Post abortion care: The broken bridge to life

Dec 18, 2009

FOR ages, termination of unwanted pregnancies has been widespread, even where the procedure is illegal. However, the World Health Organisation (WHO) recommends that every woman who gets complications after an abortion should be treated without discriminat

By Vision reporter

FOR ages, termination of unwanted pregnancies has been widespread, even where the procedure is illegal. However, the World Health Organisation (WHO) recommends that every woman who gets complications after an abortion should be treated without discrimination.

“We cannot afford two deaths. These women need care but how are we going to offer it in a judgemental environment?” says Dr Olive Ssentumbwe, the national professional officer population and family planning at the WHO Uganda Office.

“Even if abortion is illegal, we need to teach them about complications of pregnancy including abortion-spontaneous or induced so that they can seek medical care immediately,” Ssentumbwe argues.

In Uganda, the law prohibits abortion but allows it when the pregnancy endangers the mother’s life. But with an estimated 775,000 unintended pregnancies annually, 297,000 end up in abortions, according to a 2007 report by the Guttmacher institute. Of these, 85,000 are hospitalised after getting complications. Another 65,000 suffer silently in their homes.

According to Jane Bichachi, director of Livelihood Concern for the Voiceless, the majority of the people procuring abortion are youths aged between 22-25 years. This age group accounts for 49% of abortions, followed by 14-21 with 30%.
Studies indicate that most women with post-abortion complications are reluctant to go for treatment for fear that medical staff might ridicule them. The women only go when the condition becomes severe.

Sister Emily Nakirijja, a midwife in charge of the Mulago Hospital’s Ward 5A where abortion complications are handled, says every day they receive 10-15 women suffering from post-abortion complications. They come with excessive bleeding and bad smell.

“But majority of the cases are in advanced stages that call for major interventions like removing the uterus,” Nakirijja reveals. “Women are often desperate enough to try many strategies. Coming to hospital is their last resort and they do it when they are staring death in the eye,” she explains.

She continues: “It’s a common story especially for the illiterate woman. She discovers that she is pregnant but because they hardly take pregnancy tests, she keeps hoping for a miracle until the third month when pregnancy blues set in.”
Determined to secure an abortion but not having money for a professional, they end up using crude methods such as taking overdose of drugs, inserting herbs or sharp objects into the vagina or taking very strong tea.

When they get complications they often go to a traditional healer and then to a clinic. Fearing to be held responsible for the abortion, the clinics refer them to Mulago.
“They come here after weeks of hoping they will be ok, sometimes succumbing to an otherwise preventable death,” she says.

“Some come to us asking for abortion. We counsel them about complications of abortion and urge them to carry the pregnancy, but once a woman is determined, nothing can stop her. Once, a woman went away saying, ‘musawo wish me luck’, only to return with a perforated uterus after an abortion,” she explains.

Dr Peter Ibembe, the national programme coordinator Reproductive Health Uganda, says the delays aggravate complications and increasing costs.

“Most facilities especially those upcountry have staff with basic skills and few available stock of essential medicines like antibiotics. When women report late with severe complications, with our poor referral system, they may never have another lease on life,” he argues.

“Besides, the available antibiotics may not be strong enough for the infection,” he adds.
Nakirijja substantiates, “For example, we only have basic medicines. If you need stronger ones, you have to buy them.”

Unfortunately most of the people seeking unsafe abortions cannot afford the medicines needed for treating the resultant complications. Majority are adolescents, unemployed housewives, while the few with income generating activities work in salons, vend food in markets and parks for a wage or are petty traders on the streets.

“People end up with incomplete doses because they only buy medicine they can afford. Either they will find equally weaker substitutes to the recommended strong antibiotics or buy an incomplete dose. That is how many women end up with blocked tubes and infertility because as long as the pain subsides, they think that they are ok, not knowing that they are nurturing future complications like chronic pelvic pain,” Nakirijja explains.

Often abortion leads to life-threatening complications like bleeding, bacterial infection, perforation of the uterus, injury to the cervix, infertility, ectopic pregnancy and other complications in subsequent pregnancy. In extreme cases it caused death.

Post Abortion care
  • In hospital the victims receive counselling, medication and family planning services.

  • They also flush out the residues that might have remained in the uterus.

  • Most health facilities, however, do not have the necessary facilities and skills to effectively handle post-abortion complications.
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