Relationship of family formation characteristics with unsafe abortion: is it confounded by women's socio-economic status? - A case-control study from Sri Lanka.
BACKGROUND
Literature shows that choice for unsafe abortion is often driven by poverty. However, factors related to the family formation behaviour of women are also implied as determinants of this decision. This study assessed which family formation characteristics of women are associated with the risk of unsafe abortion, without being confounded by their low socio-economic status among Sri Lankan women admitted to hospital following post-abortion complications.


METHODS
An unmatched case-control study was conducted in nine hospitals in eight districts in Sri Lanka among 171 women with post-abortion complications following unsafe abortion (Cases) and 600 postpartum mothers admitted to same hospitals during the same period for delivery of term unintended pregnancies (Controls). Interviewer-administered-questionnaires obtained demographic, socio-economic and family formation related characteristics. Risk factors of abortion were assessed by odds-ratio (OR), adjusted for their socio-economic status in logistic regression analysis.


RESULTS
Low socio-economic status, characterised by low-education (adjusted OR = 1.5; 95 % CI = 1.1-2.4) and less/unskilled occupations (2.3; 1.4-3.6) was a significant risk factor for unsafe abortion. Independent of this risk, being unmarried (9.3; 4.0-21.6), failure in informed decisions about desired family size (2.2; 1.4-3.5), not having a girl-child (2.2; 1.4-3.4) and longer average birth intervals (0.7 years; 0.6-0.8) signified the vulnerability of women for unsafe abortion. Cases were as fast as the controls in their family completion (4.3 versus 4.5 years; p = 0.4), but were at increased risk for abortion, if their average birth intervals (including the last one) were longer. Previous contraceptive use, age at reproductive events or partners' characteristics did not impart any risk for abortion.


CONCLUSIONS
Low socio-economic status is not the most influencing risk factor for unsafe abortions leading to complications, but many other factors in relation to their family formation characteristics that are independent of their low socio-economic status.
Department of Community Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka. carukshi@yahoo.com.
Carukshi
C
Arambepola
University of Colombo, Kynsey Road, Colombo 8, Sri Lanka.
Lalini C
LC
Rajapaksa
Family Health Bureau, Ministry of Health, de Saram Place, Colombo 8, Sri Lanka.
Deepika
D
Attygalle
Family Health Bureau, Ministry of Health, de Saram Place, Colombo 8, Sri Lanka.
Loshan
L
Moonasinghe
D000024:Abortion, Illegal / Q000009:adverse effects* / Q000523:psychology; D000028:Abortion, Induced / Q000009:adverse effects* / Q000523:psychology; D000328:Adult; D001721:Birth Intervals; D016022:Case-Control Studies; D004522:Educational Status; D005191:Family Characteristics; D005193:Family Planning Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013188:Sri Lanka
Family formation characteristics; Socio-economic status; Unsafe abortion