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Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997. Katherine Berger, MPH 1 Roger Rochat, MD 2 Halida Akhter, MD, PhD 3. 1 Department of Epidemiology, University of Pittsburgh 2 Department of Global Health, RSPH, Emory University

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abortion related morbidity and mortality in bangladesh 1996 1997

Abortion Related Morbidity and Mortality in Bangladesh, 1996-1997

Katherine Berger, MPH1

Roger Rochat, MD2

Halida Akhter, MD, PhD3

1 Department of Epidemiology, University of Pittsburgh

2 Department of Global Health, RSPH, Emory University

3 Health Promotion Limited, Dhaka, Bangladesh

slide2

Bangladesh

  • 144 million people
  • 144,000 square km
  • 83% Muslim
  • ~ 4 million annual live births
changes in maternal health services over the last 25 years
Changes in maternal health services over the last 25 years.
  • Increased family planning services.
  • Abortion Practices: Introduced Menstrual Regulation services in mid-1970s
    • Legal up to 10 weeks gestation
    • Consent of woman’s husband
    • FWV: 12,000 trained over last 25 years
    • Challenges: access, convenience
estimates of abortion related maternal mortality over the last 25 years
Estimates of abortion related maternal mortality over the last 25 years.
  • National survey: 1978-1979
    • Interviewed 795 health centers
    • Maternal mortality rate – 5.4 deaths/100,000 women aged 10+
    • 26% of all maternal deaths due to abortions
  • Matlab area – 30 km SE of Dhaka
    • Pilot study area to reduce fertility and maternal mortality
    • MMR: 5.5 deaths/1000 live births.
    • 15% due to abortion complications
    • MMR decreased, proportion due to abortion – no change
birperht 1996 1997 survey of causes of death among reproductive age women
BIRPERHT 1996-1997 survey of causes of death among reproductive age women
  • Interviewed health care providers for family planning and MCH services
  • 4515 facilities
  • Questionnaire administered for:
    • 1) known death, or
    • 2) abortion complication/death case.
  • Ascertainment:
    • 79.4% of gov. facilities
    • 54% of community health workers
  • Obtained case reports on ~43% of all deaths within the past year.
birperht 1996 1997 survey of causes of death among reproductive age women7
BIRPERHT 1996-1997 survey of causes of death among reproductive age women
  • 28,998 deaths identified
    • Medical, pregnancy related, injury
    • Estimated
  • 8562 (30%) maternal deaths
    • 7086 (82.8%) obstetric deaths
    • 1476 (17.2%) abortion deaths
  • 30,668 abortion complication case reports
purposes of study
Purposes of Study
  • Describe women who have had an complication or death due to abortion.
  • Determine the risk associated with medically approved and non-approved abortion procedures.
methods
Methods
  • Utilized the 30,668 case reports detailing abortion complications and deaths from the BIRPERHT survey.
  • Information collected on:
    • Location, source of information, outcome
    • Demographic characteristics
    • Method, provider, # attempts, weeks gestation
number of attempts to achieve complete abortion
Number of attempts to achieve complete abortion

* 1430 women induced abortion and were referred to hospital for D&C.

abortion methods and providers
Abortion methods and providers
  • Menstrual regulation
    • 74.6% performed by FWV
    • 1% resulted in death
  • Plant root/stick
    • 28% performed by woman
    • 15.5% resulted in death
  • Multiple attempts (n=2129)
    • 69% used MR as last procedure
    • 1% died
    • 8.3% died if MR was not last procedure
risk associated with procedures other than mr by marital status and weeks gestation
Risk associated with procedures other than MR by marital status and weeks gestation.

* Adjusted for education, age of woman, number of attempts, live births, economic status.

conclusions
Conclusions
  • 5% of women with abortion complications died
  • Low economic status, illiteracy, rural residence, and being unmarried significantly increased risk of death.
  • Half of abortions were provided by trained providers and completed using MR
  • Women not using MR had an 8-fold increased risk of dying.
limitations
Limitations
  • Recall bias
  • Missing Data:
    • nearly 50% of abortion complication cases are missing type of method used.
  • Case selection
public health impact
Public Health Impact
  • Increasing our understanding of abortion associated morbidity and mortality in Bangladesh is necessary to increase the availability, understanding, and use of safe abortion procedures.
acknowledgements
Acknowledgements
  • Bangladesh Institute for Research for Promotion of Essential & Reproductive Health and Technologies (BIRPERHT)
    • Halida Akhter
    • Rasheduzzaman Shah
    • Mahbub-E-Elahi Khan
  • CDC
    • Roger Rochat
    • Hussain Yusuf