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.
Protocol > Research Study
Pasquier E, Fetters T, Owolabi OO, Ngbale RN, Moore AM, et al.
2020 December 15
OVERALL AIM
To describe and estimate the burden of abortion-related complications, particularly near-miss complications and deaths, and their associated factors among women presenting for abortion-related complications in health facilities supported by Médecins Sans Frontières (MSF) in African fragile and/or conflict-affected settings.
OBJECTIVES
Primary objective:
- To describe the frequency of near-miss events and deaths among women presenting for
abortion-related complications.
Secondary objective:
- To describe the frequency of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To describe the severity of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To identify risk factors quantitatively associated with abortion-related near-miss events;
- To describe the quality of the clinical management of abortion-related complications
(including near-miss cases) and the heath facilities capacity to manage these complications
- To describe the experiences of women who present as near-miss cases, including their
decision-making processes, access, pathways to care as well as conditions and factors that
could contribute to the life-threatening conditions and near-miss event.
- To describe the knowledge, attitudes, practices, and behaviors of health care workers in
relation to abortion;
- To describe the characteristics, management, outcomes of ectopic and molar pregnancies
ClinicalTrials.gov: NCT04331847
To describe and estimate the burden of abortion-related complications, particularly near-miss complications and deaths, and their associated factors among women presenting for abortion-related complications in health facilities supported by Médecins Sans Frontières (MSF) in African fragile and/or conflict-affected settings.
OBJECTIVES
Primary objective:
- To describe the frequency of near-miss events and deaths among women presenting for
abortion-related complications.
Secondary objective:
- To describe the frequency of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To describe the severity of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To identify risk factors quantitatively associated with abortion-related near-miss events;
- To describe the quality of the clinical management of abortion-related complications
(including near-miss cases) and the heath facilities capacity to manage these complications
- To describe the experiences of women who present as near-miss cases, including their
decision-making processes, access, pathways to care as well as conditions and factors that
could contribute to the life-threatening conditions and near-miss event.
- To describe the knowledge, attitudes, practices, and behaviors of health care workers in
relation to abortion;
- To describe the characteristics, management, outcomes of ectopic and molar pregnancies
ClinicalTrials.gov: NCT04331847
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.
Technical Report > Evidence Brief
Fetters T, Lissouba P, Moore AM, Lagrou D, Pasquier E, et al.
2022 December 1
Technical Report > Evidence Brief
Powell B, Chen H, Pasquier E, Fetters T, Owolabi OO, et al.
2023 July 1
English
Français
Conference Material > Slide Presentation
Chen H, Fetters T, Ngbale NR, Nguengo L, Dodane T, et al.
MSF Scientific Days International 2021: Research. 2021 May 18