Quality of care for abortion‐related complications: Insights from the WHO Multi‐Country Survey on Abortion‐related Morbidity across 11 African countries

Kouanda, Séni; Qureshi, Zahida

doi:10.1002/ijgo.14079

Cited by 3 publications

(6 citation statements)

References 13 publications

(16 reference statements)

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“…This gap in evidence exacerbates its invisibility, limiting its recognition as a health issue to be addressed. As a result, evidence about abortion in fragile and conflict-affected settings was identified by researchers, practitioners [ 27 – 29 ] and WHO [ 30 ] as a priority research topic.…”

Section: Introductionmentioning

confidence: 99%

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

Pasquier

Owolabi

Fetters³

et al. 2023

BMC Pregnancy Childbirth

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Background Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.

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Section: Introductionmentioning

confidence: 99%

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

Pasquier

Owolabi

Fetters³

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Prior studies have elucidated the relationship between low quality of care with high levels of abortion stigma and increased abortion-related morbidity and mortality, indicating that quality improvement interventions are important for reducing community stigma and improving health outcomes (25)(26)(27).…”

Section: Quality Of Abortion Carementioning

confidence: 99%

“…Unfortunately, a comprehensive review of person-centered abortion care from diverse country settings found that health facilities and providers often fail in providing adequate person-centered care to CAC clients (35). This results in devastating impacts for those seeking induced abortion or PAC, including negative mental health and psycho-social outcomes, delayed care-seeking, and using unsafe methods to avoid going to health facilities (26,27,35).…”

Section: Quality Of Abortion Carementioning

confidence: 99%

“…Within the Ethiopian context, as investments in the public sector to increase CAC access have expanded, additional research is needed to understand the differing levels of person-centered care by level of public health facility to inform quality improvement and service delivery interventions. Furthermore, without analyzing quality of CAC services and centering patient experiences, a key opportunity to improve the health outcomes of women and girls is neglected (14,27). This study utilized client perspectives to examine the quality of induced abortion and PAC services, with a speci c focus on person-centered care, in public health facilities in four regions of Ethiopia (Tigray, Amhara, Oromia, Southern Nations, Nationalities, and People's [SNNP]).…”

Section: Quality Of Abortion Carementioning

confidence: 99%

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Client’s experiences on the provision of person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional study

Chekol,

McCaffrey,

Dijkerman

et al. 2023

Preprint

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Background Ethiopia has made remarkable progress in expanding access to and provision of comprehensive abortion care. However, complications due to unsafe abortion still contributes to a significant proportion of maternal mortality in the country. As efforts to increase accessibility, availability, acceptability, and quality of comprehensive abortion care continue, evaluating service quality is critical. This study assesses the quality of comprehensive abortion care in public health facilities, from clients’ perspectives, in four regions of Ethiopia to examine how person-centered care differs based on facility and service characteristics. Methods We conducted 1,870 client exit surveys in 2018 using structured questionnaires with women who received induced abortion or postabortion care services from 76 public health facilities across four regions: Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and People’s. We calculated descriptive, bivariate, and multivariable statistics to examine service characteristics associated with 30 person-centered care outcomes grouped into five domains. Results Comprehensive abortion care clients reported high levels of person-centered care, with participants reporting exceptionally positive experiences for outcomes in the dignity and respect domain and trust, privacy, and confidentiality domain. However, there was notable room for improving client experiences across three domains of person-centered abortion care: autonomy, communication and supportive care, and health facility environment. In the multivariate analysis, client-reported quality outcomes differed significantly by diagnosis, region, health facility type, and procedure type. Findings specifically reveal that clients in Amhara, at tertiary and primary hospitals, and who received postabortion care report lower person-centered care. Conclusions The positive experiences reported by comprehensive abortion care clients highlight the impact of the Ethiopian government’s strategy to increase abortion access in the public health sector. However, numerous disparities in person-centered care were identified, providing insight into opportunities to advance the quality of comprehensive abortion care. Recommendations include investment in initiatives to improve postabortion care client experiences, better integration of reproductive health services at higher-level facilities, and leveraging qualitative methods to research regional differences. These findings can direct regional-level and facility-based person-centered abortion care interventions to ensure the most effective impact on the health outcomes and human rights of people seeking comprehensive abortion care in Ethiopia.

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“…This gap in evidence exacerbates its invisibility, limiting its recognition as a health issue to be addressed. As a result, evidence about abortion in fragile and conflict-affected settings was identified by researchers, practitioners [27][28][29] and WHO [30] as a priority research topic.…”

Section: Introductionmentioning

confidence: 99%

High severity of abortion complications in fragile and conflict-affected settings: A cross-sectional study in two referral hospitals in Sub-Saharan Africa (AMoCo study)

Pasquier

Owolabi

Fetters³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals located in such settings in northern Nigeria and Central African Republic (CAR).Methods: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study using prospective medical record review of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.Results: We analyzed data from 520 women in Nigeria and 548 women in CAR. Abortion complications represented 4.2% (Nigeria) and 19.9% (CAR) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigeria and CAR. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9%in Nigeria, 57.8% in CAR), followed by infection (18.7% in Nigeria, 27.0% in CAR). Among the 146 women (Nigeria) and 231 women (CAR) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in Nigeria (66.7%) compared to CAR (37.6%).Conclusion: Our data suggests greater severity of abortion-related complications compared with the 210 African referral facilities of a recent WHO study in more stable settings. Factors that could contribute to this greater severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe induced abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortions in fragile and conflict-affected settings.

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Quality of care for abortion‐related complications: Insights from the WHO Multi‐Country Survey on Abortion‐related Morbidity across 11 African countries

Abstract: SynopsisA collection of seven papers from the WHO Multi‐Country Survey on Abortion‐related morbidity (MCS‐A) using secondary data analysis to assess the quality of care for abortion‐related complications in facilities in Sub‐Saharan Africa.

Cited by 3 publications

References 13 publications

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

Client’s experiences on the provision of person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional study

High severity of abortion complications in fragile and conflict-affected settings: A cross-sectional study in two referral hospitals in Sub-Saharan Africa (AMoCo study)

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