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Habte A, Bizuayehu HM, Lemma L, Sisay Y. Road to maternal death: the pooled estimate of maternal near-miss, its primary causes and determinants in Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:144. [PMID: 38368373 PMCID: PMC10874058 DOI: 10.1186/s12884-024-06325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. METHODS A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. RESULTS Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. CONCLUSION The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | | | - Lire Lemma
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Yordanos Sisay
- Department of Epidemiology, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, Williams T, Chen H, Fotheringham C, Lagrou D, Schulte-Hillen C, Powell B, Baudin E, Filippi V, Benova L. High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study). BMC Pregnancy Childbirth 2023; 23:143. [PMID: 36871004 PMCID: PMC9985077 DOI: 10.1186/s12884-023-05427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
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Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France. .,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | - Onikepe O Owolabi
- Guttmacher Institute, New York, USA.,Vital Strategies, New York, USA
| | | | - Richard Norbert Ngbale
- Ministère de la santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | | | | | | | | | - Elisabeth Baudin
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
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Awowole IO, Badejoko OO, Ayegbusi EO, Allen OO, Loto OM. Infertility Due to Prolonged Retention of Fetal Bones: A Case Series. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ibraheem Olayemi Awowole
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olusegun O. Badejoko
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Ekundayo O. Ayegbusi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olubukola O. Allen
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olabisi Morebise Loto
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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Banke-Thomas A, Avoka C, Olaniran A, Balogun M, Wright O, Ekerin O, Benova L. Patterns, travel to care and factors influencing obstetric referral: Evidence from Nigeria's most urbanised state. Soc Sci Med 2021; 291:114492. [PMID: 34662765 DOI: 10.1016/j.socscimed.2021.114492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022]
Abstract
The criticality of referral makes it imperative to study its patterns and factors influencing it at a health systems level. This study of referral in Lagos, Nigeria is based on health records of 4181 pregnant women who presented with obstetric emergencies at one of the 24 comprehensive emergency obstetric care (EmOC) facilities in the state between November 2018 and October 2019 complemented with distance and time data extracted from Google Maps. Univariate, bivariate, and multivariate analyses were conducted. About a quarter of pregnant women who presented with obstetric emergencies were referred. Most referrals were from primary health centres (41.9 %), private (23.5 %) and public (16.2 %) hospitals. Apart from the expected low-level to high-level referral pattern, there were other patterns observed including non-formal, multiple, and post-delivery referrals. Travel time and distance to facilities that could provide needed care increased two-fold on account of referrals compared to scenarios of going directly to the final facility, mostly travelling to these facilities by private cars/taxis (72.8 %). Prolonged/obstructed labour was the commonest obstetric indication for referral, with majority of referred pregnant women delivered via caesarean section (52.9 %). After adjustment, being married, not being registered for antenatal care at facility of care, presenting at night or with a foetus in distress increased the odds of referral. However, parity, presentation in the months following the commissioning of a new comprehensive EmOC facility or with abortion reduced the likelihood of being referred. Our findings underscore the need for health systems strengthening interventions that support women during referral and the importance of antenatal care and early booking to aid identification of potential pregnancy complications whilst establishing robust birth preparedness plans that can minimise the need for referral in the event of emergencies. Indeed, there are context-specific influences that need to be addressed if effective referral systems are to be designed.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, London, United Kingdom; Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
| | - Cephas Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Abimbola Olaniran
- Infectious Disease and Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria; Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olabode Ekerin
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Atuhairwe S, Gemzell-Danielsson K, Byamugisha J, Kaharuza F, Tumwesigye NM, Hanson C. Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda. BMJ Glob Health 2021; 6:bmjgh-2020-003274. [PMID: 33547174 PMCID: PMC7871269 DOI: 10.1136/bmjgh-2020-003274] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction With a view to inform policy for improved postabortion care, we describe abortion-related near-miss and mortality by sociodemographic risk factors and management options by pregnancy trimester in Uganda. Methods This secondary data analysis used an adapted WHO near-miss methodology to collect cross-sectional maternal near-miss and abortion complications data at 43 health facilities in Central and Eastern Uganda in 2016–2017. We computed abortion severe morbidity, near-miss and mortality ratios per 100 000 live births, and described the proportion of cases that worsened to an abortion near-miss or death, stratified by geographical region and trimester. We tested for association between independent variables and abortion near-miss, and obtained prevalence ratios for association between second trimester near-miss and independent demographic and management indicators. We assessed health facility readiness for postabortion care provision in Central and Eastern regions. Results Of 3315 recorded severe abortion morbidity cases, 1507 were near-misses. Severe abortion morbidity, near-miss and mortality ratios were 2063, 938 and 23 per 100 000 live births, respectively. Abortion-related mortality ratios were 11 and 57 per 100 000 in Central and Eastern regions, respectively. Abortion near-miss cases were significantly associated with referral (p<0.001). Second trimester had greater abortion mortality than first trimester. Eastern region had greater abortion-related morbidity and mortality than Central region with facilities in the former characterised by inferior readiness to provide postabortion care. Conclusions Uganda has a major abortion near-miss morbidity and mortality; with mortality higher in the second trimester. Life-saving commodities are lacking especially in Eastern region compromising facility readiness for postabortion care provision.
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Affiliation(s)
- Susan Atuhairwe
- Department of Obstetrics and Gynaecology, Makerere University CHS, Kampala, Uganda .,Reproductive Endocrinology and Infertility, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | | | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University CHS, Kampala, Uganda
| | - Frank Kaharuza
- Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda
| | | | - Claudia Hanson
- Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Dept of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
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Fontanelli Sulekova L, Spaziante M, Vita S, Zuccalà P, Mazzocato V, Spagnolello O, Lopalco M, Pacifici LE, Bello L, Borrazzo C, Angeletti S, Ciccozzi M, Ceccarelli G. The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health. J Immigr Minor Health 2020; 23:232-239. [PMID: 33278011 PMCID: PMC7914189 DOI: 10.1007/s10903-020-01126-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Background Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women. Methods Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors. Results Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion. Conclusion This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.
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Affiliation(s)
- Lucia Fontanelli Sulekova
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy. .,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy. .,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.
| | - Martina Spaziante
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Paola Zuccalà
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Valentina Mazzocato
- Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Emergency NGO, Milan, Italy.,Emergency Department, Policlinico Umberto I Hospital, University of Rome Sapienza, Rome, Italy
| | - Maurizio Lopalco
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Laura Elena Pacifici
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Luca Bello
- Unit of Gynecology, Department of Obstetrics and Gynecology, University of Turin, Maria Vittoria Hospital, Turin, Italy
| | - Cristian Borrazzo
- Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy.,Italian Red Cross, Metropolitan Area of Rome Committee, Sanitary Direction of Reception Centers for Migrants, Rome, Italy
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Heemelaar S, Josef M, Diener Z, Chipeio M, Stekelenburg J, van den Akker T, Mackenzie S. Maternal near-miss surveillance, Namibia. Bull World Health Organ 2020; 98:548-557. [PMID: 32773900 PMCID: PMC7411319 DOI: 10.2471/blt.20.251371] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods From the results of an initial feasibility study, we adapted the World Health Organization’s criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings During the 6-month period, we recorded 37 106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100 000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Mirjam Josef
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Zoe Diener
- Department of Obstetrics & Gynaecology, University of North Carolina, North Carolina, United States of America
| | - Melody Chipeio
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Jelle Stekelenburg
- Department of Health Science, Global Health, University Medical Center Groningen, Groningen, Netherlands
| | | | - Shonag Mackenzie
- Department of Obstetrics & Gynaecology, University of Namibia, Windhoek, Namibia
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Ushie BA, Juma K, Kimemia G, Ouedraogo R, Bangha M, Mutua M. Community perception of abortion, women who abort and abortifacients in Kisumu and Nairobi counties, Kenya. PLoS One 2019; 14:e0226120. [PMID: 31830102 PMCID: PMC6907763 DOI: 10.1371/journal.pone.0226120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
Background Abortion draws varied emotions based on individual and societal beliefs. Often, women known to have sought or those seeking abortion services experience stigma and social exclusion within their communities. Understanding community perception of abortion is critical in informing the design and delivery of interventions that reduce the gaps in access to safe abortion for women. Objective We explored community perceptions and beliefs relating to abortion, clients of abortion services, and abortifacients in Kenya. Methods We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) in Kisumu and Nairobi counties in Kenya among a mix of adult men and women, pharmacists, nurses, and community health volunteers. Results Community perspectives around abortion were heterogeneous, reflecting a myriad of opinions ranging from total anti-abortion to more pro-choice positions, and with rural-urban differences. Notably, negative views on abortion became more nuanced and tempered, especially among young women in urban areas, as details of factors that motivate women to seek abortion became apparent. Participants were mostly aware of the pathways through which women and girls access abortion services. Whereas abortion is commonplace, multiple structural and socioeconomic barriers, as well as stigma, are prevalent, thus impeding access to safe and quality services. Conclusion Community perceptions on abortion are heterogeneous, varying by gender, occupation, level of education, residence, and position in society. Stigma and the hostile abortion environment limit access to safe abortion services, with several negative consequences. There is urgent need to strengthen community-based approaches to mitigate predisposing and enabling factors for unsafe abortions.
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Affiliation(s)
| | - Kenneth Juma
- African Population and Health Research Center, Nairobi, Kenya
- * E-mail:
| | - Grace Kimemia
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
| | - Michael Mutua
- African Population and Health Research Center, Nairobi, Kenya
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