Abstract
Unsafe abortion continues to impact negatively on women’s health in countries with restrictive abortion laws. It remains one of the leading causes of maternal mortality and morbidity. Paradoxically, modern contraceptive prevalence remains low and the unmet need for contraception continues to mirror unwanted pregnancy rates in many countries within sub-Saharan Africa. This qualitative study assessed women’s knowledge; their expectation and experiences of the methods employed for abortion; and their health care-seeking decisions following a complicated abortion. Women who presented with abortion complications were purposively sampled from seven health facilities in south-west Nigeria. In-depth interviews were conducted by social scientists with the aid of a semi-structured interview guide. Coding schemes were developed and content analysis was performed with WEFTQDA software. Thirty-one women were interviewed. Misoprostol was used by 16 women; 15 women used other methods. About one-fifth of respondents were aged ≤ 20 years; almost one-third were students. Common reasons for terminating a pregnancy were: “too young/still in school/training”; “has enough number of children”; “last baby too young” and “still breastfeeding”. Women had little knowledge about methods used. Friends, nurses or pharmacists were the commonest sources of information. Awareness about use of misoprostol for abortion among women was high. Women used misoprostol to initiate an abortion and were often disappointed if misoprostol did not complete the abortion process. Given its clandestine manner, women were financially exploited by the abortion providers and only presented to hospitals for post-abortion care as a last resort. Women’s narratives of their abortion experience highlight the difficulties and risks women encounter to safeguard and protect their sexual and reproductive health. To reduce unsafe abortion therefore, urgent and synergized efforts are required to promote prompt access to family planning and post-abortion care services.
Highlights
Unsafe abortion accounts for a significant proportion of maternal morbidity and mortality [1,2]
The Nigerian arm of the study was conducted in nine health facilities, in the south-west geo-political zone of Nigeria, where it was estimated that 164,000 induced abortions occurred in 2012 and represents an induced abortion rate of 27 per 1,000 women aged 15–49 years [12]
Reduction of unsafe abortion as a strategy for improving maternal health would require a robust and comprehensive effort. These strategies would include reducing the recourse to abortion through (1) improving women’s reproductive health knowledge through education; (2) enhancing women-centered uptake of family planning based on their choice of methods; (3) engagement and involvement of women’s significant others in abortion prevention efforts [27,36,37,38]
Summary
Unsafe abortion accounts for a significant proportion of maternal morbidity and mortality [1,2]. Between 2010 and 2014, 25% of all pregnancies ended in an induced abortion and on the average, 56 million induced abortions occurred annually [3]. Global annual estimate of unsafe abortion was around 25 million, with 97% of these in developing countries. Sub-Saharan African women had the highest risk of dying from an unsafe abortion [2], with the sub-region accounting for an estimated 125,000 deaths [4]. In Bankole et al.’s 2006 report [9], which was largely based on data from three surveys (community-based survey, hospital-based survey and 2003 NDHS), 28.0% of all women interviewed had had unwanted pregnancies at some point. It is not all unwanted pregnancies that are aborted, yet these figures suggest that there are a significant number of abortion seekers in these regions. Use of modern contraception would reduce these numbers, but 27.0% of sexually-active women were not on any contraception despite being undesirous of pregnancy [9]
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