Technical Report > Evidence Brief
Pasquier E, Owolabi OO, Fetters T, Chen H, Williams TN, et al.
2022 August 30
English
Français
Abortion complications remain a major cause of maternal mortality worldwide and abortion-related mortality has decreased very little over the last decade, unlike maternal mortality linked to other main causes such as haemorrhage, infection or obstructed labour. Global estimates suggest that most abortion-related deaths are the result of unsafe induced abortions, 97% of which occur in low- and middle-income countries which can be largely prevented by providing comprehensive abortion care, including post- abortion care, contraceptive services, and safe abortion care.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
Conference Material > Abstract
Chen H, Fetters T, Ngbale NR, Nguengo L, Dodane T, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
INTRODUCTION
Abortion-related complications remain a major cause of maternal mortality worldwide. The Castor Maternity Unit (CMU) in Bangui, CAR, serves nearly 500,000 people affected by chronic armed conflict. The country’s maternal mortality ratio (890/100,000 live births) is among the world’s highest. Abortion-related complications are a major cause of maternal death in the country and a substantial contributor to CMU admissions. To understand factors contributing to the magnitude and severity of abortion complications in this setting, we carried out a knowledge, attitudes, practices, and behavior (KAPB) survey among CMU health professionals.
METHODS
A cross-sectional quantitative survey was done using a self-administered questionnaire to all physicians, midwives, and nurses providing post-abortion care (PAC) in CMU, asking questions about PAC, contraception, and safe abortion care (SAC). We used descriptive analysis to present frequencies and proportions.
ETHICS
This study was approved by the CAR Ethics Committee, the Institutional Review Board of the Guttmacher Institute, and the MSF Ethics Review Board.
RESULTS
The provider response rate was 94% (84/89). Personal experience with unsafe abortion was common: 89% (n=75) of respondents knew someone personally who had died from an unsafe abortion. Almost 70% (n=56) considered access to SAC to be every woman’s right. Correct knowledge of the legality of abortion in CAR varied between 48-80% (n=40-67). Most of the respondents (n=47; 56%) reported having referred at least one woman for SAC. A question about providers’ conscientious objections to providing SAC found that 76% (n=59) noted strong agreement with the statement that health professionals should refer patients to another provider if they had objections to SAC provision. More than 90% (n=75) considered PAC to be every woman’s right. Despite a significant caseload of severe complications linked with abortion, only 21% of respondents (n=18) correctly identified the WHO near-miss criteria, which diagnose very severe abortion complications. Additionally, while dilatation and curettage is currently not recommended by clinical guidelines, 44% of respondents providing PAC (n=27) stated they were still using this method, at least some of the time. Contraception was provided by 85% of respondents (n=71) without issue but a smaller proportion (n=49; 59%) stated overt support when asked if they would provide contraception to minors without parental consent. While 76% (n=64) of respondents were trained in implant insertion, only 30% (n=26) were trained in inserting intrauterine devices.
CONCLUSION
CMU healthcare professionals were generally supportive of PAC, contraception and SAC. Nevertheless, we still found shortcomings in their knowledge and practices. Although limited by small sample size, the high response rate does permit drawing recommendations for this maternity unit. Innovative approaches for continuing education and capacity-building are needed, which could include workshops exploring values and attitudes about abortion, alongside efforts to simplify near-miss approaches, and training on all contraception methods to provide for women’s personal preferences. These could improve the facility towards provision of the full range of comprehensive abortion care.
CONFLICTS OF INTEREST
None declared.
Abortion-related complications remain a major cause of maternal mortality worldwide. The Castor Maternity Unit (CMU) in Bangui, CAR, serves nearly 500,000 people affected by chronic armed conflict. The country’s maternal mortality ratio (890/100,000 live births) is among the world’s highest. Abortion-related complications are a major cause of maternal death in the country and a substantial contributor to CMU admissions. To understand factors contributing to the magnitude and severity of abortion complications in this setting, we carried out a knowledge, attitudes, practices, and behavior (KAPB) survey among CMU health professionals.
METHODS
A cross-sectional quantitative survey was done using a self-administered questionnaire to all physicians, midwives, and nurses providing post-abortion care (PAC) in CMU, asking questions about PAC, contraception, and safe abortion care (SAC). We used descriptive analysis to present frequencies and proportions.
ETHICS
This study was approved by the CAR Ethics Committee, the Institutional Review Board of the Guttmacher Institute, and the MSF Ethics Review Board.
RESULTS
The provider response rate was 94% (84/89). Personal experience with unsafe abortion was common: 89% (n=75) of respondents knew someone personally who had died from an unsafe abortion. Almost 70% (n=56) considered access to SAC to be every woman’s right. Correct knowledge of the legality of abortion in CAR varied between 48-80% (n=40-67). Most of the respondents (n=47; 56%) reported having referred at least one woman for SAC. A question about providers’ conscientious objections to providing SAC found that 76% (n=59) noted strong agreement with the statement that health professionals should refer patients to another provider if they had objections to SAC provision. More than 90% (n=75) considered PAC to be every woman’s right. Despite a significant caseload of severe complications linked with abortion, only 21% of respondents (n=18) correctly identified the WHO near-miss criteria, which diagnose very severe abortion complications. Additionally, while dilatation and curettage is currently not recommended by clinical guidelines, 44% of respondents providing PAC (n=27) stated they were still using this method, at least some of the time. Contraception was provided by 85% of respondents (n=71) without issue but a smaller proportion (n=49; 59%) stated overt support when asked if they would provide contraception to minors without parental consent. While 76% (n=64) of respondents were trained in implant insertion, only 30% (n=26) were trained in inserting intrauterine devices.
CONCLUSION
CMU healthcare professionals were generally supportive of PAC, contraception and SAC. Nevertheless, we still found shortcomings in their knowledge and practices. Although limited by small sample size, the high response rate does permit drawing recommendations for this maternity unit. Innovative approaches for continuing education and capacity-building are needed, which could include workshops exploring values and attitudes about abortion, alongside efforts to simplify near-miss approaches, and training on all contraception methods to provide for women’s personal preferences. These could improve the facility towards provision of the full range of comprehensive abortion care.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
Confl Health. 2024 August 5; Volume 21; 114.; DOI:10.1186/s12978-024-01835-9
Pasquier E, Owolabi OO, Powell B, Fetters T, Ngbale R, et al.
Confl Health. 2024 August 5; Volume 21; 114.; DOI:10.1186/s12978-024-01835-9
BACKGROUND
Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR).
METHODS
We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals’ PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.
RESULTS
Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.
CONCLUSIONS
Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.
Other > Pre-Print
Res Sq. 2023 March 20; DOI:10.21203/rs.3.rs-2671712/v1
Moore AM, Pasquier E, Williams TN, Fetters T, Powell B, et al.
Res Sq. 2023 March 20; DOI:10.21203/rs.3.rs-2671712/v1
BACKGROUND
Conducting abortion research in fragile settings presents challenges, many of which are present in other low-resourced settings to various degrees but when appearing all together, collectively served to create a set of barriers to collecting data that required creative adaptations to address and even then, we could not overcome all of them.
RESULTS
Challenges that we experienced in the course of this mixed methods research project included limited access to the study sites by research team members, research being delayed to prioritize life-saving priorities which must take precedence when resource constraints mean that both cannot be carried out, a population skeptical of participating in research due to having negative experiences with the state/other actors as well as due to being research-naïve, geographic and language constraints impacting participant recruitment because of the fact that people are coming from various displaced locations to a particular health facility, a low literacy population meant that they could not read the consent form and due to the stigmatized subject matter we did not want a family member consenting them, and respondents’ challenges participating around the time of discharge because respondents needed to travel home with family members.
CONCLUSIONS
These strategies are relevant not only to abortion research but also other research in resource-constrained/fragile and conflict-affected contexts. Improving the health of the most vulnerable can only be done through understanding barriers to care in insecure and challenging environments. Recommendations include to plan for offsite and long-distance training, supervision, and quality assurance; attempt to negotiate flexible timelines with donors; hire field staff whose only responsibility is data collection; where possible, find a way to include the most vulnerable members of the study population; adapt informed consent processes for low literacy populations; and consider including travel support for respondents. Iterating improvements in data collection innovations in these contexts will advance the field by spurring more research upon which to base policy and practices.
Conducting abortion research in fragile settings presents challenges, many of which are present in other low-resourced settings to various degrees but when appearing all together, collectively served to create a set of barriers to collecting data that required creative adaptations to address and even then, we could not overcome all of them.
RESULTS
Challenges that we experienced in the course of this mixed methods research project included limited access to the study sites by research team members, research being delayed to prioritize life-saving priorities which must take precedence when resource constraints mean that both cannot be carried out, a population skeptical of participating in research due to having negative experiences with the state/other actors as well as due to being research-naïve, geographic and language constraints impacting participant recruitment because of the fact that people are coming from various displaced locations to a particular health facility, a low literacy population meant that they could not read the consent form and due to the stigmatized subject matter we did not want a family member consenting them, and respondents’ challenges participating around the time of discharge because respondents needed to travel home with family members.
CONCLUSIONS
These strategies are relevant not only to abortion research but also other research in resource-constrained/fragile and conflict-affected contexts. Improving the health of the most vulnerable can only be done through understanding barriers to care in insecure and challenging environments. Recommendations include to plan for offsite and long-distance training, supervision, and quality assurance; attempt to negotiate flexible timelines with donors; hire field staff whose only responsibility is data collection; where possible, find a way to include the most vulnerable members of the study population; adapt informed consent processes for low literacy populations; and consider including travel support for respondents. Iterating improvements in data collection innovations in these contexts will advance the field by spurring more research upon which to base policy and practices.
Conference Material > Video (talk)
Chen H
MSF Scientific Days International 2021: Research. 2021 May 18
Technical Report > Evidence Brief
Powell B, Chen H, Pasquier E, Owolabi OO, Fetters T, et al.
2023 July 1
English
Français
Conference Material > Abstract
Pasquier E, Lissouba P, Moore AM, Owolabi OO, Chen H, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/pq3n-my95
INTRODUCTION
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. We aimed to describe the severity of abortion-related complications and contributing factors in two MSF-supported referral hospitals; one in a rural setting, northern Nigeria, and one in the capital city, Bangui, in the Central African Republic (CAR).
METHODS
This cross-sectional mixed-methods study included four components: 1) a clinical study using prospective review of medical records for women presenting with abortion-related complications between November 2019 and July 2021; 2) a quantitative survey among hospitalized women, to identify contributing factors for severe complications; 3) a qualitative study to understand the care pathways of women with severe complications; and 4) a knowledge, attitude, and practice (KAP) survey among health professionals providing post-abortion care in the two hospitals. The clinical study and the quantitative survey used the methodology of the WHO multi-country study on abortion led in 11 sub-Saharan African countries in stable contexts.
ETHICS
This study was approved by the MSF Ethics Review Board, the Central African Republic’s Comité Scientifique Chargé de la Validation des Protocoles d’Etude et des Résultats de Recherche en Santé, and by the Guttmacher Institute International Review Board.
RESULTS
520 and 548 women comprised the clinical study enrollees for the Nigerian and CAR settings, respectively; of these, 360 and 362, respectively, participated in the quantitative survey. Of these women, 66 in Nigeria and 18 in CAR were interviewed for the qualitative study. Lasty, 140 and 84 health providers in Nigeria and CAR, respectively, participated in the KAP survey. The severity of abortion complications was high: 348 (67%) and 278 (50,7%) of women had a severe complication (potentially life-threatening, near-miss, or death) respectively in Nigerian and CAR hospitals. The KAP survey showed that almost 60% and 91% of health providers in Nigerian and CAR hospitals respectively, personally knew a woman who had died from abortion complications. Among women who did not have severe bleeding (146 in Nigeria and 231 in CAR), anemia was nonetheless frequent, affecting 66.7% of women in Nigeria and 37.6% in CAR. Among women participating in the quantitative survey, 23% in Nigeria and 45% in CAR reported having induced their abortion. Among them, 97% in Nigeria and almost 80% in CAR used unsafe methods. In CAR, qualitative data indicated that these included unsafe instrumental evacuations performed by unskilled individuals, and self-administered decoctions of traditional ingredients such as herbs, roots, or vegetables, ingested either alone or in combination with pharmaceutical drugs. In Nigeria, 50% did not want to be pregnant but fewer than 3% reported using contraception at the start of the index pregnancy. In CAR, 56% did not want the pregnancy, but 37% of women reported using contraception at its start. Women faced long delays accessing care, with 50% of hospitalized women in both settings taking two or more days to reach adequate post-abortion care after the onset of symptoms. Nevertheless, delays were worse in Nigeria where 27% took six days or more to access those care, versus 16% in CAR. Qualitative data indicated that factors implicated in longer delays included delayed recognition of danger signs necessitating medical care, unsuccessful attempts to self-manage symptoms, internalized stigma causing fear of disclosure among women reporting induced abortion, and in Nigeria, requiring permission to seek care. In both settings, structural barriers associated with lack of capacity and low quality of care in local health care structures, and transport difficulties to access adequate care also increased delays. Lastly, despite restrictive legal environments in both contexts, the KAP survey revealed that most health providers (74% in Nigeria and 67% in CAR) considered that access to safe abortion care was the right of every woman.
CONCLUSION
Our data suggests a higher severity of abortion-related complications, as compared to WHO data from African hospitals in more stable settings. Factors that could contribute to such high severity include greater delays in accessing post-abortion care, decreased access to contraception and safe abortion care, resulting in unsafe abortions; and food insecurity leading to iron deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high-quality post-abortion care, to prevent and manage complications of abortions in fragile and conflict-affected settings.
CONFLICTS OF INTEREST
None declared
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. We aimed to describe the severity of abortion-related complications and contributing factors in two MSF-supported referral hospitals; one in a rural setting, northern Nigeria, and one in the capital city, Bangui, in the Central African Republic (CAR).
METHODS
This cross-sectional mixed-methods study included four components: 1) a clinical study using prospective review of medical records for women presenting with abortion-related complications between November 2019 and July 2021; 2) a quantitative survey among hospitalized women, to identify contributing factors for severe complications; 3) a qualitative study to understand the care pathways of women with severe complications; and 4) a knowledge, attitude, and practice (KAP) survey among health professionals providing post-abortion care in the two hospitals. The clinical study and the quantitative survey used the methodology of the WHO multi-country study on abortion led in 11 sub-Saharan African countries in stable contexts.
ETHICS
This study was approved by the MSF Ethics Review Board, the Central African Republic’s Comité Scientifique Chargé de la Validation des Protocoles d’Etude et des Résultats de Recherche en Santé, and by the Guttmacher Institute International Review Board.
RESULTS
520 and 548 women comprised the clinical study enrollees for the Nigerian and CAR settings, respectively; of these, 360 and 362, respectively, participated in the quantitative survey. Of these women, 66 in Nigeria and 18 in CAR were interviewed for the qualitative study. Lasty, 140 and 84 health providers in Nigeria and CAR, respectively, participated in the KAP survey. The severity of abortion complications was high: 348 (67%) and 278 (50,7%) of women had a severe complication (potentially life-threatening, near-miss, or death) respectively in Nigerian and CAR hospitals. The KAP survey showed that almost 60% and 91% of health providers in Nigerian and CAR hospitals respectively, personally knew a woman who had died from abortion complications. Among women who did not have severe bleeding (146 in Nigeria and 231 in CAR), anemia was nonetheless frequent, affecting 66.7% of women in Nigeria and 37.6% in CAR. Among women participating in the quantitative survey, 23% in Nigeria and 45% in CAR reported having induced their abortion. Among them, 97% in Nigeria and almost 80% in CAR used unsafe methods. In CAR, qualitative data indicated that these included unsafe instrumental evacuations performed by unskilled individuals, and self-administered decoctions of traditional ingredients such as herbs, roots, or vegetables, ingested either alone or in combination with pharmaceutical drugs. In Nigeria, 50% did not want to be pregnant but fewer than 3% reported using contraception at the start of the index pregnancy. In CAR, 56% did not want the pregnancy, but 37% of women reported using contraception at its start. Women faced long delays accessing care, with 50% of hospitalized women in both settings taking two or more days to reach adequate post-abortion care after the onset of symptoms. Nevertheless, delays were worse in Nigeria where 27% took six days or more to access those care, versus 16% in CAR. Qualitative data indicated that factors implicated in longer delays included delayed recognition of danger signs necessitating medical care, unsuccessful attempts to self-manage symptoms, internalized stigma causing fear of disclosure among women reporting induced abortion, and in Nigeria, requiring permission to seek care. In both settings, structural barriers associated with lack of capacity and low quality of care in local health care structures, and transport difficulties to access adequate care also increased delays. Lastly, despite restrictive legal environments in both contexts, the KAP survey revealed that most health providers (74% in Nigeria and 67% in CAR) considered that access to safe abortion care was the right of every woman.
CONCLUSION
Our data suggests a higher severity of abortion-related complications, as compared to WHO data from African hospitals in more stable settings. Factors that could contribute to such high severity include greater delays in accessing post-abortion care, decreased access to contraception and safe abortion care, resulting in unsafe abortions; and food insecurity leading to iron deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high-quality post-abortion care, to prevent and manage complications of abortions in fragile and conflict-affected settings.
CONFLICTS OF INTEREST
None declared
Journal Article > ResearchFull Text
BMC Pregnancy Childbirth. 2023 March 4; Volume 23 (Issue 1); 143.; DOI:10.1186/s12884-023-05427-6
Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, et al.
BMC Pregnancy Childbirth. 2023 March 4; Volume 23 (Issue 1); 143.; DOI:10.1186/s12884-023-05427-6
BACKGROUND
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
METHODS
We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS
We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSION
Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
METHODS
We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS
We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSION
Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
Technical Report > Evidence Brief
Fetters T, Lissouba P, Moore AM, Lagrou D, Pasquier E, et al.
2022 December 1
Conference Material > Slide Presentation
Pasquier E, Lissouba P, Chen H, Williams TN, Baudin E, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/bxth-m543