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A study of two hospitals in conflict-affected settings finds patients at significantly higher risk of developing severe complications resulting from unsafe abortions.
Unsafe abortion is one of the leading causes of maternal mortality in the world, with over 20,000 people dying each year due to related complications. In fragile or conflict-affected settings, the complications resulting from unsafe abortion are up to seven times more severe.
Doctors Without Borders/Médecins Sans Frontières (MSF) recently took part in the first-ever study on this issue, focusing on two referral hospitals in Africa: Bangui hospital in the Central African Republic (CAR) and a hospital in Jigawa state in northern Nigeria. Conducted in partnership with Épicentre, the Guttmacher Institute, Ipas, and the Nigerian and Central African Ministries of Health, the Abortion-related Morbidity and Mortality in Fragile and Conflict-affected Settings study (AMoCo) found that in these two hospitals, severe abortion complications were five to seven times more frequent than hospitals in more stable settings in Africa, which were studied by the World Health Organization (WHO) using a similar methodology.
"I was distraught. I had drunk the traditional medicine. Before that, someone had shown me how to insert a piece of iron into my vagina. This person told me it would dilate the cervix, but it didn't work. She also told me to boil the roots of a plant called kava with natron [sodium carbonate] and then drink the mixture. After drinking it, I felt sick to my stomach and dizzy. I couldn't get out of bed. The pain was intense.”
— Anonymous, 32, Bangui hospital
Around 70 percent of maternal deaths occur in sub-Saharan Africa. Among the five main causes are abortion-related complications—an issue in which little progress has been made in recent decades. Yet most abortion-related deaths are the result of unsafe induced abortions, which could be largely avoided by providing comprehensive abortion care, including post-abortion care, contraception, and safe abortion services, so that no one feels they have to resort to dangerous procedures or delay care until it’s too late.
What is an unsafe abortion?
An unsafe induced abortion is one carried out by someone who does not have the necessary skills to perform it, or does not comply with medical standards.
Often, unsafe abortions result in severe abortion-related complications, defined by WHO as potentially life-threatening cases that result in death or near-misses, based on a set of standardized clinical, biological, and treatment criteria used in a multi-country survey on abortion (MCS-A).
In the hospitals MSF studied, more than 50 percent of women admitted for abortion-related complications arrived with severe symptoms, mainly hemorrhage (72 percent in the Nigerian hospital and 58 percent in the Central African hospital).
The severity of complications can be explained by inadequate and inaccessible post-abortion care services. Women in fragile, conflict-affected settings also face a higher risk of exposure to sexual violence, as well as barriers to accessing contraception. These factors increase the risk of unwanted pregnancy and recourse to unsafe abortion, particularly in places where abortion laws are restrictive.
"A woman explained that if I waited any longer, I might die because I was bleeding out. The motorcycle driver said that he had taken a woman in the same condition to the hospital, and that it saved her life. He told us to hurry and that's how they got me here."
— Anonymous, 35, Bangui hospital