The severity and management of postabortion care complications in Liberia

Abstract Background: Complications from unsafe abortion are a major contributor to maternal morbidity and mortality in resource poor settings. This study aims to assess the severity and management of abortion complications in Liberia. Methods: Data were collected among a nationally representative sample of health facilities in Liberia (n=100). Study staff administered a survey to all postabortion care (PAC) patients and their health providers arriving at a study facility over the course of 30 days. A total of 387 patient surveys and 429 provider surveys were included in the final analysis. Postabortion complication severity was classified into five categories, ranging from mild to near miss. Likely induced abortions were identified though patient self-reports reports and provider reports of clinical evidence of a foreign body or mechanical injury. We conducted bivariate tests to determine whether PAC management practices varied by complication severity. Poisson regression models were used to assess the relationship between patient characteristics and complication severity, as well as between complication severity and receipt of a family planning method. Results: Overall, 10.9% of PAC patients were classified as near miss and 34.7% had severe complications. Likely induced abortions were identified in 38% of women. Having a more severe complication was associated with marital status (uIRR 0.69, 95% CI 0.48,0.99) and the indicator for likely induced abortion (uIRR 1.74, 95% CI 1.11,2.74). Most women accessed PAC at primary level facilities (76.7%). The most common uterine evacuation methods were MVA (67.5%) and misoprostol (16.3%). Only 38.9% of patients received a family planning method prior to discharge. Controlling for age, residence, future intentions to use, and provider type, women classified as having severe or near miss complications were approximately twice as likely (aIRR 1.98, 95% CI 1.18,3.32) to receive a contraceptive method. Conclusions: Postabortion complications are a major public health concern in Liberia. Our results underscore the need for high quality postabortion care and greater access to safe abortion care. Liberia should invest in primary level facilities and strengthen their ability to manage postabortion complications. Future research is needed to understand how provider practices/attitudes shape the provision of postabortion family planning services.