Unsafe abortion in legally restricted areas. How politics and abortion laws decides women’s future. A literature review on the incidence of induced abortion and adverse health consequences in Sub-Saharan African countries with restrictive abortion laws

Abstract

Introduction: Sub-Saharan Africa has one of the world’s highest rates of unsafe abortions, and most maternal deaths due to unsafe abortion arises from this region. Abortion is restricted by law in most of these countries. The aim of the thesis is to address the impact of restrictive abortion laws on the incidence, morbidity and mortality from unsafe abortion in Sub-Saharan African countries. Material and methods: A systematic literature search was performed in April 2017 for studies published between January 2000 and April 2017. The studies were selected based on the following inclusions-criteria; incidence and complications of induced abortions, maternal deaths due to unsafe abortion, and abortion laws in Sub-Saharan Africa. Selected studies were then assessed for their relevance to the thesis and for scientific quality. Results: 37 studies were found eligible, and included in the final list. Many countries in Sub- Saharan Africa have liberalized their abortion laws the past decade, and there is a political trend towards a liberal law change in the region. Estimates of induced abortion showed that a substantial proportion of women are still having unsafe abortions in Sub-Saharan African countries, and that the rates varied between rural and urban regions, with the highest estimates in the urban regions. Sepsis was the most reported complication after unsafe abortion, and contributed to the high estimated proportion of maternal deaths in this region. Unsafe abortion affects adolescents more than any other pregnancy-related complication. Estimating unsafe abortion incidence, morbidity and mortality is challenging in a restrictive law setting. Conclusions: Restrictive abortion laws will not lower the incidence of abortion. High rates of complications and mortality arises from Sub-Saharan African countries in a restrictive law setting, in addition to high levels of induced unsafe abortions. Liberalizing abortion laws is not sufficient alone. Access to high-quality health facilities and trained health personal are equally important measures towards lowering morbidity and mortality following unsafe abortion.