Examining the hidden and stigmatized practice of induced abortion is very hard to do. Despite a 2006 Constitutional Court ruling that partially legalized abortion, only a tiny proportion of all induced abortions that take place in Colombia are legal. Those that do not meet the limited legal criteria may pose a grave risk to women’s health and wellbeing. This report presents estimates, derived using an indirect technique, of the levels of induced abortion in the country. It discusses Colombian women’s ability to plan their pregnancies and what happens when they are unable to do so. Trends in abortion over the past two decades are examined, along with trends in what leads directly to women’s recourse to it—namely, unintended pregnancies. The report focuses on the current practice and conditions of abortions, whether they meet the legal criteria or not.
Progress has been made on many fronts
• As of 2010, a high proportion—nearly 80%—of Colombian women in a union practice contraception, with an encouraging 73% using a modern method and only 6% using a less effective traditional method.
• Increased use of contraceptives is an essential factor underlying the country’s fertility trends: Average family size, which has been falling steadily over the past two decades, is now at replacement level (2.1 children per woman).
• A legal breakthrough occurred in 2006 when the Constitutional Court lifted the total ban on induced abortions to legalize the procedure in three circumstances (when a doctor certifies that the life or health of the pregnant woman is threatened, when a doctor certifies that the fetus has an abnormality incompatible with life, and when a pregnancy results from an incident of rape or incest that has been duly reported to the authorities). The Court’s decision was framed in terms of women’s inviolable rights to health and life.
Yet unintended pregnancy and unplanned births are widespread
• Each year in Colombia, there are 89 unintended pregnancies (i.e., those that are wanted at a later time or are not wanted at all) per 1,000 women of reproductive age. Rates vary widely among regions, from 67 per 1,000 in the regions of Central and Oriental, to nearly twice that in the region of Bogotá (113 per 1,000).
• Despite notable gains in contraceptive use over the past two decades, growing motivation to have smaller families means that the proportion of all pregnancies that are unintended rose from one-half to two-thirds during that period.
• Unintended pregnancy often leads to unplanned births. The proportion of recent births that were unplanned has risen dramatically, from just 36% in 1990 to 51% in 2010, with notably little difference across regions in 2010.
Many unintended and unwanted pregnancies end in abortion
• An estimated two-fifths (44%) of all unintended pregnancies in Colombia end in an induced abortion.
• This translates to an estimated 400,400 induced abortions each year. As of 2008, only about 322 (0.08%) of these abortions were reported as legal procedures.
• The absolute number of abortions rose nearly 40% from 1989 to 2008, largely because there are many more women of reproductive age today than there were two decades ago.
• The country’s annual abortion rate rose slightly over that period, reaching 39 abortions per 1,000 women of reproductive age in 2008, compared with 36 per 1,000 in 1989. Rates of abortion range widely, from 66 per 1,000 women in Bogotá to just 18 per 1,000 in Oriental, likely reflecting regional differences in the strength of women’s motivation to avoid giving birth.
How the number of abortions relates to the number of births is an indicator of women’s motivation to avoid giving birth when faced with an unwanted pregnancy. There are currently 52 abortions for every 100 live births, a substantial increase from 35 per 100 in 1989.
Unsafe abortions endanger women’s health and burden the health system
• An induced abortion performed outside the law can be unsafe. As a result, an estimated one-third of all women having a clandestine abortion develop complications that need treatment in a health facility. The rate of complications is highest for the abortions of poor rural women, compared with the abortions of women in the three other subgroups by poverty and area of residence (53% vs. 24–44%). Unfortunately, one-fifth of all women experiencing abortion-related complications do not receive any treatment at all, and these women are especially likely to suffer debilitating consequences.
• Each year, the Colombian health system treats 93,000 women for postabortion complications, and these avoidable complications drain scarce medical resources. Currently, nine women per 1,000 of reproductive age receive facility-based postabortion care. This treatment rate—and the attendant burden on the health system—is highest in the region of Pacífica, where 16 out of every 1,000 women receive treatment each year.
• An estimated half of all abortions in Colombia are induced using the drug misoprostol. Providers’ inadequate knowledge of evidence-based protocols, and women’s misunderstanding of when and how to use the method, likely lead to an unnecessarily high complication rate—32%, usually heavy bleeding and incomplete abortion, for which many women seek facility-based care.
• Women who are poor and live in rural areas are especially likely to not use misoprostol and turn to traditional midwives or to self-induce. Overall, the highest estimated complication rate for all abortions is 54–66% for those induced by methods other than misoprostol and performed by unskilled traditional providers or by the woman herself.
Action is needed to improve women’s health and lives
The recent rise in unintended pregnancies and unplanned births—not to mention persistently high rates of clandestine abortion—point to the need for concerted, unified efforts across the spectrum of Colombian society. Below are some steps to help reduce unsafe abortion’s burden on women and the medical system; improve the provision of legal procedures; and reduce unintended and unwanted pregnancy, the root cause of the vast majority of abortions.
Strengthen contraceptive services. Women and service providers need better information about correct and consistent method use to utilize their current methods as effectively as possible. Access to emergency contraception should be expanded to improve women’s ability to avoid unwanted pregnancy and its consequences. Tailored interventions are needed to meet the contraceptive needs of groups at high risk for unwanted pregnancy.
Improve postabortion care services. The coverage of postabortion services needs to be extended and their quality improved. Providers need more accurate information about caring for women who have used misoprostol; they also need training in treating complications with manual vacuum aspiration, a technique far less invasive and less resource-dependent than the widespread dilation and curettage.
Improve implementation of the Constitutional Court decision and provision of legal abortions. Public education campaigns are needed to continue to spread awareness of the ruling, as are mechanisms to assure that legal abortion guidelines are strictly followed. It is also vital to research the types of barriers to legal abortion that women and providers currently face.