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Fact Sheet: Unintended Pregnancy and Induced Abortion in Colombia

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Fact Sheet: Unintended Pregnancy and Induced Abortion in Colombia Fact Sheet October 2013 Unintended Pregnancy and Induced Abortion In Colombia • In 2006, Colombia’s Constitutional • However, the abortion rate has re- CONDITIONS OF CLANDESTINE Court overturned an absolute ban on mained relatively constant: 36 abortions ABORTION abortion, allowing the procedure in cases per 1,000 women of reproductive age in • Colombian women routinely face un- of threat to a woman’s life or health, 1989, compared with 39 per 1,000 in necessary barriers in accessing legal fetal abnormality incompatible with life, 2008. abortions. As a result, many resort to and rape or incest. Despite the ruling, clandestine procedures. • Abortion rates vary greatly by region, the vast majority of abortions remain from 18 abortions per 1,000 women in • Half of all abortions in Colombia are clandestine and thus potentially unsafe. Oriental to 66 per 1,000 in Bogotá. performed using the drug misoprostol, • Conditions for women have changed in which is widely available. However, de- • Despite notable gains in contraceptive recent decades. Between 1990 and 2010, spite the drug´s safety and efficacy when use over the past two decades, 67% of all the proportion of the population living used correctly, inadequate knowledge pregnancies in Colombia were unintended in urban areas rose from 68% to 75%, of its use among women and providers in 2008, an increase from 52% in 1989. and the proportion of women educated results in a high rate of complications beyond primary school increased from • Similarly, the proportion of all preg- (32%), primarily heavy bleeding and 55% to 76%. nancies that ended in abortion rose incomplete abortion. by a third from 1989 to 2008. Both of • Although average family size in Colom- • The most common type of abortion these increases likely occurred because bia steadily declined over this period, the among women living in urban areas in- of women’s growing motivation to avoid poorest women still have the largest gap volves the use of misoprostol—obtained unplanned births. between actual and wanted fertility (that from a number of sources, including the black market, pharmacies and doctors. is, they have roughly one child more than THE PROVISION OF LEGAL they want to have). ABORTION SERVICES However, in rural areas, poor women are • Although manual vacuum aspiration much less likely than nonpoor women • In 2010, nearly 80% of Colombian (MVA) is the method recommended by the to use misoprostol. Half of poor rural women in union (legal or consensual) WHO for first trimester abortions, eight in women’s abortions involve methods other practiced contraception; 73% used a 10 legal abortion procedures performed than misoprostol and are provided by modern method and 6% used a less effec- at secondary and tertiary facilities are traditional midwives or are induced by tive traditional method. carried out using dilation and curettage the woman herself. INCIDENCE OF ABORTION AND (D&C), a method which is more invasive, • Abortions that do not involve misopro- 1 UNINTENDED PREGNANCY more time consuming and more costly. stol are performed by a range of provid- • An estimated 400,400 induced abor- • The estimated cost of a legal abortion ers, including doctors (primarily using tions were performed in Colombia in at higher-level facilities where D&C is the surgical techniques), pharmacy personnel 2008, of which only 322 were reported primary method used is approximately (using high doses of oral contraceptives), as legal procedures. In 1989, there were US$200. At primary-level specialized nurses (using methods such as oxytocin 288,400 abortions. This increase was pri- facilities, where MVA or medication abor- injections and insertion of catheters) and marily due to an increase in the number tion is offered, the estimated cost is just traditional midwives (by vaginally insert- of women of reproductive age. $45.1 ing sharp objects or herbs, or providing herbal preparations or massages). Not supported by Title X Title X-supported Not supported by Title X Title X-supported Pregnancy Outcomes in Colombia POLICY IMPLICATIONS AND 1. Prada E, Maddow-Zimet I and Juarez RECOMMENDATIONS F, The cost of postabortion care and The proportion of pregnancies that are unintended increased from half legal abortion in Colombia, International in 1989 to two-thirds in 2008. Miscarriages 8% • There is great need to im- Perspectives on Sexual and Reproductive prove the implementation of Health, 2013, 39(3):114–123. the 2006 ruling, ensure that Miscarriages 8% Unplanned births 1989 guidelines are followed, lift Unless otherwise indicated the data 23% barriers to legal services, and in this fact sheet come from Prada Intended Planned Unplanned Unintended E et al., Unintended Pregnancy and pregnancies births births pregnancies improve the dissemination of Induced Induced Abortion in Colombia: Causes 40% 23% information on legal criteria Intended Planned abortions Unintended and Consequences, New York: 22% pregnancies births pregnancies among women, physicians and Guttmacher Institute, 2011. 40% Induced abortions judges. Support for this factsheet and the 22% monograph on which it is based was Miscarriages 7% • The coverage and quality of provided by the Dutch Ministry of postabortion care needs to be Foreign Affairs. Miscarriages 7% improved, and more widespread use of MVA should be encour- aged. The cost of providing both postabortion care and Miscarriages 6% 2008 legal abortion services would be significantly reduced if MVA and Miscarriages 6% Intended medication abortion were more pregnancies Planned Unplanned births births widely used at primary-level 29% Intended 27% facilities, rather than D&C. pregnancies Planned Unplanned Unintended births births pregnancies 27% Induced29% • Special attention must be abortions Unintended devoted to poor and rural Miscarriages 29% pregnancies 9% Induced women, who are the most likely34% abortions At centers Miscarriages 29% to develop complications and 9% not supported the least likely to receive by 34%Title X treatment. At centers not supported by Title X CONSEQUENCES OF UNSAFE misoprostol and who self-induce • Almost two-thirds of health ABORTION (65%) or seek the help of a facilities that could provide postabortion care do not, sug- • Thirty-three percent of all traditional midwife (54%). 66% women having clandestine abor- gesting that there is a Atneed Title X–supported to • The highest regional compli- expand the number of facilitiescenters tions experience complications 66% that require medical attention, cation rate is found in Pacífica, offering such care, particularlyAt Title X–supported but the complication rate is as a relatively poor area in which in rural areas. centers 40% of abortions require follow- high as 53% among poor rural • Colombian women want fewer women. up treatment; the lowest rate (25%) is found in the much children than they did in the • However, approximately one- wealthier region of Bogotá. past. Higher-quality contracep- fifth of all women who develop tive services—including focused complications do not receive • According to projections from counseling on improving the the medical attention they 2008 data, in 2012, approxi- consistency and effectiveness of need. Among poor rural women, mately 102,000 women were current use, and wider access to half of postabortion complica- treated for complications at emergency contraception—will tions go untreated. higher-level health facilities in reduce unintended pregnancies Colombia (71% at secondary and women’s need for abortion. • The vast majority of facili- facilities and 29% at tertiary ties offering postabortion care facilities).1 (93%) most commonly use D&C. 125 Maiden Lane Only 7% most commonly treat • It costs the Colombian health New York, NY 10038 USA complications with nonsurgical care system approximately Tel: 212.248.1111 [email protected] MVA. $14.4 million annually to pro- vide postabortion care (includ- www.guttmacher.org • Complication rates are highest ing only direct costs).1 among women who do not use October 2013.
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