Abortion‐related complications in Cambodia

Abstract

Introduction Although termination of pregnancy (termination) has been legal in the Kingdom of Cambodia since 1997, a number of barriers to safe termination services persist and many women continue to induce their own terminations or seek unsafe services that result in complications requiring 'post-abortion' care.Objective To describe the complications of miscarriage and failed terminations and document the magnitude of the resulting morbidity in the Cambodian public sector.Design Cross-sectional descriptive study.Setting Public sector hospitals and health centres.Sample Stratified multistage sampling design included all hospitals (n = 71), 14% of eligible high-level health centres (n = 58) and 22% of eligible low-level health centres (n = 57).Methods Data collectors used a standardised questionnaire to record information on diagnosis, reproductive history and treatment from 629 women seeking care for termination or miscarriage-related complications in study facilities over a 3-week period.Main outcome measures Annual estimate of cases, clinical symptoms, severity distribution of morbidity, ratio of complications to live births and incidence of abortion complications for Cambodian public health facilities.Results In 2005, an estimated 31 579 women with complications of miscarriage or terminations were treated in Cambodian government facilities; 80% of these women sought care at a health centre. Forty percent of all women seeking care for complications either reported or showed strong clinical evidence of prior attempted terminations. Nearly 17% of these women were in the second trimester of pregnancy and 42% of them presented with high severity complications. The annual incidence of termination and miscarriage complications (abortion complications) was 867 per 100 000 women of reproductive age. The projected ratio of complications was 93 per 1000 live births.Conclusions To reduce maternal morbidity in Cambodia, women must be encouraged to seek safe termination services or seek postabortion care without delay. Additionally, providers need further training, and facilities greater commitment, to provide safe terminations and care for complications of unsafe terminations and miscarriage.

Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications

“…Although women may be more likely to report a termination attempt to their health care providers than to standard interviewers, 15,20,25 pervasive stigma against abortion-as well as a lack of knowledge that abortion is legal-may have kept even more women from disclosing a clandestine abortion attempt. In addition, women who desired to terminate an unwanted pregnancy may not have been able to do so safely because of the attitudes of their partner or family members or the belief that a safe abortion is expensive or unavailable.…”

“…The methodology, which was developed by a WHO task force, has been adapted and used to measure the severity of abortion-related complications in countries as diverse as South Africa, Cambodia and Kenya. 8,[19][20][21][22][23] For this study, we reviewed data collection instruments from Kenya and Cambodia and revised them on the basis of input obtained from a panel of experts and investigators.…”

Towards safe abortion access: an exploratory study of medical abortion in Cambodia

“…4 Lack of awareness of the law and lack of available safe abortion services means many women continue to induce their own abortions through nonregistered abortion medications or seek unsafe services that result in complications requiring post-abortion care. 5 Several public health studies have documented these problems in Cambodia 4,6,7 and advocated for improved access to safe abortion services.…”

Using a harm reduction lens to examine post-intervention results of medical abortion training among Zambian pharmacists

“…Providing women with referrals to health facilities was an integral part of the training provided, yet even where this option exists, as it does in some parts of Zambia, some women are too ashamed, afraid or lack the knowledge or ability to navigate the formal health system to obtain a legal abortion as has also been found in studies in Cambodia, Ethiopia and South Africa. 6,[13][14][15] Ensuring that pharmacy workers reflect on their responsibility to respect women's autonomy and choices and provide them with evidence-based information on their options, including self-induction, to mitigate as much harm as possible, was also an integral component of the training provided.…”

“…16 In a study conducted in Cambodia, where abortion in the first trimester is unrestricted, 37% of women seeking post-abortion care in 2005 had already attempted termination prior to seeking care; 80% had sought advice or assistance from someone who sold medications. 13 Women in Zambia also deserve to benefit from scientific advances regarding safe induced abortion, whether or not they reach a health facility. 9 These study results demonstrate that Zambian pharmacy workers have a role to play in safe abortion services and that some are willing to play that role, even though they may choose to not sell medical abortion products directly.…”