The severity of abortion complications in Malawi

Kalilani-Phiri, Linda; Gebreselassie, Hailemichael; Levandowski, Brooke A.; Kuchingale, Edgar; Kachale, Fannie; Kangaude, Godfrey Dalitso

doi:10.1016/j.ijgo.2014.08.022

Cited by 43 publications

(51 citation statements)

References 14 publications

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“…An additional assumption is that the distribution by wealth and residential status (urban vs. rural) of women having an induced abortion is similar to the distribution of all women in Malawi, although it is possible that differences in rates of unintended pregnancy, or propensity to abort, may vary by wealth and residence. An additional limitation of this approach is that it does not provide information on the characteristics of individual women seeking PAC or the severity of abortion complications, though studies in prior years have investigated these issues with additional data collection efforts [16;30]. …”

Section: Discussionmentioning

confidence: 99%

“…The majority of terminations in Malawi are performed under unsafe conditions [14], and the stigmatized nature of the procedure often leads to delays or avoidance in seeking medical care for complications [15]. Among women who do reach a facility for post-abortion care (PAC), more than one in four have severe or moderate morbidity, and there were an estimated 387 deaths per 100,000 PAC complications in 2009 [16]. …”

Section: Introductionmentioning

confidence: 99%

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Incidence of induced abortion in Malawi, 2015

et al. 2017

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BackgroundIn Malawi, abortion is legal only if performed to save a woman’s life; other attempts to procure an abortion are punishable by 7–14 years imprisonment. Most induced abortions in Malawi are performed under unsafe conditions, contributing to Malawi’s high maternal mortality ratio. Malawians are currently debating whether to provide additional exceptions under which an abortion may be legally obtained. An estimated 67,300 induced abortions occurred in Malawi in 2009 (equivalent to 23 abortions per 1,000 women aged 15–44), but changes since 2009, including dramatic increases in contraceptive prevalence, may have impacted abortion rates.MethodsWe conducted a nationally representative survey of health facilities to estimate the number of cases of post-abortion care, as well as a survey of knowledgeable informants to estimate the probability of needing and obtaining post-abortion care following induced abortion. These data were combined with national population and fertility data to determine current estimates of induced abortion and unintended pregnancy in Malawi using the Abortion Incidence Complications Methodology.ResultsWe estimate that approximately 141,044 (95% CI: 121,161–160,928) induced abortions occurred in Malawi in 2015, translating to a national rate of 38 abortions per 1,000 women aged 15–49 (95% CI: 32 to 43); which varied by geographical zone (range: 28–61). We estimate that 53% of pregnancies in Malawi are unintended, and that 30% of unintended pregnancies end in abortion. Given the challenges of estimating induced abortion, and the assumptions required for calculation, results should be viewed as approximate estimates, rather than exact measures.ConclusionsThe estimated abortion rate in 2015 is higher than in 2009 (potentially due to methodological differences), but similar to recent estimates from nearby countries including Tanzania (36), Uganda (39), and regional estimates in Eastern and Southern Africa (34–35). Over half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of induced abortion in Malawi, 2015

et al. 2017

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“…We selected these two government hospitals because public hospitals provide the majority of PAC in Malawi (Kalilani-Phiri et al 2015) and the selection of a rural and urban site enabled exploration of potential differences between rural and urban facilities. Furthermore, QECH is the largest referral hospital in Malawi and sees the majority of women with abortion complications.…”

Section: Methodsmentioning

confidence: 99%

‘It’s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study

Cook

Kok

Odland

2016

Health Policy Plan.

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Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources ; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low-and middle-income country perspective.

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“…Abortions performed at over 12 weeks of gestation make up a relatively small proportion of cases in areas where safe abortion is easily accessible. However, where abortion is restricted, women have a higher likelihood of presenting in the second trimester, with presentation rates as high as 17% in Cambodia [20], 35% in Malawi [21], and 41% in Kenya [22]. Risk factors for second‐trimester abortion include young age, financial hardship, domestic violence, and late recognition of pregnancy.…”

Section: What Can Obstetrician/gynecologists Do?mentioning

confidence: 99%

What can obstetrician/gynecologists do to support abortion access?

Mark¹,

Wolf²,

Edelman

et al. 2015

Intl J Gynecology & Obste

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Unsafe abortion causes approximately 13% of all maternal deaths worldwide, with higher rates in areas where abortion access is restricted. Because safe abortion is so low risk, if all women who needed an abortion could access safe care, this rate would drop dramatically. As women's health providers and advocates, obstetrician/gynecologists can support abortion access. By delivering high-quality, evidence-based care ourselves, supporting other providers who perform abortion, helping women who access abortion in the community, providing second-trimester care, and improving contraceptive uptake, we can decrease morbidity and mortality from unsafe abortion.

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The severity of abortion complications in Malawi

Abstract: In 2009, many women seeking postabortion care in Malawi presented with complications. Advocacy is needed to influence policies that will allow expanded access to safe abortion services for women of all ages and in all areas.

Cited by 43 publications

References 14 publications

Incidence of induced abortion in Malawi, 2015

Incidence of induced abortion in Malawi, 2015

‘It’s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study

What can obstetrician/gynecologists do to support abortion access?

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