By conservative estimates, complications from unsafe abortion kill more than 3,000 women each year, according to a new study published in the March 2008 issue of International Family Planning Perspectives. Though abortion is illegal in Nigeria except to save a woman’s life, previous research has shown that many women will risk the dangers of a clandestine procedure rather than carry an unintended pregnancy to term. In 1996, an estimated 610,000 abortions occurred (25 per 1,000 women of childbearing age), of which 142,000 resulted in complications severe enough to require hospitalization. (The number of abortions is estimated to have risen to 760,000 in 2006.)

"Women and their families pay dearly for unsafe abortion, first for the clandestine procedure and then the far greater costs of treating resulting complications and risking permanent damage and death," said Akinrinola Bankole, director of international research at the Guttmacher Institute and a coauthor of "Severity and Costs of Unsafe Abortion Complications Treated in Nigerian Hospitals," by Stanley Henshaw et al.

The researchers, from Guttmacher and its Nigerian partner, The Campaign Against Unwanted Pregnancy, interviewed more than 2,000 women receiving abortion or postabortion care at hospitals throughout Nigeria, as well as their doctors. They found that women with serious complications paid an average of 13,900 Nigerian naira (about $118), including 2,900 naira for the procedure that caused the complications—no small sum for the average Nigerian woman. By comparison, women without complications paid an average of 3,800 naira ($32) for the procedure.

In addition, two-thirds of women who had obtained a clandestine abortion before coming to a hospital experienced serious health consequences, including bloodstream infections (24%), pelvic infections (21%) and injury from instruments used in an unsafe procedure (11%); 2% died from their complications.

The study found that despite legal restrictionssome Nigerian women are able to avoid the dangers of clandestine abortion by obtaining a procedure in hospital settings. One in three women interviewed had received an abortion at a hospital without having previously attempted to terminate the pregnancy. These women were cared for by trained providers and experienced fewer complications than women who had had a clandestine abortion prior to arriving at the hospital.

To reduce maternal mortality and the costs of unsafe abortion on both the health care system and society, the authors recommend widespread training of Nigerian doctors in abortion procedures. Increased training should go hand-in-hand with increased supplies for the most cost-effective postabortion technologies, such as manual vacuum aspiration. Nevertheless, the authors note, these measures would have little impact on the costs and consequences of clandestine abortion without a change in the existing laws restricting access to safe abortion in Nigeria. In addition, programs and policies that support family planning are needed to reduce the incidence of unwanted pregnancy and, in turn, the number of women who resort to abortion.

Also in this issue:

"Fertility-Limiting Behavior and Contraceptive Choice Among Men in Nepal," by Govinda P. Dahal et al.

"Links Between Sex-Related Expectations About Alcohol, Heavy Episodic Drinking and Sexual Risk Among Young Men in a Shanytown in Lima, Peru,” by Juan Antonio Gálvez-Buccollini et al.

"Women’s Sexual and Reproductive Health in Post-Socialist Georgia: Does Internal Displacement Matter?” by Khatuna Doliashvili and Cynthia J. Buckley

"Changing Family Formation in Nepal: Marriage, Cohabitation and First Sexual Intercourse,” by Marcantonio Caltabiano and Maria Castiglioni