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Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997

Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997. Katherine Berger, MPH 1 Roger Rochat, MD 2 Halida Akhter, MD, PhD 3. 1 Department of Epidemiology, University of Pittsburgh 2 Department of Global Health, RSPH, Emory University

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Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997

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  1. Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997 Katherine Berger, MPH1 Roger Rochat, MD2 Halida Akhter, MD, PhD3 1 Department of Epidemiology, University of Pittsburgh 2 Department of Global Health, RSPH, Emory University 3 Health Promotion Limited, Dhaka, Bangladesh

  2. Bangladesh • 144 million people • 144,000 square km • 83% Muslim • ~ 4 million annual live births

  3. Maternal Mortality in Bangladesh: 1980s to present

  4. Changes in maternal health services over the last 25 years. • Increased family planning services. • Abortion Practices: Introduced Menstrual Regulation services in mid-1970s • Legal up to 10 weeks gestation • Consent of woman’s husband • FWV: 12,000 trained over last 25 years • Challenges: access, convenience

  5. Estimates of abortion related maternal mortality over the last 25 years. • National survey: 1978-1979 • Interviewed 795 health centers • Maternal mortality rate – 5.4 deaths/100,000 women aged 10+ • 26% of all maternal deaths due to abortions • Matlab area – 30 km SE of Dhaka • Pilot study area to reduce fertility and maternal mortality • MMR: 5.5 deaths/1000 live births. • 15% due to abortion complications • MMR decreased, proportion due to abortion – no change

  6. BIRPERHT 1996-1997 survey of causes of death among reproductive age women • Interviewed health care providers for family planning and MCH services • 4515 facilities • Questionnaire administered for: • 1) known death, or • 2) abortion complication/death case. • Ascertainment: • 79.4% of gov. facilities • 54% of community health workers • Obtained case reports on ~43% of all deaths within the past year.

  7. BIRPERHT 1996-1997 survey of causes of death among reproductive age women • 28,998 deaths identified • Medical, pregnancy related, injury • Estimated • 8562 (30%) maternal deaths • 7086 (82.8%) obstetric deaths • 1476 (17.2%) abortion deaths • 30,668 abortion complication case reports

  8. Purposes of Study • Describe women who have had an complication or death due to abortion. • Determine the risk associated with medically approved and non-approved abortion procedures.

  9. Methods • Utilized the 30,668 case reports detailing abortion complications and deaths from the BIRPERHT survey. • Information collected on: • Location, source of information, outcome • Demographic characteristics • Method, provider, # attempts, weeks gestation

  10. Abortion Morbidity and Mortality in Bangladesh by Age: 1996-1997

  11. Characteristics of women obtaining abortions and associated risk of mortality.

  12. Characteristics of women obtaining abortions and associated risk of mortality.

  13. Number of attempts to achieve complete abortion * 1430 women induced abortion and were referred to hospital for D&C.

  14. Abortion providers at last attempt and associated mortality rates.

  15. Abortion methods at last attempt and associated mortality rates.

  16. Abortion methods and providers • Menstrual regulation • 74.6% performed by FWV • 1% resulted in death • Plant root/stick • 28% performed by woman • 15.5% resulted in death • Multiple attempts (n=2129) • 69% used MR as last procedure • 1% died • 8.3% died if MR was not last procedure

  17. Risk associated with procedures other than MR by marital status and weeks gestation. * Adjusted for education, age of woman, number of attempts, live births, economic status.

  18. Conclusions • 5% of women with abortion complications died • Low economic status, illiteracy, rural residence, and being unmarried significantly increased risk of death. • Half of abortions were provided by trained providers and completed using MR • Women not using MR had an 8-fold increased risk of dying.

  19. Limitations • Recall bias • Missing Data: • nearly 50% of abortion complication cases are missing type of method used. • Case selection

  20. Public Health Impact • Increasing our understanding of abortion associated morbidity and mortality in Bangladesh is necessary to increase the availability, understanding, and use of safe abortion procedures.

  21. Acknowledgements • Bangladesh Institute for Research for Promotion of Essential & Reproductive Health and Technologies (BIRPERHT) • Halida Akhter • Rasheduzzaman Shah • Mahbub-E-Elahi Khan • CDC • Roger Rochat • Hussain Yusuf

  22. Thank you

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