Magnitude of abortion in Egypt: A Cross-Sectional StudyYoussef MA1, Atef El Shitany2, Nagwa Boshra2, Mohamed El Helaly2,Amal Philip2, Youssef Waheeb3, Mahmoud Hosny4, Ali Abdel Hafeez1,Maged Elmohamedy1, Ayman Osama Raslan1, Hazem Alashmwai1, Mohamed Hassan Abdella5, Mohamed Nagi Mohesen6
1Department of Obstetrics & Gynecology, Cairo University, Cairo, Egypt
2Department of Community Medicine, Suez, Canal University, Suez canal, Egypt
3Family Planning Sector, Ministry of Health (MOH), Cairo, Egypt
4Department of Obstetrics & Gynecology, Menia University, Menia, Egypt
5Department of Obstetrics & Gynecology, Helwan University
6Department of Obstetrics & Gynecology, Beni-Suef University, Beni Suef, Egypt
Objective: To find the incidence, risk factors, characteristics and complications of abortion among women in Egypt. Design: A cross-sectional population-based study. Setting: Four areas in Egypt with variable socio-demographic characteristics were included in the study. Participants: The study included 10106 women with 31345 pregnancies during their past reproductive life. Interventions: Data collection was done by trained community health workers, through a door-to-door approach, using interview forms covering different aspects of the abortion problem. Main outcome measures: Incidence and characteristics of abortion in Egypt Results: The overall fetal loss incidence was of 12.9% (95% CI: 12.3 - 13.6), of which abortion accounted for 9.7% (95% CI: 9.12 - 10.28) and stillbirth for the remaining 3.2%. Abortion rates were significantly higher in consanguineous marriages than in non-consanguineous marriages (10.44% vs. 9.43%, RR: 1.24; 95% 1.14 – 1.34, P˂0.0001), in rural women than in urban women (10.35% vs. 9.2%, RR: RR: 1.39; 95% 1.2 – 1.5, P=< 0.0001) and in less educated women than in better-educated women (10.56% vs. 9.46%, RR: 1.2; 95% CI: 1.14-1.34, P< 0.0001). Significant differences were also found among women of different age groups (28% of those aged 40-44 vs. 14.3% of those aged 20-24, RR: 1.95; 95% CI: 1.69-2.26; P< 0.0001). Overall, more than one fifth of interviewed women (21.1%) had a history of abortion. During the course of the 3 years preceding the study, 557 women experienced 649 abortions. Of these, unwanted pregnancies were encountered in 14.6% of spontaneous abortions, 20.6% of pregnancies terminated for medical reasons and in 100% of voluntarily induced abortions. Failed contraception was encountered in 13.7% of spontaneous abortions, 17.2% of pregnancies terminated for medical causes and 45.5% of voluntarily induced abortions. Failed methods were pills (53.6%), IUDs (33%), injectables (8.2%), condoms (4.1%) and lactational amenorrhea (1%). Of all abortion cases, 6.2% were complicated by fever, distributed as 5.8% of spontaneous abortions, 5.9% of abortions performed for medical reasons and 25% of voluntarily induced abortions. Most cases sought medical help while a non-negligible percentage (19%) did not. The major help providers were private doctors at their offices (44.7%) and hospitals (35.6%). Surgical procedures were performed in 64.4% of cases. Induced abortions accounted for only 3.9% of cases during the study period. They were induced by a health care provider in 32% of cases and self-induced in all other cases. Conclusion: Abortion is a major health problem in Egypt. Extrapolating to the national level, the magnitude of this problem – whether complicated by sepsis or not – turns out to be still of importance, hiding some serious health issues, namely poor health education and inaccessibility of adequate health services.