The first national estimates of abortion incidence in Rwanda show that one in 40 women aged 15–44 had an abortion in 2009 and that virtually all of these abortions were clandestine procedures that are highly likely to be unsafe. The study, conducted by the National University of Rwanda’s School of Public Health and the U.S.-based Guttmacher Institute, in collaboration with the Ministry of Health, found that an estimated 60,000 induced abortions occurred that year, which translates to a national rate of 25 abortions per 1,000 women of reproductive age. This is lower than the abortion rate for Sub-Saharan Africa as a whole (31 per 1,000) and for Eastern Africa (36 per 1,000).
The researchers, who gathered data from a nationally representative sample of health facilities and knowledgeable key informants, found that 25,000 women—more than 40% of women who had an abortion—suffered complications that required medical treatment. However, 30% of these women did not receive the medical care they required, indicating a greater need for postabortion care than is currently being provided.
A substantial proportion of abortion complications are likely due to the actions of untrained providers, such as traditional healers, lay practitioners, pharmacists, or pregnant women themselves. Such procedures may involve ingesting dangerous substances or inserting sharp objects into the body to end a pregnancy.
“Reducing maternal mortality and ill-health is a priority for Rwanda. These important findings will help us better address the issue and improve the health and well-being of Rwandan women and their families,” said Dr. Agnes Binagwaho, Rwanda’s Minister of Health. “The fact that so many women are suffering complications from unsafe abortion and that so many are not receiving the care they need is very concerning. It is clearly an issue we must address.”
Approximately 20% of Rwandan women will require treatment for complications from an unsafe abortion at some point in their lifetime. The study found that the quality of postabortion care was poor throughout the health system. While 92% of health facilities in the country provide some form of treatment for abortion complications, the majority do not use techniques recommended by the World Health Organization.
Though the number of women who die from unsafe abortions in Rwanda is not known, the World Health Organization estimates unsafe abortion accounts for 17% of all maternal deaths in Eastern Africa.
The researchers also found that despite growing modern contraceptive use in Rwanda, 47% of all pregnancies in the country are unintended.
“Unintended pregnancy is the root cause of the vast majority of abortions,” notes Dr. Fidel Ngabo, Director of maternal and Child Health Unit, Ministry of Health, Rwanda and coauthor to the study. “Addressing the unmet need for modern contraception is critical in order to reduce unintended pregnancy and unsafe abortions in Rwanda.”
The authors recommend that Rwanda improve its family planning policies and programs to meet the need for modern contraception as a way to reduce unsafe abortion. In addition, postabortion care needs to be expanded and improved so all women have access to the high quality services they need. Furthermore, the authors note, because most Rwandans believe abortion is illegal under all circumstances, programs to educate women and couples about the criteria under which abortion is legally permitted is needed.
"Abortion Incidence and Postabortion Care in Rwanda", by Paulin Basinga, et al. appears in the March 2012 issue of the journal Studies in Family Planning.
This press release is also available in French.