Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil

Abstract

Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.

Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018

“…Delays in adequate obstetric care are associated with a higher occurrence of severe maternal outcomes 87 . Taking into consideration the illegality of abortion, one may assume that these delays occur either because women delay seeking services due to lack of social support 88 , fear of admitting an illegal practice 82 or due to the stigma associated with abortion 88,89 ; or because of the difficulty accessing health care services or a timely offer of care 88 . Studies conducted in the Northeast showed low quality of the care offered to women hospitalized due to complications from abortion, measured through an analysis of the service structure and of women's perception of the care they received 90,91,92 .…”

Vulnerabilidade racial e barreiras individuais de mulheres em busca do primeiro atendimento pós-aborto

“…Resistance to seeking services is included among the impediments that extrapolate the mere availability of services, but involve the population's power, time, and access to transportation, buying power, and power to deal with the healthcare organization. Women experience numerous difficulties to obtain post-abortion care, since the legal restrictions on induced abortion in Brazil contribute to delays in seeking care 40 . Racism in health services and stigma towards abortion can act simultaneously, delaying black and brown women's search for services, and this decision puts women in an extreme situation with exacerbation of their post-abortion condition.…”

A cena da ultrassonografia na atenção ao aborto: práticas e significados em uma maternidade pública em Salvador, Bahia, Brasil

“…The interactions are marked by a distancing that characterizes the relationship between the health professionals and the women experiencing abortion in hospitals, as shown by various studies 5,6,10,11,12 . During USG tests, the health professionals use an instrumental technical language in providing a service whose characteristics allow it to be performed as a serial production.…”

“…Half of the women who have undergone clandestine abortion are hospitalized to finalize the abortion or treat its complications 5 . Criminalization of the practice influences women's delay in seeking care and in the treatment received from health professionals in public services, causing unnecessary suffering 6 .…”