Impact of the choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria

Abstract

AIM: To evaluate the impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. SETTING: Indigent South Africans managed in two public hospitals in the west of Pretoria. METHOD: Data were collected on all abortions (incomplete or induced) treated in the hospitals in the study area in 1997 - 1998 and 2003 - 2005. All cases of severe acute maternal morbidity and maternal deaths due to abortion were identified for these time periods. Data exclude referrals from outside the west of Pretoria. OUTCOME MEASURES: The case fatality rate (CFR), mortality index (MI) and maternal mortality ratio (MMR) due to abortions. RESULTS: In 1997 - 1998 there were 2 050 abortions, of which 80.2% were regarded as being incomplete, and in 2003 - 2005 there were 3 999 abortions, of which 42.8% were regarded as incomplete. Twenty-four women who were critically ill due to complications of abortion presented in 1997 - 1998 (a rate of 3.05/1 000 births), compared with 50 (2.76/1 000 births) in 2003 - 2005. There were 5 deaths in 1997 - 1998 (CFR of 2.4/1 000 abortions) compared with 1 death in 2003 - 2005 (CFR 0.25/1 000 abortions) (p = 0.01, relative risk (RR) 0.1, 95% confidence interval (CI) 0.01 - 0.89). The MI fell from 21.7% to 2.0% (p = 0.02, RR 0.1, 95% CI 0.01 - 0.89). The MMR was 63.6/100 000 births in 1997 - 1998 compared with 5.54/100 000 in 2003 - 2005 (p = 0.017, RR 0.09, 95% CI 0.01 - 0.74). Conclusion: The introduction of the Choice on Termination of Pregnancy Act has been associated with a massive reduction in women presenting with incomplete abortions. The prevalence of critically ill women due to complications of abortion has not changed, but the CFR, MI and MMR have declined significantly.