Illegal abortions in Addis Ababa, Ethiopia

To identify the primary abortionist while the patient is in the hospital; to determine the type of materials used to terminate the pregnancy; to determine the number of attempts made to terminate the index pregnancy and; to characterise women with induced abortions at five hospitals in the City of Addis Ababa.

Cross-sectional hospital-based descriptive multi-centre (WHO) study.

Addis Ababa University, Faculty of Medicine.

All cases of abortions admitted to the study hospitals at five hospitals with obstetric and gynaecologic services.

Identification of the primary abortionist, the places where abortion is carried out, the number of attempts made to terminate the index pregnancy and the materials used to terminate the pregnancy and reasons for terminating the pregnancy.

A total of 2275 cases of abortion had been identified and managed in the five study hospitals. The study demonstrated that 984 (43.3%) were spontaneous abortions. Of the 1290 illicit or unsafe abortions admitted by the patients (certainly induced) in 455 (35.3%) of the abortions were performed by the health assistants, 366 (28.3%) self-induced, and 306 (23.7%) by cleaners working in the operation theatres. In 744 (60%) of the abortion procedures were carried out at the abortionists home while 452 (35%) at the patients' home. The remaining 94 (5%) of the abortions were done safely in the hospital or doctor's office by professionals. The most commonly used methods for inducing the abortions were; in 417 (32.3%) high doses of ampicillin per OS, and in 414 (32.1%) by inserting plastic tubes (intravenous giving set) per vagina.

The issue of abortion clearly presents an enormous complex moral and ethical dilemma. The study results are very clear. Where abortion is illegal or where the services are not readily available and/or personnel are not well trained, unsafe abortion carries a high risk of complications, permanent damage resulting in infertility and even death. The question is not really whether or not abortion should be legal or illegal but whether or not it should be prevented through modern family planning methods, safe or unsafe abortions. In all societies no matter what the legal moral or cultural status of abortion are, there will be some women who will desperately seek to terminate an unwanted or unplanned pregnancy. Unsafe abortion is a major medical and public health problem in Ethiopia. The magnitude of the problem in terms of numbers affected, and severe adverse consequences can no longer be ignored.