A new study finds that adolescent women have benefited greatly from the 2005 expansion of Ethiopia’s abortion law that gave them access to safe, legal abortion services. “Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia,” conducted by researchers from the Guttmacher Institute and Ipas, documents for the first time legal and clandestine abortion rates among Ethiopian adolescents (aged 15–19), and the severity of abortion-related complications in this age-group. The study found that adolescents are more likely than older women to obtain legal abortion services, and that complications from unsafe abortion are just as severe among adolescents as they are among other age-groups.
Ethiopia is one of only a few countries that have explicitly reduced barriers to safe and legal abortion for adolescent women. Until 2005, Ethiopian law permitted abortion only to save the life of a woman or to protect her physical health. The new criteria now permit abortion in instances of rape, incest and fetal impairment; if a woman has physical or mental disabilities; or if she is younger than 18 years old.
The 2014 data show that 64% of abortions obtained by adolescents are legal procedures performed in a health facility. Among older women, lower proportions of abortions are legal: 46% of those obtained by women aged 25–29 and 22% of those obtained by women aged 35 and older. The remainder are clandestine and potentially unsafe.
“The liberalization of Ethiopia’s abortion law has enabled many adolescents to obtain safe abortion care,” said Yohannes Dibaba, one of the study’s authors. “Yet additional research is needed to understand why a substantial number of adolescent women continue to obtain clandestine—and potentially unsafe—abortion procedures.”
The study also finds that adolescents seeking care for complications from miscarriage or unsafe clandestine abortion experience severe complications at the same rate as older women (one severe complication per every four complications). Compared with adolescents having legal abortions, those presenting with complications from unsafe clandestine abortions are more likely to be married, to have had less education and to be in the second trimester of their pregnancy. Further research is needed to understand how marital and educational status may influence access to and use of legal abortion services among young women.
“Adolescents have the lowest rate of abortion among women of all ages in Ethiopia,” said Elizabeth Sully, senior research scientist at the Guttmacher Institute and the study’s lead author. “Yet close to half of pregnancies among adolescents are unintended, which suggests that more work is needed to meet their contraceptive needs.”
Researchers estimate that adolescents have the highest unintended pregnancy rate among sexually active women in Ethiopia (176 per 1,000 women). By comparison, the unintended pregnancy rate among all sexually active women aged 15–49 is 101 per 1,000. In large part, this discrepancy exists because adolescents are less likely to be sexually active than older women, but they often face the greatest barriers to family planning.
Abortion rates are also affected by adolescents’ low level of sexual activity relative to that of older women. As of 2014, adolescents have an estimated 96,243 induced abortions per year, which translates to the lowest rate of abortion among any age-group: 20 per 1,000 women. However, looking only at women who are sexually active, women aged 15–19 have the highest rate of abortion. The authors recommend that adolescents be provided with a full range of high-quality contraceptive methods.
The study suggests that further research is needed to shed light on the factors contributing to the continued use of clandestine abortion among some adolescent women, such as autonomy in reproductive decision making, distance from health facilities, abortion stigma and knowledge of the abortion law. These efforts will be critical to reducing inequities and to ensuring that all adolescent women have access to safe and legal abortion services.
Lechisa AssefaIpas Ethiopia