Documenting the individual- and household-level cost of unsafe abortion in Uganda.

CONTEXT: Although Uganda has a restrictive abortion law, illegal abortions performed under dangerous conditions are common. Data are lacking, however, on the economic impact of postabortion complications on women and their households.

METHODS

Data from a 2011-2012 survey of 1,338 women who received postabortion care at 27 Ugandan health facilities were used to assess the economic consequences of unsafe abortion and subsequent treatment. Information was obtained on treatment costs and on the impact of abortion complications on children in the household, on the productivity of the respondent and other household members, and on changes in their economic circumstances.

RESULTS

Most women reported that their unsafe abortion had had one or more adverse effects, including loss of productivity (73%), negative consequences for their children (60%) and deterioration in economic circumstances (34%). Women who had spent one or more nights in a facility receiving postabortion care were more likely than those who had not needed an overnight stay to experience these three consequences (odds ratios, 1.6-2.8), and women who had incurred higher postabortion care expenses were more likely than those with lower expenses to report deterioration in economic circumstances (1.6). Wealthier women were less likely than the poorest women to report that their children had suffered negative consequences (0.4-0.5).

CONCLUSIONS

The impact of complications of unsafe abortion and the expense of treating them are substantial for Ugandan women and their households. Strategies to reduce the number of unsafe procedures, such as by expanding access to contraceptives to prevent unintended pregnancies, are urgently needed.