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International Perspectives on Sexual and Reproductive Health Self-reported Abortion-related Morbidity: a Comparison of Measures in Madhya Pradesh,india Symptom-based Measure Bed Rest–based Measure

International Perspectives on Sexual and Reproductive Health Globally, unsafe abortion results in a heavy burden of preventablemortality andmorbidity. The vast majority of unsafe abortions—98%—occur in developing countries, and more than half occur in Asia.1 An estimated 66,500 women die annually from complications of unsafe abortion,2 and amuch greater, and largely uncounted, number suffer morbidity.1,3 Furthermore, an estimated 7.4million disability-adjusted life years are lost annually as a result of unsafe abortion,4 and each year 1.6 million women suffer secondary infertility and 3–5 million experience chronic reproductive tract infections.5 The cost of treating complications of unsafe abortion is a substantial burden on struggling health care systems in the developing world, where the direct cost is estimated at $375–$838 million annually; women and families pay an additional $600million out of pocket.5 In addition to these economic costs, abortionrelated morbidity takes a largely unmeasured toll on women, not only physically and emotionally, but also in disruption of their daily social and economic activities. Despite the considerable physical, economic and social costs of abortion-related morbidity in developing countries, there is a dearth of data on population-level morbidity in these settings.1,3,6 These data are essential both for drawing policymakers’ attention to the importance of addressing abortion-related morbidity and for providing an evidence base fromwhich to develop effective strategies to reduce it. The difficulty of measuring morbidity is another challenge, especially given the lack of a standard set of measures. This study documents the population-level abortion-relatedmorbidity inMadhya Pradesh, India, and compares the performance of two measures designed to capture different dimensions: the effect of suchmorbidity onwomen’s physical health and on their ability to perform daily social and economic activities. We hope to focus attention on how morbidity is measured, and improve the understanding of how abortion-relatedmorbidity is influenced by the provider and method used.