Abstract
BackgroundWhile the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda.MethodsWe interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support.ResultsOur study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported “some or severe” problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean differences in EQ-5D utility score.ConclusionsOur study suggests that abortion complications are associated with diminished HRQoL and the magnitude of the association depends on social support. However, the mediating role of social support in a setting of social and legal proscriptions to induced abortion is complex.
Highlights
In Uganda, where abortion is illegal except to save the life of the mother, illegally-induced abortions are often carried out in unsafe conditions, by unskilled providers
In this study comparing Health-Related Quality of Life (HRQoL) between women discharged following treatment for abortion complications and those visiting the hospital for routine obstetric care, we found that abortion complications were associated with a significantly diminished HRQoL, and that this association depended on social support
We found that higher proportions of women with abortion complications reported either some or severe problems with self-care, usual activity, pain/ discomfort and anxiety/depression compared to the women visiting the hospital for routine obstetric care
Summary
In Uganda, where abortion is illegal except to save the life of the mother, illegally-induced abortions are often carried out in unsafe conditions, by unskilled providers. Unsafe abortions and resultant complications represent a significant burden to women and the healthcare system. Recent studies in Uganda have documented the substantial economic costs associated with unsafe abortions and resulting complications. Babigumira et al [2], using a decision-analytic model to represent the consequences of an induced abortion, estimated an annual per-patient societal cost of $171, translating into $64 million in costs per year for the country. Though cost estimates differ—likely as a consequence of the different methodologies and perspectives adopted by the studies—both highlight the substantial negative economic impact of induced abortions on the health care system and society. While the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. We performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda
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