Economic Impact of Unsafe Abortion-Related Morbidity and Mortality: Evidence and Estimation Challenges
Unsafe abortion-related morbidity and mortality (UARMM) exacts a huge price annually in terms of the lives and health of women in developing countries each year. Almost 20 million unsafe abortions occur annually, virtually all in the developing world. More than 5 million of these result in medical complications so serious that they require hospitalisation.
The economic cost of UARMM is also enormous, burdening public health systems, the households in which these women live and also the economies of the countries themselves. The empirical data needed to estimate most of these costs are scant and in some cases, practically non-existent, but several studies of direct health-system costs are available in the literature. These data exist in two forms which allow cost estimation using two distinct methodologies, one which uses cost-per-patient data, and one which uses a model of ideal treatment inputs.
Examining the cost of UARMM to health systems using both of these methodologies, we find that the total cost to the developing world lies between $375 and $838 million, with a central estimate of around $500 million (2006 US$). Regional cost estimates show that in relation to purchasing power, abortion complications are considerably more expensive to treat in sub-Saharan Africa than in Latin America. Furthermore, millions of other women with serious complications receive no treatment from the health system. If they were able to do so, an additional $375 million or so would be expended, but this estimate rests on scant empirical data. The cost of long-term morbidities, mainly infertility and chronic reproductive tract infections, may cost many billions of dollars annually, while the losses to the economies of developing countries from lower productivity caused by UARMM may be more than $400 million. Out-of-pocket expenses to the women and their families may amount to a further $600 million. Very little data exist to make these latter estimates, but they at least show that the total cost of UARMM would be many times greater than the direct health costs, for which solid evidence does exist.
IDS Research Report 59, ISBN 1 85864 539 5, 94 pp.