Introduction: Unsafe abortion is a preventable cause of maternal mortality. While studies report high number of abortions in India, the population-level rates of unsafe abortion and their risk factors are not well understood. Our objective was to analyse the rates of and risk factors for unsafe abortion and abortion-related maternal death in India.

Methods: We conducted a secondary analysis of data from 1 876 462 pregnant women aged 15-58 years from nine states in the Indian Annual Health Survey (2010-2013). We calculated the rate of unsafe abortion and abortion-related mortality with 95% CI. Multivariable logistic regression models examined the associations of sociodemographic characteristics, health seeking behaviours and family planning with unsafe abortion and abortion-related mortality.
Results: There were 89 447 abortions among 1 876 462 pregnant women in 2007-2011 (4.8%, 95% CI 4.8 to 4.9). Of these, 58 266 were classified as unsafe (67.1%, 95% CI 66.7 to 67.5). There were 253 abortion-related maternal deaths (0.3%, 95% CI 0.2 to 0.3). Factors associated with unsafe abortion: maternal age 20-24 years (adjusted OR (aOR): 1.13, 95% CI 1.09 to 1.18), illiteracy (aOR: 1.48, 95% CI 1.39 to 1.59), rural residence (aOR: 1.26, 95% CI 1.21 to 1.32), Muslim religion (aOR: 1.16, 95% CI 1.12 to 1.22), Schedule caste social group (aOR: 1.08, 95% CI 1.04 to 1.12), poorest asset quintile (aOR: 1.45, 95% CI 1.38 to 1.53), antenatal care (aOR: 0.69, 95% CI 0.67 to 0.72), no surviving children (aOR: 1.30, 95% CI 1.16 to 1.46), all surviving children being female (aOR: 1.12, 95% CI 1.07 to 1.17), use of family planning methods (aOR: 0.69, 95% CI 0.66 to 0.71). Factors associated with abortion-related deaths: maternal age 15-19 (aOR: 7.79, 95% CI 2.73 to 22.23), rural residence (aOR: 3.28, 95% CI 1.76 to 6.11), Schedule tribe social group (aOR: 4.06, 95% CI 1.39 to 11.87).

Conclusion: Despite abortion being legal, the high estimated prevalence of unsafe abortion demonstrates a major public health problem in India. Socioeconomic vulnerability and inadequate access to healthcare services combine to leave large numbers of women at risk of unsafe abortion and abortion-related death.

Yokoe R, Rowe R, Choudhury SS, Rani A, Zahir F, Nair M. Unsafe abortion and abortion-related death among 1.8 million women in India. BMJ Global Health. 2019 May 2,4(3):e001491.