlier study of maternal mortality to estimate that about 21,600 pregnancy-related deaths occur each year in Bangladesh. We estimate that about 7.5% of all pregnancy-related deaths were identified in this survey. We infer from these data that safe and effective fertility control, including abortion performed by adequately trained health workers in both in- and out-patient facilities, might be the most appropriate first step in preventing pregnancy-related deaths in Bangladesh.
Article
A survey of all married women aged 15-49 was conducted in 1976 in five rural villages in the predominantly Roman Catholic Philippines. Of 676 respondents, 17 percent admitted that they had had at least one induced abortion. Hilots, physicians, and drugstores were the major providers of abortion, and the methods used ranged from oral tablet to herb, injection, D&C, and massage. About 12 percent of respondents were hospitalized with complications from abortion, signifying a serious public health problem. An upward trend of abortion over time was speculated. There was an age differential in reported abortion experience. A large minority was aware of how an abortion could be performed and believed that abortions were easily obtained in their communities. Half the respondents approved of abortion, and 57 percent stated incorrectly that abortion is legal.
Induced Abortion in South Central and Southeast Asia: Results of a Survey of Health Professionals
  • S Singh
  • D Wulf
  • H Jones
S. Singh, D. Wulf and H. Jones, “Induced Abortion in South Central and Southeast Asia: Results of a Survey of Health Professionals,” International Family Planning Perspectives, 23:59–67 , 1997