The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018

Authors

DOI:

https://doi.org/10.7196/SAMJ.2025.v115i1.1987

Keywords:

abortions, morbidity, Prevalence, public hospital

Abstract

Background. The occurrence of abortion-related morbidity indicates limited access to safe abortion. Globally, unsafe abortions remain a persistent, yet preventable, cause of maternal mortality. South Africa (SA) is internationally recognised for its progressive reproductive rights framework, supported by its Constitution and laws. However, evidence suggests that women encounter barriers to accessing safe abortions, including stigma, resistance from healthcare providers, a shortage of trained professionals and a lack of awareness of their rights. We hypothesised that, 20 years after the promulgation of the Choice on Termination of Pregnancy Act, the incidence of incomplete abortion (ICA) and the prevalence of abortion-related morbidity would change, influenced by access to safe abortion and the introduction of medication abortion. We wanted to compare our data with 2000 and 1994 survey results to assess change.

Objectives. To estimate the incidence of incomplete abortion and describe the prevalence of abortion-related morbidity in SA public hospitals in 2018.

Methods. This was a cross-sectional, retrospective study. We selected a stratified random sample of public hospitals. We extracted data from medical records of women who presented with ICA during a predetermined 21-day period in 2018. Data were captured directly into a REDCap database. To estimate the national incidence of ICA, we used population estimates for 2018, comprising 17 199 227 women aged 12 - 49 years, and 1 200 436 live births. The prevalence of ICA morbidity is reported. We compared the rates in this study with those reported from similar studies in 2000 and 1994.

Results. We found 913 medical records of women presenting with ICA in the 56 public hospitals. ICA incidence was 367 (274 - 459) per 100 000 women aged 12 - 49 years. The average age of the women was 27 years, and the majority had a previous pregnancy before the ICA. A large proportion (73.9%) of women were in the first trimester. There was no sign of infection in 92.5% of records, no organ failure in 99.1% of records and there were no deaths. There was no change in the ICA incidence when compared with the 1994 and 2000 results. Women’s mean age and having a previous pregnancy were similar in the three studies (1994, 2000 and 2018). The proportion of women presenting in the first trimester increased over time: 60.5% in 1994, 67.1% in 2000 and 73.9% in 2018. There has been a decline in the prevalence of abortion-related morbidity, demonstrated by lower levels of severity, no signs of infections and no organ failure.

Conclusion. ICA incidence has not changed, but related morbidity is declining. Various factors could explain our findings, but the lack of change in ICA incidence indicates that access to formal abortion care has not improved over the past 20 years.

Author Biographies

  • D N Conco, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Senior Lecturer, Wits School of Public Health, University of the Witwatersrand

  • J Levin, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Professor, Epidemiology and Biostatistics, Wits School of Public Health

  • B Komane, MRC-Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Researcher, MRC-Wits Development Pathways for Health Research Unit, University of the Witwatersrand.

  • K Blanchard, Ibis Reproductive Health, Cambridge, USA

    President, Ibis Reproductive Health

  • T Bessenaar, Ibis Reproductive Health, Johannesburg, South Africa

    Vice President of Africa Programs, Ibis Reproductive Health

  • N G Nkosi, Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Senior Lecturer, Nursing Education, Department of Nursing Science

  • S Fonn, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden

    Professor School of Public Health, University of the Witwatersrand; Visiting Professor School of Public and Community Medicine, University of Gothenburg, Sweden

     

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Published

2025-02-18

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Research

How to Cite

1.
Conco DN, Levin J, Komane B, Blanchard K, Bessenaar T, Nkosi NG, et al. The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018. S Afr Med J [Internet]. 2025 Feb. 18 [cited 2025 Feb. 19];115(1):e1987. Available from: https://samajournals.co.za/index.php/samj/article/view/1987