Incidence of Induced Abortion among Adolescents

A Practice with Greater Consequences for Certain Women

The problem of abortion among the adolescent population warrants particular attention. Several factors combine to make it an event that is potentially more dangerous and traumatic in the life of young women than it would be for adult women. This phenomenon primarily affects poorer young women and those with less education. Those who suffer particularly are the under-sixteen, who face a greater risk of suffering physiological and psychological damage when they undergo an abortion (Guzmán et al., 2001). Several authors agree that for an adolescent, it is more difficult to find a suitable abortion provider, in addition to which she is more likely to attempt to perform an abortion on herself (Persaud, 1994; Salter et al., 1997).

Sometimes adolescents abort at late stages of gestation, which increases the risk of complications (Deidre, 1999). Insufficient knowledge of and attunement to the reactions of their bodies usually means that they only realize they are pregnant quite late on. Moreover, the decision to abort is often difficult to take in view of the social sanctions that hang over this act and the lack of support they have to perform it, particularly from the second author of the pregnancy, who is rarely near his partner under these circumstances (CDM, 2005). Adolescents wishing to abort also face difficulties such as finding service providers willing to perform an abortion and, above all, the money required to cover its cost.

Adolescent women often perceive the risks associated with illegal abortion, but, given the strong social or familial disapproval in the event of an unforeseen pregnancy, abortion continues to be the only solution for many of them. In a study conducted in the city of Havana in 1999 on 400 adolescents from four schools, 68% of the young men and 78% of the girls said that they agreed with the statement, “pregnancy is a risk to adolescent health”. Similarly, 63% of the former and 78% of the latter said that they knew about the health risks associated with the practice of abortion (Calero et al., 2001).

Likewise, adolescents, like older Cuban women who have or have not resorted to abortion, frequently assume an extremely ambivalent attitude toward this resource, although many of them acknowledge that it is a solution to unwanted pregnancy (Álvarez Vázquez et al., 1999). A study that took place in northeastern Brazil from 1995 to 1998 reached similar conclusions. Participants in the study included adolescents who had interrupted their pregnancy and others who had taken it to term, some of whom were interviewed a year later. It was found that those who had aborted regarded the practice as less acceptable than those that had only contemplated the possibility of aborting (Bailey et al., 2003).

In Chile, a predominantly Catholic country where abortion is illegal under any circumstances, women who become pregnant out of wedlock are harshly sanctioned both socially and morally and feel extremely ashamed. In a study conducted in 1991 in Santiago on women aged 10 to 19, Palma and Quilodrán concluded (1995) that, according to the living conditions and circumstances in which sex took place, pregnant adolescents chose between continuing the pregnancy within the framework of marriage, living together, living apart, or aborting. In the event of having had sex without consent, through rape or incest, certain women resorted to abortion while others chose to give their children up for adoption (Palma and Quilodrán 1995).

The practice of abortion is also closely linked to the stability of family circumstances. In a study conducted at a school in Havana, Calero and Santana (2001) concluded that “there is a greater likelihood of having an abortion and subjecting themselves to other risky processes among the children of divorced parents than among those that live with both biological parents”. In a study conducted from August 1992 to January 1993 at two hospitals in Mexico, Romero et al. (1994) found that a woman is twice as likely to abort if she is an adolescent whose mother is absent from the household, whereas the absence of the father does not, apparently, have much of an effect.

In 1995, a study was conducted on the risk factors associated with abortion among residents of the urban zones of Pelotas, belonging to the southern Brazilian state of Rio Grande do Sul. The study showed that adolescents in families with low incomes and little educational attainment abort in riskier conditions, jeopardizing their health (Olinto and Moreira-Filho, 2006).

A Poorly Known Prevalence

As mentioned earlier, it is difficult to find reliable, accurate statistics in the region on the occurrence of abortion, because of, among other things, the illegal circumstances in which they are usually performed. The literature on the subject clearly reflects the fact that this illegality more commonly affects adolescents, for whom it is even more difficult to obtain reliable information about the incidence of abortion. However, certain studies show data confirming that a large number of adolescents have abortions. This phenomenon has tended to increase in certain countries, particularly where there is restrictive legislation (WHO, 1998).

On the basis of information for 2000, Shah and Ahman (2004) estimate that in Latin America and the Caribbean 520,000 risky abortions are performed annually on women under the age of 20. This number constitutes 14% of total abortions in the region. The abortion rate is 20 per 1000 women and the abortion ratio is 28 per 100 live births. This last figure represents a higher level than that of Africa and Asia, where it is 22% and 15%, respectively.

In 1998, Singh made indirect estimates of the abortion rate for the adolescent population in five countries in the region. According to his study, this indicator varied from 13 annual abortions per thousand women ages 15 to 19 in Mexico, to 36‰ annually in the Dominican Republic. The rate was 32‰ in Brazil, 26‰ in Colombia and 23‰ in Peru. As for abortion ratio for each 100 pregnancies among women 15 to 19, it was 13% in Mexico, 29% in the Dominican Republic, 30% in Brazil, 23 in Colombia and 28% in Peru (Singh, 1998). Another study based on demographic and health surveys conducted in Brazil, Colombia, Peru and the Dominican Republic notes that the total percentage of unwanted pregnancies ending in abortion was between 69% and 97% (Hakkert, 2001).

In a study analyzing the records of all the women treated from January 1992 to June 1995 in a clinic in a small city in Latin America where illegal abortions are performed, Strickler et al. (2001) obtained the following results: of a total of 808 women, 13% were under 20, and a considerable portion of those (12%) aborted with no more than 12 weeks’ pregnancy.

Other studies conducted in countries where the interruption of pregnancy is decriminalized show that in this context, adolescent abortion also has a high incidence. In a study carried out in Cuba, Gonzáles (2005) shows that whereas during the period from 1970 to 1980, a third of abortions were in adolescent women (those under the age of 20), after 1986 there were more abortions than births among this age group. This ratio has increased to over 180 abortions per 100 live births. The author adds that as a result of the introduction of Menstrual Regulation since the late 1980s, there has been a decline in the number of abortions recorded in the Public Health Ministry statistics. This statistic has to be viewed with caution, however, as Menstrual Regulation frequently disguises a voluntary abortion.

The results of a survey conducted in the 10 de Octubre municipality in Havana throughout 1991 and the first half of 1992, show that of a total of 659 women who had interrupted their first pregnancy during this time period, nearly 60% were under 20 and 35% were 20 to 24 years old. The probability of having an abortion is 3.3 times higher among those under 20 than among those over 25. Among women that had voluntarily interrupted their first pregnancy, 80% had begun their sex lives under the age of 20 and had high educational attainment (Cabezas García et al., 1998). One of the conclusions of the study is that “the risk of having an abortion during the first pregnancy is high among very young women who have yet to fulfill their professional work or marital expectations. These reasons appear to be incompatible with motherhood among the group of women studied”. Likewise, the authors showed that young women usually find out about the consequences of pregnancy and the difficulties of obtaining access to abortion services rather late on. According to Guzmán et al. (2001), if one considers the abortions performed in the island in 1998 using the Menstrual Regulation method, the abortion rate for each 1000 women ages 12 to 19 was 101, and the abortion ratio 64 for each 100 pregnancies.

In another study on the sexual and preventive behavior of students at a polytechnic school in Havana conducted during the 1995-1996 school year, 82% of the young ones consulted admitted having had early sex, whereas 63% of the girls said that they had had their first intercourse under the age of 16. Moreover, 16% of them said that they had used the Menstrual Regulation method at least once, whereas 11.9% had resorted to abortion. Among the latter, 29% had aborted twice or more (Cortes Alfaro et al., 1999). Other research results show that the majority of young women that abort are students and wish to continue their studies, being this the reason for having an abortion (Navarro González and Ramos Planco, 1998). In this same country, a study showed that adolescents have very superficial knowledge of contraceptive methods and that they resort to abortion when they have an unstable relationship with their partners. The majority did not have children and chose this method to delay the start of motherhood. Over half are single but have similar sexual activity to married women and therefore, the same likelihood of conceiving. They are also women who had had several abortions, they have a family economic situation that is “unbalanced and inappropriate values regarding the role of women and single mothers.” (Libertad and Reyes Díaz, 2003).

At the same time, in 1995, Guyana had an abortion rate of 26 for every 1000 women between ages of 15 and 19, and 29 for every 100 pregnancies of women within the same age range (Guzmán et al., 2001). In the French Antilles, where abortion is legal, the abortion ratio among women age 12 to 17 and 18 to 19 during the same time period, was 42%. In Guadeloupe and Martinique it was 57% and 44% respectively, and in French Guyana it was 20% and 22% for each of the age ranges mentioned. For these young women, frequent abortions are common, with 12% having had at least one abortion (Bordan, 2000). It is estimated that on the Caribbean island of Guadeloupe, in 2002, 31 abortions were performed for every 1000 women under the age of 20, and 59 abortions were performed for every hundred pregnancies among women within the same age range (Claire, 2003).

According to a study on the sexual behavior of students aged 13 to 22, conducted in the Brazilian city of Porto Alegre, 12% of girls in secondary school and 15% of university students said that they had had at least one abortion. In the case of males, 2.7% of those at secondary school and 11.6% of university students said that they had been involved in a friend’s abortion. As for their position on abortion, 47% of secondary school students and 64% of university students said they would approve that this practice as a recourse for unwanted pregnancies not be penalized under Brazilian law (Souza et al., 1997).

In a survey conducted on Mexican medical students aged 15 to 24, very few women (2%) said they had resorted to abortion. They also stated that the pregnancy they had interrupted was the result of failure of the contraceptive method used (Ortiz Ortega, et al., 2003). In another study, also undertaken in Mexico in 1997, for which women aged 18 to 24 were interviewed, 20% said they had had an unforeseen pregnancy. Of these women, 23% said that they had attempted to interrupt their pregnancy, although only 10% of those who had thought about it had actually done so (Núñez-Urquiza, 2003).

At the same time, in two surveys undertaken on middle-class youth aged 13 to 18 in the main Colombian cities, it turned out that 5% of the adolescents consulted had become pregnant between the ages of 15 and 17. Of these pregnancies, 66% had ended in abortion (Ramírez, 1991).

In another study conducted in 1992 on residents of urban zones also from Colombia (Zamudio et al., 1999), it was found that nearly half the women consulted who were under the age of 20 and had been pregnant (44.5%) had had at least one abortion: 42.6% had had only one, 3.9% had had two, and 10.9% had had three. This gives an idea of the frequency of repeated abortions. This study also showed how terminating a pregnancy is particularly common among young women, since 32% of the women aged 20 to 24 and 25 to 29 consulted said that they had had at least one abortion. The abortion ratio for young women under the age of 20 was 36.6%, which is the highest of all the women in the study. Likewise, it was confirmed that the practice of abortion is widespread among the youngest adolescents, which also illustrates the role of abortion in the regulation of fertility within this population group.

A study conducted in 2000 in three Brazilian cities (El Salvador, Rio de Janeiro and Porto Alegre) to estimate the prevalence of adolescence pregnancy found that a larger percentage of men (41.3%) than women (15.3%) declared that a pregnancy (in which they have been involved) had been interrupted by abortion (Aquino et al., 2003) .

Sanseviero (2003) estimated that during the year 2000, the specific abortion rate among Uruguayan women aged 15 to 19 was approximately one abortion for every 30 women, or 32.5‰, whereas the fertility rate was 62.5‰, and over a third of pregnancies (34.2%) ended in abortion.

All this empirical evidence shows a fairly high prevalence of the practice of abortion in certain countries and specific population groups. Although they are not representative of the total number of adolescents in the region, it does warn us about the importance of abortion among them. The results of studies on the complications of abortion provide a clearer overview of how this practice affects young women.

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