There are more refugees and displaced people than ever before—more than 100 million according to current estimates. While it is often believed that abortion care is not a priority need in refugee camps and other humanitarian settings, a study from the Central African Republic (CAR) adds to the growing body of evidence that it is.
The study is one component of a multi-site study in African humanitarian settings conducted by Ipas in partnership with Médecins Sans Frontières, the Guttmacher Institute, Epicentre, and the Central African Republic Ministry of Health. This study looked at the magnitude and severity of near miss abortion-related complications in Castors Maternity in Bangui, a conflict-affected urban city that is the country’s capitol. In 2019, the 66-bed facility recorded over 10,000 deliveries and assisted more than 2,600 women seeking post-abortion care.
“We chose the Central African Republic as a study site because it has one of the highest maternal mortality ratios in the world and is one of the world’s most fragile states,” says Tamara Fetters, senior research scientist for Ipas and one of the study’s principal investigators. “Although abortion is legal there for the first eight weeks of pregnancy for some indications, safe and legal abortion is effectively unavailable for most people.”
Some key findings from the study:
- Women and girls in Castors Maternity suffered from potentially life-threatening complications— almost seven times more often than those treated in hospitals in stable settings across Africa.
- One in five pregnancy-related admissions during the study period was for abortion-related complications.
- More than 45% of the 362 women interviewed reported having done something to end their pregnancies; the risk of very severe complications was more than three times higher among women who reported unsafely inducing their abortions.
“What this evidence highlights and reinforces,” says Fetters, “is the urgent need to recognize abortion as a serious health issue among fragile or crisis-affected populations.”
The study findings have drawn the support of the country’s Ministry of Health and were released at a workshop also attended by representatives of the Ministry of Women, the Society of OB/GYNs, the Society of Midwifery, UN agencies, and international and national NGOs.
This research was funded by Médecins Sans Frontières and Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the Foreign, Commonwealth & Development Office of the United Kingdom, Wellcome, and the UK National Institute for Health Research.