Spatial distribution of hospitalizations for abortion in Brazil: an ecological study, 2020-2023
TL;DR
The results highlight regional inequalities and suggest that socioeconomic and health factors are related to hospitalization patterns observed at the aggregate level, which reinforce the need for public policies focused on reproductive health.
Abstract
Abstract Objectives: to analyze the spatial distribution and factors associated with hospitalizations for abortion in Brazil from 2020 to 2023. Methods: an ecological study of hospitalizations for abortion across the Brazilian Federative Units among women aged 10-49 years and their association with socioeconomic, demographic, and health indicators analyzed at the aggregate level. Public hospitalization and sociodemographic data were used. Spatial autocorrelation was assessed using Moran’s I index, and associations were investigated using ordinary least squares (OLS) regression, with assessment of spatial dependence in the residuals. Results: a total of 700,926 hospitalizations for abortion were analyzed, with rates ranging from 1,373.14 to 1,843.10 per 100,000 women, concentrated in Federative Units located in the North and Northeast regions. Spatial clusters were identified in all regions. Associations were observed between hospitalization rates for spontaneous abortion, vulnerability to poverty, and the percentage of hospitalizations among Black individuals; hospitalizations for medically indicated abortion were associated with the average income of employed women and the maternal mortality rate; and hospitalizations for other pregnancies ending in abortion were associated with fertility. Conclusions: the results highlight regional inequalities and suggest that socioeconomic and health factors are related to hospitalization patterns observed at the aggregate level. These associations should be interpreted as exploratory and hypothesis-generating. The findings reinforce the need for public policies focused on reproductive health.