Multiple factors including a women’s age, marriage status, education and how many living children she has are associated with pregnancy termination in low- and middle-income countries, according to a new study published this week in the open-access journal PLOS Global Public Health by Djibril Ba of Penn State College of Medicine, U.S., and colleagues.

In low- and middle-income countries (LMICs), a woman’s decision to terminate a pregnancy is often impacted by a patriarchal structure of society, restrictive abortion laws, cultural and religious beliefs and economic factors. About 45% of all abortions are considered unsafe; of those, 97% take place in LMICs. To reduce these unsafe abortions, it is crucial to fully understand the factors associated with the prevalence of pregnancy termination.

In the new study, the researchers used data on more than 1.2 million women aged 15–49 who participated in the Integrated Public Use Microdata Series (IPUMS) Demographic and Health Surveys (DHS). The women were from 36 LMICs across Africa and Asia and answered the question “Have you ever had a pregnancy terminated?” in addition to providing other health and sociodemographic data.

The average pooled weighted prevalence of pregnancy termination across the entire study was 13.3% (95% CI 13.2%–13.4%), ranging from a low of 7.8% in Namibia to 33.4% in Pakistan. Overall, being married had the strongest association with pregnancy termination (adjusted OR 2.94, 95%CI 2.84–3.05, pSince the data only included women who self-reported pregnancy termination, they cannot be used to draw conclusions about the general populations of the LMICs studied. However, the authors conclude that the study provides some guidance for targeted public health interventions.

“Our current analysis suggests that policies that will effectively reduce the prevalence of pregnancy termination should target individuals such as married women [and] older women,” the researchers say. “Providing birth control assistance and promoting breastfeeding may also play an essential role in reducing the risk of unintended pregnancies and unsafe abortions in LMICs.”

The authors add, “There is a need for future demographic and health surveys (DHS) to distinguish between induced abortions, miscarriages, and stillbirths for every country. Such a distinction will guide pregnancy termination specific public health and medical intervention needs in Low-and Middle-Income Countries.”