Lisa Hallgarten, Reproductive Health Matters

We know that RHM is read in the highest offices and the humblest clinics. Papers we publish provide the evidence to change government policies and support change at the level of clinical practice…and this happens. In our most recent issue of Reproductive Health Matters one paper reports on the impact of changes made as a result of research published in an earlier journal issue.

In 2009 RHM published a paper (1) on the delays in care experienced by women who died from complications of unsafe abortion and other maternal complications in Centre Hospitalier de Libreville, Gabon. The results showed an ‘abysmal difference in delay providing care, from just over one hour for women who had died of eclampsia or postpartum haemorrhage, to 23.7 hours for women who had died from unsafe abortion complications’. The authors measured the time between identification of the problem and initiation of care and concluded that discriminatory treatment, in the context of a culture of abortion stigma, was a factor in the delays. The delays were ‘not due to any lack of life-saving equipment or supplies, or of properly trained personnel, because no such delays were observed in the treatment of the women who died from other causes in the hospital in the same time period.’ The authors suggested this might be the first study to directly link such discrimination with an increased risk of death and called for the hospital to address discriminatory practice in the hope that this might lead to a decrease in abortion-related mortality.

An article in the current issue of RHM provides evidence of ‘dramatic improvements in post-abortion care in the same hospital in Gabon’. The authors of the study (2) report that the original findings were presented to the government and to the hospital authorities. Following this, women with complications of abortion were given a higher priority, and there was a change in the kind of care provided. Changes in care included a shift to manual vacuum aspiration (MVA) under local anaesthesia for two thirds of women, with care provided by midwives in half of those: by contrast in 2008 all cases were treated with surgical methods that required general anaesthetic and care from a doctor. The authors suggest that it was these changes that led to a ‘ten-fold reduction in the average time from admission to treatment for abortion complications in only a few years’. Though they cannot demonstrate a cause and effect, the study finds that awareness raised by the original report ‘was the main determining factor in the observed change.

Authors found a  low rate of complications following MVA, which they say confirms ‘the capacity of properly trained mid-level providers to master this technique.’ Hopefully this finding will be presented to hospital authorities and governments elsewhere and help inform the provision of services for women presenting with complications of unsafe abortion wherever they are.

(1) Mayi-Tsonga S, Oksana L, et al. Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon. Reproductive Health Matters 2009;17(34):65-70.

(2) Mayi-Tsonga S, Assoumou P, et al. The Contribution of research results to dramatic improvements in post-abortion care: Centre Hospitalier de Libreville, Gabon. Reproductive Health Matters 2012; 20(40): 16-21.