Joseph B. Babigumira

Almost 300,000 induced abortions are performed annually in Uganda, resulting in 85,000 abortion-related complications and 1,200 deaths. This exerts a substantial morbidity, mortality, and cost burden on the country. The abortions are a consequence of the high prevalence of unintended pregnancies, which are a result of the high level of unmet need for contraception: 33 percent of Ugandan women have an unmet need for effective contraception. Since abortion is illegal in Uganda, it is usually performed in clandestine, unhygienic places by undertrained and unskilled practitioners and is associated with a wide range of complications and myriad health and economic consequences.

Although some aspects of the health impact of abortion have been studied in Uganda, the post-hospitalization health impact is not well understood. Also, the economic impact of induced abortion has in general not been well studied. This study will characterize the health impact of induced abortion in Uganda by estimating the morbidity, mortality, and costs associated with abortion procedures, abortion complications, hospitalizations, and post-hospitalization complications. It will also estimate the cost-effectiveness of increasing contraceptive coverage or reducing the unmet need for contraception.

The study has three specific aims: to quantify the health and economic impact of the post-hospitalization complications of induced abortion; to estimate the national cost of unsafe induced abortions; and to calculate the cost-effectiveness of increasing contraceptive coverage (reducing the unmet need for contraception). These aims will be achieved by performing three independent studies: (1) a six-month observational cohort study comparing the health (out-patient visits, hospitalizations, all-cause mortality, self-reported health, and health-related quality of life) and economic (labor and school participation, earning, and savings) characteristics of women discharged following a complication of induced abortion and women who have not had an induced abortion; (2) a cost-of-illness study to determine the total economic impact of unsafe induced abortion on Ugandan society; and (3) a decision analytic cost-effectiveness model to calculate the incremental costs and benefits—in terms of lives saved and maternal quality-adjusted life years saved—of increasing contraceptive coverage in Uganda.

Contact Information:
Joseph B. Babigumira, babijo@u.washington.edu, University of Washington