UNSAFE ABORTIONS AND UNWANTED PREGNANCIES CONTRIBUTE TO MATERNAL MORTALITY IN ZIMBABWE

Objective. To determine the contribution of unsafe abortion and unwant ed pregnancy to maternal mortality in a rural and urban population, In addition, to investigate the background characteristics, risk factors and preventable factors associated with abortion deaths. Design. Inci dent case-referent study of maternal mortality using a community netwo rking system to report maternal deaths during 1989 and 1990. Questionn aire administered at village, primary and referral health care levels; all clinical case notes were studied. Setting. A rural province, Masv ingo, and an urban centre, Harare, in Zimbabwe.Subjects and controls. The subjects were all maternal deaths, Controls were women who deliver ed before or after at the same site without mortality. There were 3 co ntrols per subject, with 1 matched for age. Outcome measures. 1. Abort ion deaths as a percentage of all maternal deaths, and the abortion-sp ecific maternal mortality rate (MMR). 2. Background characteristics, r isk factors. 3. Preventable factors associated with abortion deaths.Re sults. 1. Rural Masvingo - 16 (15%) of 105 maternal deaths due to unsa fe abortion, Abortion-specific MMR and overall MMR were 25 and 168 per 100 000 live births respectively, Urban Harare - 14 (23%) of 61 mater nal deaths due to unsafe abortion. Abortion-specific MMR and overall M MR were 18 and 85 per 100 000 live births respectively, Four deaths in Masvingo were suicides as a result of unwanted pregnancy. 2. No signi ficant difference between subjects and referents in respect of age, pa rity, religion and education, Significant risk factors for abortion de ath included being single (Masvingo: OR 6.4; 95% CI 2.3 - 17.7 and Har are: OR 12.6; 95% CI 3.8 - 42.5), being economically self-supporting ( Masvingo: OR 5.7; 95% CI 1.6 - 19.9 and Harare: OR 27.0; 95% CI 8.0 - 90.8), and having had a previous abortion (Masvingo: OR 29.7; 95% CI 1 0.2 to 86.4 and Harare: OR 89.6; 95% CI 5.0 - 1951). 3. All abortion d eaths were primarily due to sepsis. In Masvingo 12 (75%) and Harare 12 (86%) abortions were certainly illegal. Delay in seeking medical help for abortion complications occurred in 9 (56%) and 8 (57%) subjects i n Masvingo and Harare respectively. Health service factors, including delays in appropriate management and inadequate medical and surgical t reatment, contributed to the death of 6 Masvingo subjects (38%) and 8 Harare subjects (77%). Conclusion. Unsafe abortions were a major cause of maternal mortality in both rural and urban settings, the majority having been illegally induced. Women at risk tended to be single and s elf-supporting. Unwanted pregnancy is a major problem in rural and urb an settings. Earlier presentation by women with abortion complications and earlier more intensive management by health service facilities co uld have prevented many deaths. The authors suggest that the availabil ity of safe legal termination of pregnancy in the formal health sector would help to reduce abortion mortality.