Hospital admission following induced abortion in Eastern Highlands Province, Papua New Guinea--a descriptive study

Barriers and enablers to young people accessing sexual and reproductive health services in Pacific Island Countries and Territories: A scoping review

BACKGROUND

The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people's low access to sexual and reproductive health information and services in this region.

METHODS

Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes.

FINDINGS

Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people's limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members.

CONCLUSION

This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people's sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.

Induced abortion in Papua-New Guinea: Experience and opinions of health professionals

BACKGROUND

Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals.

AIM

To conduct a study of PNG health professionals' experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women.

MATERIALS AND METHODS

A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea.

RESULTS

Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG's abortion laws, and to views on the provision of safe accessible abortion services in the country's public health system.

CONCLUSIONS

Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self-abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG.

Incidence of self-induced abortion with misoprostol, admitted to a provincial hospital in Papua New Guinea: A prospective observational study

BACKGROUND

Misoprostol is a life-savingmedication in obstetric practice but the prevalence of misoprostol-related self-induced abortion is increasing in many communities.

AIMS

To investigate the hospital incidence, clinical management, and legal framework of self-induced abortions with misoprostol.

MATERIALS AND METHODS

This was a prospective observational study conducted over 18 months. All patients <20 weeks pregnant who were admitted with a diagnosis of misoprostol-induced abortion were included in the study.

RESULTS

Of 186 women with abortion-related admissions during the study period, 51 (27.4%) women reported using misoprostol to induce abortion. The majority were young (27.8 ± 5.5) married women (32/51: 62.7%), particularly educated (27/51: 52.9%) employed women (27/51: 52.9%), who were not on any contraception (46/51: 90.1%). Most abortions were induced in the first trimester (39/51: 76.5%) and patients were admitted because of prolonged bleeding (23/51: 45.1%). A significant proportion of participants who did not receive the correct dose of misoprostol developed sepsis compared to those who received a correct dose (6/18 (33.3%) vs 1/30 (3.3%); P = 0.008).

CONCLUSION

The use of misoprostol as an abortifacient is increasing in Papua New Guinea, particularly among educated and employed women. A review of the laws to meet the demand for abortion services and to limit complications of unsafe abortion practices is required.

Maternal and newborn health indicators in Papua New Guinea - 2008-2018

Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health care – especially in rural areas, where most people live – is challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.

Self-managed abortion: A systematic scoping review

Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.

Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia

Papua New Guinea has one of the world's highest maternal mortality rates with approximately 215 women dying per 100,000 live births. The sustainable development goals outline key priority areas for achieving a reduction in maternal mortality including a focus on universal health coverage with safe surgery and anesthesia for all pregnant women. This narrative review addresses the issue of reducing maternal mortality in Papua New Guinea by contextualizing the need for safe obstetric surgery and anesthesia within a structure of enabling environments at key times in a woman's life. The 3 pillars of enabling environments are as follows: a stable humanitarian government; a safe, secure, and clean environment; and a strong health system. Key times, and their associated specific issues, in a woman's life include prepregnancy, antenatal, birth and the postpartum period, childhood, adolescence and young womanhood, and the postchildbearing years.

Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea--a descriptive study of women's and health care workers' experiences

Background

In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality.

Methods

We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women’s reflections post abortion.

Results

28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help.

Conclusion

In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion.

Dezocine for anesthesia and stress reduction in induced abortion

BACKGROUND

The purpose of this study was to evaluate the efficacy of dezocine with regard to analgesic and stress reduction outcomes in women undergoing induced abortion.

METHODS

A total of 126 women in early pregnancy (up to 14 weeks' gestation) who underwent induced abortion at Cangzhou Central Hospital from May 2012 to May 2013 were randomly assigned to a control (propofol) group (n=63) or an intervention (propofol + dezocine) group (n=63). Wake-up time, orientation force recovery time, incidence of adverse reactions, postoperative visual analog scale (VAS) score, analgesic effect, and respiratory and circulatory monitoring before the operation, 5 minutes into the operation, and 5 minutes after the operation were compared between the two groups.

RESULTS

The surgical procedure and anesthesia were performed successfully in all patients. Systolic and diastolic blood pressure and oxyhemoglobin saturation in the intervention group were significantly higher than in the control group; however, heart rate was significantly lower in the intervention group than in the control group 5 minutes into the operation (all P<0.05). There were no statistically significant differences in these parameters before surgery and after recovery. The postoperative VAS score (2.82±0.72), Ramsay score (2.65±0.65), and anesthetic effect in the intervention group were better than in the control group (3.90±0.84 and 2.21±0.49, respectively), and all differences were statistically significant (P<0.05). The wake-up time (3.41±0.79 minutes) and orientation force recovery time (4.28±0.92 minutes) were all significantly shorter (P<0.05) in the intervention group than in the control group, as was the incidence of adverse reactions (7.94% versus 26.98%, respectively).

CONCLUSION

Adverse reactions of propofol combined with dezocine in painless induced abortion are less while the analgesic effect is better.