Impact Case Study: Strengthening post-abortion care – Evidence driving action in humanitarian contexts
Background
Unsafe abortion is a major cause of preventable maternal death, with risks heightened in fragile and conflict‑affected settings where access to contraception, safe abortion services and timely post‑abortion care is limited. In places such as Jigawa State in Nigeria and Bangui in the Central African Republic (CAR), weak health systems, insecurity and social stigma contribute to delays in seeking care and reliance on unsafe methods.
Reliable data on abortion complications in humanitarian contexts has been extremely limited, hindering effective service planning and advocacy. The abortion-related morbidity and mortality in fragile and conflict-affected settings (AMoCo) study was developed to fill this evidence gap and strengthen understanding of abortion‑related morbidity in crisis settings.
The study
The AMoCo study examined the scale and severity of abortion complications in two MSF‑supported hospitals in Nigeria and CAR. Using mixed methods, it combined clinical record reviews, interviews with more than 1,000women, qualitative research on care‑seeking pathways, facility assessments and surveys of health workers.
The study aimed to inform clinical practice, strengthen health system responses and support advocacy for improved access to contraception, safe abortion and post‑abortion care. Its success was driven by strong collaboration among MSF, Epicentre, the Guttmacher Institute, Ipas and national Ministries of Health, alongside deep engagement with communities and providers.
Findings and impact
- Demonstrated a high burden of severe abortion complications, with more than half of cases in CAR and nearly two‑thirds in Nigeria classified as severe.
- Revealed widespread use of unsafe abortion methods and long delays in reaching care.
- Strengthened clinical practice and documentation within MSF and partner facilities.
- In Nigeria, contributed to a state‑level roadmap for expanding family planning services and establishing new sexual‑violence care centres.
- In CAR, supported momentum for implementing the Maputo Protocol and helped shift media narratives through targeted journalist engagement.
- Informed refinements to WHO’s near‑miss methodology for abortion in fragile settings and contributed to global evidence on unsafe abortion in humanitarian contexts.
- Inspired further organisational change within MSF to expand access to safe abortion care.
Lessons learn
- Robust mixed‑methods data is essential for influencing sensitive policy and clinical debates.
- Diverse communication outputs beyond academic publications significantly increase reach and impact.
Partners
Ministries of Health in Jigawa State (Nigeria) and the Central African Republic, Epicentre, Médecins Sans Frontières, Guttmacher Institute, Ipas.
Methodology
R2HC captures detailed case studies through a process that triangulates and validates evidence on uptake and impact. The case study methodology and full version of this summary case study including references are available on request. Outputs and resources from this study are available on the project page.