Percent of obstetric and gynecological admissions owing to abortion

The percent of admissions to an obstetric or gynecological ward at a health care facility due to abortion-related complications for a reference pe­riod (e.g., one-year)

This indicator includes both complications resulting from spontaneous abortion (miscarriage) and those oc­curring as a result of induced abortions.

This indicator is calculated as:

(# of admissions to an obstetric or gynecological ward at a health care facility due to abortion-related complications for a reference pe­riod / Total # of obstetric or gynecological ward admissions) x 100 

Postabortion complications include hemorrhage, local and systemic infection, injury to the genital tract and internal organs, and toxic or chemical reactions from attempts at self-induced or unsafe abortion. This indi­cator omits long-term sequelae (physical impairment, pain, pelvic inflammatory disease, secondary infertil­ity, increased rate of ectopic pregnancy).

Counts of women admitted to an obstetric or gynecological ward  health care facility for treatment of abortion-related complications during a ref­erence period

Special studies or services statistics from health facili­ties providing treatment of abortion complications

Note: In hospitals in developing countries, treatment of abortion complications may be performed in many dif­ferent locations within the facility, such as the gyneco­logical ward, emergency room or operating room; data collection should therefore include admissions from all locations.

This indicator monitors changes in caseloads and has important administrative implications. Evaluators and managers can also use it to track resource use and needs for treatment of abortion-related complications. It also has policy implications in that it is useful for assessing the cost of unsafe, induced abortions to individual hos­pitals or to a national health system. Numbers of ad­missions for abortion complications can also provide denominators for other useful indicators, such as the percentage of PAC patients under the age of 20 or the percentage of PAC patients presenting at 12 or fewer weeks of pregnancy.  In some individual facilities, such as health centers, however, the number of admissions for abortion complications may be small so that calcu­lation of percentages may be inappropriate.

Peru provides an example of current efforts to improve the quality of information about PAC caseloads at pub­lic sector health centers and hospitals in one state. The process involves completion of a standardized clinical history form for each postabortion patient receiving treatment in the facility.  The form requests informa­tion about a limited number of key indicators, such as diagnosis, patient age, evacuation technique used, and duration of pregnancy.  Providers in these facilities are accustomed to completing a similar form for obstetric deliveries, so they have easily adopted the form. Staff are responsible for entering the information into a data­base at each facility, and the Ministry of Health makes the information available for use at the facility, state, and national levels.

This indicator can estimate the extent of induced abor­tion in countries where abortion is restricted. Research­ers have utilized data on abortion-related hospital ad­missions to construct such estimates. Evaluators can extrapolate the number of abortion-related hospital ad­missions to estimate the number of abortions in the population by using a variety of multipliers. These multipliers will be region and country specific. They will vary by the degree of restrictiveness of the legal and social climate, the availability of induced abortion performed by trained providers, the procedures used by clandestine providers, the availability of antibiotics, and the socioeconomic status of the women who undergo abortions. To address the uncertainty related to these multipliers, researchers have suggested using a range of estimates with several different multipliers (Singh and Wulf, 1994).

The best way to collect data for this indicator may be to conduct special studies at specific facilities (e.g., hos­pitals in urban areas). A hospital-based study in Nige­ria indicated that over 75 percent of gynecological ad­missions to hospitals were due to abortion-related causes (Rogo, Lema, and Rae, 1999).

A possible alternative indicator is Percent of women treated for PAC at service facilities who die.

This indicator includes both complications due to in­duced and to spontaneous abortions. While it is often of interest to distinguish between the two types in order to estimate the number of induced abortions, this infor­mation is often difficult to obtain.  Moreover, many would question the ethics of asking young women if they have had an abortion in restrictive legal settings. Clinical evidence is often inconclusive, and reports may also be heavily biased in restrictive environments. Even where service providers are fairly certain that an abor­tion-related complication results from an induced abor­tion, they may choose not to report this in the records due to a legally and/or socially restrictive environment. This omission results in service data that are potentially misleading in terms of the number of spontaneous ver­sus induced abortions.

Evaluators have used several approaches in attempting to distinguish between spontaneous and induced abor­tions. These approaches range from a series of ques­tions asked of the patient to multipliers based on the biological occurrence of spontaneous abortion to mul­tipliers based on expert opinion of the proportion of hospitalizations due to complications of induced abor­tion.

postabortion care, safe motherhood (SM)