Abortion in Zimbabwe: A National Study of the Incidence of Induced Abortion, Unintended Pregnancy and Post-Abortion Care in 2016

Elizabeth A. Sully, Guttmacher Institute Mugove Gerald Madziyire, University of Zimbabwe College of Health Sciences Taylor Riley Ann M. Moore, Guttmacher Institute Marjorie Crowell, Guttmacher Institute Margaret Tambudzai Nyandoro, Zimbabwe Ministry of Health and Child Care Bernard Madzima, Zimbabwe Ministry of Health and Child Care Tsungai Chipato, University of Zimbabwe College of Health Sciences

First published on PLOS ONE:

| DOI: https://doi.org/10.1371/journal.pone.0205239
Abstract / Summary
Background

Zimbabwe has the highest contraceptive prevalence rate in sub-Saharan Africa, but also one of the highest maternal mortality ratios in the world. Little is known, however, about the incidence of abortion and post-abortion care (PAC) in Zimbabwe. Access to legal abortion is rare, and limited to circumstances of rape, incest, fetal impairment, or to save the woman’s life.


Objectives

This paper estimates a) the national provision of PAC, b) the first-ever national incidence of induced abortion in Zimbabwe, and c) the proportion of pregnancies that are unintended.


Methods

We use the Abortion Incidence Complications Method (AICM), which indirectly estimates the incidence of induced abortion by obtaining a national estimate of PAC cases, and then estimates what proportion of all induced abortions in the country would result in women receiving PAC. Three national surveys were conducted in 2016: a census of health facilities with PAC capacity (n = 227), a prospective survey of women seeking abortion-related care in a nationally-representative sample of those facilities (n = 127 facilities), and a purposive sample of experts knowledgeable about abortion in Zimbabwe (n = 118). The estimate of induced abortion, along with census and Demographic Health Survey data was used to estimate unintended pregnancy.


Results

There were an estimated 25,245 PAC patients treated in Zimbabwe in 2016, but there were critical gaps in their care, including stock-outs of essential PAC medicines at half of facilities. Approximately 66,847 induced abortions (uncertainty interval (UI): 54,000–86,171) occurred in Zimbabwe in 2016, which translates to a national rate of 17.8 (UI: 14.4–22.9) abortions per 1,000 women 15–49. Overall, 40% of pregnancies were unintended in 2016, and one-quarter of all unintended pregnancies ended in abortion.


Conclusion

Zimbabwe has one of the lowest abortion rates in sub-Saharan Africa, likely due to high rates of contraceptive use. There are gaps in the health care system affecting the provision of quality PAC, potentially due to the prolonged economic crisis. These findings can inform and improve policies and programs addressing unsafe abortion and PAC in Zimbabwe.

Topic

Global

Geography