Self-reports of induced abortion: an empathetic setting can improve the quality of data

Abstract

Objectives. This study estimated the proportion of incomplete abortions that are induced in hospital-based settings in Tanzania.Methods. A cross-sectional questionnaire study was conducted in 2 phases at 3 hospitals in Tanzania. Phase 1 included 302 patients with a diagnosis of incomplete abortion, and phase 2 included 823 such patients.Results. In phase 1, in which cases were classified by clinical criteria and information from the patient, 3.9% to 16.1% of the cases were classified as induced abortion. In phase 2, in which the structured interview was changed to an empathetic dialogue and previously used clinical criteria were omitted, 30.9% to 60.0% of the cases were classified as induced abortion.Conclusions. An empathetic dialogue improves the quality of data collected among women with induced

Unsafe abortion in rural Tanzania – the use of traditional medicine from a patient and a provider perspective

“…More than two-third of the women who were admitted with an incomplete abortion reported having had an unsafely induced abortion prior to admittance in the hospital. Similarly high rates of unsafe abortions have been reported in other Tanzanian studies [ 9 , 12 , 13 ]. Almost half of the women had either turned to traditional providers to have a clandestine abortion or self-induced their abortion.…”

“…Reliable data on abortion are difficult to obtain, both due to the illegality of the procedure as well as the social stigma associated with it. However, it is believed that the empathetic approach utilised [ 9 ] enabled us to identify women having experienced an unsafe induced abortion. It is also important to stress that many of the traditional providers interviewed were reluctant to be tape recorded for fear of the legal consequences, and it should be kept in mind that the traditional providers who gave us the information about the different plants used to induce abortion, might not themselves have performed the procedure, but they knew about it and in case they did not provide the plant species themselves they could pass the instructions on to the women in need.…”

“…Hence there is a lack of detailed, structured information, which describes the remedies and methods used to induce abortion in more detail. We have previously through a quantitative approach described that unsafe abortion is a significant problem in hospital based settings in Tanzania [ 9 ], we have also described that many of the women who are admitted with abortion complications have had their abortion induced by traditional providers who are using roots and plant specimens to induce abortion [ 5 ] and we have documented that some of the herbs used to induce abortion have a significant uterus contractive effect [ 10 ]. Many women who experience an unwanted pregnancy resort to traditional medicine, either provided by a traditional provider, a family member or the woman/girl herself [ 5 ].…”

Conducting Collaborative Abortion Research in International Settings

“…Role playing, mock interviews, and training in empathic interviewing are particularly important, regardless of the interviewer’s experience or skill (Rasch et al, 2000). Empathic interviewing involves approaching participants gently and respectfully, avoiding judgmental language (including nonverbal language), supporting a participant through strong emotions, and listening actively.…”

“…The paper discusses the design and implementation of research on abortion in international settings, both to ensure data quality and to appropriately frame inferences from this research. Although the challenges of research on abortion are widely recognized, little has been published on how best to conduct such research (Barzelatto & World Health Organization, 1996; Coeytaux, Leonard, & Royston, 1989; Rasch, Muhammad, Urassa, & Bergstrom, 2000). Our purpose here is to share insights and lessons learned with new and established researchers to inform the development and implementation of abortion-related research.…”