Induced abortion in Matlab, Bangladesh: Trends and determinants

Context: Although many women in Bangladesh resort to abortion when confronted with an unwanted pregnancy, neither the incidence of induced abortion nor the characteristics of women who rely on abortion have been well studied. Methods: Data from a longitudinal demographic surveillance system are used to analyze the outcomes of about 75,000 pregnancies between 1982 and 1991 in Matlab, a rural area of Bangladesh. Outcomes among women in the Matlab treatment area, who have access to an intensive maternal and child health and family planning program, are compared with those among women in a comparable neighboring area who receive the standard government-sponsored services. Results: The ratio of induced abortions to live births increased in both the treatment and comparison areas-from 15 per 1,000 in 1982 to 29 per 1,000 in 1991 in the treatment area and from 12 to 45 per 1,000 in the comparison area. The incidence of abortion was higher among women who had had six or more births or who became pregnant fewer than 12 months after the previous pregnancy. Induced abortion ratios were higher among users of the pill, condoms or traditional methods than among users of injectable contraceptives or among contraceptive nonusers. In most subgroups, women in the treatment area were less likely to have obtained an abortion than were those in the comparison area. Abortion ratios in the treatment area began falling after 1992, and returned to 16 per 1,000 by 1995. Conclusions: A high-quality reproductive health program offering use-effective contraceptive methods can reduce the burden of induced abortion in Bangladesh.