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Cited by 19Reproductive Health and ContraceptionGlobal Maternal and Child HealthInternational Human Rights and Reproductive Law

Who is Excluded When Abortion Access is Restricted to Twelve Weeks? Evidence from Maputo, Mozambique

Open access
Ustá, Momade Bay, Mitchell, Ellen M.H, Gebreselassie, Hailemichael, Brookman-Amissah, Eunice, Kwizera, Amata·2008·Reproductive Health Matters
DOI 10.1016/s0968-8080(08)31386-x
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Abstract

In Mozambique, since 1985, induced abortion services up to 12 weeks of pregnancy are performed in the interest of protecting women's health. We asked whether any women were being adversely affected by the 12-week limit. A retrospective record review of all 1,734 pregnant women requesting termination of pregnancy in five public hospitals in Maputo in 2005–2006 revealed that it tended to be those who were younger and poorer, with lower levels of education, literacy and formal employment who were coming for abortions after 12 weeks. Countries such as Mozambique that endeavor to enhance equality, equity and social justice must consider the detrimental effect of narrow gestational limits on its most vulnerable citizens and include second trimester abortions. We believe the 12-week restriction works against efforts to reduce maternal deaths due to unsafe abortion in the country.RésuméAu Mozambique, depuis 1985, les avortements jusqu'à 12 semaines de grossesse sont pratiqués pour protéger la santé de la femme. Nous avons souhaité savoir si les femmes souffraient de la limite des 12 semaines. Un examen rétrospectif des dossiers des 1734 femmes enceintes ayant demandé une interruption de grossesse dans cinq hôpitaux publics de Maputo en 2005–2006 a révélé que c'étaient en général les femmes les plus jeunes et les plus pauvres, avec les plus faibles niveaux d'instruction, d'alphabétisme et d'emploi formel qui demandaient un avortement après 12 semaines. Des pays comme le Mozambique qui s'efforcent de promouvoir l'égalité, l'équité et la justice sociale doivent tenir compte des conséquences néfastes de ces limites étroites sur les citoyens les plus vulnérables et inclure les avortements du deuxième trimestre. Nous pensons que la restriction des 12 semaines va à l'encontre des activités pour réduire les décès maternels dus à l'avortement non médicalisé dans le pays.ResumenEn Mozambique, desde 1985, los servicios de aborto inducido hasta las 12 semanas de embarazo, son efectuados con el fin de proteger la salud de las mujeres. Preguntamos si algunas mujeres estaban siendo afectadas adversamente por el límite de 12 semanas. Una revisión retrospectiva de los registros de 1,734 mujeres embarazadas, que solicitaron una interrupción del embarazo en cinco hospitales públicos de Maputo, en 2005–2006, reveló que casi siempre eran las mujeres más jóvenes y más pobres, con los niveles más bajos de escolaridad, alfabetismo y empleo oficial, quienes llegaban para que se les practicara un aborto después de 12 semanas. En países como Mozambique, que se esfuerzan por mejorar la igualdad, equidad y justicia social, se debe tomar en cuenta el efecto perjudicial de los límites gestacionales en sus ciudadanos más vulnerables y establecer servicios de aborto en el segundo trimestre. La restricción de 12 semanas va en contra de los esfuerzos por disminuir las tasas de muertes maternas atribuibles al aborto inseguro.

AI snapshot

Written from the paper’s full text.

TL;DR

A retrospective record review of 1,734 women requesting termination of pregnancy in five Maputo public hospitals in 2005–2006 found that the 4.3% presenting at ≥13 weeks were more likely to be younger and poorer, with lower education, literacy, and formal employment. The authors argue that Mozambique’s 12-week gestational limit excludes vulnerable women and should be expanded to include second-trimester abortion to reduce unsafe abortion and maternal deaths.

Key findings

  • Of 1,734 women requesting termination, 78 (4.3%) presented with pregnancies ≥13 weeks and were excluded from the study, compared with 1,656 women who presented at <13 weeks.
  • Women presenting at ≥13 weeks were more likely to be younger and to have lower levels of education, literacy, and formal employment; they were probably also more likely to live in rented dwellings and to still be in school.
  • The paper reports contextual figures: abortion-related deaths represented 11–18% of all hospital-based maternal deaths; case fatality for abortion complications at Maputo general hospital was 3%, three times the UN maximum recommended level of 1%; safe abortion fees averaged US$24 (range nil to US$100) until 2007, against a per capita annual income of US$340 in 2006.
  • The authors conclude that limiting safe termination to the first trimester may discriminate against younger women and those with fewer educational and financial assets, potentially contributing to precocious motherhood or unsafe abortion, and that expanding the 12-week restriction would help reduce maternal morbidity and mortality.

Methods

  • Retrospective record review and secondary analysis of an eligibility screening tool administered to all women presenting for termination of pregnancy between April 2005 and November 2006 in five public hospitals in Maputo, as part of a clinical study of alternatives to ultrasound for misoprostol abortion up to 11 weeks.
  • Compared socio-demographic characteristics of 78 women (4.3%) who presented with pregnancies ≥13 weeks (excluded from the study) with 1,656 women who presented at <13 weeks.
  • Used t-tests for continuous variables and χ² for dichotomous variables to test for significant differences at the p=.05 level.

Limitations

  • The paper states that this was an exploratory secondary analysis of screening data; it does not include a dedicated limitations section.
  • Evident from the text: the ≥13-week group was small (78 women), the data came only from five public hospitals in Maputo in 2005–2006, and the analysis is descriptive/comparative, limiting generalizability and causal inference.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s0968-8080(08)31386-x

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 18 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among 1,734 women requesting termination of pregnancy in five public hospitals in Maputo in 2005-2006, 78 (4.3%) presented with pregnancies at or above 13 weeks.

    “We compared the socio-demographic characteristics of 78 women (4.3%) who presented with pregnancies z13 weeks (excluded from the study) with 1,656 women who presented at less than 13 weeks.”
    • Also stated in: § Results · plain
      “Table 1 shows that those who presented for termination at or above 13 weeks of pregnancy represented a small proportion of those seeking safe abortion in the five public sector hospitals overall (4.3%).”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    In Mozambique, poorer women were more likely to arrive later in pregnancy because of the efforts needed to amass sufficient funds for safe abortion services that incurred a fee until recently.

    “In countries such as Mozambique, where safe abortion services incurred a fee until recently, poorer women were more likely to arrive later in pregnancy because of the efforts needed to amass sufficient funds.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    The 12-week restriction works against efforts to reduce maternal deaths due to unsafe abortion in Mozambique.

    “We believe the 12-week restriction works against efforts to reduce maternal deaths due to unsafe abortion in the country.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.
    • Rests on an assumption: Women presenting for termination at or above 13 weeks in the study hospitals are representative of those excluded by the 12-week gestational limit.
  • Interpretationown data

    Policies that limit safe termination of pregnancy to women presenting in the first trimester may discriminate against younger women and those with fewer educational and financial assets.

    “From this exploratory secondary analysis of screening data, we conclude that policies that limit safe termination of pregnancy to women presenting in the first trimester may discriminate against younger women and those with fewer educational and financial assets, disproportionately affecting young women, and potentially contributing to precocious motherhood or unsafe abortion, with their well-dOCU”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.
    • Rests on an assumption: Women presenting for termination at or above 13 weeks in the study hospitals are representative of those excluded by the 12-week gestational limit.
  • Premisecitation

    Given a per capita annual income of only US$340 in 2006, the cost of safe abortion places it out of the reach of many women in Mozambique.

    “Given a per capita annual income of only US $340 in 2006, the cost of safe abortion places it out of the reach of many women in Mozambique.13”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 10
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Findingreasoning

    Among women requesting termination of pregnancy in five public hospitals in Maputo in 2005-2006, those presenting at or above 13 weeks were probably more likely to live in rented dwellings and to still be in school.

    “They were probably also more likely to live in rented dwellings, a sign of limited resources in the family, and to still be in school.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among women requesting termination of pregnancy in five public hospitals in Maputo in 2005-2006, those presenting at or above 13 weeks were more likely to be younger and to have lower levels of education, literacy, and formal employment than those presenting at less than 13 weeks.

    “However, the women needing second trimester services were more likely to be younger and with lower levels of education, literacy and formal employment.”
    • Also stated in: § Abstract · hedged
      “A retrospective record review of all 1,734 pregnant women requesting termination of pregnancy in five public hospitals in Maputo in 2005-2006 revealed that it tended to be those who were younger and poorer, with lower levels of education, literacy and formal employment who were coming for abortions after 12 weeks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Case fatality rates for abortion complications presenting at Maputo general hospital are 3%, three times the UN maximum recommended level of 1%.

    “Case fatality rates for abortion complications presenting at Maputo general hospital are 3%, three times the UN maximum recommended level of 1%.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Even though fees are no longer charged, other reasons for presenting after 12 weeks and being denied a safe abortion may relegate Mozambique's most vulnerable citizens to risk their lives with unsafe services.

    “Even though fees are now no longer charged, other reasons for presenting after 12 weeks and being denied a safe abortion may relegate the country's most vulnerable citizens to risk their lives with unsafe services.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.

  • May combine two claims.

    Premisecitation

    Women getting a safe abortion were more likely to be married, employed, light-skinned, with a history of contraceptive use, and completed secondary education than those presenting with complications of unsafe abortion.

    “They were more likely to be married, employed, lightskinned, with a history of contraceptive use, and completed secondary education than those presenting with complications of unsafe abortion.15”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Abortion-related deaths are a major cause of preventable mortality, particularly among adolescents, representing 11-18% of all hospital-based maternal deaths.

    “Abortion-related deaths are a major cause of preventable mortality, particularly among adolescents, representing 11-18% of all hospitalbased maternal deaths.7,8”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Policies that limit safe termination of pregnancy to the first trimester potentially contribute to precocious motherhood or unsafe abortion, with health and social risks.

    “From this exploratory secondary analysis of screening data, we conclude that policies that limit safe termination of pregnancy to women presenting in the first trimester may discriminate against younger women and those with fewer educational and financial assets, disproportionately affecting young women, and potentially contributing to precocious motherhood or unsafe abortion, with their well-dOCU”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.
    • Rests on an assumption: Women presenting for termination at or above 13 weeks in the study hospitals are representative of those excluded by the 12-week gestational limit.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Maternal mortality in Mozambique remains among the highest despite impressive declines in recent years.

    “Despite impressive declines in recent years, however, maternal mortality in Mozambique remains among the highest.[3][4][5][6]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [5]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [6]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Historically, women getting a safe abortion in Mozambique have tended to be older, urban, and with higher income.

    “Historically, women getting a safe abortion have tended to be older, urban and with higher income.13,14”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Mozambique has taken steps to reduce pregnancy-related mortality through training and empowerment of mid-level providers, expanding access to essential obstetric care and contraception, and to HIV and malaria prevention and treatment.

    “Mozambique has taken bold steps to reduce pregnancy-related mortality through training and empowerment of mid-level providers, expanding access to essential obstetric care and contraception, and to HIV and malaria prevention and treatment.[1][2][3]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Expanding the 12-week restriction would help maximize Mozambique's efforts to reduce maternal morbidity and mortality.

    “We believe that expanding the 12-week restriction would help to maximise Mozambique's many efforts to reduce maternal morbidity and mortality.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.

  • May combine two claims.

    Interpretationcitation

    Adolescents may be physiologically predisposed to present later for antenatal care and abortion because irregular menses can make identifying pregnancy early difficult and due to fear of social consequences.

    “Adolescents may be physiologically pre-disposed to present later for both antenatal care and abortion because irregular menses can make identifying pregnancy early difficult, 17 and due to fear of the social consequences.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

12 of 12

  • The paper relies on this without support.

    In Mozambique, induced abortion services are authorized only up to 12 weeks of pregnancy in public hospitals under a policy since 1985.

    “In Mozambique, since 1985, induced abortion services up to 12 weeks of pregnancy are performed in the interest of protecting women's health.”

  • The paper relies on this without support.

    Women presenting for termination at or above 13 weeks in the study hospitals are representative of those excluded by the 12-week gestational limit.

    “To understand who is excluded by the 12-week gestational limit, we re-analysed data from a study eligibility screening tool administered to all women presenting for termination of pregnancy between April 2005 and November 2006 in the five public hospitals in Maputo, as part of a clinical study of alternatives to ultrasound for misoprostol abortion up to 11 weeks.”
    “We compared the socio-demographic characteristics of 78 women (4.3%) who presented with pregnancies z13 weeks (excluded from the study) with 1,656 women who presented at less than 13 weeks.”
2 of 2

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?

  • Most recent studies on abortion in Mozambique were based on hospital data and were likely to miss a substantial proportion of illegally induced abortions taking place outside health facilities.

    “Because most of these studies were based on hospital data they were more likely to miss out a substantial proportion of illegally induced abortions taking place outside the health facilities.”

    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 [17]

    The Methods (page not provided) show that this study used records from five public hospitals in Maputo. The paper does not say that most abortion studies in Mozambique were hospital-based or estimate how many illegally induced abortions outside health facilities such studies missed. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

Self-check

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

  • Percentage presenting at 13 weeks or later is misstated

    Minor

    The two groups total 1,734 women. Of these, 78 represent about 4.5%, not 4.3%.

    Reported 4.3 · recomputed 4.49827

1 of 1

Cites

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Related

Authors
Ustá, M. B., Mitchell, E. M. H., Gebreselassie, H., Brookman-Amissah, E., & Kwizera, A.
Affiliations
  • Eduardo Mondlane University (MZ)
  • Ipas (US)
ORCID
Mitchell, Ellen M.H
Venue
Reproductive Health Matters
Publisher
Informa UK Limited
Published
2008-01
Volume
16
Issue
sup31
Pages
14-17
ISSN
  • 0968-8080 (ISSN-L)
  • 1460-9576
DOI
10.1016/s0968-8080(08)31386-x
OpenAlex
W1985079575
Semantic Scholar
29ab9984cc8ab96360824249b7b5af7a46bde403
Cited by
19
References
13
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2020: 2 · 2018: 2 · 2016: 2 · 2014: 3 · 2012: 1
FWCI
0.93
Type
journal article
Language
en
Open access
Locations
  • Reproductive Health Matters (publishedVersion)
  • PubMed (publishedVersion)
  • SSRN Electronic Journal (submittedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
Keywords
abortion access, gestational limits, second-trimester abortion, unsafe abortion, maternal mortality, vulnerable populations, social equity, Mozambique, Maputo, public hospitals, women's health
MeSH terms
Abortion, Induced, Adult, Female, Health Services Accessibility, Hospitals, Public, Humans, Maternal Mortality, Mozambique, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Retrospective Studies, Risk Factors, Social Justice, Chi-Square Distribution

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-19.

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