The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018
Background. The occurrence of abortion-related morbidity indicates limited access to safe abortion. Globally, unsafe abortions remain a persistent, yet preventable, cause of maternal mortality. South Africa (SA) is internationally recognised for its progressive reproductive rights framework, su...
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South African Medical Association
2025-02-01
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| author | D N Conco J Levin B Komane K Blanchard T Bessenaar N G Nkosi S Fonn |
| author_facet | D N Conco J Levin B Komane K Blanchard T Bessenaar N G Nkosi S Fonn |
| author_sort | D N Conco |
| collection | DOAJ |
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Background. The occurrence of abortion-related morbidity indicates limited access to safe abortion. Globally, unsafe abortions remain a persistent, yet preventable, cause of maternal mortality. South Africa (SA) is internationally recognised for its progressive reproductive rights framework, supported by its Constitution and laws. However, evidence suggests that women encounter barriers to accessing safe abortions, including stigma, resistance from healthcare providers, a shortage of trained professionals and a lack of awareness of their rights. We hypothesised that, 20 years after the promulgation of the Choice on Termination of Pregnancy Act, the incidence of incomplete abortion (ICA) and the prevalence of abortion-related morbidity would change, influenced by access to safe abortion and the introduction of medication abortion. We wanted to compare our data with 2000 and 1994 survey results to assess change.
Objectives. To estimate the incidence of incomplete abortion and describe the prevalence of abortion-related morbidity in SA public hospitals in 2018.
Methods. This was a cross-sectional, retrospective study. We selected a stratified random sample of public hospitals. We extracted data from medical records of women who presented with ICA during a predetermined 21-day period in 2018. Data were captured directly into a REDCap database. To estimate the national incidence of ICA, we used population estimates for 2018, comprising 17 199 227 women aged 12 - 49 years, and 1 200 436 live births. The prevalence of ICA morbidity is reported. We compared the rates in this study with those reported from similar studies in 2000 and 1994.
Results. We found 913 medical records of women presenting with ICA in the 56 public hospitals. ICA incidence was 367 (274 - 459) per 100 000 women aged 12 - 49 years. The average age of the women was 27 years, and the majority had a previous pregnancy before the ICA. A large proportion (73.9%) of women were in the first trimester. There was no sign of infection in 92.5% of records, no organ failure in 99.1% of records and there were no deaths. There was no change in the ICA incidence when compared with the 1994 and 2000 results. Women’s mean age and having a previous pregnancy were similar in the three studies (1994, 2000 and 2018). The proportion of women presenting in the first trimester increased over time: 60.5% in 1994, 67.1% in 2000 and 73.9% in 2018. There has been a decline in the prevalence of abortion-related morbidity, demonstrated by lower levels of severity, no signs of infections and no organ failure.
Conclusion. ICA incidence has not changed, but related morbidity is declining. Various factors could explain our findings, but the lack of change in ICA incidence indicates that access to formal abortion care has not improved over the past 20 years.
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| format | Article |
| id | doaj-art-c3670c767fdd4ebd86012a9f175709d6 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | South African Medical Association |
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| series | South African Medical Journal |
| spelling | doaj-art-c3670c767fdd4ebd86012a9f175709d62025-02-10T12:25:25ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352025-02-01115110.7196/SAMJ.2025.v115i1.1987The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018D N Conco0https://orcid.org/0000-0003-4999-7502J Levin1https://orcid.org/0000-0002-6177-614XB Komane2https://orcid.org/0000-0003-0585-1106K Blanchard3https://orcid.org/0000-0001-9691-0700T Bessenaar4https://orcid.org/0000-0002-2148-0715N G Nkosi5https://orcid.org/0000-0002-3227-1775S Fonn6https://orcid.org/0000-0001-6115-8707School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaMRC-Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaIbis Reproductive Health, Cambridge, USAIbis Reproductive Health, Johannesburg, South AfricaDepartment of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden Background. The occurrence of abortion-related morbidity indicates limited access to safe abortion. Globally, unsafe abortions remain a persistent, yet preventable, cause of maternal mortality. South Africa (SA) is internationally recognised for its progressive reproductive rights framework, supported by its Constitution and laws. However, evidence suggests that women encounter barriers to accessing safe abortions, including stigma, resistance from healthcare providers, a shortage of trained professionals and a lack of awareness of their rights. We hypothesised that, 20 years after the promulgation of the Choice on Termination of Pregnancy Act, the incidence of incomplete abortion (ICA) and the prevalence of abortion-related morbidity would change, influenced by access to safe abortion and the introduction of medication abortion. We wanted to compare our data with 2000 and 1994 survey results to assess change. Objectives. To estimate the incidence of incomplete abortion and describe the prevalence of abortion-related morbidity in SA public hospitals in 2018. Methods. This was a cross-sectional, retrospective study. We selected a stratified random sample of public hospitals. We extracted data from medical records of women who presented with ICA during a predetermined 21-day period in 2018. Data were captured directly into a REDCap database. To estimate the national incidence of ICA, we used population estimates for 2018, comprising 17 199 227 women aged 12 - 49 years, and 1 200 436 live births. The prevalence of ICA morbidity is reported. We compared the rates in this study with those reported from similar studies in 2000 and 1994. Results. We found 913 medical records of women presenting with ICA in the 56 public hospitals. ICA incidence was 367 (274 - 459) per 100 000 women aged 12 - 49 years. The average age of the women was 27 years, and the majority had a previous pregnancy before the ICA. A large proportion (73.9%) of women were in the first trimester. There was no sign of infection in 92.5% of records, no organ failure in 99.1% of records and there were no deaths. There was no change in the ICA incidence when compared with the 1994 and 2000 results. Women’s mean age and having a previous pregnancy were similar in the three studies (1994, 2000 and 2018). The proportion of women presenting in the first trimester increased over time: 60.5% in 1994, 67.1% in 2000 and 73.9% in 2018. There has been a decline in the prevalence of abortion-related morbidity, demonstrated by lower levels of severity, no signs of infections and no organ failure. Conclusion. ICA incidence has not changed, but related morbidity is declining. Various factors could explain our findings, but the lack of change in ICA incidence indicates that access to formal abortion care has not improved over the past 20 years. https://samajournals.co.za/index.php/samj/article/view/1987abortionsmorbidityPrevalencepublic hospital |
| spellingShingle | D N Conco J Levin B Komane K Blanchard T Bessenaar N G Nkosi S Fonn The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 South African Medical Journal abortions morbidity Prevalence public hospital |
| title | The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 |
| title_full | The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 |
| title_fullStr | The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 |
| title_full_unstemmed | The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 |
| title_short | The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018 |
| title_sort | incidence of incomplete abortion and the prevalence of abortion related morbidity in south african public hospitals 2018 |
| topic | abortions morbidity Prevalence public hospital |
| url | https://samajournals.co.za/index.php/samj/article/view/1987 |
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