An indirect approach to estimate the number of induced abortions that were admitted in Thyolo district hospital during one calendar year and the approximate direct medical cost of managing them is described. This is preceded by an indirect estimate of the number of hospital admissions that resulted from spontaneous abortions.

The proposed indirect approach derives adjustment factors to make total district induced abortion estimates. This is achieved by combining vital statistics information on health seeking behaviour of women of reproductive age, the proportion of women admitted for management of complications of clandestine abortions at district main referral hospital from all of its satellite health centres in the year 1998 with "spontaneous abortion probabilities that are known to be fairly constant and distributed through out history and populations "( Harlap et al, 1980).

For the population of Thyolo, abortion ratio is found to be 13 /1,000. 27% of all abortions in the district are due to clandestine activities. However, among the cases with complications of abortions seen in the hospital, only 16% is attributed to botched induced abortions. Case fatality rate of complications of abortions is 2%, five times more than what WHO estimates should have been the rate (0.4%) in the same environmental settings (WHO, 1994). Death due to complications of abortions are among the top three leading causes of Maternal deaths, along side HIV/AIDS and Obstructed labour, and abortion related deaths account for 20% of the maternal mortality rate which for the district is 548/100,000.

Dilatation and curettage under general Anaesthesia is the standard treatment for incomplete/ complicated abortions in the district. Nearly all women with abortions that are admitted into the main hospital (96.5%) undergo dilatation and curettage. To make up for low standards of aseptic procedures and to prevent hospital-acquired infections, prophylactic antibiotics are widely prescribed. For example, although the diagnosis of septic abortion was made in only 30% of cases, up to 79% of cases had one or two antibiotics prescribed for them.

Management of complications of abortions take up substantial resources from scarce health care resources for the district health care system not only in terms of drugs used but also Ward and Theatre staff time expended, hotel costs and transportation of patients. 2.3% of total district Pharmacy budget of MK 6,500,000.00 is spent on drugs for managing complications of abortions, with each abortion case on average costing MK 486.41, just under a quarter of a monthly salary for a newly employed registered nurse.