Temporal trends and spatial distribution of unsafe abortion in
          Brazil, 1996-2012

Martins-Melo, Francisco Rogerlândio; Lima, Mauricélia da Silveira; Alencar, Carlos Henrique; Ramos Jr, Alberto Novaes; Carvalho, Francisco Herlânio Costa; Machado, Márcia Maria Tavares; Heukelbach, Jorg

doi:10.1590/S0034-8910.2014048004878

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Brasil

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Sumário

Public Health Practice • Rev. Saúde Pública 48 (3) • June 2014 • https://doi.org/10.1590/S0034-8910.2014048004878 copy

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

Tendência temporal e distribuição espacial do aborto inseguro no Brasil, 1996-2012

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze temporal trends and distribution patterns of unsafe abortion in Brazil.

METHODS

Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis.

RESULTS

In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R²: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R²: 93.0%, p < 0.001), Southeast (R²: 92.0%, p < 0.001) and Central-West regions (R²: 64.0%, p < 0.001), whereas the North (R²: 39.0%, p = 0.030) presented an increase, and the South (R²: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions.

CONCLUSIONS

Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Abortion, Induced; statistics & numerical data; Epidemiology; Spatio-Temporal Analysis

Region/States	Number of admissions due to abortions (in thousands)	Estimate of unsafe abortions^a (in thousands)	Percentage of unsafe abortions (%)	Annual Average of unsafe abortions (in thousands)	Unsafe abortion rate (per 1,000 WCBA)^b	Unsafe abortion ratio (per 100 NV)
North	364,431	1,537,443	90,438	9.1	20.2	30.3
Rondônia	29,877	126,044	7,414	0.7	15.4	26.0
Acre	24,894	105,022	6,178	0.6	32.0	38.6
Amazonas	85,000	358,594	21,094	2.1	21.4	30.9
Roraima	12,465	52,587	3,093	0.3	26.5	31.5
Pará	158,559	668,921	39,348	4.0	18.6	29.1
Amapá	25,916	109,333	6,431	0.6	35.9	43.8
Tocantins	27,720	116,944	6,879	0.7	17.4	26.1
Northeast	1,404,084	5,923,479	348,440	35.0	21.6	39.7
Maranhao	111,535	470,538	27,679	2.8	14.7	24.6
Piauí	80,699	340,449	20,026	2.0	20.9	39.7
Ceará	224,350	946,477	55,675	5.6	22.1	41.4
Rio Grande do Norte	51,097	215,565	12,680	1.3	13.4	24.0
Paraíba	59,830	252,408	14,848	1.5	13.1	25.0
Pernambuco	227,464	959,614	56,448	5.7	20.9	37.7
Alagoas	87,386	368,660	21,686	2.2	22.7	35.9
Sergipe	79,525	335,496	19,735	2.0	31.6	52.9
Bahia	482,198	2,034,273	119,663	12.0	27.1	53.6
Southeast	1,571,665	6,630,462	390,027	39.2	15.5	33.0
Minas Gerais	388,272	1,638,023	96,354	9.7	15.8	36.6
Espírito Santo	73,141	308,564	18,151	1.8	16.5	33.5
Rio de Janeiro	350,053	1,476,786	86,870	8.7	17.6	37.3
Sao Paulo	760,199	3,207,090	188,652	19.0	14.4	29.8
South	381,912	1,611,191	94,776	9.5	11.1	23.0
Paraná	149,830	632,095	37,182	3.7	11.3	22.3
Santa Catarina	103,578	436,970	25,704	2.6	13.7	28.9
Rio Grande do Sul	128,504	542,126	31,890	3.2	9.4	20.3
Central-West	263,207	1,110,405	65,318	6.6	15.4	28.8
Mato Grosso do Sul	47,231	199,256	11,721	1.2	16.2	28.8
Mato Grosso	42,966	181,263	10,663	1.1	12.0	21.4
Goiás	90,981	383,826	22,578	2.3	12.4	24.5
Federal District	82,029	346,060	20,356	2.0	25.1	45.1
Brazil	4,007,327	16,905,911	994,465	100.0	17.0	33.2

Regions/States	Model^a	R^2b	p	Trend
North	Y = 21.139 + 0.66x - 0.044x²	0.393	0.03	Increasing, not constant
Rondônia	Y = 15.363 - 0.079x + 0.011x²+ 0.003x³	0.061	0.838	Stable
Acre	Y = 31.433 - 0.538x	0.328	0.016	Decreasing and constant
Amazonas	Y = 25.043 + 0.416x - 0.165x²	0.710	< 0.001	Increasing, not constant
Roraima	Y = 22.496 + 1.035x + 0.148x²	0.135	0.362	Stable
Pará	Y = 18.533 - 0.276x	0.728	< 0.001	Decreasing and constant
Amapá	Y = 34.636 + 1.122x	0.335	0.015	Increasing and constant
Tocantins	Y = 17.140 + 0.454x	0.380	0.008	Increasing and constant
Northeast	Y = 21.747 - 0.631x	0.930	< 0.001	Decreasing and constant
Maranhao	Y = 14.529 + 0.248x	0.443	0.004	Increasing and constant
Piauí	Y = 21.160 - 0.609x	0.863	< 0.001	Decreasing and constant
Ceará	Y = 22.342 - 0.778x	0.873	< 0.001	Decreasing and constant
Rio Grande do Norte	Y = 12.267 - 0.550x + 0.048x²+ 0.009x³	0.368	0.103	Stable
Paraíba	Y = 12.835 + 0.630x	0.686	< 0.001	Increasing and constant
Pernambuco	Y = 21.073 - 0.724x	0.927	< 0.001	Decreasing and constant
Alagoas	Y = 22.931 - 0.741x	0.747	< 0.001	Decreasing and constant
Sergipe	Y = 32.287 - 1.513x	0.956	< 0.001	Decreasing and constant
Bahia	Y = 27.321 - 1.113x	0.921	< 0.001	Decreasing and constant
Southeast	Y = 15.817 - 0.431x	0.921	< 0.001	Decreasing and constant
Minas Gerais	Y = 16.105 - 0.457x	0.881	< 0.001	Decreasing and constant
Espírito Santo	Y = 17.110 - 0.760x	0.911	< 0.001	Decreasing and constant
Rio de Janeiro	Y = 17.938 - 0.609x	0.768	< 0.001	Decreasing and constant
Sao Paulo	Y = 14.770 - 0.323x	0.894	< 0.001	Decreasing and constant
South	Y = 11.358 - 0.122x - 0.005x²+ 0.003x³	0.220	0.340	Stable
Paraná	Y = 11.461 - 0.110x	0.268	0.033	Decreasing and constant
Santa Catarina	Y = 13.991 - 0.355x	0.698	< 0.001	Decreasing and constant
Rio Grande do Sul	Y = 9.569 + 0.354x	0.508	0.001	Increasing and constant
Central-West	Y = 15.542 - 0.274x	0.637	< 0.001	Decreasing and constant
Mato Grosso do Sul	Y = 16.412 - 0.521x	0.866	< 0.001	Decreasing and constant
Mato Grosso	Y = 11.682 + 0.077x + 0.016x²- 0.003x³	0.215	0.352	Stable
Goiás	Y = 13.647 - 0.117x - 0.047x²	0.683	< 0.001	Decreasing, not constant
Federal District	Y = 25.275 - 0.662x	0.534	0.001	Decreasing and constant
Brazil	Y = 17.221 - 0.396x	0.942	< 0.001	Decreasing and constant

Region/States	Model^a	R^{2 b}	p	Trend
North	Y = 30.106 + 0.554x	0.60	< 0.001	Increasing and constant
Rondônia	Y = 26.405 + 0.992x	0.602	< 0.001	Increasing and constant
Acre	Y = 38.152 + 0.900x + 0.021x²- 0.023x³	0.150	0.568	Stable
Amazonas	Y = 30.299 + 1.066x	0.486	0.003	Increasing and constant
Roraima	Y = 31.435 + 2.385x	0.288	0.032	Increasing and constant
Pará	Y = 29.306 - 0.307x	0.380	0.011	Decreasing and constant
Amapá	Y = 43.603 + 2.947x	0.725	< 0.001	Increasing and constant
Tocantins	Y = 26.281 + 1.315x	0.634	< 0.001	Increasing and constant
Northeast	Y = 39.775 - 0.623x	0.572	0.001	Decreasing and constant
Maranhao	Y = 22.347 - 0.073x + 0.122x²	0.436	0.024	Decreasing, not constant
Piauí	Y = 40.617 - 1.337x	0.533	0.001	Decreasing and constant
Ceará	Y = 41.403 - 0.573x	0.428	0.006	Decreasing and constant
Rio Grande do Norte	Y = 22.033 - 0.594x + 0.097x²+ 0.027x³	0.474	0.046	Decreasing, not constant
Paraíba	Y = 24.841 + 1,296x	0.627	< 0.001	Increasing and constant
Pernambuco	Y = 37.614 - 0.407x	0.418	0.007	Decreasing and constant
Alagoas	Y = 38.496 - 0.090x - 0.122x²	0.383	0.043	Decreasing, not constant
Sergipe	Y = 52.718 - 0.730x	0.361	0.014	Decreasing and constant
Bahia	Y = 53.733 - 1,574x	0.641	< 0.001	Decreasing and constant
Southeast	Y = 32.943 - 0.210x	0.254	0.047	Decreasing and constant
Minas Gerais	Y = 37.378 - 1,079x	0.424	0.006	Decreasing and constant
Espírito Santo	Y = 33.396 - 0.692x	0.798	< 0.001	Decreasing and constant
Rio de Janeiro	Y = 41.354 - 0.282x - 0.194x²	0.744	< 0.001	Decreasing, not constant
Sao Paulo	Y = 31.884 + 0.072x - 0.093x²	0.677	0.001	Decreasing, not constant
South	Y = 23.314 + 0.695x	0.781	< 0.001	Increasing and constant
Paraná	Y = 22.495 + 0.380x	0.557	< 0.001	Increasing and constant
Santa Catarina	Y = 28.592 + 0.027x + 0.015x²+ 0.001x³	0.106	0.705	Stable
Rio Grande do Sul	Y = 21.104 + 1,357x	0.744	< 0.001	Increasing and constant
Central-West	Y = 28.815 + 0.268x	0.231	0.006	Increasing and constant
Mato Grosso do Sul	Y = 28.851 - 0.367x	0.392	0.009	Decreasing and constant
Mato Grosso	Y = 21.365 + 0.404x	0.631	< 0.001	Increasing and constant
Goiás	Y = 24.685 + 0.487x	0.377	0.011	Increasing and constant
Distrito Federal	Y = 50.223 + 0.273x - 0.241x²	0.798	< 0.001	Decreasing, not constant
Brazil	Y = 33.606 + 0.290x - 0.019x²- 0.011x³	0.462	0.052	Stable

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[1] Correspondence: Francisco Rogerlândio Martins-Melo Departamento de Saúde Comunitária Faculdade de Medicina – UFC Rua Professor Costa Mendes, 1608 5º andar Rodolfo Teófilo 60340-140 Fortaleza, CE, Brasil E-mail: rogerlandio@bol.com.br