Morbidity and Mortality following Induced Abortion in Nnewi, Nigeria

Abstract

We present a study of the maternal morbidity and mortality among 76 patients treated at the Nnamdi Azikiwe University Teaching Hospital, Nnewi for complications of induced abortion from January 1996 to December 2000. The total number of maternal admissions over this period was 5750, and illegal induced abortion was responsible for 1.3% of the admissions, with a mortality rate of 5.3% (n = 4) for induced abortion. This accounted for 21.1% of the total maternal deaths (n = 19) for the period. The mean age of the women was 20.6 years (range 15-34 years), 94.7% (n = 72) were unmarried, 93.5% (n = 71) were nulliparous and 76.5% (n = 58) were unemployed, 67.1% (n = 51) had had a mid-trimester termination at > 13 weeks gestational age. It is significant that 55.3% of the patients were teenagers and 45.1% of the mid-trimester abortions occurred in this group. Genital sepsis, haemorrhage, pelvic infection with peritonitis and abscess formation, uterine perforation, and gut injury were the major complications encountered. This study demonstrates that induced abortion is still a major cause of maternal mortality in Nigeria. Integrated family health education, planned parenthood and contraceptive education, a mass literacy campaign and improvement of the existing national health services are recommended in order to ameliorate the problems of illegally induced abortion in Nigeria.

Post induced abortion morbidity and mortality in Oleh, Nigeria

“…This explains the high incidence of serious complications such as anaemia and infectious morbidities genital sepsis/ septicaemia/ peritonitis/ pelvic abscess seen in this study; necessitating various modalities of definitive treatment. In this study, nonmedically qualified practitioners working in substandard medical environment carried out most (85%) of the attempted abortions which is similar to findings from other studies 3,5 . Some of the immediate complications of unsafe abortion that are lifethreatening are haemorrhage and infectious morbidities such as septicaemia 12 .…”

“…This has been attributed to their attitude of wanting to keep sexual activity secret; therefore most sexually active women do not use contraceptive, with the attendant risk of unwanted pregnancy, consequent induced abortion and its health consequences as shown in this study and others 5,7,9 . Finally, this study demonstrate that induced abortion is still a major cause of maternal morbidity and mortality in Nigeria as has been reported previously other studies 2, 3,6,7 Legislation alone may not effectively control induced unsafe abortion and its sequelae until alternatives are provided. Some of these alternatives include mass literacy campaign on the dangers of induced abortion, family-life education, provision of family planning services to all women and men without discrimination and liberalization of abortion laws which has been shown 12 to markedly reduce abortion-related maternal morbidity and mortality by enabling the provision of safe/legal abortion services.…”

“…As in other studies 13,14 , majority of our patients who had undergone induced abortion were teenagers and presented themselves for abortion when the pregnancy was advanced and, therefore requiring relatively more complicated termination procedure which only a specialist may handle. But, either because of their healthseeking behaviour, socio-economic, cultural disapproval of pre-marital sex and/or legal restriction reasons, these women hide their pregnancy and resort to unskilled providers, use dangerous methods and most times, delay in seeking help after complication(s) develop; and only seek help when they become seriously ill 3,7 . This explains the high incidence of serious complications such as anaemia and infectious morbidities genital sepsis/ septicaemia/ peritonitis/ pelvic abscess seen in this study; necessitating various modalities of definitive treatment.…”

“…In Nigeria, Clinicians are often faced by patients requiring immediate and sympathetic help in procuring induced abortion because the pregnancy was unwanted at the time. Inspite of this, abortion law in Nigeria is still restrictive 2 , hence abortions are clandestinely and illegally undertaken everyday by those least qualified to do so 3,4 and in substandard medical environment 4 resulting in unsafe abortion which has been reported 5 to cause about 20,000 deaths a year in Nigeria.…”

Small bowel obstruction following perforation of the uterus at induced abortion

“…1,2 Unsafe abortion accounts for 20-50% of the over 500,000 maternal deaths that occur globally every year. 3 The World Health Organization (WHO) estimates that about 40-60 million abortions occur around the world annually and half of these are unsafe.…”