Kim Caron R, Tunçalp Özge, Ganatra Bela, Gülmezoglu Ahmet Metin
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
BMJ Glob Health. 2016 Nov 25;1(3):e000113. doi: 10.1136/bmjgh-2016-000113. eCollection 2016.
According to the WHO, abortion accounts for about 8% (4.7-13.2) of maternal mortality worldwide. In 2010, the WHO Multi-Country Survey (MCS) on Maternal and Newborn Health collected data on over 300 000 women who were admitted in health facilities to receive pregnancy-related care. Abortion data were partially captured by centring on severe maternal outcomes (ie, near-miss or maternal deaths). Building on the experiences of the prior MCS as well as current WHO reproductive health projects, we are undertaking a multi-country survey to better capture the burden and severity of abortion-related complications and management among women presenting to the health facilities.
This is a large cross-sectional study with prospective data collection. It will be implemented in health facilities in 30 countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia and Western Pacific. Countries and facilities will be identified through a multistage sampling methodology. Data collection will be at both the facility and individual levels, involving review of medical records and exit surveys with eligible women using audio computer-assisted self-interview. All women presenting to the health facilities with signs and symptoms of abortion complications will comprise the study population. Online data entry and management will be performed on a web-based data management system. Analysis will include prevalence of abortion-related complications and descriptive frequencies of procedural/non-procedural management and experience of care.
Ethical issues of the consent process are addressed. Dissemination plans will involve the participating facilities and communities to further strengthen abortion-related research capacity within the MCS on Abortion (MCS-A) countries. Furthermore, dissemination of results will be an iterative process at both the facility and national level to potentially propagate positive changes to abortion-related policies and practices.
根据世界卫生组织（WHO）的数据，堕胎约占全球孕产妇死亡人数的8%（4.7%-13.2%）。2010年，WHO关于孕产妇和新生儿健康的多国调查（MCS）收集了超过30万名入住医疗机构接受妊娠相关护理的妇女的数据。堕胎数据部分通过关注严重孕产妇结局（即接近死亡或孕产妇死亡）来获取。基于之前MCS以及当前WHO生殖健康项目的经验，我们正在开展一项多国调查，以更好地了解前往医疗机构就诊的妇女中与堕胎相关并发症的负担、严重程度及管理情况。
这是一项采用前瞻性数据收集的大型横断面研究。将在WHO非洲、美洲、东地中海、欧洲、东南亚和西太平洋区域的30个国家的医疗机构中实施。将通过多阶段抽样方法确定国家和医疗机构。数据收集将在机构和个人层面进行，包括审查医疗记录以及使用音频计算机辅助自我访谈对符合条件的妇女进行出院调查。所有因堕胎并发症的体征和症状前往医疗机构就诊的妇女将构成研究人群。将在基于网络的数据管理系统上进行在线数据录入和管理。分析将包括与堕胎相关并发症的患病率以及手术/非手术管理和护理体验的描述性频率。
解决了同意过程中的伦理问题。传播计划将涉及参与的医疗机构和社区，以进一步加强堕胎问题多国调查（MCS-A）国家内与堕胎相关的研究能力。此外，结果传播将在机构和国家层面进行反复过程，以可能推动与堕胎相关政策和实践的积极变革。
