MEASURE DHS+ assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Funded by the U.S. Agency for International Development 

(USAID), MEASURE DHS+ is implemented by ORC Macro in Calverton, Maryland. 

The main objectives of the MEASURE DHS+ project are: 

1) to provide decisionmakers in survey countries with information useful for informed policy choices, 

2) to expand the international population and health database, 

3) to advance survey methodology, and 

4) to develop in participating countries the skills and resources necessary to conduct high-quality 

demographic and health surveys. 

Information about the MEASURE DHS+ project or the status of MEASURE DHS+ surveys is available on 

the Internet at http://www.measuredhs.com or by contacting: 

ORC Macro 

11785 Beltsville Drive, 

Suite 300 

Calverton, MD 20705 USA

Telephone: 301-572-0200

Fax: 301-572-0999 

E-mail: reports@macroint.com
DHS Analytical Studies No. 6 

Contraception–Abortion Connections 

In Armenia 

Charles F. Westoff 

Jeremiah M. Sullivan 

Holly A. Newby 

Albert R. Themme 

August 2002 

ORC Macro 

Calverton, Maryland USA 
This publication was made possible through support provided by the U.S. Agency for International

Development under the terms of Contract No. HRN-C-00-97-00019-00. The opinions expressed herein

are those of the authors and do not necessarily reflect the views of the U.S. Agency for International 

Development. 

Recommended citation: 

Westoff, Charles F., Jeremiah M. Sullivan, Holly A. Newby and Albert R. Themme. 2002. Contraception–

Abortion Connections in Armenia. DHS Analytical Studies No. 6. Calverton, Maryland: ORC Macro. 
Contents 

Page 

Preface .................................................................................................................. v

Acknowledgements...............................................................................................vi

Executive Summary .............................................................................................vii

1 Background............................................................................................... 1

2 Contraception and Abortion: Levels and Trends...................................... 2

3 Contraceptive Use Before and After Abortion ......................................... 6

4 Intention to Use Contraception ................................................................. 7

5 Other Dimensions of Abortion.................................................................. 8

Pregnancy Order................................................................................. 8

Abortion for Spacing and Limiting Births.......................................... 8

6 Attitudes toward Abortion and Contraception........................................ 10

7 Covariates of Contraceptive Use ............................................................ 11

8 Covariates of Abortion............................................................................ 13

The Urban-Rural Anomaly............................................................... 14

9 Models of Abortion and Contraception .................................................. 17

Parameters of the Models................................................................. 17

Results.............................................................................................. 18

Implications of Changes in the Components.................................... 18

Role of Contraceptive Discontinuation in Abortion......................... 21

10 Conclusions............................................................................................. 23

References............................................................................................................ 25 

iii 

Preface 

One of the most significant contributions of the MEASURE DHS+ 

program is the creation of an internationally comparable body of data on the 

demographic and health characteristics of populations in developing countries. 

The DHS Analytical Studies series and the DHS Comparative Reports series

examine these data, focusing on specific topics. The principal objectives of both 

series are: to provide information for policy formulation at the international level, 

and to examine individual country results in an international context. Whereas 

Comparative Reports are primarily descriptive, Analytical Studies take a more 

analytical approach. 

The Analytical Studies series comprises in-depth, focused studies on a

variety of substantive topics. The studies are based on a variable number of data 

sets, depending on the topic under study. A range of methodologies is used, 

including multivariate statistical techniques. The topics covered are selected by 

MEASURE DHS+ staff in conjunction with the MEASURE DHS+ Scientific

Advisory Committee and USAID. 

It is anticipated that the Analytical Studies will enhance the understanding of significant issues in the fields of international population and health 

for analysts and policymakers. 

Martin Vaessen 

Project Director 

v 
Acknowledgements 

Special thanks are due to Judie Miller at the Office of Population 

Research, Princeton University, for her secretarial assistance and to Sidney 

Moore and Katherine Senzee at ORC Macro for editing and production of this 

report. The authors also want to thank Shea Rutstein for his critical review of the 

manuscript. 

vi 
Executive Summary

In Armenia, as in other countries in the orbit of the former Soviet Union,

induced abortion is an important method of birth control. The total abortion rate 

is high in Armenia, estimated at 2.6 abortions per woman for the 1998-2000

period, although there is evidence of a decline over the past 15 years. The general 

level of contraceptive practice in the country is also high, as would be expected 

in a population with low fertility (a total fertility rate of 1.7). The abortion rate 

has remained so high because the use of modern contraception is so low; the

primary method is withdrawal, which has a high failure rate. The use of modern

methods has been increasing slowly; however, the decline in abortion in the 

recent past is more the result of postponement of marriage. 

Unlike in the West, almost all abortions in Armenia and in that region of

the world are generally performed on married women with at least one child. 

Abortion is relied on mainly to limit fertility rather than to space births. The high

abortion rate notwithstanding, most Armenian women disapprove of abortion and

prefer contraception; however, at least half report that they would seek an

abortion if they were to become pregnant unintentionally. 

The analysis includes a description of the covariates of both contraceptive practice and the use of abortion and concludes with the construction of a 

model of the components of abortion. The model is used to illustrate the potential 

reduction in the number of abortions that could be realized with shifts in the 

prevalence and mix of contraceptive methods. The reduction of unmet need and a 

shift from traditional to modern methods are the main avenues in that direction. 

vii 
1 Background 

In Armenia, as in other republics of the former Soviet Union, abortion is an important method of

birth control. The reasons for this include the history of liberal legislation on abortion and its availability, 

the limited availability of modern contraception, and the attitudes and practices of the medical 

establishment. Abortion is legally available on request during the first 12 weeks of gestation and 

thereafter on more restrictive grounds (GOA, UNICEF, and SCF, 1999). There has been a shortage of 

modern contraception and a lack of training of health personnel on the subject. In the Soviet years, there 

was a suspicion of oral contraception and resistance to surgical sterilization, some of which continues

today. Condoms were in short supply. The result in Armenia has been a widespread reliance on traditional 

rather than modern methods, particularly on withdrawal, and a high abortion rate. As noted in a 1999 

assessment, “a significant demand for fertility regulation exists in Armenia but this demand is not 

adequately met. Generally speaking, Armenian people still do not have access to modern means of family 

planning” (Ministry of Health, 1999). The situation is different in some other former republics of the 

Soviet Union, where the IUD is the method most commonly used and abortion rates are lower. The 

demand for fertility regulation is evident from the low levels of fertility throughout the region; in

Armenia, low levels of fertility, coupled with a significant post-Soviet out-migration, have caused 

concern in some quarters. The 2000 Armenia Demographic and Health Survey (DHS) estimated the total

fertility rate (TFR) at 1.7 (NSS, MOH, and ORC Macro, 2001), which is higher than official estimates but 

still well below replacement. 

This analysis reviews the data on abortion and contraception collected in the Armenia DHS

survey with a focus on the interactions between the two forms of birth control and evaluates the potential 

reductions in abortion that could be realized by various combinations of increases in contraceptive 

prevalence and changes in the mix of methods used. The analysis begins with a description of current 

contraceptive practice and abortion and recent trends. 

1 
2 Contraception and Abortion: Levels and Trends 

Although a recent “Green Path” campaign has been launched in Armenia to promote family

values and to support women in their choice of modern methods of contraception, the use of withdrawal

still dominates the contraceptive profile in Armenia, accounting for about half of all current use at the 

time of the survey (Table 2.1). Since the likelihood of experiencing an unintended pregnancy with this

method is very high (a failure rate during the first year of use of nearly 30 percent), the potential for 

abortion is considerable. The more limited use of modern methods is dominated by the IUD and the 

condom, which are common in this part of the world. These estimates are consistent with those in surveys

conducted about three years before the 2000 DHS in Armenia (Khachikyan and Abrahamyan, 1998;

Ministry of Health, 1998) and suggest little overall change. In the Armenian DHS survey, a five-year

monthly calendar was used, which permits reconstructing annual estimates of contraceptive prevalence 

between 1995 and 2000. These estimates are shown in Table 2.2 based on months of marriage for women 

who were 15-44 years of age in each month (the values are roughly comparable with those for women

who ever had sex in Table 2.1). There has been an overall increase during the period primarily because of 

the rise in the use of modern methods—from 17.9 percent in 1995 to 23.1 percent in 2000. 

Table 2.1 Current contraceptive use for women who 

have ever had sex and for all women 15-44, Armenia 

DHS 2000 

Ever had

sex All women

Not using any method 40.9 59.8

Using any method 59.1 40.2

Using a modern method 22.0 15.0

Pill 1.2 0.8

Condom 7.1 4.8

IUD 9.3 6.3

Sterilization 2.1 1.4

Other 2.3 1.7

Using a traditional method 37.0 25.2

Withdrawal 31.5 21.5

Periodic abstinence 4.2 2.9 

Other 1.3 0.8

Table 2.2 Percentage of married months during 

which contraception was used in the past six years 

by women 15-44, Armenia DHS 2000 

Years ago 

Any

method 

Modern 

method 

Traditional 

method 

1 64.1 23.1 41.0

2 64.1 22.1 42.0

3 62.9 21.7 41.2

4 61.6 20.9 40.7

5 59.2 19.3 39.9

6a 57.4 17.9 39.5

a

 Up to nine months of the year included 

Estimates of abortion are unreliable in most parts of the world where registration systems are

inadequate or nonexistent or where abortion is illegal or underreported because of women’s feelings about

the subject. In the former Soviet Union, as well as in some Eastern European countries where abortion has 

been more or less institutionalized, women have been less reluctant to report the practice. Even with 

adequate registration systems, however, many abortions are not reported in official statistics because of

the growing number of abortions performed in the private sector using the vacuum aspiration procedure; 

therefore, the estimates based on survey data are more reliable. This certainly seems to be the case in 

Armenia. Whereas the official abortion rate based on registered events (per 1,000 women of reproductive 

age) was reported as 25 in 1998 (UNDP, 2000), the DHS estimate for the three-year period preceding the 

survey in 2000 is 81. The total abortion rate for this period is 2.6 abortions per woman. As noted in other 

recent surveys, the most common outcome of pregnancy in Armenia is induced abortion; for the threeyear period prior to the DHS survey, 55 percent of all pregnancies ended in abortion (Table 2.3). 

2 
Determining the trend in the 

abortion rate in Armenia is not straightforward. Using the pregnancy histories 

collected in the DHS survey to reconstruct the trend, overall there is some

evidence of a recent decline but age patterns are different from those in earlier

years. In Figure 2.1, the abortion rates 

for the four age groups have been plotted 

in three-year averages from 1980 to 

2000. For women in their twenties, the 

abortion rates increased in the early 

years, reaching a peak in 1992-1994 and declining thereafter. The rates for women in their thirties have 

been declining fairly steadily. 

Table 2.3 Indicators of the level of abortion, Armenia DHS 2000 

Percentage of women who have 

ever had an abortion 46.8 

Abortions per 1,000 women 15-44a 81 

Total abortion ratea 2.6

Percentage of pregnancies ending in abortiona 55

Mean number of abortions among women 40-49 2.8 

Mean number of abortions if ever had an abortion 3.3 

a

 For the three years preceding the survey

Figure 2.1 Trends in age-specific abortion rates 1980-2000, Armenia DHS 2000

'

'

'

'

'

,

,

,

, ,

,

&

&

& &

&

&

&

#

#

#

#

#

#

#

1980-82 1983-85 1986-88 1989-91 1992-94 1995-97 1998-00

70

80

90

100

110

120

130

140

150

160

170

180

190

200

210

220

230

Abort oi ns per 1,000

20-24

25-29

30-34

35-39

A more detailed picture of the recent trend in abortion rates and their proximate determinants can

be derived from data in the month-by-month reproductive calendar. In Armenia, sexual relations before 

marriage are uncommon and unmarried women contribute almost nothing to the abortion rates. Thus, 

Table 2.4 shows estimated abortion rates based on all woman-months of exposure and on married

woman-months of exposure. Also shown in the table are the proportion of months of exposure at high risk

of abortion and at low risk of abortion among all women and among married women.1

 1

 In the case of all women, low risk is defined as nonmarried months and married months using modern methods,

while high risk is defined as married months using either no method or a traditional method. In the case of married 

women, the low-risk category consists only of married women using modern methods, while the composition of the

high-risk category remains unchanged. 

3 
Table 2.4 Recent trends in abortion rates and exposure to the risk of abortion, Armenia DHS 2000 

Months ago 

46-66 25-45 4-24

Panel A: All Women 15-44 

Abortions per 1,000 women 85 84 78 

Percentage of months at high-risk exposure to abortion 56 53 50 

Percentage of months at low-risk exposure to abortion 44 47 50 

Panel B: Married Women 15-44 

Abortions per 1,000 married women 123 127 122 

Percentage of months at high-risk exposure to abortion 81 79 78 

Percentage of months at low-risk exposure to abortion 19 21 22 

Note: High-risk exposure includes married months in which no method or a traditional method was 

used. Low-risk exposure for married women is months of modern method use. Low-risk exposure 

for all women includes months not married as well as months of modern method use. 

Abortion rates based on all women declined by 8 percent during the period, from 85 to 78 per

1,000 (Panel A). The percentage of months at high risk of abortion declined from 56 to 50 percent, while 

months at low risk of abortion increased from 44 to 50 percent. The risk profile changed primarily due to 

an increase in nonmarried months (from 31 to 36 percent) and only secondarily due to an increase in

months of modern method use (from 13 to 14 percent). Thus, most of the recent decline in abortion for all 

women is the result of postponement of marriage. In the earliest period, 69 percent of all months were in

marriage, while in the period just before the survey, the proportion declined to 63 percent. Postponement 

of marriage is even more dramatic among younger women: the percentage of months married among 

women 20-24 dropped from 60 to 48 over the short period. 

Abortion rates based on married exposure eliminate the effect of the recent trend in postponement

of marriage and show almost no decline during the period, from 123 to 122 per 1,000 (Panel B). In the 

case of married women, the percentage of months at high risk of abortion decreased relatively little during

the period, from 81 to 78 percent.2

Thus, the recent decline in abortion in Armenia is mainly due to fewer women being married and 

exposed to the risk of pregnancy. However, the declines in abortion prior to 1995 cannot be attributed to

marriage postponement because age at marriage had been declining at least for women age 25-49 in 2000 

(NSS, MOH, and ORC Macro, 2001). The larger picture of a general decline in the abortion rate over the 

past 15 years is clearly apparent in Figure 2.2, which shows total abortion rates for all women and for 

ever-married women. Both series show a similar picture of decline over the longer period. 

 2

 It might be asked why a decrease of 3 points (from 81 to 79 percent) in the proportion of months at high risk of

abortion produced virtually no change in the marital abortion rate (from 123 to 122 per 1,000) while a decrease of 6

points (from 56 to 50 percent) produced a decrease of 8 percent (from 85 to 78 per 1,000) in the abortion rate for all

women. The explanation primarily lies in the fact that almost all abortions in Armenia are contributed by womanmonths in the high-risk exposure category (i.e., married women using either no method or a traditional method), so 

that a reduction in the relative magnitude of this category will drive a reduction in the abortion rate. For married

women, the 3-point reduction in the high-risk group is a relative decline of 4 percent (3/81), while for all women, the

6-point reduction is a relative decline of 11 percent (6/56), i.e., a relative decline almost four times as great). 

4 
Figure 2.2 Trends in total abortions rates for all women and for married women 

age 15-39 during the 15 years preceding the survey, Armenia DHS 2000 

,

,

,

,

,

3.1

2.9

3.1

2.6

2.5

%

%

%

%

%

3.8

3.6

3.8

3.2 3.2

 12 - 14 9 - 11 6 - 8 3 - 5 0 - 2

Years before survey

2

2.5

3

3.5

4

Abort oi ns per woman

% Ever-married women age 15-39 , All women age 15-39

5 
3 Contraceptive Use Before and After Abortion 

That 55 percent of women whose last pregnancy (in the past three years) ended in abortion were

using a traditional method of contraception, primarily withdrawal, indicates the magnitude of the problem

(Table 3.1, column one). Additionally, 36 percent of these women were using no method at all at the time 

of conception. The combination adds to 91 percent who had been using either an ineffective method or no

method at all. 

It is important to see how women’s use of contraception changed after their abortion experience. 

There was a slight increase in contraceptive use (Table 3.1, column two). The percentage using some

method increased from 64 to 72, with an increase in the use of modern methods (mostly the IUD) from 9 

to 19 percent. However, there is still a primary dependence on traditional methods; withdrawal declined

only from 46 to 44 percent. In another tabulation (not shown), 13 percent of women who had a recent

abortion were classified (at the time of the survey) as having an unmet need for family planning, mostly 

women who want no more children. 

Table 3.1 Method of contraception used at the time of the last 

conception (in the three years preceding the survey) among

pregnancies that ended in abortion and method currently used 

after the abortion, Armenia DHS 2000 

Method 

Use before 

abortion 

Use after 

abortion 

No method 35.6 27.9 

Any method 64.4 72.0 

Modern method 9.1 19.3 

Traditional method 55.4 52.7 

IUD 1.2 7.9 

Condom 5.1 7.9 

Periodic abstinence 6.9 6.6 

Withdrawal 46.1 44.3

6 
4 Intention to Use Contraception 

Since a significant proportion (28 percent) of women with a recent abortion are not currently

using any contraceptive method, it is of interest to see how many intend to use a method in the future. 

About three-quarters of these nonusers say that they intend to use contraception, compared with about 

half of nonusers who did not have an abortion (Table 4.1). 

Nonusers who do not intend to use a contraceptive method were asked their reason. Low 

exposure to the risk of pregnancy (either because of low fecundity or infrequent sexual activity) was the 

main reason given by both nonusers who have had a recent abortion and nonusers who have not, followed 

by opposition to the use of contraception (by either spouse). 

Table 4.1 Intention to use contraception and reasons for not 

intending to use contraception by whether woman had an abortion

in the three years preceding the survey, Armenia DHS 2000

Intention to use/ 

Reason for not

intending to use 

Nonusers with 

abortion in 

last 3 years 

Nonusers with 

no abortion in 

last 3 years 

(had sex) 

Intention to use 

Intend to use 73.0 48.3 

Not intend to use 27.0 51.7 

Reason for not intending to use

Little exposure 43.6 67.2 

Opposition to use 25.0 12.4 

Health reasons 6.1 1.8 

Side effects of use 2.5 0.5 

Interferes with body 7.0 6.2 

Other reasons 15.8 11.9 

7 
5 Other Dimensions of Abortion 

Pregnancy Order 

Unlike the West, where abortion rates are highest among unmarried women with first 

pregnancies, abortion in Armenia and in other republics of the former Soviet Union is used almost 

exclusively by married women and rarely involves first pregnancies. There is little premarital sex in

Armenia; 99 percent of never-married women 15-44 report that they have never had sex (NSS, MOH, and 

ORC Macro, 2001). Less than 1 percent of first pregnancies are aborted. The rate increases to 14 percent 

for second pregnancies and then jumps sharply to 44 percent of third pregnancies and nearly two-thirds of

fourth pregnancies (Figure 5.1). At higher orders, the abortion rate continues to increase slowly. 

Figure 5.1 Percentage of pregnancies that ended in abortion, 

by pregnancy order, Armenia DHS 2000 

&

&

&

&

&

&

&

&

1 2 3 4 5 6 7-8 9+

Pregnancy order

0

20

40

60

80

100

Percent

0.8

44.4

63.9

71.1

76.1

79.7

87.7

14.0

 

Abortion for Spacing and Limiting Births 

Fertility regulation is used both for spacing and limiting births. In Armenia, abortion is relied on 

principally to limit fertility. Of all recent abortions, 82 percent were among women who wanted no more 

children in contrast to 18 percent who reported that they would still like to have another child. Among

older women (40-49) who ever had an abortion, the largest category (53 percent) was women with one 

abortion (the last pregnancy) indicating its use for limiting purposes only. An additional 28 percent 

terminated the last pregnancy with abortion but had earlier abortions that were followed by a birth. These 

women had used abortion for both spacing and limiting purposes, but only 16 percent had used it 

exclusively for spacing (their last pregnancy resulted in a live birth).3

3

 An additional 3 percent reported their last pregnancy to be a miscarriage or stillbirth. 

8 
Among these older women, 91 percent of abortions followed an unwanted pregnancy. Given the 

increasing preference for small families, the likelihood of an abortion occurring appears even greater than

in the past, unless modern contraceptive methods become more widely used. The total fertility rate in 

Armenia, currently 1.7, would be 1.5 if only wanted births occurred. 

9 
6 Attitudes toward Abortion and Contraception

Despite the high abortion rate, Armenian women’s attitudes toward abortion are generally 

negative. Health concerns or side effects are cited by 67 percent of the women, difficulty in obtaining an 

abortion by 72 percent, costs by 61 percent, and disapproval of abortion by 69 percent. Two-thirds say 

they prefer contraception to abortion. These unfavorable attitudes toward abortion are underestimated 

because a significant proportion of women (about 20 percent) replied “don’t know” or “depends.” Despite 

these negative attitudes, half of the women say they would have an abortion if they were to become

pregnant unintentionally, and another quarter say they do not know now whether they would seek an 

abortion. Only 23 percent gave a clear negative response. 

Attitudes toward contraception are equally negative. Almost half of women who know about any 

method believe that contraception is unreliable and that no methods are completely free of health 

problems and side effects. The IUD and the condom are regarded as the most reliable methods but only

by about 20 percent of women. The condom is perceived to be the safest method (24 percent). The 

general situation is that neither abortion nor known contraceptive methods are regarded positively. In 

some respects, the attitudes toward contraception are a commentary on the lack of information about 

modern methods. In summary, there is little enthusiasm for the contraceptive methods Armenian women

know about either in terms of their perceived reliability or health safety. Similarly, there is substantial 

opposition to abortion but a clear willingness to rely on it, if necessary.

10 
7 Covariates of Contraceptive Use 

Table 7.1 Odds ratios for currently using a modern method

of contraception or for intending to use any method (if not 

currently using) among women who have ever had sex, 

Armenia DHS 2000 

Covariate 

Whether using a 

modern method

Whether intending 

to use any method

Age (in single years) 0.91 0.84 

Children ever born 1.29 NS 

Wants more children 0.73 0.72 

Years of schooling 1.19 1.10 

Currently working NS NS 

Wealth 1.24 0.85

Residence NS NS

Region 

Yerevan 1.00 1.00

Aragatsotn NS NS

Ararat NS NS

Armavir NS 1.68

Gegharkunik 0.64 NS

Lori NS 2.94

Kotayk 0.49 2.08

Shirak NS 1.52

Syunik 0.34 2.53

Vayots Dzor 0.31 NS 

Tavush NS 2.18

Ever used a method NA 2.12 

Knows source of 

method NA 1.26

Family planning media 

messages NS NS

Mass media exposure NS 1.10 

Ever had abortion 1.39 0.62 

Likelihood of having 

an abortion NS 1.59

Number of women 4,454 2,048 

Chi squared 380 857 

R squared 0.090 0.302 

NS = Not significant at 0.05 level 

NA = Not applicable 

The characteristics associated with 

contraceptive use and with the future intentions of nonusers are described in the final 

report for the DHS survey in Armenia (NSS,

MOH, and ORC Macro, 2001). Current use 

of modern contraceptive methods increases 

with age through the thirties and is highest 

for women with two or three children and 

women who want no more children. Education is directly associated with the use of

modern methods, as is urban residence. 

Women who have had an abortion are more 

likely to use a method than women with no 

history of abortion. 

These and some additional covariates are examined in a multivariate analysis 

in Table 7.1 for two dependent variables: 

1) whether women (who ever had sex) are 

currently using a modern method of contraception and 2) whether women not currently 

using any method intend to use a method in 

the future. Exactly the same multivariate 

analyses were conducted for women who 

had terminated their last pregnancy, but the 

results are so similar that they are not presented separately in Table 7.1. Younger 

women and those who want no more children are likely to be using modern contraceptive methods. Women with more schooling

and with greater wealth4

 are more likely to 

use a method. With all of these variables 

controlled, urban-rural residence shows no

association with modern contraceptive practice. Women who have ever had an abortion

are more likely to use contraception. 

The same covariates are examined in 

connection with intention to use contraception in column two of Table 7.1. Nonusers who are younger but who do not want 

more children are more likely to intend to 

use a method. Women with less wealth are

more likely to intend to use, as well as those 

exposed to the mass media in general. 

Women who have ever had an abortion are 

 4 Wealth is a summary index based on possession of a telephone, automobile or truck, refrigerator, and flush toilet. 

11 
less likely to intend to use a method, but those who say they would have an abortion if they became pregnant (the likelihood of having an abortion) are more likely to intend to use. The experience of having used 

contraception in the past is strongly associated with intending to use in the future. 

12 
8 Covariates of Abortion 

The covariates of four different measures of abortion—ever had an abortion, had an abortion in

the past three years, had more than one abortion, and whether the woman would have an abortion if she 

became pregnant unintentionally—are shown in Table 8.1.5

Nearly two-thirds of women (who have had sex) report that they have had at least one abortion, a

percentage that reaches 79 percent among women 45-49 years of age. As noted earlier, there is a striking 

increase in abortion when women have two or more children, although about a third of the women who

want more children have had an abortion. There is limited direct association with years of schooling and 

with employment, but not with residence. The range across regions is fairly narrow. There is a significant 

difference in the abortion experience in connection with past use of contraception—73 percent of the 

women who had used a method have had an abortion, compared with 41 percent of those who had never 

used contraception. This difference is no doubt related in part to the fact that as the years pass, women are 

more likely both to have used a method and to have had an abortion.

Nearly 20 percent of these women report having had an abortion in the past three years, a

percentage that peaks at age 25-29. Most of the other covariates show associations with this abortion 

statistic similar to those with ever having had an abortion, but rural women are more likely than urban

women to have had a recent abortion (a relationship that disappears in the later multivariate analysis). 

Of the women who have had an abortion, three-quarters have had more than one. The association 

with number of children is very strong, but, again, the interrelation with age must be considered. The

other covariates do not show much relationship to this dimension of abortion behavior. 

The last column of Table 8.1 focuses on the likelihood of having an abortion, measured here by 

the percentage of women who say that they would seek an abortion if they found themselves pregnant

unintentionally. Two-thirds of women (who ever had sex) said they would have an abortion under these 

circumstances. The percentage increases with age and parity and with intention to have no more children. 

There is little association with other covariates although again rural women seem more likely to have an 

abortion. There is a strong association with past use of contraception that probably reflects the motivation

to control fertility.

These variables, with some others added, are examined in the multivariate context in Table 8.2. 

What generalizations emerge when all of these variables are considered simultaneously? All four 

measures of abortion show a significant association with the number of children ever born. Years of

schooling show no association with any of these measures of abortion. Women in rural areas are more

likely to have an attitude conducive to abortion and less likely to have had more than one abortion, but 

residence shows no independent association with the likelihood of ever having had an abortion or of 

having had a recent abortion. Associations with region, with Yerevan as the reference category, strongly

indicate that Lori women have a low probability of having an abortion (consistent with the fact that Lori

has the lowest total abortion rate of any region in the country) but have a higher likelihood of having an

abortion in the hypothetical case that they were to become pregnant unintentionally. 

Perhaps the strongest predictor of abortion behavior and attitude is whether a contraceptive 

method has ever been used. For example, if a method has been used, the likelihood of having had an 

abortion at any time or in the recent past is nearly three times greater than if no method was used in the 

 5

 By definition, a woman who had an abortion in the past three years will be included among women who ever had 

an abortion although the reverse is not necessarily true. Nonetheless, the two measures are likely to show similar 

patterns of association. 

13 
past. As noted earlier, this relationship probably reflects the intensity of trying to control fertility compounded with high contraceptive failure rates. 

Table 8.1 Among women who have ever had sex, percentage who ever had an abortion, had 

an abortion in the last 3 years, had one versus more than one abortion, or would have an 

abortion if they became pregnant unintentionally, by background characteristics, Armenia DHS 

2000 

Characteristic 

Ever had an

abortion 

Had abortion in

last 3 years 

Had more than

one abortion 

Would have an

abortion 

Age

15-19 6.5 6.5 30.7

20-24 26.3 23.5 }39.4 48.7 

25–29 54.1 35.6 59.0 60.7

30–34 69.7 31.1 73.5 68.5

35-39 76.8 21.6 78.4 70.1

40-44 72.2 10.0 79.1 73.7

45-49 79.1 2.2 83.0 68.4

Children ever born

< 2 17.4 6.9 40.9 33.8 

2 70.6 28.8 69.4 68.7

3 83.2 21.6 79.5 77.3

4+ 83.3 21.1 85.6 78.3

Wants more children

Wants more 36.7 15.6 64.5 37.5 

Wants no more 75.8 20.9 76.2 75.8 

Years of schooling

< 10 55.6 17.7 76.9 59.4 

10 67.2 22.6 73.7 67.1

11-12 65.9 19.2 75.5 67.8

13+ 65.7 16.8 74.1 63.4

Currently working

Yes 73.1 17.7 77.3 66.8

No 61.1 20.6 72.5 64.7

Residence

Urban 65.3 16.5 75.0 62.0

Rural 65.8 23.9 73.7 70.6

Region

Yerevan 65.9 15.4 74.7 59.5

Aragatsotn 69.7 31.1 74.7 73.1

Ararat 67.1 21.9 72.7 72.1

Armavir 67.5 28.5 74.3 63.2

Gegharkunik 71.1 25.4 81.4 67.5

Lori 51.0 15.2 57.6 66.1

Kotayk 72.4 20.4 83.6 68.7

Shirak 64.0 16.7 73.0 72.9

Syunik 63.5 19.5 73.2 57.3

Vayots Dzor 55.8 14.2 75.0 61.9 

Tavush 64.8 18.0 74.3 73.1

Ever used a method

Yes 72.5 22.8 75.2 71.3

No 40.7 7.8 69.4 45.2

Total 65.5 19.5 74.5 65.5

14 
Table 8.2 Odds ratios for ever having an abortion, having an abortion in the last 3 years, ever having 

more than one abortion, and the likelihood of having an abortion, among women who have ever had 

sex, Armenia DHS 2000 

Covariate 

Ever had an

abortion 

Had abortion in

last 3 years 

Had more than

one abortion 

Likelihood of 

having an

abortion 

Age (in single years) 1.06 0.89 1.06 NS 

Children ever born 1.80 1.45 1.53 1.29 

Wants more children 0.53 0.55 NS 0.29 

Years of schooling NS NS NS NS 

Currently working 1.29 NS NS NS 

Wealth NS 1.07 NS NS 

Residence 

Urban 1.00 1.00 1.00 1.00

Rural NS NS 0.76 1.40 

Region 

Yerevan 1.00 1.00 1.00 1.00

Aragatsotn NS 1.55 NS NS 

Ararat NS NS NS 1.41 

Armavir NS 1.60 NS NS 

Gegharkunik NS NS NS NS 

Lori 0.42 NS 0.41 1.32

Kotayk NS NS 1.66 NS 

Shirak 0.79 NS NS 1.68 

Syunik 0.66 NS NS 0.64 

Vayots Dzor 0.43 NS NS NS 

Tavush NS NS NS 1.48 

Ever used a method 2.93 2.73 1.70 1.92

Knows source of method NS 0.64 NS NS 

Family planning media 

messages 1.08 NS NS 1.17 

Mass media exposure NS NS 0.93 NS 

Number of women 4,583 4,583 2,992 4,454

Chi squared 1,383 596 284 787 

R squared 0.235 0.131 0.084 0.137 

NS = Not significant at 0.05 level 

The Urban-Rural Anomaly

The urban-rural abortion differential in Armenia differs from that of most other countries in the 

region. Typically, abortion rates are higher in urban areas than in rural areas, a contrast that is observed in 

Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Ukraine, and Uzbekistan. Only in Armenia and 

Azerbaijan is there clear evidence of a higher abortion rate in rural areas (in Georgia, there is no

15 
difference). In Armenia, the total abortion rate in rural areas is 3.4, compared with 2.1 in urban areas

(NSS, MOH, and ORC Macro, 2001); in Azerbaijan, the corresponding rates are 3.4 and 2.8 (Serbanescu

et al., 2002). That the difference in Armenia is not statistically significant when viewed in the multivariate 

context—at least in connection with ever having had an abortion or having had an abortion in the past

three years—does not diminish the program implications of its greater incidence in rural areas.

For both of these countries, the explanation appears to lie in the greater use of traditional methods 

in rural areas, particularly withdrawal with its high failure rate. In Armenia, 41 percent of rural women

(married, 15-44) rely on withdrawal, compared with 29 percent in urban areas; in Azerbaijan, the 

corresponding estimates are 48 and 34 percent, respectively. In Armenia, higher failure rates in rural areas 

with both modern and traditional methods also contribute to the differential. A greater proportion of

married women live in rural areas (69 percent) than in urban areas (58 percent), so that about one-third of 

the urban-rural abortion differential arises from differences in the proportion married. Nevertheless, in 

both Armenia and Azerbaijan, differences in contraceptive use appear to be the primary cause of the

higher abortion rates in rural areas. 

16 
9 Models of Abortion and Contraception 

To evaluate the relative importance of contraceptive prevalence and method mix on levels of 

abortion, data from the monthly calendar have been used to construct a model. These data include the 

type of method used, the duration of each segment of use and nonuse, the reasons for method discontinuation, and the outcome of each pregnancy. Such information permits estimation of contraceptive

failure rates, pregnancy rates in periods of nonuse, rates of method discontinuation, and the proportion of 

pregnancies terminated by abortion. 

Parameters of the Models 

Table 9.1 Model parameters based on women 15-44, Armenia 

DHS 2000 

Contraceptive users 

 Percentage currently using any method 40.1 

 Annual failure rate (per woman-year of use) 0.153 

 Percentage of failures that ended in abortion 80.7 

 Percentage currently using a modern method 15.0 

 Annual failure rate (per woman-year of use) 0.070 

 Percentage of failures that ended in abortion 68.6 

 Percentage currently using a traditional method 25.1 

 Annual failure rate (per woman-year of use) 0.198 

 Percentage of failures that ended in abortion 83.3 

Nonusers 

 Percentage not using any method 59.9 

 Pregnancy rate (per woman-year of nonuse, all 

 women) 

0.159 

 Pregnancy rate (per woman-year of nonuse,

 women who ever had sex) 

0.300 

 Percentage of pregnancies that ended in abortion 37.8 

Unmet needa

 Percentage in need of family planning 10.3 

 Pregnancy rate (per woman-year of exposure) 0.638 

 Percentage of pregnancies that ended in abortion 43.2 

Seeking pregnancyb

 Percentage seeking pregnancy 5.5 

 Pregnancy rate (per woman-year of exposure) 0.662 

 Percentage of pregnancies that ended in abortion 10.4 

Low risk 

 Percentage at low risk of pregnancy 12.5 

 Pregnancy rate (per woman-year of exposure) 0.020 

 Percentage of pregnancies that ended in abortion 43.8 

Exposure

 Percentage never had sex 31.5 

Note: Estimates are based on the experience of women 15-44 in 

the past 36 months except for unmet need, those seeking 

pregnancy, and the low-risk category, which are based on the 

3-20 months preceding the survey. a Includes those currently pregnant unintentionally. b

 Includes those currently pregnant intentionally. 

The contraceptive failure rates 

are estimated for modern and traditional 

methods for the three-year period preceding the survey (approximately 1998-

2000) for women 15-44 years of age (in

each year). The rates are based on the

pregnancies reported to have occurred

while the method was being used, divided by the number of months of use of

that method. The average annual failure

rate for modern methods (principally the 

IUD and the condom) is 0.070 per

woman-year of use, and for traditional 

methods (mostly withdrawal), it is 

0.198. The likelihood of terminating a 

pregnancy that resulted from contraceptive failure is 81 percent; for users of 

modern methods it is 69 percent, and for

users of traditional methods, it is 83 percent (Table 9.1). 

Pregnancy rates for users and 

nonusers of contraception are calculated 

in the same way. Nonusers who have 

ever had sex are a heterogeneous mixture of different kinds of exposure including fecund women who do not want

to become pregnant but are not using a

method (classified in the unmet need 

category), women who are trying to become pregnant and women who are at 

low risk of pregnancy for physiological 

reasons or because of low coital frequency.

The estimation of pregnancy 

rates and the likelihood of having an 

abortion for the three categories of nonuse—unmet need, seeking pregnancy, 

17 
and low risk—is not straightforward because only current status information is available to classify 

women into these categories. Women may have been trying to get pregnant for a month or for a couple of

years. Women currently at low risk of pregnancy could be in that category for very different durations.

How long women have been in the unmet need category is also unknown. As in earlier work on

Kazakhstan (Westoff, 2000), the pregnancy rate and likelihood of having an abortion for women in these 

categories are estimated based on the number of women in each category and the number of pregnancies 

and abortions in the recent past (a recent 18-month period). This is clearly very crude, but it yields

plausible estimates. The pregnancy rate for women with an unmet need for family planning is estimated at

0.638 per woman-year of exposure, for women seeking pregnancy it is 0.662, and for those at low risk it 

is 0.020 (Table 9.1). The likelihood of having an abortion for women in the unmet need category is 43 

percent. The likelihood of having an abortion for women seeking pregnancy is understandably much 

lower (10 percent). That 10 percent of women seeking pregnancy would have an abortion may seem high,

but it must be remembered that pregnant women’s situations can change and that abortion levels are high 

in Armenia. Perhaps more relevant is the estimation methodology that uses current status data for

classifying nonusers into exposure categories. 

Results 

The main criterion of how well the model fits is how closely it approximates the abortion rate. As 

indicated in Figure 9.1, the two components of use and nonuse of contraception yield the same abortion 

rate as the direct calculation of 81 abortions per 1,000 women 15-44 over the past three years—the sum of 

49 for users of contraception and 32 for nonusers. Most of the contribution of users to the abortion rate 

(41 of the 49) is from women using traditional methods, mainly withdrawal with its high failure rate. 

Nonusers, although they have less likelihood of having an abortion (38 percent) than users (81 percent), 

have a higher pregnancy rate (0.300) than users of all methods in general (0.153). In fact, the product of

the two component rates is very similar for both users and nonusers. It is evident that a reduction of 

abortions in Armenia can be realized by an increase in the use of modern contraception with its lower 

failure rates. 

Implications of Changes in the Components 

The main purpose of constructing these models is to show the potential effects on the abortion 

rate of changes in the underlying parameters. Thus, if all current users were to use modern rather than 

traditional methods, the abortion rate would be 52 rather than 81 even without any increase in overall

contraceptive prevalence (Figure 9.2). In contrast, an increase of say 10 percent in overall prevalence

(from 40 to 44 percent, which is a reasonable expectation) would itself not change the population abortion 

rate because of the high failure rate of traditional methods.6

 This expectation is unrealistic, however, since

it implies that nonusers who become users are drawn proportionately from the different subtypes of 

nonusers. As can be seen in Figure 9.3, women with an unmet need for family planning are the primary

source of abortions among nonusers. Thus, if the 10 percent increase in contraceptive prevalence were

drawn from the unmet need category (not an unreasonable assumption), the abortion rate would then be 

76 rather than 81. The rate would be 58 if all unmet need were to shift to modern method use exclusively. 

If all unmet need, as well as all current use, were to shift to modern method use, the abortion rate would 

fall to 29. 

 6

 Even if all (sexually active) nonusers became users and experienced the pregnancy rates and rates of terminating

pregnancies, the overall abortion rate would remain unchanged. This is because although users have a pregnancy 

rate only half that of nonusers, the likelihood they will terminate a pregnancy is twice as high, so that the product of 

the two is about equal. 

18 
Figure 9.1 Use and nonuse of contraception and the abortion rate 

for women 15-44, Armenia DHS 2000 

Using Contraception 

401 

Not Using Contraception 

599 

Modern Method

150 

10 50 85 0 

Never Had Sex 

315 

Traditional Method

251 

Had Sex 

283 

8 41 32 0 

Abortions per 1,000 Women 

81 

All Women 

1,000 

Pregnancies 

Abortions 

19 
Figure 9.2 Specific components of the abortion rate, Armenia DHS 2000 

 Ddgkd’k’g 

 

 Pregnancies 

 Abortions 

Using Contraception 

401

Modern 

Method 

150

In Need

103

Low Risk

125

10 50 66 3

Traditional 

Method 

251

8 41 28 1

Seeking 

Pregnancy

55

Had Sex 

283 

Never Had 

Sex

315 

0 

0 

4

36

Abortions per 1,000 Women 

81 

Not Using Contraception 

599

All Women 

1,000

Note: Women in need includes those pregnant unintentionally. Women seeking pregnancy includes those pregnant 

intentionally. 

20 
Figure 9.3 Abortion rates (per 1,000 women) under different assumptions, Armenia DHS 2000 

81

81

76

58

52

33

29

5

0 10 20 30 40 50 60 70 80 90 1

Abortions per 1,000 women 15-44

Current abortion rate

10% increase in contraceptive prevalence

10% increase in contraceptive prevalence all from unmet need

All unmet need shifts to modern methods

All current use with modern methods

Current use with zero failure

All unmet need and all current use shift to modern method use

No unmet need and zero failures

00

 

In summary, most abortions (about 60 percent) in Armenia result from contraceptive failure 

related to the heavy dependence on traditional methods. For the remaining 40 percent from women not 

using a method, most abortions occur among those with an unmet need for family planning. If 

contraception were perfect and unmet need nonexistent, the abortion rate would theoretically be 5 rather

than 81 per 1,000 women. 

These hypothetical illustrations all assume that the current proportion of women 15-44 in 

Armenia who have never had sex (31 percent) remains unchanged. However, this proportion is higher 

than that of many other countries in the region7

 and may decline in the future. Any decline will put more 

pressure on fertility regulation and, without increases in modern contraceptive practice, would increase 

the abortion rate. On the other hand, any increase in premarital sex may be more than offset by the recent

postponement of marriage in Armenia noted earlier. The proportion of months in union for women 15-24

declined by 27 percent over the 5 to 6 years before the survey—from 40 to 29 percent. This postponement 

of marriage contributed to the decline in abortion in the younger age groups. 

Role of Contraceptive Discontinuation in Abortion 

An estimated 13 percent of all pregnancy outcomes (in the 1997-1999 period) resulted from 

discontinuation of method use in contrast to those resulting from method failure (43 percent) and general 

7

 Recent estimates of the proportion of women (15-44) who have never had sex are 18 percent in Romania, 1999 

(Serbanescu, Morris, and Marin, 2001), 22 percent in Kazakhstan, 1999 (APM and Macro International, 2000), 27

percent in Uzbekistan, 1996 (IOG and Macro International, 1997), 23 percent in the Kyrgyz Republic, 1997 (RIOP

and Macro International, 1998), and 14 percent in the Ukraine, 1999 (Goldberg et al., 2001). In Georgia, the rate is

comparable—33 percent (Serbanescu et al., 2001)—and in Azerbaijan, it is slightly higher at 36 percent (Serbanescu

et al., 2002). 

21 
nonuse of contraception (44 percent). Most of this 13 percent were deliberate interruptions of 

contraceptive use in order to become pregnant, accounting for more than half of all discontinuations. A 

variety of other reasons are cited for discontinuation, but health concerns and side effects of method use 

are mentioned most commonly (see Figure 9.4). Of the 548 abortions per 1,000 pregnancies in this

period, 10 percent are attributable to discontinuation, which is clearly less than the proportion attributed

to contraceptive failure and to other nonuse, but not insignificant. 

Figure 9.4 Contributions to the abortion rate of contraceptive failure, contraceptive 

discontinuation, and other nonuse, 1997-1999, Armenia DHS 2000 

 

 

 

Method Failed

426 

No Use 

445 

Discontinued Method 

129 

To Get

Pregnant

68

Health and Side

Effects 

21

All Other 

Reasons 

40 

342 149 2 19 36 

All Pregnancy Outcomes 

1,000 

Abortions per 1,000 Pregnancies 

548 

22 
10 Conclusions 

Like most countries in the region, Armenia has experienced a sharp drop in fertility as the number 

of children desired has declined. And like most populations that were part of the former Soviet Union,

there has been heavy reliance on abortion to regulate fertility. Unlike most of the countries in the region,

Armenia still has widespread use of traditional methods of contraception, primarily withdrawal, which,

because of its high failure rate, contributes significantly to the high abortion rate. Nevertheless, there is

evidence of a decline in abortion over the past 15 years and a gradual adoption of modern contraceptive 

methods in recent years. The explanation for the decline in abortion over the past 5 to 6 years lies 

primarily in the postponement of marriage, a trend that has not only reduced exposure to the risk of 

unintended pregnancy and thus abortion but also played a role in the decline of fertility.

A variety of hypothetical calculations have been made to illustrate the potential reduction in 

abortion that could be realized by the use of more effective contraceptive methods. For example, if

nonusers with unmet need for family planning switched to using modern methods, the abortion rate could

be reduced by 28 percent. If, in addition, current users of traditional methods switched to modern

methods, the abortion rate would decrease by 60 percent. 

23 

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