Background: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country.

Methods: We conducted a large population-based survey of women aged 18–29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure.

Results: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%–12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%–14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%–3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07–1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84–0.91), geographic region (highlands: OR 1.56, 95% CI 1.23–1.97; jungle: OR 1.81, 95% CI 1.41–2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68–0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23–2.09; = 3 partners: OR 2.79, 95% CI 2.12–3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01–1.72; = 2 partners: OR 1.54, 95% CI 1.14–2.02). Overall, 49.0% (95% CI 47.6%–50.3%) of the women who reported being currently sexually active were not using contraception.

Interpretation: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.