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. 2017 Feb;95(2):167-174.
doi: 10.1016/j.contraception.2016.08.014. Epub 2016 Sep 1.

Incidence of Abortion-Related Near-Miss Complications in Zambia: Cross-Sectional Study in Central, Copperbelt and Lusaka Provinces

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Incidence of Abortion-Related Near-Miss Complications in Zambia: Cross-Sectional Study in Central, Copperbelt and Lusaka Provinces

Onikepe O Owolabi et al. Contraception. .
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Objectives: To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized.

Study design: We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index.

Results: Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births.

Conclusions: Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception.

Implications: The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology.

Keywords: Abortion-related mortality; Abortion-related near-miss; Induced abortion; Prospective morbidity methodology; Termination of pregnancy; WHO near-miss criteria.

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