Management of post abortion complications in Botswana -The need for a standardized approach

Abstract: Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women’s health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.

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Treatment with metronidazole did not reduce post-abortion complications in women with suspected bacterial vaginosis

Evidence-based Obstetrics and Gynaecology ◽

10.1016/j.ebobgyn.2005.06.001 ◽

2005 ◽

Vol 7 (3) ◽

pp. 137-138

Keyword(s):

Bacterial Vaginosis ◽

Abortion Complications ◽

Post Abortion

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Understanding reproductive health challenges during a flood: insights from Belkuchi Upazila, Bangladesh

Gates Open Research ◽

10.12688/gatesopenres.12920.1 ◽

2019 ◽

Vol 3 ◽

pp. 788

Author(s):

Nibedita S. Ray-Bennett ◽

Denise M. J. Corsel ◽

Nimisha Goswami ◽

Aditi Ghosh

Keyword(s):

Health Workers ◽

Health Care Facilities ◽

Menstrual Regulation ◽

Primary Health ◽

Health Infrastructure ◽

Abortion Complications ◽

Care Facilities ◽

Facility Level ◽

Post Abortion ◽

Primary Health Care Facilities

Background: Bangladesh is exposed to natural hazards such as floods, cyclones and droughts. As such, its health systems and health infrastructure are exposed to recurrent disasters. Research studying the impacts of natural disasters on reproductive health in particular is lacking. This research contributes to this knowledge gap by studying the challenges related to menstrual regulation and post-abortion care at both the facility and community levels, and the care-seeking patterns of pregnant women during the 2016 flood in Belkuchi, Bangladesh. Methods: Six government-run primary health care facilities were assessed using a structured assessment tool prior to the flood of 2016. In total, 370 structured interviews were conducted with women in three unions of Belkuchi (Belkuchi Sadar, Daulatpur and Bhangabari) 4 months after the 2016 flood. Results: The main challenges at the facility level are a lack of services and a shortage of medicines, equipment and trained health workers. The main challenges at the community level are displacement, high rates of self-diagnosed spontaneous abortion and a lack of treatment for post-abortion complications. A majority of the interviewed women (48%) sought menstrual regulation from the residence of a nurse or family welfare visitor. In total, 73.2% of the women who experienced post-abortion complications sought medical care. Conclusion: To overcome the challenges at the facility level, it is important to construct flood-resistant health infrastructure and train health workers in menstrual regulation and post-abortion care, so that these services can be made available during a flood. At the community level, more research is required to understand the reasons for spontaneous abortions so that these, and the subsequent chronic conditions/complications women experience, may be avoided. Context specific interventions that can overcome local challenges (both at the community and facility levels) are required to promote disaster resilience at primary health care facilities.

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MEN'S ATTITUDES ABOUT ABORTION IN UGANDA

Journal of Biosocial Science ◽

10.1017/s0021932010000507 ◽

2010 ◽

Vol 43 (1) ◽

pp. 31-45 ◽

Cited By ~ 23

Author(s):

ANN M. MOORE ◽

GABRIEL JAGWE-WADDA ◽

AKINRINOLA BANKOLE

Keyword(s):

Care Seeking ◽

Dominant Culture ◽

Safe Abortion ◽

Abortion Care ◽

Post Abortion Care ◽

Abortion Complications ◽

Appropriate Treatment ◽

Induced Abortions ◽

Post Abortion ◽

Depth Interviews

SummaryAbortion is illegal in Uganda except to save the life of the woman. Nevertheless, the practice is quite common: about 300,000 induced abortions occur annually among Ugandan women aged 15–49 (Singh et al., 2005) and a large proportion of these women require treatment for post-abortion complications. In the male-dominant culture of Uganda, where men control most of the financial resources, men play a critical part in determining whether women receive a safe abortion, or appropriate treatment if they experience abortion complications. This study examines men's roles in determining women's access to a safer abortion and post-abortion care. It draws on in-depth interviews carried out in 2003 with 61 women aged 18–60 and 21 men aged 20–50 from Kampala and Mbarara, Uganda. Respondents' descriptions of men's involvement in women's abortion care agreed that men's stated attitudes about abortion often prevented women from involving them in either the abortion or post-abortion care. Most men believe that if a woman is having an abortion, it must be because she is pregnant with another man's child, although this does not correspond with women's reasons for having an abortion – a critical disjuncture revealed by the data between men's perceptions of, and women's realities regarding, reasons for seeking an abortion. If the woman does experience post-abortion complications, the prevailing attitude among men in the sample was that they cannot support a woman in such a situation seeking care because if it had been his child, she would not have had a covert abortion. Since money is critical to accessing appropriate care, without men's support, women seeking an abortion may not be able to access safer abortion options and if they experience complications, they may delay care-seeking or may not obtain care at all. Barriers to involving men in abortion decision-making endanger women's health and possibly their lives.

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"Post-abortion Complications after Interruption of Pregnancy with Misoprostol".

Studies in Family Planning ◽

10.2307/2138004 ◽

1996 ◽

Vol 27 (5) ◽

pp. 290

Author(s):

A. Faundes ◽

L. C. Santos ◽

M. Carvalho ◽

C. Gras

Keyword(s):

Abortion Complications ◽

Post Abortion

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Post-abortion complications

Practice Nursing ◽

10.12968/pnur.2004.15.5.12905 ◽

2004 ◽

Vol 15 (5) ◽

pp. 246-246

Author(s):

Lin Pavey

Keyword(s):

Abortion Complications ◽

Post Abortion

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Understanding reproductive health challenges during a flood: insights from Belkuchi Upazila, Bangladesh

Gates Open Research ◽

10.12688/gatesopenres.12920.2 ◽

2019 ◽

Vol 3 ◽

pp. 788

Author(s):

Nibedita S. Ray-Bennett ◽

Denise M. J. Corsel ◽

Nimisha Goswami ◽

Aditi Ghosh

Keyword(s):

Health Workers ◽

Health Care Facilities ◽

Menstrual Regulation ◽

Primary Health ◽

Health Infrastructure ◽

Abortion Complications ◽

Care Facilities ◽

Facility Level ◽

Post Abortion ◽

Primary Health Care Facilities

Background: Bangladesh is exposed to natural hazards such as floods, cyclones and droughts. As such, its health systems and health infrastructure are exposed to recurrent disasters. Research studying the impacts of natural disasters on reproductive health in particular is lacking. This research contributes to this knowledge gap by studying the challenges related to menstrual regulation and post-abortion care at both the facility and community levels, and the care-seeking patterns of pregnant women during the 2016 flood in Belkuchi, Bangladesh. Methods: Six government-run primary health care facilities were assessed using a structured assessment tool prior to the flood of 2016. In total, 370 structured interviews were conducted with women in three unions of Belkuchi (Belkuchi Sadar, Daulatpur and Bhangabari) 4 months after the 2016 flood. Results: The main challenges at the facility level are a lack of services and a shortage of medicines, equipment and trained health workers. The main challenges at the community level are displacement, high rates of self-diagnosed spontaneous abortion and a lack of treatment for post-abortion complications. A majority of the interviewed women (48%) sought menstrual regulation from the residence of a nurse or family welfare visitor. In total, 73.2% of the women who experienced post-abortion complications sought medical care. Conclusion: To overcome the challenges at the facility level, it is important to construct flood-resistant health infrastructure and train health workers in menstrual regulation and post-abortion care, so that these services can be made available during a flood. At the community level, more research is required to understand the reasons for spontaneous abortions so that these, and the subsequent chronic conditions/complications women experience, may be avoided. Context specific interventions that can overcome local challenges (both at the community and facility levels) are required to promote disaster resilience at primary health care facilities.

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Abortion and Public Health Ethics

The Oxford Handbook of Public Health Ethics ◽

10.1093/oxfordhb/9780190245191.013.34 ◽

2019 ◽

pp. 402-414

Author(s):

Mahmoud F. Fathalla

Keyword(s):

Public Health ◽

Cost Savings ◽

Unsafe Abortion ◽

Human Right ◽

International Consensus ◽

Public Health Action ◽

Safe Abortion ◽

Abortion Complications ◽

Health Action ◽

Post Abortion

There is an ethical imperative to take public health action to eliminate the global problem of unsafe abortion. The moral obligation is dictated by the magnitude of the problem, the health inequities and social injustices that result from lack of access to safe abortion, the voices of women calling for action, and an international consensus recognizing unsafe abortion as a global health problem. The availability of public health interventions and the cost savings associated with fewer abortion complications reinforce the obligation to address unsafe abortion. Public health actions include reducing the need for abortion through family planning, providing safe abortion to the full extent of the law, managing abortion complications, and providing post-abortion care. These actions intersect with morality, religion, law, justice, and human rights. The public health community has a collective social and ethical responsibility to stand beside and behind women as they claim their human right to health.

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