which combines data from a population-based survey and a nationally
representative sample of health facilities, estimates that while the
rates of induced abortion in Cambodia increased between 2005 and 2010, unsafe
abortions did not increase. This, notes author Tamara Fetters, may be
due to changing fertility desires, improved education, increased use of
contraception, employment opportunities for girls and women, and
improved abortion service availability after legalization and national
scale-up of services.
In the five years preceding the 2005 study,
Cambodian women reported that more than 48 percent of their abortions
were performed in their own or someone else’s home, in conditions that
were unknown and likely without medical assistance or accurate
information. In the five years preceding the 2010 survey, this
proportion of women declined to 40 percent, with more women seeking care
in a health facility. While the absolute number of women seeking
abortions increased, women were more likely to obtain this care from a
health professional in a health facility.
The study, published in Global Public Health,
is one of only a handful of studies to examine abortion incidence in
Cambodia, a country that has seen rapid changes since 1992 marked the
end to 30 years of internal conflict. In 1997, the country legalized
induced abortion up to the twelfth week of pregnancy and later for some
indications. According to the study authors, law change, coupled with a
national effort to train providers, increase access and overcome stigma
around abortion, were factors in the changing landscape of abortion in
Cambodia.
Researchers used data collected from 188
public sector hospitals and health centers in 2005 and 205 hospitals and
health centers in 2010 on women with complications from an induced
abortion or miscarriage in both 2005 and 2010. During the one month of
data collection 304 women in 2005 and 554 in 2010 requested and received
a legal induced abortion in the study facilities. They also conducted a
secondary analysis of 2010 Cambodia Demographic and Health surveys and
applied this to the annualized abortion figures collected in the
national sample of public sector facilities. The midpoint estimate of
induced abortions performed in public sector facilities in 2005 was
estimated to be 8,236 and 15,416 in 2010.
Overall, says Fetters, “Progress is being
achieved to reduce unsafe abortion in the country.” Availability and
accessibility of legal abortions changed most dramatically between 2005
and 2010 after technical guidelines were introduced and the national
safe abortion training program began in 2006. “Legal abortions were
virtually unavailable in 2005 and increased from only 7 percent of
facilities to 36 percent providing this service in 2010,” she adds.
There are still barriers that prevent women from getting the care they
seek though: Overall, 20,000 women were turned away for a legal
procedure during the two study years.
But, says Fetters, the picture is improving and, with continued efforts to meet women’s needs for safe abortion and to prevent unwanted pregnancies that often lead to unsafe procedures, can get even better.
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