Determinants of Induced Abortion

Abortion is almost always the result of an unintended and unwanted pregnancy. A pregnancy may be unwanted for a variety of reasons present in most cultures: Absence of a father, economic constraints, interference with life pro­spects, inability to provide good parenting, conflict with prevailing social norms, and health concerns.

The main determinants of unwanted pregnancy and resulting recourse to abortion are women’s lack of power over their sexual activity; their lack of education, includ­ing inadequate and inaccurate knowledge of contracep­tive methods; limited access to effective contraception; and the absence of social support for pregnant women and their children. As long as these conditions exist, a large number of unwanted pregnancies will occur, and, despite legal, moral, or religious prohibitions and sanc­tions, many will result in abortion.

This is the situation in, for instance, Vietnam and Eastern Europe, and to a lesser degree in the majority of Latin American and African countries. The low abortion rates in Western Europe are likely related to the greater access of the population to education in general and to sex education in particular, universal knowledge and access to contraception, greater power balance between the sexes, and greater social pro­tection of motherhood, all of which contribute to reducing unwanted pregnancies and abortions, irrespective of the legality of and accessibility to abortion.

Knowledge of Contraception. The proportion of women who declared knowledge of at least one modern contraceptive method (hormonal meth­ods, intrauterine devices, diaphragm, male or female con­dom, or surgical sterilization) varied from less than 50% in Chad to close to 98% in Kenya, Nepal, the Philippines, and Zambia, and almost 100% in developed countries as well as some developing countries such as Bangladesh, Brazil, and the Dominican Republic.

There are also large differences within each country between urban and rural residence and socioeconomic status. While 98% or more of women who have at least a secondary education in most developing countries declare that they know of at least one modern contracep­tive method, only about 50% of women with no education have that knowledge.

Moreover, when a woman says that she knows of a method it may only mean that she has heard of the existence of that method; it is no guarantee that the knowledge she has is correct. She may believe, for exam­ple, that the IUD causes an abortion every month or that women who take the pill for too long become sterile.

A study carried out among women living in a shanty town in Rio de Janeiro, Brazil, found that 23% of con­traceptive pill users were using them incorrectly. Simi­larly, other studies have shown that adolescents and women with little education who attempt to use periodic abstinence for family planning have inaccurate knowledge of the menstrual cycle and the fertile period (Castaneda et al., 1996).

Even in the United States, a study found that close to one-third of female students and two-fifths of male students who were sexually active were unaware of the importance of leaving a space at the tip of the condom. One-third of both groups believed wrongly that Vaseline could be used with condoms (Crosby and Yarber, 2001). Some adolescents in both developed and developing countries are not even aware that girls can become preg­nant the first time they have sexual intercourse.

The accuracy of contraceptive knowledge is positively related to education attainment, according to Demo­graphic and Health Surveys (DHS) in a variety of countries. On the other hand, having a religious affiliation has been found to be associated with several misconcep­tions about how to use condoms correctly, according to a national sample of adolescents in the United States (Crosby and Yarber, 2001).

Distorted information on contraceptives disseminated by the media may also have an effect on the abortion rate, as occurred in the case of the sensationalist information published regarding the reported increase in the risk of adverse vascular effects associated with some new proges- togens contained in third-generation combined oral con­traceptive pills. At least two studies showed that these reports coincided with a dramatic decrease in the use of oral contraceptive pills in the United Kingdom and Norway, and was followed by a sharp rise in unwanted pregnancies and abortion (Skjeldestad, 1997).

Access to Contraception. If a sexually active woman does not desire a child and has no access to family planning methods she is running a high risk of having an unwanted pregnancy and consequently of having an induced abortion. A study in Nepal found, for example, that for many women unsafe abortion was the only available method of fertility control.

The highest abortion rates have been observed in countries in Eastern and Central Europe that belonged to the former Soviet Union. Contraceptive prevalence in these countries was low because only high-dose contraceptive pills, associated with more side effects, were available, the quality ofcondoms and IUDs was poor, and there were legal restrictions to surgical sterilization. For many women who wanted to control their fertility, abortion was a more easily accessible option than contraception.

Unfriendly or inappropriate delivery systems and con­flicting cultural values can create insurmountable barriers to obtaining contraception, affecting adolescents dispro- portionally in both developed and developing countries. Several studies carried out in developing countries, such as India and Tanzania, or in developed countries, such as Belgium and the United States, have found that many adolescents are either unaware that they have a right to request contraceptive services or are inhibited by cost, wait­ing times, embarrassment, and fear of gynecological exami­nation (Silberschmidt and Rasch, 2001).