Incidence of severe acute maternal morbidity associated with abortion: a systematic review.

OBJECTIVE: To systematically review articles describing complications of abortion in settings where abortions are thought to be unsafe and to determine the incidence of severe acute maternal morbidity (SAMM) attributed to abortion at the population level. METHODS: We searched relevant databases using search terms related to abortion and complications. We included population-representative studies that listed complications of abortion. We extracted data on the definitions and numbers of severe complications and SAMM, and we report abortion complication rates (per 100 000 women of reproductive age) and ratios (per 100 000 live births) for SAMM, severe complications and any complications. RESULTS: We included 15 studies representing eleven countries (six in Africa, four in Asia and one in Latin America). We found a median abortion ratio of SAMM of 237 (range 91-1892) per 100 000 live births and a median abortion ratio of severe complications of 596 (range 435-5298). There was a great degree of heterogeneity between definitions and study populations. CONCLUSIONS: The burden of SAMM attributed to abortion is much greater than what is reported for deaths caused by abortion. However, the great heterogeneity in definitions makes it difficult to draw firm conclusions. We call for future work on the burden of unsafe abortion to use strict definitions of SAMM.