Reported patterns of pregnancy termination from Demographic and Health Surveys

• Published in: PloS one Vol. 14; no. 8; p. e0221178
• Main Authors: Sánchez-Páez, David A, Ortega, José Antonio
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.08.2019; Public Library of Science (PLoS)
• Subjects: Abortion; Abortion policy; Abortion, Induced - statistics & numerical data; Abortion, Induced - trends; Adolescent; Adult; Africa South of the Sahara; Age; Asia; Biology and Life Sciences; Birth control; Calendars; Cluster Analysis; Comparative literature; Comparative studies; Contraception Behavior - statistics & numerical data; Contraceptives; Demographics; Demography; Demography - statistics & numerical data; Developing countries; Developing Countries - statistics & numerical data; Differentials; Engineering and Technology; Family planning; Family Planning Services - statistics & numerical data; Female; Fertility; Global Health - statistics & numerical data; Global Health - trends; Health; Health surveys; Humans; Indicators; International aspects; LDCs; Levels; Medicine and Health Sciences; Middle Aged; Miscarriage; Multivariate analysis; Oral contraceptives; People and Places; Physical Sciences; Polls & surveys; Pregnancy; Pregnant women; Public health; Regional analysis; Reporting; Reproduction; Reproductive health; Reproductive systems; Research and Analysis Methods; Social Sciences; Studies; Surveys; Trends; USSR; Young Adult; Africa South of the Sahara; Asia; USSR; Spain; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221178

Demographic and Health Surveys, widely used for estimation of fertility and reproductive health indicators in developing countries, remain underutilized for the study of pregnancy termination. This is partly due to most surveys not reporting the type of pregnancy termination, whether spontaneous or induced. Reproductive calendar data makes it possible to examine termination patterns according to contraceptive use at the time of pregnancy. Contraceptive failure is expected to increase the likelihood of induced abortion helping in the interpretation of reported termination patterns. We use individual-level calendar data regarding 623,966 pregnancies to analyze levels and differentials in reported patterns of pregnancy termination by age, union status, and contraceptive use in 107 DHS surveys from 50 countries. From the estimates of the probability of pregnancy termination, we compute derived reproductive health indicators providing an assessment of what is driving the differences by comparison to the few surveys reporting the type of pregnancy termination. From our estimates, 10.9% of pregnancies do not end in live-birth and 63.7% of them are spontaneous terminations. Reported pregnancy termination is higher among women using contraceptives, consistent with expectations. Very low levels of reported PT in some countries, particularly in sub-Saharan Africa, suggests possible underreporting. Differential patterns emerging from cluster analysis and regional rates indicate high rates of pregnancy termination driven by induced abortion in countries from the Former Soviet Union and Asian countries with liberal laws. Most countries with restrictive abortion laws have low levels of reported termination. While the probabilities of pregnancy termination are higher at older ages, termination rates generally peak at younger ages due to higher conception rates. This is the first large comparative study of the patterns of reported pregnancy termination in DHS surveys. While we have explored the extent to which differences arise from spontaneous terminations or induced abortion, more research is needed regarding the determinants of reported pregnancy termination.