Magnitude and Severity of abortion related complications in two African fragile and conflict-affected settings

Project Details


While maternal mortality has globally decreased over the last two decades, abortion-related mortality, one of the five main causes of maternal mortality worldwide, has shown one of the smallest declines in cause-specific maternal mortality ratio between 1990 and 2017.(1) Moreover, almost all abortion-related deaths are related to unsafe induced abortion, happen in low- and middle-income (LMIC) settings and are easily preventable.(2) The World Health Organization (WHO) has promoted the measurement and analysis of maternal near-miss events to better understand the burden of maternal morbidities and improve quality of maternal care.(3) Applied to abortion, an abortion-related near-miss event is “a woman who nearly died but survived a life-threatening complication that occurred during any type of abortion or within 42 days of the end of the pregnancy”.(3) In stable LMICs, evidence on the burden of abortion-related complications is increasingly available, showing that 6 to 9% of women presenting to health facilities for post-abortion care have a near-miss event.(4) . By contrast, in fragile and conflict-affected settings, no study has assessed the magnitude and severity of abortion-related complications. In such contexts, the vulnerability of the affected population to sexual violence and unwanted pregnancies increases, and access to care declines, potentially leading to higher incidence and increased severity of abortion-related complications. Lack of evidence about abortion-related complications in these settings is an important barrier to the provision of adequate care to prevent and treat them. As a result, this topic has been identified as a sexual and reproductive health research priority by the Safe Abortion Care Inter-Agency Working Group.(5)

Key references
1 Graham W et al. Maternal Health 1. Lancet 2016;388:2164–75.
2 Grimes DA et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368:1908–19.
3 World Health Organization. The WHO near-miss approach for maternal health. WHO 2011.
4 Calvert C et al. The magnitude and severity of abortion-related morbidity in settings with limited access to abortion services: a systematic review and meta-regression. BMJ Glob Heal. 2018;3: 1–12.
5 Tanabe M et al. Tracking humanitarian funding for reproductive health: a systematic analysis of health and protection proposals from 2002-2013. Confl Health. 2015; 9(Suppl 1):S2.
Effective start/end date30/06/21 → …

IWETO expertise domain

  • B680-public-health