title: The effect of economic downturns on maternal mortality among pregnancies with abortive outcomes in 81 countries, 1981-2010.
abstract: OBJECTIVE
  To determine the association between economic downturns and abortion-related maternal mortality in multiple countries over 30 years.
  
  
  METHODS
  In a retrospective study, WHO data were obtained for maternal deaths among pregnancies with abortive outcomes between January 1, 1981, and December 31, 2010. Economic data for the same period were obtained from The World Bank. An economic downturn was defined as an annual decline in gross domestic product per head. Multivariate regression-controlling for country-specific differences in infrastructure, population size, and demographic structure-and 5-year lag analyses were performed.
  
  
  RESULTS
  Data were available for 81 countries. Abortion-related maternal mortality was significantly increased in years of economic downturns (R=0.0708; 95% confidence interval [CI] 0.0264-0.1151; P=0.0018). The association was sustained for 4 years after an economic downturn (year 1: R=0.0709 [95% CI 0.0231-0.1187], P=0.0037; year 2: R=0.0634 [0.0178-0.1089], P=0.0065; year 3: R=0.0554 [0.0105-0.1004], P=0.0157; year 4: R=0.0593 [0.0148-0.1037], P=0.009). There was an annual 36% increase in deaths associated with unsafe abortion during economic downturn years.
  
  
  CONCLUSIONS
  Economic downturns were associated with increased abortion-related maternal mortality, possibly due to changes in government healthcare spending and service provision. A global economic downturn could impede a reduction in maternal mortality.
authors.affiliation: Imperial College London, London, UK; Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK. Electronic address: bonnie.ng@doctors.org.uk.
authors.forename: Ka Ying Bonnie
authors.initials: KY
authors.lastname: Ng
authors.affiliation: Imperial College London, London, UK.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Medical Sciences Division, University of Oxford, Oxford, UK.
authors.forename: Jawaad
authors.initials: J
authors.lastname: Farrukh
authors.affiliation: The Economist, London, UK; Faculty of History, University of Oxford, Oxford, UK.
authors.forename: Callum
authors.initials: C
authors.lastname: Williams
authors.affiliation: Imperial College London, London, UK; Harvard School of Public Health, Harvard University, Cambridge, MA, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Special Envoy for Financing, World Health Organization, Geneva, Switzerland; University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeltner
mesh_terms: D000028:Abortion, Induced / Q000191:economics / Q000401:mortality*; D000022:Abortion, Spontaneous / Q000191:economics / Q000401:mortality; D002423:Cause of Death; D003695:Delivery of Health Care / Q000191:economics; D057172:Economic Recession; D005260:Female; D006801:Humans; D063130:Maternal Death / Q000191:economics / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D015999:Multivariate Analysis; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: Abortion; Economic downturns; Maternal mortality