Provision of harm‐reduction services to limit unsafe abortion in Tanzania

Abstract

Objective: To investigate the feasibility of providing harm-reduction services to reduce unsafe abortion in Tanzania. Methods:A cross-sectional study was conducted among 110 women who received harm-reduction counseling at a public health center in Dar es Salaam between February 10 and October 10, 2014. Background and clinical information was collected for all women; a subgroup (n=50) undertook a semi-structured survey that measured the type of services women received, women's perception of the services, and pregnancy outcome. The main study outcomes were attendance at the follow-up visit, type and quality of information women received on both visits, and misoprostol use for pregnancy termination.Results: Overall, 55 (50.0%) women attended follow-up services. Misoprostol was used for induced abortion among 54 (98.2%); 38 (70.4%) of these women had obtained contraception at the follow-up visit. Likelihood of attendance for follow-up was increased among women who were older than 34 years (odds ratio [OR] 2.2, 95% confidence interval [CI] 0.1-35.8), were married (OR 2.1, 95% CI 0.8-5.7), and had a post-primary education level (OR 2.0, 95% CI 0.8-5.3). On average, 44 (87.0%) women received all required information at the initial counseling session and none reported major complications that required hospitalization. Conclusion:Harm-reduction services for unsafe abortion are feasible and acceptable, and could provide an excellent opportunity to fight abortion-related morbidity and mortality in Tanzania. K E Y W O R D SClandestine abortion; Contraception; Counseling; Harm reduction; Maternal mortality; Misoprostol; Unintended pregnancy; Unsafe abortion | INTRODUCTIONUnintended pregnancy is a well-documented reality for women in Africa.1 Nevertheless, the highly restrictive abortion laws of most be initiated during the interim period. A risk-reduction approach to unsafe abortion-i.e. harm reduction-has proven an effective strategy for reducing maternal deaths in Latin America and the Caribbean. 5 Harm reduction involves the implementation of strategies that aim to reduce damage caused by behaviors that cannot easily be changed, especially in settings where such behaviors are driven underground by prohibitive and stigmatizing policies and practices. 6 The best-known application of this approach is needle-exchange programs that are highly effective in preventing transmission of HIV among users of illicit drugs. 7The harm-reduction model for unsafe abortion is centered on the right to information, focusing on the periods before and after the pro- In Tanzania, induced abortion is permitted only when pregnancy endangers the life or health of the woman, 10 and unsafe abortion is reported as the second leading cause of maternal deaths in this country. 3,4,11 The aim of the present study was, therefore, to investigate the feasibility of applying the harm-reduction model to the problem of unsafe abortion in Tanzania. | MATERIALS AND METHODSA cross-sectional survey was conducted among a group of women who had received harm...

Understandings of self-managed abortion as health inequity, harm reduction and social change

“…13 Similar programmes undertaken in Tanzania, and contemplated in the U.S., are justified by a professional imperative to care for women, interpreted as a narrow exemption to any criminal prohibition. 14,15 These programmes are measured and assessed by public health impact, including the redress of social inequities in unsafe abortion by reducing resort to more dangerous methods and related death and injury. They are contemplated strictly as an interim measure until legal care can be provided in the formal system on the presumption that care under a medical provider is superior to SMA.…”

Health, life and rights: a discourse analysis of a hybrid abortion regime in Tanzania

“…The Harm-Reduction Strategy was another approach mentioned [17]. The strategy entails the implementation of interventions geared towards reducing the health damage caused by abortion in contexts where access to safe abortion services is prohibited and stigmatized.…”

“…Although there is a serious lack of quality data, the available figures indicate that about 16% of maternal deaths in Tanzania are due to complications from abortion, and unsafe abortion is estimated to be the second leading cause of maternal deaths in Tanzania [14–16]. A related regional figure indicates that 18% of maternal deaths are linked to unsafe abortion in Eastern Africa [17, 18]. The challenge of unsafe abortion thus emerges as substantial in the region, not least among the younger population.…”

“…The challenge of unsafe abortion thus emerges as substantial in the region, not least among the younger population. There are a few published studies related to post abortion care [17–19], a service that also the government of Tanzania has committed to. Comprehensive Post Abortion Care (PAC) are as such introduced also in countries with restrictive abortion laws.…”

Abortion in Countries with Restrictive Abortion Laws—Possible Directions and Solutions from the Perspective of Poland

“…A study conducted in Zambia demonstrated that despite liberal abortion law the percentage of complications of unsafe abortions was still high and resulted from the lack of access to qualified medical personnel. The costs of the treatment of complications are higher by 27% than in the case of safe abortions [34].…”