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Jessica Malter
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NEW STUDY FINDS THAT IN UGANDA, UNSAFE ABORTION TAKES A FINANCIAL TOLL ON WOMEN, THEIR CHILDREN AND THEIR HOUSEHOLDS

Unsafe abortion often takes a considerable financial toll on Ugandan women and their families, resulting in a decline in economic stability and household well-being. The findings come from a new study, "Documenting the Individual and Household-Level Cost of Unsafe Abortion in Uganda," by Aparna Sundaram of the Guttmacher Institute, et al. The study found that the majority of women treated for complications from an unsafe abortion experience some adverse economic effect. Of the women surveyed, 73% reported that they had lost wages, 60% that their children had less to eat, were unable to attend school or both, and 34% experienced a decline in the economic stability of their household.

On average, Ugandan women paid 59,600 (US$23) shillings for their abortion procedure. However, those who received treatment at a health facility for postabortion complications spent an average of 128,000 shillings (US$49) for both the procedure and the treatment of resulting complications. For many women these expenditures are significant, given that Uganda has one of the lowest per capita incomes in the world and that a substantial proportion of the population lives in poverty.

"Our findings show that the harm caused by unsafe abortion extends well beyond the health complications women often experience," said Dr. Fred Mugisha, a coauthor of the study. "In order to pay for needed treatment, some women have to sacrifice their assets, such as their home or their livestock, and others may incur new debt. This is especially true for poor women, who are also the most likely to suffer serious complications from a clandestine abortion."

Using data collected in 2011–2012 from more than 1,300 women who had received postabortion care at health facilities, the researchers found that women who had spent a single night in a health facility faced significantly greater expenses—and the resulting financial hardship—than women who had been treated as outpatients. For these women, the risks of experiencing a loss of earnings and of reporting negative consequences for their children were twice as high as those for women treated as outpatients, and the risk of experiencing some economic deterioration of the household was three times as high.

The proportion of women who reported that their children had suffered negative consequences was highest among teenagers (92%), followed by women in their 20s (62%) and older women (51%).

"These findings make clear that more must be done to reduce unintended pregnancy by ensuring Ugandan women have access to family planning services," said Moses Mulumba, executive director of the Center for Health, Human Rights and Development. "Accurate information on contraception and high-quality services must be made available as a matter of constitutionally guaranteed rights to allow women to avoid an unwanted pregnancy. Young and poor women in particular need access to these services."

According to the authors, the findings call for programs and policies that help address women's reasons for obtaining unsafe abortion and diminish the consequences of such abortions, in particular through the provision of abortion services to the full extent of the law. Furthermore, concerted efforts must be made to reduce the overall costs associated with postabortion care, so that women suffering from complications of unsafe abortion do not have to sacrifice the well-being of their families to receive treatment.

"Documenting the Individual and Household-Level Cost of Unsafe Abortion in Uganda," is currently available online and will appear in the December issue of International Perspectives on Sexual and Reproductive Health.

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