Severe morbidities associated with induced abortions among misoprostol users and non-users in a tertiary public hospital in Ghana

Abstract

BackgroundMisoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.MethodsThis was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher’s exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.ResultsOverall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks’ gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).ConclusionSelf-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

A prospective study of severity of complications associated with use of misoprostol and other abortion methods in South West Nigeria

“…Despite abortion being illegal in Nigeria, one‐third (33.9%) of the women in the study who were admitted with complications of abortion had attempted to terminate their pregnancy. Most of the women who had induced abortion were young, nulliparous, and were not using any form of contraception, which is in keeping with a similar study from Ghana . This demonstrates a high prevalence of unmet need for contraception among women.…”

“…The present study also revealed that the different methods employed in procuring an abortion in South West Nigeria included misoprostol, surgical abortion, use of medicinal drugs, injectables, and herbs. Although use of misoprostol for procuring an abortion was associated with fewer complications, the reported rate of its use (23.2%) was lower than the 60% reported in Ghana . This could be because women are just getting to know about the use of misoprostol for procuring an abortion in Nigeria.…”

Uptake of Misoprostol among women seeking abortion in Accra, Ghana

“…Although Ghana is one of the countries which amended its abortion law in 1985 to make it more liberal; the current law permits abortion carried out by a registered medical practitioner in a registered public or private health facility. The circumstances under which abortion is permissible are: rape, defilement and incest; where the pregnancy poses substantial risk to the physical or mental health of the woman; or in cases of severe foetal anomaly [8][9][10]. In 2003, a policy to provide abortion care to the full extent of the law was developed.…”

“…And since 2006, service delivery standards and protocols on prevention and management of unsafe abortion including provision of comprehensive abortion care have been implemented nationwide [11]. Although the law is liberal, about 70 induced abortions per 1000 performed in Ghana each year among women of reproductive age are unsafe [10,12,13].…”

“…Scarce but growing body of literature exist on misoprostol use in Ghana. With some focusing on morbidities associated with induced abortions among misoprostol users [10], management of incomplete abortions with misoprostol [27] and its availability and prescription in community pharmacies [14]. Despite these studies, none has focused on the prevalence and factors associated with misoprostol uptake among women seeking abortion care in an urban area in Ghana.…”