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- Articles
- Submited: January 31, 2021
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Published: March 29, 2022
Abstract
It is commonly assumed that legalisation of abortion leads to reduced maternal mortality both generally, and from abortion specifically. This paper surveys the available literature on maternal mortality and its causes in Ethiopia before and after legalisation of abortion in 2005, finding that abortion mortality had already fallen to low levels before legalisation, and did not drop noticeably further after legalisation. These findings are then compared with abortion mortality in other African contexts. Explanations for these findings are offered.
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References
- Center for Reproductive Rights (2022). ‘The World’s Abortion Laws,’ available online at https://reproductiverights.org/maps/worlds-abortion-laws/.
- Treffers, PE (1973). ‘A study of the changing frequency of abortion in The Netherlands after 1967,’ European Journal of Obstetrics & Gynecology and Reproductive Biology, 3: 173-180.
- Sayinzoga, F et al. (2016). ‘Maternal death audit in Rwanda 2009-2013: a nationwide facility-based retrospective cohort study,’ BMJ Open, 6: e009734.
- World Health Organization (2021). ‘European Health Information Gateway,’ available online at https://
- gateway.euro.who.int/en/hfa-explorer/.
- Koch, E (2012). ‘Women’s education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in Chile from 1957 to 2007,’ PLoS One, 7: e36613.
- World Bank (2021). ‘Maternal mortality ratio,’ available online at https://data.worldbank.org/indicator/ SH.STA.MMRT.
- Miller, C (forthcoming). ‘Does legalising abortion reduce deaths from backstreet abortions? A multi-country survey’.
- Gaym, A (2009). ‘Maternal mortality studies in Ethiopia—magnitude, causes and trends,’ Ethiopian Medical Journal, 47: 95-108.
- Abdella, A (2010). ‘Maternal mortality trend in Ethiopia,’ Ethiopian Journal of Health Development, 24: 115-122.
- Yifru, B and Asres, B (2014). ‘Causes of maternal mortality in Ethiopia: a significant decline in abortion related death,’ Ethiopian Journal of Health Sciences, 24: 15-28.
- Mekonnen, W and Gebremariam, A (2018). ‘Causes of maternal death in Ethiopia between 1990 and 2016: systematic review with meta-analysis,’ Ethiopian Journal of Health Development, 32: 225-242.
- Gebrehiwot, Y et al. (2008). ‘Trends of abortion complications in a transition of abortion law revisions in Ethiopia,’ Journal of Public Health, 31: 81-87.13. Tessema, GA et al. (2017). ‘Trends and causes of maternal mortality in Ethiopia during 1990-2013: findings from the Global Burden of Disease study 2013,’ BMC Public Health, 17: 160.
- Ministry of Health Kenya (2017). Saving Mothers Lives: Confidential Enquiry into Maternal Deaths in Kenya. Nairobi: Ministry of Health.
- Ministry of Health of Uganda (2019). Annual Health Sector Performance Report 2018/2019. Kampala: Ministry of Health.
- Nakimuli, A et al. (2016). ‘Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors,’ BMC Pregnancy and Childbirth, 16:24.
- Sayinzoga, F et al. (2016). ‘Maternal death audit in Rwanda 2009-2013: a nationwide facility-based retrospective cohort study,’ BMJ Open, 6: e009734
- Ratsma, YEC et al. (2005). ‘Why more mothers die: confidential enquiries into institutional maternal deaths in the Southern region of Malawi, 2001,’ Malawi Medical Journal, 17: 75-80.
- Owolabi, H et al. (2014). ‘Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification,’ British Journal of Obstetrics and Gynaecology, 121: 95-101.
- Say, L et al. (2014). ‘Global causes of maternal death: a WHO systematic analysis,’ The Lancet Global Health, 2: E323-333.
- Zamané, H et al. (2018). ‘Maternal mortality at the Dori Regional Hospital in Northern Burkina Faso, 2014-2016,’ International Journal of MCH and AIDS, 7(2): 235-241.
- Konnon, R et al. (2020). ‘Trends on maternal mortality in the Republic of Benin and comparison with the neighboring countries,’ Medicine, Law & Society, 13(2): 197-216.
- Sierra Leone Government Ministry of Health and Sanitation (2016). ‘Maternal Death Surveillance and Response,’ available online at https://sierraleone.unfpa.org/sites/default/files/pub-pdf/Annual%
- MDSR%20Report%202016.pdf.
- Umar, AS and Kabamba, L (2016). ‘Maternal mortality in the main referral hospital in Angola, 2010-2014: understanding the context for maternal deaths amidst poor documentation,’ International Journal of MCH and AIDS, 5(1): 61-71.
- Republic of Benin Health Ministry (2018). Plan National de Developpement Sanitaire 2018-2022. Porto-Novo: Republic of Benin Health Ministry.
- Moore, AM et al. (2016). ‘The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008,’ International Perspectives on Sexual and Reproductive Health,
- (3): 111-120.
- Gebrehiwot, Y et al. (2016). ‘Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014,’ International Perspectives on Sexual and Reproductive Health, 42(3): 121-130.
- Harrison, CP (1966). ‘On the futility of legalizing abortion,’ Canadian Medical Association Journal, 95(8): 360-366.
- Kwast, BE et al. (1986). ‘Maternal mortality in Addis Ababa, Ethiopia,’ Studies in Family Planning, 17(6): 288-301.
- Miller, C (2021). ‘Maternal mortality from induced abortion in Malawi: what does the latest evidence suggest?’ International Journal of Research and Public Health, 18: 10506.
- Tesfaye, G et al. (2018). ‘Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, eastern Ethiopia,’ BMC Women’s Health, 18: 198.
- Tessema, GA et al. (2017). ‘Trends and causes of maternal mortality in Ethiopia during 1990-2013: findings from the Global Burden of Disease study 2013,’ BMC Public Health, 17: 160.
- Geleto, A et al. (2020). ‘Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study,’ BMC Pregnancy and Childbirth, 20: 130.
- Shiferaw, MA et al. (2021). ‘Maternal death review at a tertiary hospital in Ethiopia,’ Ethiopian Journal of Health Sciences, 31(1): 35-42.
- Kumela, L et al. (2020). ‘Determinants of maternal near miss in Western Ethiopia,’ Ethiopian Journal of Health Sciences, 30(2): 161-168.
- Teka, H et al. (2022). ‘Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia,’ Women’s Health, 18: 17455057221078739.
- Tenaw, SG et al. (2021). ‘Maternal near miss among women admitted in major private hospitals in eastern Ethiopia: a retrospective study,’ BMC Pregnancy and Childbirth, 21: 181.
- Tariku, M (2020). ‘Magnitude of severe acute maternal morbidity and associated factors related to abortion: a cross-sectional study in Hawassa University Comprehensive Specialized Hospital, Ethiopia, 2019,’ BioMed Research International, 2020: 1781652.
- Footman, K et al. (2018). ‘Medical abortion provision by pharmacies and drug sellers in low- and middle-income countries: a systematic review,’ Studies in Family Planning, 49: 57-70.
- Dzuba, IG et al. (2013). ‘Medical abortion: A path to safe, high-quality abortion care in Latin America and the Caribbean,’ European Journal of Contraception & Reproductive Health Care, 18(6): 441-450.
- Bello, FA et al. (2018). ‘Trends in misoprostol use and abortion complications: a cross-sectional study from nine referral hospitals in Nigeria,’ PLoS One, 13(12): e0209415.
- Endler, M et al. (2019). ‘Telemedicine for medical abortion: a systematic review,’ British Journal of Obstetrics and Gynaecology, 126(9): 1094-1102.
- Stillman, M et al. (2020). ‘Women’s self-reported experiences using misoprostol obtained from drug sellers: A prospective cohort study in Lagos State, Nigeria,’ BMJ Open, 10(5): e034670.
- Huda, FA et al. (2014). ‘Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey,’ International Journal of Obstetrics and Gynecology, 124: 164-168.
- Diamond-Smith, N et al. (2019). ‘Knowledge, provision of information and barriers to high quality medication abortion provision by pharmacists in Uttar Pradesh, India,’ BMC Health Services Research,19: 476.
- World Health Organization (2018). ‘Medical management of abortion,’ available online at https://www.who.int/reproductivehealth/publications/medical-management-abortion/en/.
- Serbanescu, F et al. (2019). ‘Impact of the saving mothers, giving life approach on decreasing maternal and perinatal deaths in Uganda and Zambia,’ Global Health: Science and Practice, 7(Suppl 1): S27-S47.
- Ganatra, B and Faundes, A (2016). ‘Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality,’ Best Practice & Research: Clinical Obstetrics and Gynaecology, 36: 145-155.
- Makenzius, M et al. (2017). ‘Post-abortion care with misoprostol—equally effective, safe and accepted when administered by midwives compared to physicians: A randomised controlled equivalence trial in
- a low-resource setting in Kenya, BMJ Open, 7(10): e016157.
- Atuhairwe, S et al. (2021). ‘Abortion-related near-miss morbidity and mortality in 43 health facilities
- with differences in readiness to provide abortion care in Uganda, BMJ Global Health, 6(2): e003274.
- Namagembe, I et al. (2022). ‘Preventing death following unsafe abortion: a case series from urban Uganda,’ AJOG Global Reports, 2(1): 100039.
- Ekblad, M (1956). ‘Relation of the legal-abortion clientele to the illegal-abortion clientele and the risk of suicide,’ Acta Psychiatrica Scandinavica, 30: 93-98.
- Weaver, G et al. (2020). ‘Misoprostol knowledge and distribution in Mexico City after the change in abortion law: a survey of pharmacy staff,’ BMJ Sexual & Reproductive Health, 46: 46-50.
- Moseson, H et al. (2020). ‘Self-managed medication abortion outcomes: results from a prospective pilot study,’ Reproductive Health, 17: 164.
- Chemlal, S and Russo, G (2019). ‘Why do they take the risk? A systematic review of the qualitative literature on informal sector abortions in settings where abortion is legal,’ BMC Women’s Health, 19(1): 55.
- Levine, PB (2004). Sex and Consequences: Abortion, Public Policy, and the Economics of Fertility. Princeton: Princeton University Press.
- Koch, E et al. (2012). ‘Methodological flaws on abortion estimates for Latin America: Authors’ reply to Singh and Bankole,’ Revista Ginecología Obstetricia México, 80(11): 740–747.
- Independent Commission for Aid Impact (2018). ‘Assessing DFID’s results in improving Maternal Health,’ available online at https://icai.independent.gov.uk/html-report/maternal-health/.
- Royal College of Obstetricians and Gynaecologists (1970). ‘The Abortion Act (1967): findings of an inquiry into the first year’s working of the Act conducted by the Royal College of Obstetricians and Gynaecologists,’ British Medical Journal, 2(5708): 529-535.
- Karalis, E et al. (2017). ‘Decreasing mortality during pregnancy and for a year after while mortality after termination of pregnancy remains high: a population-based register study of pregnancy-associated deaths in Finland 2001-2012,’ British Journal of Obstetrics and Gynaecology, 124: 1115-1121.
- Reardon, DC and Thorp, JM (2017). ‘Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: a systematic review with a narrative synthesis and meta-analysis,’ SAGE Open Medicine, 5: 2050312117740490.
- Reardon, DC et al. (2004). ‘Deaths associated with abortion compared to childbirth – a review of new and old data and the medical and legal implications,’ Journal of Contemporary Health Law and Policy, 20(2): 279-327.
- Fergusson, DM et al. (2013). ‘Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence,’ Australian & New Zealand Journal of Psychiatry, 47(9):819-827.
- Klick, J and Stratmann, T (2003). ‘The effect of abortion legalization on sexual behaviour: evidence from sexually transmitted diseases,’ Journal of Legal Studies, 32(2): 407-433.
- Klick, J and Stratmann, T (2008). ‘Abortion access and risky sex among teens: parental involvement laws and sexually transmitted diseases,’ Journal of Law, Economics and Organization, 24(1): 2-21.
- Klick, J et al. (2012). ‘The relationship between abortion liberalization and sexual behaviour: international evidence,’ American Law and Economics Review, 14(2): 457-487.
- Akerlof, GA et al. (1996). ‘An analysis of out-of-wedlock childbearing in the United States,’ Quarterly Journal of Economics, 111(2): 277-317.
- Robards, J et al. (2012). ‘Marital status, health and mortality,’ Maturitas, 73(4): 295-299.
- Akerlof, GA (1998). ‘Men without children,’ The Economic Journal, 108(447): 287-309.
How to Cite
Miller, C. (2022). LEGALISATION OF ABORTION AND MATERNAL MORTALITY IN ETHIOPIA. Ethiopian Medical Journal, 60(2). Retrieved from https://emjema.org/index.php/EMJ/article/view/1855