Peter J. White and Antonio Bernabé-Ortiz
CMAJ May 26, 2009 180 (11) 1133-1134; DOI: https://doi.org/10.1503/cmaj.1090013
Peter J. White
Antonio Bernabé-Ortiz
Two of the authors respond:
The correct measure of the public health burden of a discrete event is its incidence: the annual per capita rate of occurrence of the event of interest in the relevant population group. As we reported, the incidence of induced abortion in Peru is as high as, or higher than, the incidence in Britain and the United States, but in Peru this practice is illegal, performed clandestinely and potentially unsafe. 1
Evaluating the impact that legal restrictions on access to induced abortions have on the rates of induced abortion in different countries requires consideration of data from many countries. Neither we nor Renzo Puccetti undertook such an analysis; our aim was to perform a detailed analysis of data from a single country.
Puccetti's calculation does not allow for underreporting of induced abortion by participants in our study; this does not affect the British and US statistics, which are based on clinical records. 1 Nevertheless, he is probably correct in his assertion that the legal restrictions in Peru result in relatively fewer pregnancies being terminated in that country than in Britain or the United States; that is, there are more unwanted births in Peru. Indeed, Ferrando reported that the "desired fertility rate in Peru is 1.8 children; however, an average of 2.9 children are born." 2
The high incidence of induced abortion clearly indicates a high incidence of unwanted pregnancy. In our study, 22% of pregnant women (91/410) reported that the pregnancy was unwanted. Almost half of the sexually active women in our study reported that they did not use contraception; therefore, increased provision of contraception and education on safer sex could greatly reduce the rates at which induced abortions are performed. We hope that our study will increase awareness of the scale of the problem and stimulate political action to address it; there is already public support in Latin America for such action. 3
Ferrando D. Clandestine abortion in Peru: facts and figures 2002. Lima (Peru): Centro de la Mujer Peruana Flora Tristan; 2002.
Yam EA, Dries-Daffner I, Garcia SG. Abortion opinion research in Latin America and the Caribbean: a review of the literature. Stud Fam Plann 2006;37:225–40.
Vol. 180, Issue 11
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Peter J. White, Antonio Bernabé-Ortiz
CMAJ May 2009, 180 (11) 1133-1134; DOI: 10.1503/cmaj.1090013
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