CoChat
Sign Up
Cited by 44Reproductive Health and ContraceptionAdolescent Sexual and Reproductive HealthGlobal Maternal and Child Health

Estimating abortion incidence among adolescents and differences in postabortion care by age: a cross-sectional study of postabortion care patients in Uganda

Open access
Sully, Elizabeth A, Atuyambe, Lynn, Bukenya, Justine, Whitehead, Hannah S, Blades, Nakeisha, Bankole, Akinrinola·2018·Contraception
DOI 10.1016/j.contraception.2018.07.135PMC PMC6219390
Open this paper in CoChat — free accountOpen PDF

Abstract

OBJECTIVES: To provide the first estimate of adolescents' abortion incidence in Uganda and to assess differences in the abortion experiences and morbidities of adolescent and nonadolescent postabortion care (PAC) patients. STUDY DESIGN: We used the age-specific Abortion Incidence Complications Method, drawing from three surveys conducted in Uganda in 2013: a nationally representative Health Facilities Survey (n=418), a Health Professionals Survey (n=147) and a Prospective Morbidity Survey of PAC patients (n=2169). Multivariable logistic and Cox proportional hazard models were used to compare adolescent and nonadolescent PAC patients on dimensions including pregnancy intention, gestational age, abortion safety, delays to care, severity of complications and receipt of postabortion family planning. We included an interaction term between adolescents and marital status to assess heterogeneity among adolescents. RESULTS: Adolescent women have the lowest abortion rate among women less than 35 years of age (28.4 abortions per 1000 women 15-19) but the highest rate among recently sexually active women (76.1 abortions per 1000 women 15-19). We do not find that adolescents face greater disadvantages in their abortion care experiences as compared to older women. However, unmarried PAC patients, both adolescent and nonadolescent, have higher odds of experiencing severe complications than nonadolescent married women. CONCLUSIONS: The high abortion rate among sexually active adolescents highlights the critical need to improve adolescent family planning in Uganda. Interventions to prevent unintended pregnancy and to reduce unsafe abortion may be particularly important for unmarried adolescents. Rather than treating adolescents as a homogenous group, we need to understand how marriage and other social factors shape reproductive health outcomes. IMPLICATIONS: This paper provides the first estimate of the adolescent abortion rate in Uganda. Studies of adolescent abortion and reproductive health must account for sexual activity and marital status. Further, interventions to address unintended pregnancy and unsafe abortion among unmarried women of all ages in Africa should be a priority.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.contraception.2018.07.135

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Studies in some Sub-Saharan African countries indicated a high proportion of induced abortion, ranging from 13 to 32.8% among young women.

    “Furthermore, studies conducted in some Sub-Saharan African countries also indicated a high proportion of induced abortion, ranging from 13 to 32.8% among young women [35, 36].”

    From Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique (2020) · cites this paper as [36]

    The Results section reports that 15% of adolescent pregnancies in Uganda ended in abortion, supporting a proportion within the claimed range. The paper does not establish the stated 13–32.8% range across Sub-Saharan African countries; its other country comparisons in the Introduction do not provide those percentages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Studies from Ethiopia, Tanzania, South Africa, among others, showed that women, especially adolescents, still rely on unsafe methods or untrained providers to terminate pregnancy as a result of those factors.

    “Studies from Ethiopia [36], Tanzania [37], South Africa [57], among others showed that women, especially adolescents still rely to unsafe methods or untrained provider to terminate pregnancy, as result of those factors mentioned above.”

    From Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique (2020) · cites this paper as [36]

    The Introduction (page not provided) says adolescents are more likely to receive abortions from untrained providers or providers using inappropriate methods. It also describes social, economic and cultural barriers, but does not establish that those factors cause reliance on unsafe methods, or make that finding specifically for Ethiopia, Tanzania and South Africa. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The proportion of induced abortion found among women of reproductive age and young women in this study is lower than the proportion found in other African countries.

    “However, the proportion of abortion found among women of reproductive age, as well as among young women is lower than the proportion of induced abortion found in other African countries.”

    From Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique (2020) · cites this paper as [36]

    The Results section reports abortion rates by age within Uganda, and the Introduction discusses findings from other African countries. Neither passage compares the proportion of induced abortions in Uganda with proportions in those countries, so our copy does not establish the claimed cross-country difference. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. [1]Prada E, Atuyambe LM, Blades NM, Bukenya JN, Orach CG, Bankole A. Incidence of induced abortion in Uganda, 2013: new estimates since 2003. PLoS ONE 2016; 11: e0165812. 27802338 PMC5089684
  2. [3]Kaye DK, Mirembe F, Bantebya G, Johansson A, Ekstrom AM. Reasons, methods used and decision-making for pregnancy termination among adolescents and older women in Mulago hospital, Uganda. East Afr Med J 2005; 82: 579– 85. 16463752
  3. [4]Olukoya AA, Kaya A, Ferguson BJ, AbouZahr C. Unsafe abortion in adolescents. Int J Gynaecol Obstet 2001; 75: 137– 47. 11684109
  4. [6]Mulumba M, Kiggundu C, Nassimbwa J, Nakibuuka NM. Access to safe abortion in Uganda: leveraging opportunities through the harm reduction model. Int J Gynaecol Obstet 2017; 138: 231– 6. 28455836
  5. [8]Mbonye AK. Abortion in Uganda: magnitude and implications. Afr J Reprod Health 2000; 4: 104– 8.
  6. [9]Paluku JL, Kalisoke S, Julius W, Kiondo P. Knowledge and attitudes about induced abortions among female youths attending Naguru Teenage Information and Health Centre, Kampala, Uganda. J Public Health Epidemiol 2013; 5: 178– 85.
  7. [11]Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet 2017; 390: 2372– 81. 28964589 PMC5711001
  8. [12]Mbonye AK, Asimwe JB, Kabarangira J, Nanda G, Orinda V. Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda. Int J Gynaecol Obstet 2007; 96: 220– 5. 17292370
  9. [15]Kalyanwala S, Jejeebhoy SJ, Francis Zavier AJ, Kumar R. Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India. Cult Health Sex 2012; 14: 241– 55. 22077603
  10. [16]Sowmini CV. Delay in termination of pregnancy among unmarried adolescents and young women attending a tertiary hospital abortion clinic in Trivandrum, Kerala, India. Reprod Health Matters 2013; 21: 243– 50. 23684207
  11. [17]Munasinghe S, van den Broek N. Abortions in adolescents. Trop Doct 2005; 35: 133– 6. 16105332
  12. [18]Mutua MM, Maina BW, Achia TO, Izugbara CO. Factors associated with delays in seeking post abortion care among women in Kenya. BMC Pregnancy Childbirth 2015; 15(241): 1– 8. 26445973 PMC4597436
  13. [20]Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Unsafe abortion: the preventable pandemic. Lancet 2006; 368: 1908– 19. 17126724
  14. [21]Olukoya P Reducing maternal mortality from unsafe abortion among adolescents in Africa. Afr J Reprod Health 2004; 8: 57– 62. 15487614
  15. [22]Sundaram A, Juarez F, Bankole A, Singh S. Factors associated with abortion-seeking and obtaining a safe abortion in Ghana. Stud Fam Plann 2012; 43: 273– 86. 23239247
  16. [23]Levandowski BA, Pearson E, Lunguzi J, Katengeza HR. Reproductive health characteristics of young Malawian women seeking post-abortion care. Afr J Reprod Health 2012; 16: 253– 62. 22916557
  17. [24]Varga CA. Pregnancy termination among South African adolescents. Stud Fam Plann 2002; 33: 283– 98. 12553186
  18. [25]Neal S, Mahendra S, Bose K, Camacho AV, Mathai M, Nove A, The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature. BMC Pregnancy Childbirth 2016; 16(352): 1– 18. 27836005 PMC5106816
  19. [26]Ziraba AK, Izugbara C, Levandowski BA, Gebreselassie H, Mutua M, Mohamed SF, Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors. BMC Pregnancy Childbirth 2015; 15(34): 1– 18. 25884662 PMC4338617
  20. [27]Chae S, Desai S, Crowell M, Sedgh G, Singh S. Characteristics of women obtaining induced abortions in selected low- and middle-income countries. PLoS ONE 2017; 12: e0172976. 28355285 PMC5371299
  21. [28]Sully E, Dibaba Y, Fetters T, Blades N, Bankole A. Playing it safe: legal and clandestine abortions among adolescents in Ethiopia. J Adolesc Health 2018; 62: 729– 36. 29550154 PMC6166408
  22. [29]Chae S Timing of orphanhood, early sexual debut, and early marriage in four sub-Saharan African countries. Stud Fam Plann 2013; 44: 123– 46. 23719999 PMC4000696
  23. [31]Palermo T, Peterman A. Are female orphans at risk for early marriage, early sexual debut, and teen pregnancy? Evidence from sub-Saharan Africa. Stud Fam Plann 2009; 40: 101– 12. 19662802
  24. [32]Maly C, McClendon KA, Baumgartner JN, Nakyanjo N, Ddaaki WG, Serwadda D, Perceptions of adolescent pregnancy among teenage girls in Rakai, Uganda. Glob Qual Nurs Res 2017; 4: 1– 12. PMC5555492 28835911
  25. [35]Harlap S, Shiono PH, Ramcharan S. A life table of spontaneous abortions and the effects of age, parity and other variables. In: Porter I, Hook E, editors. Human embryonic and fetal death. New York: Academic Press; 1980 p. 145– 58.
  26. [36]Leridon H Human fertility: the basic component. Chicago: University of Chicago Press; 1977.
  27. [37]Singh S, Prada E, Juarez F. The abortion incidence complications method: a quantitative technique Methodologies for estimating abortion incidence and abortion-related morbidity: a review. New York, NY: Guttmacher Institute; 2010 p. 71– 98.
  28. [39]Madziyire MG, Polis CB, Riley T, Sully EA, Owolabi O, Chipato T. Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study. BMJ Open 2018; 8: e019658. PMC5829940 29440163
  29. [40]Kalilani-Phiri L, Gebreselassie H, Levandowski BA, Kuchingale E, Kachale F, Kangaude G. The severity of abortion complications in Malawi. Int J Gynaecol Obstet 2015; 128: 160– 4. 25468057

Cited by

Sorted by citations

Authors
Sully, E. A., Atuyambe, L., Bukenya, J., Whitehead, H. S., Blades, N., & Bankole, A.
Affiliations
  • Guttmacher Institute (US)
  • Makerere University (UG)
Corresponding author
Sully, Elizabeth A
ORCID
Venue
Contraception
Publisher
Elsevier BV
Published
2018-12
Volume
98
Issue
6
Pages
510-516
ISSN
0010-7824 (ISSN-L)
DOI
10.1016/j.contraception.2018.07.135
PMC
PMC6219390
OpenAlex
W2891024633
Cited by
44
References
3
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 7 · 2020: 8 · 2019: 3
FWCI
4.29
Type
journal article
Language
en
Open access
Licence
Locations
  • Contraception (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion, other-oa)
  • PubMed Central (acceptedVersion, cc-by-nc-nd)
Funders
  • Swedish International Development Cooperation Agency, Sweden
  • Dutch Ministry of Foreign Affairs, Netherlands
  • UK Aid, United Kingdom
  • Guttmacher Center for Population Research Innovation and Dissemination
  • National Institutes of Health, United States (5 R24 HD074034)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
adolescent abortion, abortion incidence, post-abortion care, abortion complications, marital status, adolescent sexual activity, unintended pregnancy, unsafe abortion, adolescent family planning, abortion safety, Uganda
MeSH terms
Abortion, Induced, Adolescent, Adult, Aftercare, Contraception Behavior, Family Planning Services, Female, Gestational Age, Humans, Middle Aged, Pregnancy, Pregnancy in Adolescence, Uganda, Multivariate Analysis, Logistic Models, Proportional Hazards Models, Marital Status, Pregnancy, Unplanned, Young Adult, Time-to-Treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review