Evidence brief: Pathways to care among women hospitalized with severe abortion complications at Castors Maternity in Bangui, CAR

Global estimates indicate that up to 45% of all abortions are unsafe. As a consequence, abortion-related complications are significant contributors to maternal mortality and morbidity. Seven million women are hospitalized each year in low-income countries as a result of unsafe abortion complications. It is estimated that globally, most abortion-related deaths, occurring almost exclusively in low- and middle-income countries, are related to unsafe induced abortions, which are responsible for 7.9% to 18% of all maternal deaths. These deaths could almost entirely be prevented by ensuring access to comprehensive abortion care (safe abortion and post-abortion care, as well as contraceptive services). It is therefore imperative that high-quality and timely post-abortion care is accessible and available before complications become life-threatening.

Conflict-affected and fragile settings bear a heavy burden of maternal mortality. The Central African Republic (CAR) is one of the countries most affected by conflict and fragility, and where the risk of pregnancy-related illness and death is compounded by disruption or restriction of access to essential health services, including sexual and reproductive health care. CAR is one of the poorest and most fragile countries in the world, affected by decades-long internal conflict and chronic insecurity. With 829 deaths for every 100,000 live births, it holds the fifth highest maternal mortality rate in the world, with abortion-related complications estimated to be responsible for 24% of all maternal deaths (or 31% of the direct causes of maternal deaths).

As research about abortion, abortion-related complications, and abortion care in fragile and conflict-affected settings remains very limited, the AMoCo (Abortion- Morbidity and Mortality in Conflict-affected and Fragile Settings) mixed methods study was designed to describe, quantitatively and qualitatively, the burden of abortion-related complications and their contributing factors in three fragile and conflict-affected settings: CAR, Northern Nigeria and the Democratic Republic of Congo.

This evidence brief summarizes key findings from its qualitative component, which aims to describe the access to care and treatment of women and girls hospitalized in Castors Maternity Hospital in Bangui for potentially life-threatening and near-miss abortion complications such as severe haemorrhage, severe sepsis, and uterine and intra-abdominal perforation.