COMPLICATIONS OF UNSAFE ABORTION IN SUB-SAHARAN AFRICA - A REVIEW

The Commonwealth Regional Health Community Secretariat undertook a stu dy in 1994 to document the magnitude of abortion complications in Comm onwealth member countries. The results of the literature review compon ent of that study, and research gaps identified as a result of the rev iew, are presented in this article. The literature review findings ind icate a significant public health problem in the region, as measured b y a high proportion of incomplete abortion patients among all hospital gynaecology admissions. The most common complications of unsafe abort ion seen at health facilities were haemorrhage and sepsis. Studies on the use of manual vacuum aspiration for treating abortion complication s found shorter lengths of hospital stay (and thus, lower resource cos ts) and a reduced need for a repeat evacuation. Very few articles focu sed exclusively on the cost of treating abortion complications, but au thors agreed that it consumes a disproportionate amount of hospital re sources. Studies on the role of men in supporting a woman's decision t o abort or use contraception were similarly lacking. Articles on contr aceptive behaviour and abortion reported that almost all patients suff ering from abortion complications had not used an effective, or any, m ethod of contraception prior to becoming pregnant, especially among th e adolescent population; studies on post-abortion contraception are vi rtually nonexistent. Almost all articles on the legal aspect of aborti on recommended law reform to reflect a public health, rather than a cr iminal, orientation. Research needs that were identified include: comm unity-based epidemiological studies; operations research on decentrali zation of post-abortion care and integration of treatment with post-ab ortion family planning services; studies on system-wide resource use f or treatment of incomplete abortion; qualitative research on the role of males in the decision to terminate pregnancy and use contraception; clinical studies on pain control medications and procedures; and case studies on the provision of safe abortion services where legally allo wed.