(Book) Estimating the Level of Abortion In the Philippines and Bangladesh

International Family Planning Perspectives
Volume 23, Number 3, September 1997

By Susheela Singh, Josefina V. Cabigon, Altaf Hossain, Haidary Kamal and Aurora E. Perez

In countries where data on induced abortion are underreported or nonexistent—such as the Philippines and Bangladesh—indirect estimation techniques may be used to approximate the level of abortion. The collection of data about women hospitalized for abortion complications and the use of such indirect estimation techniques indicates that the abortion rate in the Philippines is within the range of 20-30 induced abortions per 1,000 women aged 15-49, and the rate in Bangladesh ranges between 26 and 30 per 1,000. About 400,000 abortions are estimated to occur each year in the Philippines, while the number in Bangladesh is calculated to be about 730,000. Some 80,000 women per year are estimated to be treated in hospitals in the Philippines for complications of induced abortion; in Bangladesh, about 52,000 women are treated for such complications, and another 19,000 are treated for complications resulting from menstrual regulation procedures. The probability that a woman will be hospitalized for abortion complications in the Philippines is twice that in Bangladesh, probably because menstrual regulation procedures by trained providers account for about two-thirds of all voluntary pregnancy terminations in Bangladesh.

(International Family Planning Perspectives,23:100-107 & 144, 1997)

Regardless of the legal status, accessibility or safety of induced abortion, information about it is essential if health planners are to ensure that women’s reproductive health is protected. However, reliable information on abortion is extremely difficult to obtain in many parts of the developing world.1 Although the problem is most severe where the procedure is highly restricted by law, there are a number of reasons why the procedure is often underreported, even in countries where abortion is legally permitted under broad conditions. Providers may not report all of the procedures they perform, an official system for recording abortions may not exist or may be incomplete, and women may not always acknowledge an abortion.

The countries of South Central and Southeast Asia are no different from the rest of the developing world in this regard, and most lack accurate information on abortion. These countries span a wide range of situations regarding the legal status and safety of abortion provision. The Philippines and Bangladesh are at very different points along the continuums of legality, access and safety. Although we focus on these countries partly to portray the variation that exists in Asia, other, equally important factors that influenced the choice of these two countries include the high level of concern about the consequences of unsafe abortion,2 the possibility of collecting data that would allow us to estimate the level of abortion, the availability of collaborators who had experience with research on the subject of abortion and resource limitations that restricted the research to only two countries of moderate size.

The Philippines and Bangladesh have very different official policies on abortion. The Philippine penal code contains a general prohibition on abortion, but while no exceptions are specified, it may be interpreted to permit abortion to save the life of a pregnant woman.3 Despite the law’s severity, abortion appears to be widely practiced, however, judging from studies carried out over the past few decades.4 A recent survey of health professionals in the Philippines suggests that about one-third of women seeking an abortion obtain it from a doctor or nurse; the majority of women consult traditional practitioners or attempt to induce the abortion themselves—increasingly, through the use of prostaglandins like misoprostol.5

In Bangladesh, the penal code permits induced abortion only to save a woman’s life. However, menstrual regulation by vacuum aspiration is not regulated by the code and is considered to be an “interim method for establishing nonpregnancy.”6 The procedure is allowed up to 10 weeks since the last menstrual period, but in practice, it is sometimes provided up to 12 weeks.7 About 12,000 doctors and paramedical providers have received formal training in menstrual regulation,8 although many other practitioners with only informal training are also believed to provide it. However, many women do not know that menstrual regulation is available, do not know of a provider or are unaware of time limits. In addition, access to legal menstrual regulation services is poorer in rural areas than in urban areas. As a result, in both urban and rural areas, a substantial proportion of women are believed to obtain abortions from traditional midwives or attempt to perform the abortion themselves.9

Despite the policy differences, both countries face serious health and health service problems related to the widespread practice of abortion. In both, maternal mortality resulting from unsafe abortion and a heavy demand for hospital services to treat abortion complications are serious public health problems.10 The maternal mortality ratio is estimated to be much higher in Bangladesh (480 maternal deaths per 100,000 births) than in the Philippines (100 per 100,000).11 A survey of health workers in Bangladesh in the late 1970s indicated that as many as 26% of maternal deaths were due to abortion;12 Philippine government statistics indicate that about 10% of recorded maternal deaths were classified as due to abortion.13

This article presents estimates of levels of induced abortion in the Philippines and Bangladesh in the mid-1990s, based on an indirect estimation methodology. However, the data collection efforts differ for each country, reflecting variations both in the availability of the relevant data and in the provision of abortion services.

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Source: http://www.guttmacher.org/pubs/journals/2310097.html


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