Unsafe abortion, and complications, too common in Malawi

Friday, November 21, 2014

In countries like Malawi, where safe abortion is restricted or not available, women often turn to clandestine and unsafe abortions when faced with an unintended pregnancy. However, abortion isn’t uncommon—roughly 67,300 induced abortions occur annually in Malawi. Unfortunately, neither are the injuries and even deaths that occur because of the law and other barriers—such as stigma and lack of access to services— that leave women with few safe options.

Roughly one in five women seeking postabortion care in Malawi suffers from severe, often life-threatening complications, such as sepsis, according to a study published in the International Journal of Gynecology and Obstetrics.

In 2009, the Malawi College of Medicine, Ipas and the Ministry of Health’s Reproductive Health Unit conducted a nationally representative study to estimate the severity of abortion complications in health facilities and to determine the risks for women. Data on 2067 women seeking postabortion care was collected from a  total of 166 facilities—primarily public and some private and NGO—throughout the country. 

According to a related study published in June 2013, about 18,700 women were treated in health facilities for complications from unsafely performed induced abortions in the community in 2009. “What we found in this work is that severe complications are common, particularly for rural and vulnerable women,” says Brooke Levandowski, one of this study’s authors and lead author of the 2013 study.

Women most at risk: a profile

More than 27 percent of the women presented with one or more signs of complications; most frequently sepsis. Overall, more than one third of the women were in their second trimester of pregnancy, when the risk of complications is much higher. Almost one quarter said they were using some form of contraception to prevent the current pregnancy.

Most were married and from rural areas. The study results show that women categorized as having severe or moderate complications were more likely to live in a rural area, be separated, divorced or widowed, more likely to seek care after the first trimester, and to have attempted to interfere with the pregnancy.

It’s important to note, say the researchers, when women’s access to safe abortion is restricted, women will seek unsafe services or use unsafe methods to end a pregnancy.

When paired with previous studies and data about abortion in Malawi, this study paints a stark picture. Eighteen percent of maternal deaths are attributable to unsafe abortion, according to the World Health Organization. Young women, poor women, rural women and otherwise marginalized women suffer the most—from lack of contraception and youth-appropriate services to scarce access to safe abortion and postabortion care.

“This research highlights the tremendous impact that unsafe abortion plays in maternal mortality, underscoring the need to invest in women and ensure their access to comprehensive reproductive health care, including contraception and safe abortion,” says Hailemichael Gebraselassie, Ipas senior research advisor and co-author.

“This research definitely highlights the need for law reform and widespread expansion of safe abortion services,” adds Chrispine Sibande, Ipas Malawi senior policy advisor.

This study was part of a larger body of research conducted in Africa and supported primarily by the Consortium for Research on Unsafe Abortion in Africa and its principal donor, the UK Department for International Development. Additional funding was provided by the United Nations Population Fund Malawi.