Sarah Jamil, Shirin Ramzan Ali , Fauziah Rabbani.

Introduction. The Department of Community Health Sciences of the Aga Khan University has designed and developed Primary Health Care (PHC) programme modules in selected urban squatter settlements of Karachi. Each of the modules serves a population of approximately 10,000 with emphasis on mothers and children under five. Mortality at these urban field sites is discussed as a routine to identify the problems and issues related to these deaths. Assignment of the cause of death is done through a structured verbal autopsy form. Recently, at one of the field sites, induced abortion as a cause of maternal death was identified. This tragic death lead the team to investigate the frequency and determinants of induced abortions among ever-married women living in Orangi.

Research design and methods. Basic demographic information including a detailed reproductive history is collected periodically and entered in family folders maintained for every family registered in the PHC field sites. We selected 34 ever-married women who had at least one abortion in their reproductive history as cases. This case series collected information on total number of pregnancies, total number of abortions, total number of induced abortions, methods used for induced abortions, and family planning methods used.

Results. Out of a total of 283 pregnancies, 66 (23 %) ended in abortions. Twelve percent (33/ 283) of these abortions were induced. Most common methods used for the induction of abortion were dilatation and curettage ( 50%), followed by oral pills(17 %) intravaginal pessaries ( 11 %), and traditional methods (11%). These abortions were mainly conducted by traditional birth attendants( 69 %) . Only in 23 % of cases, were abortions performed by qualified medical personnel. Mean birth order for induced abortions was nine ( range of 3-15 ), and a median of 8.5. Of the 34 interviewed women, 68% (23/34) were "familiar with the use of modern family planning methods" though 48% (11/23) resorted to induced abortion. The 33 induced abortions were reported by 18 women, of whom 8 reported more than one induced abortion.

Conclusion. These findings emphasize the need for better and effective family planning services in the community. The morbidity and the mortality risk associated with the induced abortions performed in presumed contaminated conditions needs to be further explored as a reproductive health issue.

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