A recent Maternal Mortality Report indicates that out of the 346 maternal deaths in the country, 255 or 74 per cent are direct causes.
Abortions account for 53, or 20 per cent of the direct causes.
“Among the five major causes of maternal deaths of 346, abortion is the third leading cause at 15 per cent. This proportion is higher than global estimates which stipulate that abortion contributes at most 12 per cent of the maternal deaths. An average of 12 women died yearly due to abortion over the 5 year period under review,” it narrates.
This could be attributed to low family planning uptake as evidenced by the contraceptive prevalence rate of 52 per cent as revealed by Botswana Family Health Survey of 2007.
“Studies elsewhere have found that 17 per cent of women admitted to hospital for post abortion cares have ever used contraception. Previous studies have found that even though women use contraceptives, they experience higher failure rates, suggesting that, because of gender inequality, these women frequently do not even control the circumstances in which they have intercourse, much less the decision regarding contraceptive use.”
Furthermore, this could reflect the fact that levels of contraceptive use are not sufficient to meet the fertility desires and family planning needs of women and couples. In Europe, deterioration in family planning services and sexual education has been observed in connection with the decrease of contraception use and with the increase in abortion rates.
Majority of maternal death due to abortions are non-citizens 10/36 (27.8%) compared to 41/302 or 13.6 percent of citizens. According to age groups, the majority of abortion cases are within 20-34 years which is the sexually active group. These findings are consistent with reports from Perez et.al 2010 which stated high rates of abortion among 20-24 year olds. What is clear is that abortion deaths are concentrated in the adult group, less in teenagers and peri-menopausal age group. Jones et al 2002 reported that the proportion of abortion clients aged 30 years and older who are cohabiting has increased over the years. The proportion of abortion patients have also increased. The findings in the report are also consistent with the study by Drey and Foster of 2006.
“In the current study it has been noticed that the majority of abortion cases are that of unknown educational status and data further shows that the lower the educational level the lower the abortion deaths. However, other studies have revealed that abortion rates are high among women with primary education or less. There is a significant increase in the number of abortion deaths in the first trimester compared to the second.”
“This could mean that these were, un-wanted pregnancies, where the women upon suspecting that they were pregnant decided upon abortions after confirming the pregnancies. According to study done by Eleanor and Diana 2006 it was shown that death due to abortions were more in the second trimester. In contrast our findings suggest that abortion deaths are more in the first trimester.”
Maternal deaths occur mostly after the first and second child and lesser on women who have their fifth or more children. Most probably this could be attributed to the fact that most women tend to use family planning after the fourth child. A detailed analysis of deaths occurring between 1972 and 1987, investigators found that the main contributors to an increased risk of abortion related death were age, race, parity and gestational age. Analysis of deaths in 1991 also confirmed previous findings and revealed no substantial changes.
Abortion deaths occur mostly in non-bookers and less in bookers; this could mean that the pregnancy may have been unplanned. Studies revealed that women delay to seek help due to various reasons which are: did not suspect pregnancy, logistical factors, emotional factors, financial factors and interpersonal factors. However, in this report some of these characteristics were not explored.
Among women dying of sepsis, majority were due to septic abortion compared to puerperal sepsis. Other abortion deaths were due to haemorrhage, six which is11.3per cent. These data indicate that death attributed to abortion (sepsis and haemorrhage) may be due to delaying in seeking help and in making diagnosis, referring to appropriate centres for further management and deciding on definitive management. According to the report, haemorrhage is the highest cause of death, followed by hypertensive disorders of pregnancy.