New insights into quality of care for girls, women facing the complications of unsafe abortion

Too many girls and women continue to die and to face both the short and long-term negative consequences of unsafe abortion – yet information is lacking on how health care providers and systems can best provide quality care for girls and women with abortion-related complications.

In recognition of this research gap, the Human Reproduction Programme (HRP), World Health Organization (WHO) and partners have conducted a research study across 17 countries in the African, Latin American and Caribbean regions, to gather evidence on the provision, experience and quality of care – The WHO and HRP multi-country survey on abortion (MCS-A).

A special supplement has today been launched which highlights the work done as part of this study in 11 sub-Saharan African countries. Published in the International Journal of Gynecology and Obstetrics (IJGO), the supplement includes seven research articles and an editorial.

Improving understanding on what works in relation to the clinical management and care of girls and women who face abortion-related complications, is crucial for ensuring their health and well-being. These newly published papers give a significant insight into both the clinical provision of care, as well as the quality of care as experienced by women in the sub-Saharan African region. They also explore the experiences of adolescents as well as women accessing care in insecure environments.

Özge Tunçalp, Medical Officer at WHO and HRP comments, “This supplement shows how far we still have to go in ensuring quality, respectful post-abortion care for all; it also proves how much we can learn when we commit to working together. Across 11 countries, knowledge has been gained and research capacity has been strengthened. A stronger research community is better able to listen, ask and answer questions, working together for a future where every woman and girl achieves the highest standard of sexual and reproductive health and rights.”

Through the WHO and HRP multi-country study on abortion, data were collected on over 23,000 women attending health facilities with abortion-related complications. While most of these women had mild or moderate abortion-related complications, there were still many who had severe or potentially life-threatening complications, particularly in sub-Saharan Africa. A comprehensive approach to abortion and post-abortion care, includes clinical-care, self-care, task-sharing for the provision of care, as well as a supportive health system within an enabling legal environment. This is critical for ensuring high quality abortion care, which incorporates access to a range of affordable and acceptable contraception options – key for safeguarding human rights to health and to bodily autonomy.

The papers in the supplement show however, that countries need to move fast to ensure healthcare providers and systems can give such quality care for girls and women. The editorial highlights important actions that decision-makers in the sub-Saharan Africa region can take to make a difference, which emphasize:

1. Increasing access to high-quality abortion services at all levels of healthcare.
2. Ensuring approaches to improve quality of post-abortion care are based on evidence – and to perhaps include supervision to ensure that: healthcare providers use recommended practices; to audit availability of equipment and supplies; and to conduct clinical audits such as near-miss case reviews to better understand the reasons behind health complications or negative outcomes.
3. Identifying and using interventions which go beyond the health system – including addressing harmful beliefs held by healthcare providers; recognizing and addressing constraints of health systems; and ensuring girls and women are empowered.

The authors of the editorial of the supplement, Professors Seni Kouanda and Zahida Qureshi, conclude with these hopeful words, “While we still face many challenges and obstacles to ensuring access to high-quality abortion and post-abortion care for all women, we believe that efforts such as the MCS-A in Sub-Saharan Africa and Latin America and the Caribbean represent an important step forward, and hope that the work presented throughout this Supplement will help inspire innovations and insights to help fulfil women’s reproductive rights.” (WHO)