Patent Medicine Vendors (PMVs) can play a critical role in increasing access to emergency contraceptive pills (ECPs) in developing countries, but few studies have examined their knowledge and dispensing practices. Using cluster sampling, the authors selected and interviewed 97 PMVs (60.8 per cent female) in Oyo and Ogun States of Nigeria to assess their knowledge, dispensing practices, and referral for ECPs. About one-third (27.8 per cent) of respondents were not aware of ECPs, and only half knew that ECPs could prevent pregnancy. Forty per cent had ever dispensed ECPs. Reasons proffered by those who do not dispense ECPs included barriers from the State Ministry of Health, police, other regulatory agencies, and religious beliefs. Only 50.5 per cent have referral arrangements for clients. Strategies to increase access to ECPs through PMVs include training on counseling techniques and referral, effective government regulation, and community involvement. Where unsafe abortion is a major cause of maternal mortality, these strategies offer protection for many women in the future.
OBJECTIVE: To determine the proportion of all clinically confirmed pregnancies that end as induced abortion in a cohort of pregnant women in Nigeria. METHODS: A total of 490 women who attended prenatal clinics at the University of Benin Teaching Hospital were interviewed with the preceding birth technique (PBT) on the outcomes of their previous pregnancies, including abortions. RESULTS: Of the 490 women, 384 women (78.4%) reported previous abortions. A total of 1883 previous pregnancies were reported by the women, of which 914 ended in abortion, 545 in live births, and 421 in stillbirths, with 3 unclassified. The total abortion ratio was 914/1842 (49.6%), when 41 women who reported No previous pregnancies were excluded. Of the 914 abortions, 751 (82.25) were induced abortions, 146 (16.0%) were spontaneous abortions, 9 (0.98%) were missed abortions, and 8 were unclassified. Results of logistic regression analysis showed that women aged 25-29 years were 4 times more likely to report induced abortion compared with older women. CONCLUSION: Induced abortion was found to be highly prevalent in this region of Nigeria, according to self-reports of women who were asked questions on abortion in the context of medical care.
The quality of spousal relationship may influence the acceptance of the status of pregnancies and the decision to procure abortion; however, this relationship has largely been unexplored. The objective of this paper is to assess the influence of specific dimensions of relationship quality on abortion procurement. Data from the 2010 Family Health and Wealth Survey site were used to assess the association between relationship quality and induced abortion among 763 ever-pregnant married or cohabiting women in Ipetumodu, South-west Nigeria. Abortion question though not directly related to current time, however, it provides a proxy for the analysis in such context where abortion is highly restrictive with high possibility of underestimation. The association between relationship quality and abortion risk was analyzed using bivariate and multivariate (logistic regression) methods. Only 7.9% of women 15-49 years reported ever having induced abortion. Communication was the only dimension of relationship quality that showed significant association with history of induced abortion (aOR=0.42; 95% C.I. =0.24-0.77). The paper concludes that spousal communication is a significant issue that deserves high consideration in efforts to improve maternal health in Nigeria.
Unsafe abortion is a significant contributor to maternal mortality in Nigeria, and treatment of post-abortion complications drains public healthcare resources. Provider estimates of medications, supplies, and staff time spent in 17 public hospitals were used to estimate the per-case and annual costs of post-abortion care (PAC) provision in Ogun and Lagos states and the Federal Capital Territory. PAC with treatment of moderate complications (US $112) cost 60 more per case than simple PAC (US $70). In cases needing simple PAC, treatment with dilation and curettage (D&C, US $80) cost 18 more per case than manual vacuum aspiration (US $68). Annually, all public hospitals in these 3 states spend US $807 442 on PAC. This cost could be reduced by shifting service provision to an outpatient basis, allowing service provision by midwives, and abandoning the use of D&C. Availability of safe, legal abortion would further decrease cost and reduce preventable deaths from unsafe abortion.
"BACKGROUND: Unsafe abortion accounts for a greater proportion of maternal deaths, yet it is often not adequately considered in discussions around reducing maternal mortality. AIM: The aim of this study is to determine the pattern of unsafe abortion and the extent to which unsafe abortion contributes to maternal morbidity and mortality in our setting as well as assess the impact of post‑abortion care. SUBJECTS and METHODS: A descriptive study of patients who were admitted for complications following induced abortions between January 1, 2001 and December 31, 2008 at the Federal Medical Center, Abakaliki South East of Nigeria with data obtained from case records. RESULTS: Out of the 1,562 gynecological admissions, a total of 83 patients presented with the complications arising from induced abortion. The age group 20‑24 years was mostly affected and adolescents constituted 32.5% (27/83).Nearly 15.7% (13/83) of these patients died while the remaining 84.3% (70/83) had various complications, which were mainly septicemia 59.0% (49/83), anemia 47.0% (39/83), peritonitis 41.0% (34/83), hemorrhages 34.9% (29/83) and uterine perforation 30.1% (25/83). During the study, there were 38 gynecological deaths and abortion related death accounted for 34.2% (13/38) of these gynecological deaths. 84.3% (70/83) of the patients had no documented evidence of counseling on family planning and 59.0% (49/83) were not aware of the different methods of contraception. CONCLUSION: Unsafe abortion remains one of the most neglected sexual and reproductive health problems in developing countries today despite its significant contribution to maternal mortality and morbidity. Solutions and remedies include prevention of unplanned and unwanted pregnancies by sex education and access to safe and sustainable family planning methods."
The outcomes of an intervention aimed at improving the quality of post-abortion care provided by private medical practitioners in 8 states in Northern Nigeria are reported. A total of 458 private medical doctors and 839 nurses and midwives were trained to offer high-quality post-abortion care, post-abortion family planning, and integrated sexually transmitted infection/HIV care. Results showed that among the 17009 women treated over 10 years, there was Not a single case of maternal death. In a detailed analysis of 2559 women treated during a 15-month period after the intervention was established, only 33 women experienced mild complications, while None suffered major complications of abortion care. At the same time, there was a reduction in treatment cost and a doubling of the contraceptive uptake by the women. Building the capacity of private medical providers can reduce maternal morbidity and mortality associated with induced abortion in Northern Nigeria.
OBJECTIVES: Abortion in Nigeria is permitted only to save a woman's life. Most abortions in that country take place under unsafe conditions and constitute a major source of maternal morbidity and mortality. We present a case of multiple visceral injuries complicating an induced abortion. CASE: A 28-year-old multiparous woman at 12 weeks' gestation had an induced abortion by dilatation and curettage in a private clinic. The procedure was complicated by uterine perforation and bowel injury, with protrusion of gangrenous loops of bowel from the vagina. At laparotomy the uterus was repaired, and a bowel resection with re-anastomosis was performed. The patient's recovery was uneventful. CONCLUSIONS: Increasing the uptake of contraception, training healthcare providers in safe methods of induced abortion, and liberalising abortion laws can reduce abortion-related morbidity and mortality in Nigeria.
"Background: Despite calls for advance community distribution of Misoprostol, World Health Organization is cautious about recommending this. This report highlights complications of Misoprostol use by community birth attendants, discusses implications of advance distribution and possible solutions. Case Report: Labour induced in a woman attending a facility run by a nurse using high dose (300mcg) misoprostol and another drug resulted in her infant developing severe birth asphyxia immediately after delivery. Conclusion: Misuse of Misoprostol leads to complications. Research into community usage, confidential enquiries, development of guidelines and training of birth attendants is needed. Production of low dose Misoprostol (25mcg) should be encouraged."
"OBJECTIVE: To determine the feasibility of introducing misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility. METHODS: An open-label prospective study was conducted in a secondary-level health facility in Nigeria. Eligible women diagnosed with incomplete abortion received 400-μg sublingual misoprostol as first-line treatment. Nurse-midwives took the lead in diagnosis, counseling, treatment, and assessment of final outcome. The primary outcome was the proportion of women who completed the abortion process. RESULTS: Complete evacuation was achieved in 83 of 90 (92.2%) eligible women. The most common adverse effects were abdominal pain/cramps (58 [64.4%]), heavy bleeding (21 [23.3%]), spotting (15 [16.7%]), and fever/chills (11 [12.2%]). More than 90% of women reported that the procedure was satisfactory, that pain and adverse effects were tolerable, and that bleeding was acceptable. Eighty-four (93.3%) and 86 (95.6%) women, respectively, would use the method in the future and recommend it to friends. CONCLUSION: Misoprostol is an effective, safe, and acceptable method for treating incomplete abortion. It can be successfully used as first-line treatment by nurse-midwives. Success rates over 90% are consistent with findings from previous studies in which drug administration was controlled solely by physicians."
Involuntary infertility and induced abortion exist on opposite sides of the spectrum: the first being the unwanted loss of childbearing potential while the second is the intentional termination of pregnancy. However, this paper proposes that these two poles of pregnancy loss are in fact related in Yoruba society, Nigeria. This argument is supported by qualitative and quantitative data drawn from an applied research project in communities and health institutions of Lagos State, from 1996 to 1999, where a total of 693 women recounted 1114 personal abortion experiences, and 233 women shared their experiences of fertility problems. Study statistics show that 37% of secondary infertility was most probably the result of induced abortion and that half of women with abortion complications interviewed in a referral hospital will have fertility problems. This paper provides insight into the reasons why single and married women decide to abort, and use unsafe methods, despite awareness of the serious health risks, including infertility. This is paradoxical given that fear of infertility is a major reason why women do Not use modern contraceptives when trying to prevent unwanted pregnancy. By analysing the relations between infertility and abortion within the socio-cultural, economic, and services-related structures that influence women's decisions, this paper suggests ways of addressing the problems related to both types of pregnancy loss.