Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.
PIP: A survey in 1978 estimated that about 21,600 pregnancy related deaths occured in Bangladesh in that year of which 25.8% were due to complications of induced abortion. The study was conducted to determine the prevailing rate, causes, and correlates of maternal death in 2 rural areas: Melanda and 3 unions of Islampur. The study employed 109 traditional birth attendents (TBAs) to collect the data. The fact that they were able to report 28 cases of induced abortion in women not currently married strengthens the likelihood that underreporting of induced abortion was low. Mortality from induced abortion in this study was estimated at 1.1/1000 live births. Induced abortion practice is positively related to maternal age and parity. The death to case rate is also positively related to maternal age and parity. Women in Bangladesh seek abortion from clandestine sources, generally as a last resort to terminate an unwanted pregnancy. It seems plausible that many of these women would have used menstrual regulation services had they been readily available. It is probable that the provision of safe menstrual regulation services would result in fewer women seeking abortions and a subsequent reduction in maternal mortality.