Induced abortion in Papua‐New Guinea: Experience and opinions of health professionals

Abstract

Background: Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause.Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. Aim:To conduct a study of PNG health professionals' experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. Materials and Methods:A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea.Results: Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG's abortion laws, and to views on the provision of safe accessible abortion services in the country's public health system.

Extra-legal abortion and post-abortion care knowledge, attitudes, and practices among obstetrician-gynecologist clinicians and medical residents in San José, Costa Rica: a qualitative study

“…PAC involves counseling to respond to the patient’s needs, treatment for incomplete abortion and complications arising from abortion, and the provision of family planning and other reproductive health services [ 13 ]. Reasons for the high proportion of deaths due to unsafe abortion are manifold, as individuals may not be able to access safe, legal abortions, may not be able to access PAC for complications following a spontaneous or induced abortion, or, even with access to medical institutions, may encounter healthcare professionals who decline to provide care [ 14 – 21 ]. Despite these and other barriers, some evidence has shown that healthcare professionals may be supportive of providing lifesaving PAC, though they are constrained by the health institutions in which they work [ 22 ].…”

Abortion care in Australasia: A matter of health, not politics or religion

“…7 Restricting access to abortion serves only to increase the number of unsafe abortions and the associated maternal morbidity and mortality as witnessed by our neighbours in Papua-New Guinea (PNG). 8,9 Another gain for reproductive autonomy has been the introduction of safe access zones in all jurisdictions in Australia allowing pregnant people and staff to attend services free from harassment. Similarly, a Member's Bill is currently being considered in the New Zealand parliament to grant safe areas around abortion services.…”

“…Abortion legislation in this low and middle income country is contained within criminal law (originally from 1899) and the sequelae of unsafe abortion such as sepsis including puerperal sepsis, are reported as the second leading cause of maternal mortality. 9 Women are known to attempt abortion using unsafe methods such as traditional herbal abortifacients and physical and mechanical means. The use of misoprostol acquired from friends and relations who are health workers, for self-induced abortion is increasing, particularly among educated women.…”

“…Critically, unintended pregnancy rates are highest in countries that restrict abortion access and lowest in countries where abortion is broadly legal 7 . Restricting access to abortion serves only to increase the number of unsafe abortions and the associated maternal morbidity and mortality as witnessed by our neighbours in Papua‐New Guinea (PNG) 8,9 …”

“…Although we have made some promising advances in abortion care in Australia and New Zealand, we must not forget our neighbours in PNG which has one of the highest maternal mortality rates in the world. Abortion legislation in this low and middle income country is contained within criminal law (originally from 1899) and the sequelae of unsafe abortion such as sepsis including puerperal sepsis, are reported as the second leading cause of maternal mortality 9 . Women are known to attempt abortion using unsafe methods such as traditional herbal abortifacients and physical and mechanical means.…”