Comparisons of characteristics of women requesting Termination of Pregnancy and those presenting themselves with incomplete Abortion within the University Teaching Hospital
Phiri, Dorcas Siafwa
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Induced abortion poses a great public health concern especially when performed by unskilled health care providers. The study is comparing characteristics of women seeking termination of pregnancy (TOP) and those admitted for incomplete abortion. Understanding these characteristics of women in two groups will assist determine the group at risk and in turn help policy makers decide on strategies to reduce complications arising from abortions. This is in view of the fact that 30% of maternal mortality rate in Zambia is due to complications of abortion.Objectives: To compare the sociodemographic characteristics, economic factors, obstetric characteristics, the proportion of women who knew the existence of the TOP Act of 1972 of the Zambian law and determine the reasons for inducing abortion between women who requested TOP (controls) and those who presented with incomplete abortion in the university teaching hospital (cases). Study Design: Case control hospital based study carried out between February and May, 2002. Cases being women admitted for incomplete abortion and controls being women admitted to have a termination of pregnancy at UTH. Setting: University Teaching Hospital in Ward CO3 (gynaecological ward), Lusaka, Zambia. Subjects: All women 14-49 years admitted for abortion services at UTH. Main outcome measures - comparison of the level of knowledge on termination of pregnancy Act, 1972, the utilisation of family planning methods, methods used to induce abortion and number of attempts made to terminate pregnancy between women who seek TOP and those who are admitted for incomplete abortion in the University Teaching Hospital, Lusaka. Results: A total of 212 subjects were recruited in the study, out of which 76 were controls and 136 were cases. The difference between the two groups were significant in the areas of residence where 62 (45.6%) cases lived in rural/high density areas while only 7 (9.2%) controls lived in the similar residential areas of Lusaka. Most cases 53 (39%) had not been to school or attained up to primary level of education while most controls 64 (84.2%) had attained senior secondary education. Occupation of the two groups also showed significant difference in that 126 (82.1.%) of cases were either not working or in informal employment as opposed to 30 (39.5%) of the controls who worked as professionals. The income of the two groups was consumerate to their occupations 55 (66.9%) cases got below K300,000 and 44 (83%) controls got above K301,000. Most of those who were not working in both cases 26 (19%) and controls 25 (33%) were mainly students. It was clear that most cases (71.3%) claimed to have had a spontaneous abortion while the rest 28.7% had abortion performed by non health care providers, using unsafe methods such as ingestion of herbs, dilating cervix using sticks or probes etc. The picture was different with all the controls who got their abortion services from skilled health care providers using MVA or cytotec tables in the University Teaching Hospital. It was found that 13.9% of the cases had aborted more than once while only 3.9% of controls had done the same. There was however no significant difference between cases and controls in terms of age, marital status, parity, religion, distance to health centre and to post abortion care services offered. The gestation period at which respondants aborted was above eight (8) weeks for cases (52.2%) and below eight (8) weeks for controls (75%) with most cases (71.3%) claiming to have aborted spontaneously and most controls (36.8%) to have aborted due to the desire to pursue further studies/careers. A total of 125 (92.6%) cases had one or more complications apart from having incomplete abortion, where as only 5.3% controls had complications of TOP. In view of the complications, cases stayed in hospital for an average of 24 hours in comparison to controls whose hospitalisation time was an average of one (1) hour. The cost of the services was higher than K30,000 for most controls and below K20,000 for cases. Most cases (92%) had no knowledge on the TOP Act. Most controls heard about the TOP Act although the source was mostly from non medical persons. Conclusion: In conclusion, the results show that there were significant differences in a number of characteristics between women seeking TOP and those admitted with incomplete abortion. Cases had inadequate knowledge of TOP and a number were not using family planning methods. Knowledge of TOP would help reduce the number of unsafe abortions arising from unsafe methods. It would therefore be necessary to get more people knowledgeable on the Act so as to make informed decisions on safe abortion. Increased utilisation of family planning would help reduce the number of unwanted pregnancy which finally result in abortions. Intensifying reproductive health education would also assist in the reduction of complications to abortions and to their recurrences. Reducing unsafe abortions requires a number of strategies and consented effort from all stakeholders.
- Community Health