High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. This study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières, located in northern Nigeria and Central African Republic (CAR).

A cross-sectional study reviewed prospective medical records of women presenting with abortion-related complications at the two hospitals between November 2019 and July 2021, categorising complications into four categories of increasing severity using a methodology similar to the WHO near-miss approach.

Data were analysed from 520 women in the Nigerian hospital and 548 in the CAR hospital. Abortion complications represented 4.2% of pregnancy-related admissions in Nigeria and 19.9% in CAR. Severity was high in both settings: around one in five women in Nigeria and one in sixteen in CAR had severe maternal outcomes (near-miss cases or deaths), with most remaining cases classified as potentially life-threatening. Severe bleeding was the main complication in both settings (71.9% in Nigeria, 57.8% in CAR), followed by infection (18.7% in Nigeria, 27.0% in CAR).

These findings suggest high severity of abortion-related complications in both referral facilities. Contributing factors likely include delays in accessing post-abortion care, decreased access to contraception and safe abortion care leading to unsafe abortions, and food insecurity contributing to iron deficiency and chronic anaemia. Better access to safe abortion care, contraception, and high-quality post-abortion care is needed to prevent and manage these complications in fragile and conflict-affected settings.

This publication relates to R2HC funded study; Magnitude and severity of abortion-related complications and factors associated with severe and near miss events in African humanitarian settings