Unintended pregnancy, induced abortion and abortion care-seeking experiences among adolescents in Kinshasa, Democratic Republic of Congo: a cross-sectional study

Objectives To estimate age-specific abortion incidence and unintended pregnancy in Kinshasa, Democratic Republic of Congo and compare care experiences between adolescents (15-19 years) and older women (20-49 years). Design We used the age-specific variant of the Abortion Incidence Complications Method to estimate abortion and unintended pregnancy, with data from three primary sources: Health Facility Survey (n=361) provided postabortion care (PAC) caseloads; Prospective Morbidity Survey (n=1031) provided the age distribution and characteristics of women presenting for PAC and Health Professional Survey (n=115) provided an estimate of the proportion of abortions resulting in facility-based treatment of complications. Bivariate (chi(2), t-test) and multivariable (binary logistic regression, Cox proportional hazard) analyses were used to compare abortion care experiences. Setting Health facilities proving PAC in Kinshasa. Participants Women who presented to PAC facilities with abortion complications and their care providers. Primary and secondary outcome measures The primary measures were abortion incidence and proportion of pregnancies unintended. The secondary measures were the odd of reporting specific abortion care experiences. Results Adolescents had an estimated 27 590 induced abortions, constituting 18.8% of abortions in Kinshasa in 2016. Adolescents had the lowest abortion rate among women less than 35 years (55.2/1000 women) but the highest rate among ever sexually active women (138.4/1000) and recently sexually active women (167.2/1000). Also, adolescents had the highest abortion ratio (82.4/100 live births), proportion of pregnancies unintended (80%) and proportion of unintended pregnancies ending in abortion (49%). Compared with older women, adolescents had higher odds of reporting pregnancy unintendedness (adjusted OR, AOR 1.36, 95% CI 1.75 to 2.24), seeking abortion at later than first trimester (AOR 1.34, 95% CI 1.09 to 1.63) and from non-medical professionals (AOR 1.68, 95% CI 1.31 to 2.14), and not using contraceptives before pregnancy (AOR 2.23, 95% CI 2.77 to 3.43) or postabortion (AOR 2.46, 95% CI 1.87 to 3.29). Conclusions Interventions are needed to reduce unintended pregnancy among adolescents in Kinshasa and improve their abortion care experiences.