Perceptions of misoprostol among providers and women seeking post-abortion care in Zimbabwe

Abstract

In Zimbabwe, abortions are legally restricted and complications from unsafe abortions are a major public health concern. This study in 2012 explored women's and providers' perspectives in Zimbabwe on the acceptability of the use of misoprostol as a form of treatment for complications of abortion in post-abortion care. In-depth interviews were conducted with 115 participants at seven post-abortion care facilities. Participants included 73 women of reproductive age who received services for incomplete abortion and 42 providers, including physicians, nurses, midwives, general practitioners and casualty staff. Only 29 providers had previously used misoprostol with their own patients, and only 21 had received any formal training in its use. Nearly all women and providers preferred misoprostol to surgical abortion methods because it was perceived as less invasive, safer and more affordable. Women also generally preferred the non-surgical method, when given the option, as fears around surgery and risk were high. Most providers favoured removing legal restrictions on abortion, particularly medical abortion. Approving use of misoprostol for post-abortion care in Zimbabwe is important in order to reduce unsafe abortion and its related sequelae. Legal, policy and practice reforms must be accompanied by effective reproductive health curricula updates in medical, nursing and midwifery schools, as well as through updated training for current and potential providers of post-abortion care services nationwide. Our findings support the use of misoprostol in national post-abortion care programmes, as it is an acceptable and potentially life-saving treatment option.

Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016

“…In practice, however, access to legal abortions on these grounds is difficult and rare [ 4 ]. Legal and administrative barriers coupled with stigma among both women and providers [ 5 ] and fear of social repercussions [ 6 ] serve to limit access to legal abortion in Zimbabwe. Rather than reduce abortion incidence, restrictive abortion laws like that of Zimbabwe result in women pursuing clandestine and potentially unsafe abortions [ 7 ].…”

“…The Zimbabwe Ministry of Health and Child Care (MoHCC) has made efforts to reduce maternal mortality through improving post-abortion care (PAC) services; this includes launching training programs on manual vacuum aspiration (MVA) in 2008 [ 6 , 11 ], including misoprostol on the Essential Drugs List in 2011, piloting training on using misoprostol for PAC in 2013 [ 11 ], and revising The National Guidelines for Comprehensive Abortion Care in Zimbabwe in 2014 to expand PAC to primary care facilities and ensure PAC services are free in public facilities [ 12 ].…”

From Unsafe to Safe Abortion in Sub-Saharan Africa: Slow but Steady Progress

“…152 Indeed, results of interventions to introduce misoprostol for postabortion care 152,184,185 and of interviews with postabortion patients treated with misoprostol show high levels of satisfaction with this treatment method, which is perceived as safe and natural. 186 However, the transition away from use of D&C (an invasive surgical method not recommended by WHO) is far from complete. Use of D&C to treat women needing care following an abortion or miscarriage was still fairly common, as of 2016, in Zimbabwe (63% of such cases) 108 and in Kinshasa (49%).…”

Women’s Satisfaction With and Perceptions of the Quality of Postabortion Care at Public-Sector Facilities in Mainland Tanzania and in Zanzibar

“…Young women are often more likely to seek an unsafe abortion, develop complications, and either delay or refrain from seeking treatment, 13 partly because they perceive bias, opprobrium, and discrimination from providers 14 . A qualitative assessment of women’s views on medical treatment for abortion complications in Zimbabwe found that women preferred misoprostol over vacuum aspiration techniques for PAC, perceiving it as less invasive, safer, and more affordable than surgery 15 …”