Unintended pregnancy and induced abortion in Sierra Leone: abortion incidence complications method-based estimates

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BACKGROUND: Unsafe abortions remain a significant contributor to the high maternal morbidity and mortality in Sierra Leone. The country has among the highest maternal mortalities worldwide. However, little is known about the incidence of induced abortion and unintended pregnancy in the country. METHODS: We used the Abortion Incidence Complications Method to create nationally representative estimates of the incidence of abortion and unintended pregnancy in Sierra Leone in 2021. First, we estimated the total number of post-abortion care cases resulting from induced abortions using a nationally representative sample of health facilities (n = 291). Next, we estimated the proportion of all induced abortions in the country that would result in women receiving post-abortion care using data from a survey conducted among a purposive sample of experts knowledgeable about abortion in Sierra Leone. The national estimate of induced abortion is the product of the estimated number of post-abortion care cases and the multiplier generated from the proportion of all induced abortions that would result in health facility care. The estimate of induced abortion and the national estimate of unintended births based on Demographic Health Survey data were used to estimate the incidence of unintended pregnancy in 2021. RESULTS: In 2021, 37,262 patients were treated for post-abortion complications in Sierra Leone, of which we estimated 27,467 were due to induced abortions. Approximately 91,494 induced abortions (uncertainty interval (UI): 41,489-141,500) occurred in Sierra Leone in the same year, translating to a national induced abortion rate of 44.2 (UI: 20.1-68.4) per 1,000 women aged 15-49 and with significant regional variations. Of all pregnancies in 2021, 38% were unintended. This corresponds to an unintended pregnancy rate of 70 per 1,000; we estimate that 63% of unintended pregnancies ended in induced abortions. CONCLUSIONS: This is the first study to report on the national incidence estimates of induced abortion and unintended pregnancy in Sierra Leone. Findings demonstrate that both are prevalent in the country. Findings offer insights that could be used to strengthen efforts towards reducing unsafe abortions, improving access to quality comprehensive abortion care and family planning services, and informing advocacy for abortion legal reforms in Sierra Leone.

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