Roemer Matthea, Ushie Boniface Ayanbekongshie, Akiode Akinsewa, Onuoha Ogechi, Idoko Ochanya, Taiwo Anne
MSI Reproductive Choices, 1 Conway Street, Fitzrovia, London, W1t 6LP, UK.
Beshi King Development Services Limited, Abuja, Nigeria.
BMC Public Health. 2025 Aug 21;25(1):2869. doi: 10.1186/s12889-025-23889-5.
BACKGROUND: Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Nigeria. This study aims to fill gaps in understanding of how abortion safety has evolved since previous estimates. The study also offers new insight on pregnant people's experiences along the abortion care trajectory and how sociodemographic factors correlate with these experiences and the overall safety of abortion. METHODS: Data presented are drawn from a larger study that was conducted in Lagos and Abuja, Nigeria in 2023 using a total market assessment approach. This analysis drew exclusively on data from a quantitative survey of women of reproductive age with a 5-year history of induced abortion(s). Abortion safety was operationalised based on two dimensions in line with a previous analysis of population-based survey data from Nigeria: [1] whether the method(s) used included any non-recommended methods and [2] whether the source(s) used were clinical or non-clinical. We combined source and method information to categorize a woman's abortion into one of four safety categories. Analyses include frequencies of abortion safety and experiences along the abortion care trajectory, as well as bivariate and multivariate assessments of sociodemographic and reproductive history correlates. RESULTS: Two hundred women completed the survey of which 197 reported their abortion method and were included in this analysis. Almost half (44.7%) of respondents' reported abortions were categorised as most unsafe involving non-recommended methods and non-clinical source(s). Those living in rural areas and those living in severe poverty were significantly more likely to have had the most unsafe abortions. Those living in poverty were also at increased likelihood of being unable to access an abortion from their preferred source and of experiencing any complications. CONCLUSION: These findings confirm that unsafe abortion in Nigeria is a public health concern and an issue of social inequity. Efforts to improve equitable access to safe, high-quality and client-centred services are needed. National health policies must address both the legal and practical barriers to safe abortion access. Ensuring expanded access to in-facility surgical procedures and post-abortion care is critical for management of complications from continued unsafe abortion. Simultaneously, harm reduction efforts - including increasing awareness of quality medication abortion drugs for safer self-induction and training lower-cadre providers on the medical management of abortion - can help mitigate the toll of abortion-related morbidity and mortality.
背景:在包括尼日利亚在内的许多非洲国家,不安全堕胎仍然是孕产妇发病和死亡的重要原因。本研究旨在填补自先前估计以来对堕胎安全性如何演变的理解空白。该研究还提供了关于孕妇在堕胎护理过程中的经历,以及社会人口因素如何与这些经历和堕胎的总体安全性相关的新见解。 方法:所呈现的数据来自2023年在尼日利亚拉各斯和阿布贾进行的一项更大规模的研究,采用了全面市场评估方法。本分析仅采用了对有5年人工流产史的育龄妇女进行的定量调查数据。根据尼日利亚基于人群的调查数据的先前分析,堕胎安全性基于两个维度进行操作化:[1]所使用的方法是否包括任何不推荐的方法,以及[2]所使用的来源是临床还是非临床。我们结合来源和方法信息,将妇女的堕胎分类为四个安全类别之一。分析包括堕胎安全性的频率以及堕胎护理过程中的经历,以及社会人口和生殖史相关性的双变量和多变量评估。 结果:200名妇女完成了调查,其中197人报告了她们的堕胎方法并被纳入本分析。几乎一半(44.7%)的受访者报告的堕胎被归类为最不安全,涉及不推荐的方法和非临床来源。生活在农村地区和极度贫困中的人进行最不安全堕胎的可能性显著更高。生活在贫困中的人也更有可能无法从他们首选的来源获得堕胎服务,并且更有可能经历任何并发症。 结论:这些发现证实,尼日利亚的不安全堕胎是一个公共卫生问题,也是一个社会不平等问题。需要努力改善公平获得安全、高质量和以客户为中心的服务的机会。国家卫生政策必须解决安全堕胎获取方面的法律和实际障碍。确保扩大获得设施内手术程序和堕胎后护理的机会对于管理持续不安全堕胎的并发症至关重要。同时,减少伤害的努力——包括提高对用于更安全自我引产的优质药物流产药物的认识,以及培训低级别提供者进行堕胎的医疗管理——可以帮助减轻堕胎相关发病和死亡的负担。
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