BACKGROUND: Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia. METHODS: This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis. RESULTS: There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased. CONCLUSION: Ten years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels. "
In 2009, we published an article in RHM showing a large delay in provision of emergency obstetric care to women who died from unsafe abortion complications at the Centre Hospitalier de Libreville. The paper raised awareness among hospital and government authorities of a serious delay in timely treatment, and they supported the recommendation of the hospital's Maternal Mortality Committee to greatly reduce the delay and also improve the care of women with abortion complications. Training in manual vacuum aspiration (MVA) for uterine evacuation was introduced, for use by midwives as well as obstetrician-gynaecologists, with local anaesthesia. The mean delay in providing care to women with abortion complications in the 2008 findings was compared to data from the five months from 1 November 2011 through 31 March 2012. In 2008, all incomplete abortions were treated by physicians with dilatation & evacuation (D&C) or electric vacuum aspiration (EVA) with general anaesthesia. In 2011-12, two-thirds of women were treated with manual vacuum aspiration with local anaesthesia instead, one half of them by midwives. The mean delay between presentation and treatment was 18.0 hours in 2008 and 1.8 hours in 2011-12. The mean delay did Not differ between women treated with MVA or D&C/EVA, Nor if treated by midwives or physicians.
Complications of an unsafe abortion are a major contributor to maternal deaths and morbidity in Africa. When abortions are performed in safe environments, such complications are almost all preventable. This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. The safe abortion care (SAC) model, a monitoring approach to assess the amount, distribution, use and quality of abortion services, provided a framework. Data collection included key informant interviews with 335 health care providers, prospective data on 8911 women seeking treatment for abortion complications or induced abortion and review of facility logbooks. Although the existing hospitals perform most basic abortion care functions, the number of facilities providing basic and comprehensive abortion care for the population size fell far short of the recommended levels. Almost one-half (48%) of women treated for obstetric complications in the facilities had abortion complications. The use of appropriate abortion technologies in the first trimester and the provision of post-abortion contraception overall were reasonably strong, especially in private sector facilities. Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from an unsafe abortion. This study provides the first national snapshot to measure changes in a dynamic abortion care environment.
BACKGROUND: Unwanted pregnancies and unsafe abortion pose major health risks to women in the reproductive age group. Female undergraduates are particularly exposed to these risks. This study was carried out to assess the knowledge about complications and practice of abortion among female undergraduates of the University of Ibadan. METHODS: A cross-sectional study was conducted using structured, self-administered questionnaires, to collect data on respondents’ socio-demographic characteristics, sexual behaviour, knowledge about various complications of abortion and practice of abortion. Data was analyzed using SPSS version 14. RESULTS: A total of 425 students were interviewed, mean age of the undergraduates was 21.5± 2.8 years. Overall, 122 (29%) of the respondents had ever had sexual intercourse. Twenty five percent of those who were sexually active had ever been pregnant and 90% had terminated the pregnancy. The most common reason given for termination was that pregnancy was unplanned for. Most of the respondents 354 (83.3%) had a good knowledge about complications of abortion and mean knowledge score was 4.01±1.58 (range 0-5). CONCLUSION: This group of students were aware of the risks associated with unsafe abortion; however, the abortion rate was still high. Sexual reproductive health interventions are needed on campus in order to equip female undergraduates with comprehensive knowledge and skills to reduce the likelihood of unplanned pregnancies.
"BACKGROUND: While the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found No reports of their impact on Health-Related Quality of Life (HRQoL), Nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda. METHODS: We interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support. RESULTS: Our study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported ""some or severe"" problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p0.001; and anxiety/depression: 60% v 22%, p0.001). After adjusting for age, social suport, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average numberof people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean differences in EQ-5D utility score. CONCLUSIONS: Our study suggests that abortion complications are associated with diminished HRQoL and the magnitude of the association depends on social support. However, the mediating role of social support in a setting of social and legal proscriptions to induced abortion is complex."
Background: Postabortion care (PAC), is a package of services provided to women who have had an incomplete spontaneous or induced abortion. Knowing the users and non-users of PAC and reasons for use and none-use is important. Objective: The study aimed at identifying PAC service users and non-users and reasons for using or not using the PAC services. Methods: A total of 103 users and six non-users of PAC services were interviewed. Results: Most of the PAC users were young, not formally employed, single and educated to secondary or primary education. Information sharing about one’s health status; support from partner, relative or parents; privacy and absence of queues availability of PAC services and availability of transport enhanced utilization. Inability to pay for PAC services, fear of healthcare providers, fear of being arrested and avoiding stigma hampered utilization. Conclusion. Reducing abortion stigma and making PAC services affordable may increase its use. Key words: Postabortion care, utilization, abortion complications, non-user, Tanzania
Annually, upward of 100,000 Ugandan women receive care after a spontaneous or induced abortion. Abortion-related complications account for up to 26% of maternal deaths. Pilot projects have trained Ugandan midwives in the use of manual vacuum aspiration (MVA) for postabortion care (PAC), but to date there is no published literature exploring midwifery training and PAC practices. To better understand how PAC is provided in public Ugandan hospitals, the midwife's training and role in PAC and the perceived barriers to providing PAC, interviews with midwives were conducted at 3 public hospitals. A framework analysis of emergent and a priori themes was conducted. Fewer than half of midwives interviewed had received formal PAC training. Current clinical practice in PAC includes MVA, dilatation and curettage, and medical management with misoprostol. Participants identified barriers to providing PAC, which include shortage of staff and equipment, transportation, cultural issues, and gender inequality. Solutions include increased staffing on maternity wards, training more midwives to perform MVA, and improved planning and communication with National Medical Stores. Community sensitization and support for young pregnant women is needed.
|Unsafe abortion is an important public health problem, accounting for 13% of maternal mortality in developing countries. Of an estimated annual 70,000 deaths from unsafe abortion worldwide, over 99% occur in the developing countries of sub-Saharan Africa, Central and Southeast Asia, and Latin America and the Caribbean. Factors associated with increased maternal mortality from unsafe abortion in developing countries include inadequate delivery systems for contraception needed to prevent unwanted pregnancies, restrictive abortion laws, pervading negative cultural and religious attitudes towards induced abortion, and poor health infrastructures for the management of abortion complications. The application of a public health approach based on primary, secondary, and tertiary prevention can reduce morbidity and mortality associated with unsafe abortion in developing countries. Primary prevention includes the promotion of increased use of contraception by women (and by men) at risk for unwanted pregnancy; secondary prevention involves the liberalization of abortion laws and the development of programs to increase access to safe abortion care in developing countries. In contrast, tertiary prevention includes the integration and institutionalization of post-abortion care for incomplete abortion and the early and appropriate treatment of more severe complications of abortion. Efforts to address these problems will contribute both to reducing maternal mortality associated with induced abortion and to achieving the Millennium Development Goals in developing countries.|