Unsafe abortion-related morbidity and mortality (UARMM) impact welfare at the individual, household, community and national levels. Out of an estimated 46 million induced abortions that take place every year in the world, around 19.8 million are unsafe abortions (WHO, 2007).
More than 5 million of these abortions result in serious medical complications that require hospital-based treatment (Singh, 2007). Of these cases, many suffer long-term effects, including an estimated 1.6 million women who annually suffer secondary infertility and a further 3-5 million women experience chronic reproductive tract infections.
The cost that these figures imply is a matter of importance for public policy. Despite this, little research has gone into estimating UARMM costs or developing an overall framework and costing methodology to arrive at cost estimates. The objectives of this paper are to survey the empirical information available on costing unsafe abortion, to develop an analytical framework for cost estimation, to describe the methodological approaches available, given the constraints of the subject matter, and finally to estimate cost ranges within the limitations of data on unsafe abortion.
The complications from unsafe abortion have been listed elsewhere, for instance by Bernstein and Rosenfield (1998) and WHO (1995). Empirical studies on abortion complications, however, show that the list of possible complications is a very long one. Annex Table A1 attempts to organize this long list into three categories: immediate complications, later complications and other complications that are reported only sporadically in the literature. A complete costing of abortion-related complications would need evidence on the prevalence of all the complications listed in the table. When we look at empirical costing studies below, however, we will find that in practice only a few of the major complications are taken into consideration.
The paper is divided into four substantive sections. In the next section, a general framework for the analysis of the costs of unsafe abortion is developed. In the section following this, a review of the literature on the cost of unsafe abortion is presented. This is followed by a section on the estimation of the cost of unsafe abortions to health systems in developing countries. In this section, a discussion of methodological considerations is followed by a series of cost estimations using a variety of methodological approaches.
The final substantive section of the paper examines other costs listed in the framework for which empirical evidence is less secure. A concluding section summarizes the different costs estimated in the paper in the light of limitations of data and necessary assumptions, pointing out priorities for future research into UARMM costing.