Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review

Izugbara, Chimaraoke; Wekesah, Frederick; Sebany, Meroji; Echoka, Elizabeth; Amo-Adjei, Joshua; Muga, Winstoun

doi:10.1080/07399332.2019.1703991

Cited by 29 publications

(43 citation statements)

References 136 publications

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“…8 11 31 32 Abortion remains a stigmatised issue in Africa creating further inequities and vulnerabilities for women based on their socioeconomic characteristics, such as marital status, contributing to severe complications. 10 Severe abortion-related complications were also associated with expulsion of products of conception (POC) prior to arrival to the facility. This may be attributable to a number of possible gaps in the information channels regarding the recommended medical abortion dosage, on when to seek postabortion care, side effects and symptoms of possible complications.…”

Section: Discussionmentioning

confidence: 99%

“…7 Studies that look at the morbidity from abortion globally and in Africa, using a standard measurement of severity and management of these complications are limited and varied. [8][9][10][11][12][13] Current studies offer quantification of the abortion-related complications, but they often do not investigate the gradient or severity of these complications and, do not assess the quality of the care provided.…”

Section: Introductionmentioning

confidence: 99%

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Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

et al. 2021

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IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.MethodsA cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsThere were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).ConclusionThere is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

et al. 2021

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“…Besides, in Zimbabwe, there is a strong family planning program with one of the highest contraceptive prevalence rates in Sub-Saharan Africa (SSA). Zimbabwe also has a restrictive abortion law, with legal abortion limited to circumstances of rape, incest, fetal impairment, or to save the woman’s life [ 17 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Post-abortion family planning use, method preference, and its determinant factors in Eastern Africa: a systematic review and meta-analysis

Demis

Azeze

2021

Syst Rev

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Background Utilization of post-abortion family planning is very critical to reduce high levels of unintended pregnancy, which is the root cause of induced abortion. In Eastern Africa, it is estimated that as many as 95% of unintended pregnancies occurred among women who do not practice contraception at all. Therefore, this meta-analysis aimed to assess post-abortion family planning utilization and its determinant factors in Eastern Africa. Methods Published papers from Scopus, HINARI, PubMed, Google Scholar, and Web of Science electronic databases and grey literature repository were searched from database inception to January 30, 2020, with no restriction by design and date of publishing. We screened records, extracted data, and assessed risk of bias in duplicate. Cochrane I2 statistics were used to check the heterogeneity of the studies. Publication bias was assessed by Egger and Biggs test with a funnel plot. A random-effects model was calculated to estimate the pooled prevalence of post-abortion family planning utilization. Results A total of twenty-nine cross-sectional studies with 70,037 study participants were included. The overall pooled prevalence of post-abortion family planning utilization was 67.86% (95% CI 63.59–72.12). The most widely utilized post-abortion family methods were injectable 33.23% (95% CI 22.12–44.34), followed by implants 24.71% (95% CI 13.53–35.89) and oral contraceptive pills 23.42% (95% CI 19.95–26.89). Married marital status (AOR=3.20; 95% CI 2.02–5.05), multiparity (AOR=3.84; 95% CI 1.43–10.33), having a history of abortion (AOR=2.33; 95% CI 1.44–3.75), getting counselling on post-abortion family planning (AOR=4.63; 95% CI 3.27–6.56), and ever use of contraceptives (AOR=4.63; 95% CI 2.27–5.21) were factors associated with post-abortion family planning utilization in Eastern Africa. Conclusions This study revealed that the marital status of the women, multiparity, having a history of abortion, getting counselling on post-abortion family planning, and ever used contraceptives were found to be significantly associated with post-abortion family planning utilization.

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“…Studies have shown that young and unmarried women are more likely to face provider stigma and mistreatment. [4][5][6] In Kenya, Izugbara et al 5 undertook in-depth interviews and focus group discussions with 152 PAC providers; the majority of providers treated young and unmarried PAC patients poorly because of the stigma associated with premarital pregnancy at such a young age. Many providers also reported risk of being stigmatized by colleagues if caught treating adolescent PAC patients politely.…”

Section: Introductionmentioning

confidence: 99%

“…6 Additionally, adolescentfriendly PAC services have been found to be rare in Sub-Saharan Africa. 4,6,7 Recent data from the World Health Organization (WHO) Multi-Country Survey on Abortion (MCS-A) across Sub-Saharan Africa found no evidence that the severity of complications in adolescents attending facilities with abortion-related complications was more severe when compared with older women (aged ≥30 years); however, differences in experience of care and, specifically, satisfaction with care between adolescents and older women were not reported. 8 It is important to robustly evaluate adolescents' satisfaction with the quality of their PAC to identify the associated gaps and interventions to fill those gaps.…”

Section: Introductionmentioning

confidence: 99%

Adolescents' satisfaction with care for abortion‐related complications in 11 Sub‐Saharan African countries: A cross‐sectional facility‐based study

Eboigbe¹,

Gadama

Filippi

et al. 2021

Intl J Gynecology & Obste

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Objective: To assess satisfaction with care for abortion-related complications experienced among adolescents compared to older women. Methods: A secondary analysis of the WHO Multi-Country Survey on Abortionrelated Morbidity and Mortality-a cross-sectional study conducted in health facilities in 11 Sub-Saharan African countries. Women with abortion-related complications who participated in an audio computer-assisted self-interview were included. Two composite measures of overall satisfaction were created based on five questions: (1) study participants who were either satisfied or very satisfied across all five questions; and (2) study participants who reported being very satisfied only across all five [The copyright line and legal statement in this article was changed on 26 January 2022 after online publication.]

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Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review

Cited by 29 publications

References 136 publications

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

Post-abortion family planning use, method preference, and its determinant factors in Eastern Africa: a systematic review and meta-analysis

Adolescents' satisfaction with care for abortion‐related complications in 11 Sub‐Saharan African countries: A cross‐sectional facility‐based study

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