The effect of economic downturns on maternal mortality among pregnancies with abortive outcomes in 81 countries, 1981–2010

ObjectiveTo determine the association between economic downturns and abortion-related maternal mortality in multiple countries over 30 years.MethodsIn a retrospective study, WHO data were obtained for maternal deaths among pregnancies with abortive outcomes between January 1, 1981, and December 31, 2010. Economic data for the same period were obtained from The World Bank. An economic downturn was defined as an annual decline in gross domestic product per head. Multivariate regression—controlling for country-specific differences in infrastructure, population size, and demographic structure—and 5-year lag analyses were performed.ResultsData were available for 81 countries. Abortion-related maternal mortality was significantly increased in years of economic downturns (R= 0.0708; 95% confidence interval [CI] 0.0264–0.1151; P= 0.0018). The association was sustained for 4 years after an economic downturn (year 1: R= 0.0709 [95% CI 0.0231–0.1187], P= 0.0037; year 2: R= 0.0634 [0.0178–0.1089], P= 0.0065; year 3: R= 0.0554 [0.0105–0.1004], P= 0.0157; year 4: R= 0.0593 [0.0148–0.1037], P= 0.009). There was an annual 36% increase in deaths associated with unsafe abortion during economic downturn years.ConclusionEconomic downturns were associated with increased abortion-related maternal mortality, possibly due to changes in government healthcare spending and service provision. A global economic downturn could impede a reduction in maternal mortality.