FACT SHEET

Induced Abortion and Postabortion Care in Kinshasa, Democratic Republic of Congo

■■ According to the penal code of the births—is among the highest in the of Kinshasa is likely higher than that Democratic Republic of Congo (DRC), world, despite recent improvements. for the country as a whole, given that abortion is prohibited without excep- Unsafe abortion likely contributes a pattern of elevated rates in capital tion. Legal prohibition notwithstanding, substantially to this high rate of cities has been observed in other it is generally accepted that the proce- maternal deaths. African countries where nationally dure can be performed to save a wom- representative studies have been an’s life; yet, women are rarely able to ■■ Kinshasa is the DRC’s capital and conducted. obtain safe abortion care on this basis. largest urban area, and its population The vast majority of abortions occurring of 12 million accounts for 15% of the Provision of postabortion care in the DRC are clandestine, and many country’s total population. There is ■■ Unsafe abortion is common in of these are unsafe. currently no reliable estimate of the Kinshasa, and the level of postabortion incidence of abortion for the DRC as a care gives clues as to its prevalence ■■ The DRC is a signatory to the Maputo whole, but the following new data are and consequences. In 2016, an Protocol, a regional treaty on women’s available for Kinshasa. estimated 37,900 women obtained rights that directs states to legalize treatment in health facilities for abortion when necessary to protect a Incidence of abortion abortion-related complications. These woman’s physical and mental health, ■■ An estimated 146,700 abortions were women represent only a portion of as well as in cases of rape, incest and performed in Kinshasa in 2016. This those who experienced an unsafe fetal anomaly. In March 2018, the translates to an abortion rate of 56 abortion: Some women encounter government published the protocol per 1,000 women of reproductive age barriers that prevent them from in the nation’s legal gazette, officially (15–49), which is much higher than the obtaining needed postabortion care, entering the treaty into force. regional rate for Middle Africa overall while others do not require such care. (35 per 1,000 women in 2010–2014.) ■■ The DRC’s maternal mortality rate—at ■■ Private hospitals and health centers, 693 maternal deaths per 100,000 live ■■ The abortion rate in the urban center including those run by NGOs, treated 93% of all postabortion care patients in 2016. The remaining 7% of patients COMPLICATIONS OF UNSAFE ABORTION were treated in public-sector health Almost two-thirds of postabortion care patients suffered facilities. severe or moderate complications. ■■ Among women treated for % postabortion complications, 16% 100 experienced severe complications (such as shock, organ failure or death), 90 80 46% had moderate complications None (such as localized infections) and Mild 70 60 33% had mild complications (such as a low fever or prolonged bleeding). Moderate The remaining 5% who sought care 50 40 did not require treatment. Just 15% Severe of women with severe complications 30 20 46 received pain medication as part of 33 their postabortion care. 10 0 16 ■■ Patients’ complications were most Severe Moderate Mild None commonly treated using outdated Severity of postabortion complications, 2016 methods, such as dilation and

SEPTEMBER 2018 Unintended pregnancies ending in miscarriage 5% Unintended pregnancies ending in abortion

Unintended pregnancies ending in birth

79% Intended pregnancies ending in birth or miscarriage

PREGNANCY OUTCOMES counseling and information ACKNOWLEDGMENTS that would help women The studies on which this fact In Kinshasa, six in 10 pregnancies identify and adopt methods sheet is based were made are unintended. that best meet their needs. possible by grants from the David and Lucile Packard Foundation, the Swedish ■■ The Ministry of Health 8% Intended pregnancies International Development ending in birth or miscarriage should draft and widely Cooperation Agency, the Dutch disseminate new standards Ministry of Foreign Affairs and Unintended pregnancies 26% 39% ending in birth and guidelines to reflect the Norwegian Agency for the expanded legal access Development Cooperation, Unintended pregnancies to abortion implied by the and by UK Aid from the UK ending in abortion government’s publication Government. The views expressed are those of the Unintended pregnancies of the Maputo Protocol. 27% ending in miscarriage authors and do not necessarily To increase access to reflect the positions or policies 563,000 pregnancies, 2016 safe abortion services, of the donors. investments must be made to educate health providers about the new provisions curettage (D&C), which is odds of experiencing severe and train them to provide riskier and more invasive or moderate complications safe services using WHO- than vacuum aspiration and than nonpoor women. recommended methods, medication abortion, the and public awareness must methods recommended Contraception and be raised about women’s by the World Health unintended pregnancy right to such care. Organization (WHO). ■■ In Kinshasa, 72% of married women reported in 2017 ■■ The quality of postabortion ■■ Contraceptive services that they wanted to delay care must be improved. to help prevent future or prevent having a child. Health providers need unintended pregnancies is a However, only 23% of training in best practices critical part of postabortion married women were in order to provide high- care. Sixty percent of using a modern method of quality postabortion care, postabortion care patients in contraception. and low provision of care Kinshasa in 2016 received by public facilities should contraceptive counseling. ■■ In 2016, more than 343,000 be addressed by ensuring unintended pregnancies these facilities have the Patient characteristics occurred in Kinshasa, which necessary equipment and and outcomes translates to a rate of 147 supplies. ■■ Most women presenting for unintended pregnancies per University of Kinshasa postabortion care in 2016 1,000 women aged 15–49. B.P. 127 Kinshasa XI Kinshasa, Democratic Republic had a secondary education Six in 10 pregnancies SOURCES of Congo or higher. About three- were unintended, and Most information in this fact (+243) 81 231 68 57 quarters had not had an close to half of unintended sheet can be found in Bankole [email protected] abortion before, and 81% pregnancies ended in A et al., The severity and were in their first trimester abortion. management of complications www.unikin.ac.cd among postabortion patients when they terminated their treated in Kinshasa health pregnancy. Recommendations facilities, International ■■ Unsafe abortion poses Perspectives on Reproductive ■■ Women’s health outcomes a preventable threat to Health, 2018, https://doi. varied according to social many women’s health and org/10.1363/44e5618 and and economic factors. well-being, and it puts a Chae S et al., The incidence of Women who were single significant strain on the induced abortion in Kinshasa, Democratic Republic of Congo, or cohabiting had nearly DRC’s limited health care 2016, PLOS ONE, 2017, Good reproductive twice the odds of those resources. Since most https://doi.org/10.1371/journal. health policy starts with who were formally married abortions occur in response pone.0184389. Annotated credible research of experiencing severe or to unintended pregnancy, version available at moderate complications, greater efforts are needed https://www.guttmacher.org/ 125 Maiden Lane and poor women had higher to improve contraceptive fact-sheet/abortion-kinshasa. New York, NY 10038 212.248.1111 services, including the [email protected] www.guttmacher.org

SEPTEMBER 2018