Incidence and socioeconomic determinants of abortion in rural Upper Egypt

Because of a growing cultural and religious sensitivity and controversy over reproductive health issues, particularly abortion, this area remains relatively unexplored in Egypt. This study was conducted using a participatory approach to determine the morbidity and determinants of abortion in rural Upper Egypt. In all, 1025 women from six villages in Upper Egypt were included in the study. Information regarding the incidence of abortion, patterns of health care utilization and risk factors was obtained using a structured interview format. The local dialect was used in formulating questions and they were revised and amended by a panel of local leaders, interviewers and representatives of the study population. Interviewers were local educated (secondary or university level) female volunteers. Information about exposure to 17 risk factors was also collected and statistical analysis was done by estimating the odds ratio and applying a test of statistical significance. Then, a multivariate logistic regression model was applied to control for possible interactions and confounding effects. The results were that 40.6% (n=416) had aborted at least once; of them 24.6% (n=252) had aborted more than once and were designated as recurrent aborters. The lifetime prevalence of recurrent abortion was estimated to be 25% and nearly 21% of pregnancies were aborted. The incidence of abortion was estimated to be 265 per 1000 live birth. Only 21.9% (n=91) of women received medical care for the last abortion. The vast majority of women (92%, n=299) who did not seek medical help received help from traditional and domestic sources. These sources are midwife (59.9%, n=179), relative or neighbour (29.8%, n=89), and traditional practitioner (10.4%, n=31). The multivariate analysis revealed that the incidence of abortion is significantly associated with gravidity, consanguinity, and mother occupation, while recurrent abortion is associated with gravidity, consanguinity and woman's age at marriage. In conclusion, the morbidity of abortion is a serious public health problem in Egypt. Because the incidence rate is very high and because safe abortion is limited in Egypt, maternal mortality due to abortion is expected to be underestimated. Promotion of family planning is expected to have a significant impact on the incidence of abortion in Upper Egypt.