In the first national study of abortion incidence in Senegal, researchers found that clandestine abortions —almost all of them unsafe—pose a serious threat to the health of Senegalese women. The study, which was conducted by the U.S.-based Guttmacher Institute and Senegal’s Centre de Recherche pour le Développement Humain, found that an estimated 51,500 induced abortions were performed in Senegal in 2012, a rate of 17 abortions per 1,000 women of reproductive age. More than half of those abortions resulted in complications requiring medical treatment, for which many women did not receive care.

The researchers, who conducted a survey of health facilities and another of health professionals, found that more than half of all women who have abortions–55%–experience complications requiring medical attention. However, 42% of women who experience complications do not receive the care they need. Poor women bear the greatest burden—they are far more likely than wealthier women to experience complications, but much less likely to receive medical treatment.

“Clandestine abortion in Senegal is taking a serious toll on Senegalese women, especially among the poorest and least advantaged women,” said Gilda Sedgh, a researcher at the Guttmacher Institute and the study’s lead author. “Most abortions are the result of unintended pregnancies. Meeting the need for modern contraceptives would allow Senegalese women to have greater control over when they become pregnant, and help lower the likelihood that women will resort to unsafe abortions.”

The abortion rate in Senegal is lower than the rate in Africa as a whole (29 per 1,000 in 2008) and comparable to that in the United States (17 per 1,000 in 2011) and many European countries. However, complications related to abortion are quite rare in Europe and the United States, where the procedure is broadly legal and performed under proper medical conditions.

The researchers estimate that approximately 31% of all pregnancies in Senegal are unintended, and that 24% of such pregnancies end in induced abortion. Although use of modern contraceptives among married women in Senegal rose between 2005 and 2014, it remains low, as only 20% of married women use a modern method.

“Efforts to ensure access to family planning services, including information and counseling, and to postabortion care—without risk of legal recriminations—must be expanded,” said Salif Ndiaye, director of the Centre de Recherche pour le Développement Humain. “These findings also make clear that we must focus on the needs of poor women. They have the highest risk of experiencing abortion complications and are the least likely to get the medical care they will then need.”

The researchers highlight that Senegal has a fairly well developed national program for providing postabortion care. However, challenges remain to be addressed, such as ensuring that necessary equipment and supplies are consistently available, providing ongoing training for providers to offset staff turnover and ensuring greater access to services for the most disadvantaged women. The researchers recommend that postabortion care be provided without the risk of arrest or interrogation, as this risk can inhibit women from seeking needed care. They also recommend that public health campaigns be implemented to educate women about family planning services, and that these be accompanied by expanded provision of contraceptive services in the country.

Estimates of the Incidence of Induced Abortion and Consequences of Unsafe Abortion in Senegal" by Gilda Sedgh of the Guttmacher Institute et al., is available online in International Perspectives on Sexual and Reproductive Health.