Research on abortion complications in crisis settings has been limited to date, but a multi-year study by Ipas and partners is filling that gap—with initial findings pointing to the need to prioritize programs improving postabortion, safe abortion and contraceptive care for people living in fragile and conflict-affected settings.
Known as the AMoCO (abortion-related morbidity and mortality in fragile and conflict-affected settings) study, the research is being carried out by Ipas, Médecins Sans Frontières, the Guttmacher Institute and Epicentre, in partnership with the Ministries of Health in Jigawa State, Nigeria, and the Central African Republic.
The first journal article produced by the study was recently published in BMC Pregnancy and Childbirth. It looks at findings from two referral hospitals in different types of fragile and conflict-affected settings: an urban setting in Bangui, Central African Republic, and a rural setting in Jigawa State, northern Nigeria. One of the key findings was that women and girls in these two study hospitals suffered from severe and life-threatening abortion complications five to seven times more often than women and girls whose outcomes were reported in an earlier WHO study conducted in more stable African settings.
Ipas senior medical scientist Bill Powell, one of the co-authors of the study, says the findings highlight both the extent of the consequences of unsafe abortion in these two hospitals and the unique challenges that people affected by war, migration, natural disasters and other crises faced in accessing sexual and reproductive health care.
“We’ve long suspected that the burden of unsafe abortion could be higher in crises settings, and this research confirms that for these two settings,” says Powell. “It adds to the evidence indicating the need for greater access to contraception, safe abortion care, and high-quality postabortion care to prevent and manage complications of abortion in these fragile and conflict-affected settings.”
The study also includes these key findings:
- The high severity of the complications in both study hospitals suggests that a significant number of women with severe complications may have undergone unsafe abortions. This is likely because access to sexual and reproductive health services, including contraception and safe abortion care, is very limited in these
- One in five pregnancy-related admissions in the Central African Republic (CAR) hospital during the study period was for abortion-related complications, indicating the need for prioritization of resources for postabortion care.
- The high proportion of infection among the complications, especially in the CAR hospital, suggests that many women may be using unsafe instrumental induced abortion.
This research was funded by Elrha’s Research for Health in Humanitarian Crises Programme (R2HC), which aims to improve health outcomes for people affected by crises by strengthening the evidence base for public health interventions. The programme is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR).