Date Published: May 29, 2019
Publisher: Public Library of Science
Author(s): Agnes A. Oyeniran, Folasade A. Bello, Babawale Oluborode, Ibraheem Awowole, Olabisi M. Loto, Theresa A. Irinyenikan, Adetokunbo O. Fabamwo, Lanre Olutayo, Bela Ganatra, Philip Guest, Bukola Fawole, Sharon Mary Brownie.
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.
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 . Within the same period, 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 , with the sub-region accounting for an estimated 125,000 deaths .
Thirty-one women were interviewed, and all transcripts were included in this analysis. Majority of the participants were aged 21 to 30 years (58.1%), almost half (48.4%) were nulliparous and about one-third (29.1%) were students.
This study was conducted to explore women’s experiences, knowledge of abortion methods, health care-seeking decisions and needs following an abortion complication in south-western Nigeria. All but one of the women procured an abortion because the pregnancies were unplanned. This pattern cuts across all the women irrespective of their age, occupation, level of education, social and economic status. Given the reasons adduced by participants for pregnancy termination, this study affirms previous reports that unwanted pregnancy is the underlying cause of induced abortion [6,9]. This phenomenon reflects the problem women face in regulating their childbearing; either to delay starting a family, postpone next birth or to cease childbearing. The reasons women gave for not wanting their pregnancy is consistent with findings which noted that these vary with women’s life circumstances [6,8,9]. This finding calls attention to the unmet need for family planning. The use of modern contraception evidently lowers the incidence and prevalence of induced abortion and meeting the unmet need for family planning is an effective action to reduce unintended pregnancy and induced abortion .
The abortion experiences of women highlight the burden women face to regulate and maintain their fertility and sexual and reproductive health and thus underscores the importance of collective responsibility towards ensuring a reduction in unsafe abortion. In lieu of this, 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 [27,36–38]. Strengthening of post abortion care services to ensure access for all women and quality care is a vital component among measures required to reduce the impact of unsafe abortion on women’s health. Nigerian abortion law reform has been stiffly opposed in the past. Any attempt at reform must seek to advocate to reduce the incidence of unsafe abortion and therefore promote safe motherhood .