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Abortion and Postabortion Care in Guatemala: a Report from Health Care Professionals and Health Facilities

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Abortion and Postabortion Care in Guatemala: a Report from Health Care Professionals and Health Facilities Abortion and Postabortion Care in Guatemala: A Report from Health Care Professionals and Health Facilities Elena Prada, Edgar Kestler, Caroline Sten, Lindsay Dauphinee, and Lilian Ramírez Occasional Report No. 18 December 2005 Acknowledgments Abortion and Postabortion Care in Guatemala: A Special thanks are due to the following Guatemala Report from Health Care Professionals and Health personnel who collected the data: regional coordinators Facilities is the first in a series of reports from the Zoila Calderón, Zully Hernández and Lilian Ramírez, Guttmacher Institute and its Guatemala partners that and interviewers Maria Borrayo, Flor de María Castillo, offers research findings about unsafe abortion in Nora Díaz, Elizabeth Fajardo, Ana Guadrón, Rosandra Guatemala. Susheela Singh, vice president for research Guzmán, Yolanda López, Blanca Marroquín, Bernarda at the Guttmacher Institute and Akinrinola Bankole, di- Méndez, Diana Pérez, Fabiola Reyna and Brenda Torres. rector of international research, oversaw the process from the development of the study design through the Suggested citation: Prada E et al., Abortion and production of this report. The authors thank Luisa postabortion care in Guatemala: a report from health Cabal, Center for Reproductive Rights; Rebecca Kola- care professionals and health facilities, Occasional dycz, International Planned Parenthood Federation; Report, New York: Guttmacher Institute, 2005, No. 18. Romeo Menéndez, OB/GYN Society of Guatemala; Martha Murdock, Family Care International; Sandra To order this report, go to www.guttmacher.org. García, Population Council; and Clemetine Rossier, In- stitut National D’études Démographiques for having ©2005, Guttmacher Institute, A Not-for-Profit Corpo- provided insightful comments and suggestions on an ration for Reproductive Health Research, Policy early draft. The assistance and advice of other Analysis and Public Education Guttmacher staff members was also very useful. The authors acknowledge Lisa Remez for writing the exec- ISBN: 0-939253-75-5 utive summary, Ann Moore for having provided com- ments on early drafts, Haley Ball for editing the report, Martha Urdaneta for translating the report into Span- ish and Michael Greelish for layout and production work. The study was carried out by Guatemala researchers and the Guttmacher Institute with support from the Netherlands Ministry for Development Cooperation, the World Bank and the United Kingdom Department for International Development. The principal investigator for the project in Guatemala is Edgar Kestler, director of the Epidemiological Research Center in Reproductive Health (CIESAR) in Guatemala. The coinvestigators are Gonzalo Ball-Ajú, director of the Guatemalan Federa- tion of Maternal and Child Health and Reproductive Health (FESIRGUA), and Sandra Sáenz de Tejada, anthropologist and independent consultant. Table of Contents Acknowledgements . 2 obtain an abortion, according to HPS respondents; and percentage distribution of characteristics of women who Executive Summary . 5 seek treatment for abortion complications, according to HFS respondents . .29 Chapter 1: Introduction . 9 3.2 Percentage of HPS respondents who reported use of specific Overview . 9 methods for abortion in urban and rural areas . .30 Guatemala context . 9 3.3 Percentage of HPS respondents who reported specific Trends in childbearing, contraceptive use and unmet need . .10 abortion methods as most commonly used by different pro- Rationale, goals and objectives . 11 vider types in urban and rural areas and among indigenous Report structure . .12 and nonindigenous women . 31 Figure: 3.4 Percentage of HPS respondents by perception of how com- monly various abortion provider types are used, according 1.1 Map of Guatemala . 13 to women’s economic status, place of residence and among Chapter 2: Methodology . 15 indigenous women . .32 Introduction . .15 3.5 Percentage distribution of abortions that HPS respondents Health Professionals Survey . .15 believe are performed by each type of provider, according to Health Facilities Survey . .16 women’s economic status and place of residence and among Training, fieldwork and data collection . .17 indigenous women . .33 Characteristics of HPS respondents . .17 3.6 HPS respondents’ estimates of the cost, in US$ and Quetzales, Characteristics of HFS respondents and facilities . .18 of a first trimester abortion, by type of provider, according to Tables: women’s economic status, place of residence and among indigenous women . .34 2.1 Distribution of health facilities in Guatemala by ownership of facility according to major region . 19 Chapter 4: Induced Abortion, Morbidity and 2.2 Characteristics of Health Professionals Survey respondents . .20 Postabortion Care . .35 2.3 Work experience of Health Professionals Survey respondents . 21 Types of abortion complications . .35 2.4 Characteristics of Health Facilities Survey respondents Probability of complications . .35 according to ownership of facility . .22 Probability of obtaining treatment for postabortion 2.5 Characteristics of health facilities according to ownership complications . .36 and size of facility . 23 Sources of postabortion care . .37 Chapter 3: Characteristics and Conditions of Number of postabortion patients treated . .38 Abortion Service Provision . .25 Procedures used for treatment of postabortion complications . .39 Profile of women seeking abortion . .25 Conclusion . .39 Methods of abortion . .25 Tables: Abortion providers . .26 Costs of induced abortion . .27 4.1 Percentage of HPS respondents who reported selected Conclusion . .27 complications that result from induced or spontaneous abortion as common . 41 Tables: 4.2 HPS respondent’s estimates of the percentage of women 3.1 Percentage distribution of characteristics of women who having an induced abortion who will experience complica- tions that require medical treatment by type of provider, Chapter 6: Conclusions and Implications . .57 according to women’s economic status, place of residence, Program and Policy Implications . .58 and among indigenous women . .42 Research Needs . .59 4.3 Average proportion of induced abortions likely to result in complication by type of provider and women’s poverty status Acronyms . 61 and indigenous ethnicity, as perceived by HFS respondents . .43 4.4 Of all women having an induced abortion, the percentage References . .63 who are hospitalized for complications, and constituent components: total HPS sample and for four subgroups, by sector where respondents work and type of work experience . .44 4.5 Percentage of HPS respondents, by perception of how commonly various postabortion care provider type are used, according to women’s economic status, place of residence and among indigenous women . .45 4.6 Percentage of facilities that offer inpatient and outpatient postabortion care, and average annual number of postabor- tion patients treated per facility by ownership and region . .46 4.7 Estimated number of women treated annually for complica- tions from spontaneous or induced abortions, and morbidity rate by ownership of facility according to region (weighted results) . .47 4.8 Percentage of facilities that use various procedures to treat postabortion complications by ownership of facility (weighted results) . .48 4.9 Percentage of facilities that use anesthesia with various procedures to treat postabortion complications . .49 Figures: 4.1 HPS respondent’s estimates of the percentage of women with induced abortion complications likely to be treated in a health facility, by women’s economic status, place of resi- dence and among indigenous women . .50 4.2 Percentage distribution of HFS respondents by perception of how treatment of postabortion complications can be improved in their facilities . 51 Chapter 5: Family Planning, Postabortion Counseling and Opinions on Interventions To Reduce Unsafe Abortion and Improve Postabortion Care . .53 Contraceptive services for postabortion patients . .53 Opinions on approaches to reducing unsafe abortions . .54 Conclusion . .54 Tables: 5.1 Percentage of facilities that offer counseling on contra- ceptive methods to postabortion patients, by ownership and size of facility . .55 5.2 Percentage of HPS and HFS respondents who believe that selected suggestions can be used to reduce unsafe induced abortion in Guatemala, according to respondents’ profession . .56 Abortion and Postabortion Care in Guatemala: Executive Summary In Guatemala, which has the highest fertility rate in perceptions of both abortion patients and providers. Central America, women currently have more than four The other component was a nationally representative children; among the indigenous population, which ac- survey of senior personnel from 174 health facilities counts for 43% of the total population, women have who were asked about their experience with treating more than six. Although the proportion of married women for complications from abortions. women who use a modern contraceptive method has risen in recent years—it now stands at 34%—increas- Unsafe Abortion and Treatment of Complications es in use are not keeping pace with declines in desired Because no data are available from the women them- family size. Nearly one-third of recent births to selves, respondents to the Health Professionals Survey Guatemalan women were unintended, and 28% of were asked about their perceptions of abortion provi- women have an unmet need for contraception. Unfor- sion in Guatemala. Two interrelated factors that influ- tunately, and sometimes
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