A Monograph on Complications of Unsafe Abortion in Africa was published in August 1995,
as a collaborative effort among the Commonwealth Regional Health Community Secretariat
(CRHCS) for East, Central and Southern Africa (ECSA), JHPIEGO, IPAS and the Academy for
Educational Development. The monograph contains the results of a literature review on
abortion in sub-Saharan Africa (SSA) covering the years 1980 to 1994 and primary data
collection in three Commonwealth countries (Malawi, Uganda, Zambia). Recent data collected
from the three countries specifically for this monograph confirmed, for the most part, the
findings of the comprehensive literature review.
Findings
The high proportion of incomplete abortion patients among hospital gynecology
admissions (up to 60% in some places) points to a significant public health problem.
Hemorrhage and sepsis were identified as the two most common complications of unsafe
abortion among women presenting at health facilities.
Experiences with the use of manual vacuum aspiration (MVA) in SSA for treating abortion
complications have been positive as measured by shorter lengths of hospital stay and a
reduced need for a second evacuation; however, important research gaps exist, including
how MVA services can be expanded to lower levels of the health system. Very little
information exists on the cost of treating abortion complications. One study2
which compared facility costs of patients treated with MVA versus sharp curettage
documented decreases of over 65% with the use of MVA. Researchers collecting primary data
in Malawi estimated that the cost of treating one abortion patient with no serious
complications was higher than the amount budgeted annually per capita for overall health
care by the Malawi Parliament.
In almost all facilities surveyed in the three monograph study countries, the providers
noted that incomplete abortion patients were not using any modern method of FP when they
became pregnant. In the literature reviewed, adolescents, in particular, did not use an
effective method of contraception. This was true because, often, adolescents do not have
access to FP services—which makes them a population particularly vulnerable to unsafe
abortion.
Research literature on postabortion family planning services in SSA is virtually
nonexistent, which probably reflects the lack of these services in general in the region.
In fact, in the facilities surveyed, neither postabortion FP counseling nor FP methods
were offered before discharge. Many of the providers surveyed, however, thought that FP
information and services should be provided to abortion patients following the procedure.
In most ECSA countries, local laws restrict or prohibit women from obtaining safe,
legal abortions. Providers surveyed in Malawi, Uganda and Zambia, however, were almost
unanimous in their opinion that women will choose to abort and that providers will perform
the procedure despite these laws.
Policy and Program Implications
In November 1994, study findings summarized in the initial draft of the monograph were
presented with policy and program implications to officials attending the 22nd Conference
of Health Ministers held in Blantyre, Malawi. The final version of the monograph was
presented and distributed at the CRHCS Directors’ Joint Consultative Committee
meeting in Nairobi, Kenya, in August 1995, where it was utilized to draft a regional
action plan to address various aspects of the problem. Representatives of the Ministries
of Health of the 13 ECSA countries and members of donor organizations including the World
Bank and the United Nations Population Fund attended the meeting.
Next Steps
Policy and program implications of the research will be summarized in a shorter policy
document to be shared with officials at a future CRHCS Conference of Health Ministers. In
addition, the country reports are being further developed for country-wide distribution,
and follow-on activities are being planned to facilitate the translation of regional
postabortion care policy into action.
2 Johnson BR et al. 1993. Costs and resource
utilisation for the treatment of incomplete abortion in Kenya and Mexico. Social Science
and Medicine 36(11): 1443–1453.
