seeking clandestine abortionsafely: unwanted pregnancy and … · 2017. 1. 19. · unwanted...
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ConferencepresentationatFIAPACLisbon,October14th 2016
IngridH.SolheimMedicalResearchTrack Student
Departmentof GlobalPublicHealthandPrimary CareUniversity of Bergen
Seekingclandestineabortion safely:Unwantedpregnancyandmedicalabortionamong
youngwomeninDares Salaam,Tanzania
(Ref.3and4)
Abortion inTanzania:
• Induced abortion rateof 36abortionsper1,000women (3)
• Unsafe abortion:
- 16-23%of maternalmortality (4) (5)
- 40%of hospitalizations duetoobstetric complications (6)
- Disproportinately affects young women (7)
Misoprostol inTanzania:
• Registered inTanzaniain2007
•Mentioned asanabortion method inrecent studies
• Available off-label (?)
Ø Underwhich conditions are women accessingmedicalabortion?
Ø Howismedical abortion affecting the situation ofwomen with unwanted pregnancies?
DaresSalaam,Tanzania
Study aim:
Concerning medical abortion,explore:
• Community knowledge
• Accessibility
• Experiences fromuse
Study methods:
In-depth interviews- Women (<26years)afterMA(15)- Healthworkers (17)- Drug cellers(10)
Focus group discussion- Youngwomen inlow-income areas(7)
- Students(3)
Informativeinterviews- NGOs(15)
- Authorities (6)
Fieldnotes- Smallinterviews
- Everyday conversations
- Media
Clientsimulation study (63)
Findings:
o «Miso»acommon andwell-known methodoWide availability,fromdrugstores andhealth workers
“Itiseasy.Shecangotothepharmacyorhospitalandtalktothedoctorforhelp.”(Schoolgirl,15years.)girl,15years)
o Varied andsub-optimalsafe-use instructionso Lack of aprotocolo Profit-seeking providers
“Becausethey'renotqualified(thedrugvendors),theysellitlikearice:"Takethisanduseit!"Nomoreexplanations.WhatIcansayisthatourgovernmentregulationsarealsohinderingthewomentobeopen,andthesellersofdrugstogivewideexplanationonhowtopracticesafeabortion.”
(Drugstoreowner)
o Highacceptability
• Saferalternative
• Accessible
• Lesspainful andmore‘natural’
• Private
“Ithinkit’sgood(misoprostol),becauseitseffectsarenotasbadastheonesI’veheardotherscanhave.Likeifyougotothehospital,theymightinjureyouruterusandbeatriskofbeinginfertile.Buttheysaythismethodisbetterthantherest.”(Youngwoman,20years)
Discussion:
- ‘Safer’unsafe abortions- Onwomen’s own terms- Moreaffordable
- Howabout outside DaresSalaam?
References(1/3):(Map)CenterforReproductiveRights.2014. TheWorld'sAbortionLawsMap.[ONLINE]Availableat:http://www.reproductiverights.org/document/the-worlds-abortion-laws-map.[Accessed10October2016].
(Ref.1)2nd AfricanUnionAssembly.ProtocoltotheAfricanCharteronHumanandPeoples’RightsontheRightsofWomeninAfrica,Art.14(2)(c).Maputo,Mozambique:2nd AfricanUnionAssembly;2007Mar3
(Ref.2)WorldHealthOrganization.Trendsinmaternalmortality:1990to2013.EstimatesbyWHO,UNICEF,UNFPA,theWorldBancandtheUnitedNationsPopulationDivision.Geneva,Switzerland:WorldHealthOrganization;2014.
(Ref.3)Keogh SC,Kimaro G,Muganyizi P,Philbin,J,Kahwa A,Ngadaya E,etal.(2015)Incidence of InducedAbortionandPost-AbortionCareinTanzania.PLoS ONE10(9):e0133933.doi:10.1371/journal.pone.0133933
(Ref.4)Msiwa Ret.Al.Community-basedmonitorin of safemortherhood intheUnitedRepublicof Tanzania.NewYork,USA:CenterforReproductive Rights;2012.
(Ref.5)Sorensen B.L.etal.Substandard emergency obstetric care – aconfidential enquiryintomaternaldeaths ataregionalhospitalinTanzania.TropMedIntHealth2010Aug:15(8):894-900.doi:10.1111/j.1365-3156.2010.0255.xPMID:20545917
References(2/3):
(Ref.6)RaschC.etal.Alongitudinalstudy on differentmodels of postabortion care inTanzania.ActaOcstet Gynecol Scan 2004Jun;83(6):570-5.PMID:15144340
(Ref.7)Rasch V,Kipingili R.UnsafeabortioninurbanandruralTanzania:method,providerandconsequences.Tropicalmedicine&internationalhealth:TM&IH.2009;14(9):1128-33.(Ref.8)MarieStopesTanzania.UnintendedPregnancyamongTeenagersinArushaandZanzibar,Tanzania:ASituationAnalysis.2013.
(Ref.8)PlummerM.L.etal.Abortiong andSuspendingPregnancyinRuralTanzania:AnEthnographyofYoungPeople’sBeliefsandPractices.Stud inFam Plann, 2008Dec;39(4):281-92.
(Ref.9)Sherris J,BinghamA,BurnsMA,Girvin S,WestleyE,GomezPI.Misoprostoluseindevelopingcountries:resultsfromamulticountry study.Internationaljournalofgynaecologyandobstetrics:theofficialorganoftheInternationalFederationofGynaecologyandObstetrics.2005;88(1):76-81.
(Ref.10)MaternowskaMCetal.,Teenagepregnancy,unsafeabortionandpost-abortioncareinArushaandZanzibar,unpublishedreport,SanFransisco,CA,USA:BixbyCenterforGlobalReproductiveHealth,2012.(Ref.11)NorrisA.etal.AbortionexperiencesamongZanzibari women:achain-referralsamplingstudy.ReproductiveHealth. 2016Mar11;13:23.
References(3/3):(Ref.12)JamiiForums.2006. Tanzania:Abortionpillsnowsoldoverthecounter!.[ONLINE]Availableat:http://www.jamiiforums.com/threads/tanzania-abortion-pills-now-sold-over-the-counter.101251/.[Accessed10October2016].(Ref.13)Ipas.2014.Outofthefireofanger:Awomen’scenterinTanzaniaopensapharmacytobringmisoprostoltoruralcommunities.[ONLINE]Availableat: http://www.ipas.org/en/News/2014/March/Out-of-the-fire-of-anger--A-women-s-center-in-Tanzania-opens-a-pharmacy-to-bring-misoprost.aspx.[Accessed8October2016].(Ref.14)Newsarticle inMtanzania:«Misoprostol:Dawa ya vidonda vya tumbo inayotoamimba.»insection Jamii Yetu,published 2013,september5;page 17.(Ref.15)MillerS.etal.Misoprostol anddeclining abortion-relatedmorvidity inSntoDomingoDomnincan Republic:atemporalassociation.BJOG2005,112:1291-1296.(Ref.16)Faundes A.et.al.Post-abortion complicationsafter interruptionof pregnancy withmisoprostol.AdvContracept 1996,2:1-9.(Ref.17)Sherris J.etal.Misoprostol use indevelopingcountries:results fromamulticountrystudy.IntJGynecol Obstet 2005,88:76-82.
(Ref.18)HarperC.C.etal.Reducingmaternalmortality duetoelective abortion:Potentialimpact ofmisoprostol inlow-resourse settings.IntJGynecolOcstet200.98:66-69.
(Ref.19)Gynuity HealthProjects.Providingmedical abortion inlow-resourse settings:Anintroductore guidebook.2ndedition.NewYorkGynuity HealthProjects;2009.
Acknowledgements:
Thank you toallsupervisors:
University of Bergen,Norway:Prof.AstridBlystad,DepartmentofGlobalHealthandPrimaryCareProf.KarenMarieMoland,CentreforInternationalHealth
MUHAS,Tanzania:Dr.AndreaBarnabasPembe,DepartmentofObstetrics/Gynaecology
CSKResearchSolutions,Tanzania:Dr.CatherineKahabuka
Thank you toallresearch assistants inDaresSalaam:DeborahLusenga,DeborahMaufi,SoniaKimora,AlexMoshi,DavidNyongani andLucyHiza.
Questions?
Doyou want toknow moreabout this particular [email protected]
Thisresearch ispartof astudy between academics inEthiopia,Tanzania,ZambiaandNorway,called:Competingdiscoursesimpactinggirls’andwomen’srights:FertilitycontrolandsafeabortionDoyouwanna knowmore?http://www.uib.no/en/rg/gha/99428/safezt