Estimating abortion incidence and unintended pregnancy among adolescents living in refugee settlements in Uganda

Abstract Background Uganda has one of the highest teenage pregnancy rates in the world. While barriers to contraceptive uptake are well documented, little is known about the incidence of abortion and unintended pregnancy among adolescents living in refugee settlements in Uganda. Methods We used an age-specific variant of the Abortion Incidence Complications Method (AICM), modified for refugee settings. We drew on three surveys administered in Uganda in 2023: a Health Facilities Survey, Knowledgeable Informant Survey, and Prospective Morbidity Survey. We used chi-squared tests for association to assess differences in reproductive health characteristics and outcomes between adolescent and non-adolescent post abortion care (PAC) patients. Results Adolescents aged 15–19 living in refugee settlements have the lowest overall abortion rate (19.7 per 1,000 women). However, when adjusted for sexual activity, adolescents living in refugee settlements have the highest abortion rates when assessed only among those who have ever had sex (89.0 per 1,000 women) or had recent sex (123.7 per 1,000 women). Over one-half of pregnancies among adolescent refugees are unintended (57.2%), but compared to other women of reproductive age they have the lowest proportion of unintended pregnancies ending in abortion (40.6%). There were no significant differences in patient care experiences and severity of abortion complications between adolescent and non-adolescent PAC patients. Conclusions Adolescents living in refugee settlements have high rates of induced abortion and unintended pregnancy. Expanding access to sexual and reproductive health information and services, including safe abortion and contraception, is critical. In particular, efforts should focus on strengthening supply chains, ensuring sexual and reproductive health is integrated into humanitarian programming, and strengthening community outreach to disseminate safe abortion information and make contraceptive services more accessible.