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CHAPTERS: Chapter 1-5
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ABSTRACT
The purpose of this study was to determine the knowledge and utilization of post abortion care among women of reproductive age (15 – 49 years) in Obanliku Local Government Area of Cross River State, Nigeria. The research utilized a descriptive survey design and a sample size of 350 women of reproductive age (15 – 49), selected from each of the 10 communities in the area. A structured questionnaire was used as instrument to collect data. Information obtained from the questionnaire was analyzed using the Statistical Package for Social Science (SPSS) version 21. Descriptive statistics in terms of mean and standard deviation were used; while one way Analysis of Variance (ANOVA) was used to test hypotheses. The findings of the study showed that majority 253(72.3%) of the respondents had understanding of what post abortion care is. Majority264(75.4%) had understanding that family planning can prevent death arising from unsafe abortion. Majority 88(48.4%) who had miscarriage/abortion did not use any health facility. Only few used the hospital. Majority 88(48.4) did not use any method of family planning. Reasons such as distance to the health facility, cost of obtaining PAC services, husband’s support and availability of health care services provider influenced non-use of post abortion care services. There was significant mean difference in women’s understanding of post abortion care due to their educational qualification (P < .05, Critical F = 2.37). There was also a significant difference in the mean use of post abortion care services based on their occupation. (P < .05, critical F = 2.37). Based on these findings, it was recommended that PAC should be made one key component base service delivery to improve training of community based health care providers, case identification and referral while intervention needs to be put in place by stakeholders.
CHAPTER ONE
INTRODUCTION
Background to the Study
Abortion is illegal or restricted in many developing countries causing women to seek unsafe abortion that can result in serious complications such as anaemia, septicaemia, infertility and death. Globally, an estimated 40 – 50 million abortions occur annually and nearly half of these are unsafe (Centre for Reproductive Rights, 2010). Worldwide unsafe abortion is common with an estimate of 19 million unsafe abortions occurring annually, resulting in 70,000 deaths and 5 million women suffering disability (Evans, Otieno – Masaba, Eichleay, McCarraher, Hains Worth, Makumi etal, 2013).
World Health Organization (2010) defines unsafe abortion as any procedure for terminating an unplanned pregnancy either by persons who lack the necessary skills or is conducted in an environment that lacks the minimal medical standards or both.
Tragically, unsafe abortion is the most easily preventable cause of maternal mortality. In Nigeria, the abortion lawprohibits induced abortion except for medical reasons in order to save the life of the woman (Adinma, Ikeako, Adinma, Ezeama & Eke, 2010). In spite of the law, it has been estimated that 610,000 induced abortions occur yearly in Nigeria (WHO, 2010). Due to restrictive abortion laws, lack of access to safe abortion and lack of quality post abortion care in some developing countries; millions of mothers have risked and lost their lives prematurely. Over 40% of the total deaths due to unsafe abortion have occurred in Africa making it a leading cause of maternal mortality in the region (WHO, 2010).
In Nigeria, unsafe abortion accounts for approximately 11% of all maternal deaths and similar figures abound in other sub-Saharan African countries with restrictive abortion laws (Collins, Umeora & Adeoye, 2012). At the international conference on population and development held in Cairo, Egypt in 1994, the question of unsafe abortion was recognized as a major public health problem. At this conference, participants called for prompt high quality and sympathetic medical services to treat the complications of unsafe abortion (Kumbi, Melkamu & Yeneneh, 2008). More so, participating governments agreed that family planning services should be expanded and improved to avoid repeated abortion. According to Guttmacher Institute (2011), abortion related deaths and disability can be prevented in three ways: by preventing unplanned pregnancy, by providing a safe legal abortion, and by providing post abortion care (PAC).
Post abortion care as a comprehensive approach consists of a series of medical and related interventions designed to manage complications of spontaneous and induced abortion, both safe and unsafe. The care was introduced in the public health systems around the world since the 1994 International Conference on Population and Development and was programmed to meet the needs of abortion complications and at the same time be cost effective. The post abortion care concept was developed as a way to reduce maternal morbidity and mortality especially in settings where abortion laws are restrictive (Billings, Crane, Benson, Solo & Fetters, 2007). The approach included: emergency treatment of incomplete abortion and its complications, family planning counseling and services, and linking the emergency treatment along with other reproductive health services (Kumbi et al, 2008).
Recently, the Post Abortion Care ConsortiumCommunity Task Force developed an expanded and updated model which includes two more elements, that is, providing appropriate counseling based on individual needs and community-provider partnership in prevention of unsafe abortion and care (Collins et al, 2013). These are important strategies for developing countries where access to safe abortion is restricted and knowledge and practice of family planning is low. In addition, due to severe poverty and lack of access to health care services in general, PAC is one of the very few opportunities for women to seek medical services and benefit from reproductive health and family planning services.
Similar to other maternal health services, utilization of post abortion care has also remained low although access to better quality post abortion care services have improved significantly in the last few years (WHO, 2013). As a result of this low usage, most women of reproductive age are liable to develop complications associated with abortion. The study therefore, aims to assess the knowledge and utilization of post abortion care services among women of reproductive age in Obanliku local government area of Cross River State.
Statement of Problem
The World Health Organization estimated that 210 million pregnancies occur each year of which 38% are planned and 22% end up in abortion (WHO, 2007). Nearly 5.5 million African women have unsafe abortion, and 36,000 of these women die from complications while a million or more experience short or long term illness and disability (WHO, 2013).
A study conducted in Ebonyi State University Teaching Hospital in 2012 revealed that one thousand three hundred and fourty four (1,344) gynecological cases were admitted and of these, five hundred and fifty six (556) cases were abortion complications. In another study conducted in the University of Benin Teaching Hospital in 2010, one hundred and four (104) patients with complicated induced abortion were admitted over a five year period, about twenty one patients per year. The incidence was 27.4 per 1000 live births and 3.93% of gynaecological admissions. A similar study conducted in six States of Nigeria (Ekiti, Gombe, Kaduna, Kano, Kogi, Lagos) showed that 36% of women admitted for abortion related reasons had serious complications.
Statistics from selected health facilities in the northern part of Cross River State have shown that abortion accounts for over 10.9% of maternal mortality though significant under reporting is likely.A significant proportion of abortions and complications such as haemorrhage, septicaemia, and uterine perforation occur among women aged 25 years and below and only few facilities in the northern part of Cross River State are able to provide care for women with abortion related complications (Public Health Department 2014). More so, in Obanliku Local Government Area, the researcher observed an increased maternal mortality rate of 5% from complications of unsafe abortions. Such complications as hemorrhage, septicemia, anemia, are common due to lack of safe abortion services (Public Health Department, 2014). The question is, whether the women are knowledgeable about post abortion care services or not? If they know, are these services being utilized? This challenge motivated the researcher to assess the knowledge and utilization of post abortion care services in Obanliku LGA in the northern part of
Cross River State.
Purpose of the Study
The purpose of this study was to assess knowledge and utilization of post abortion care services among women of reproductive age (15 – 49 years) in Obanliku Local
Government Area of Cross River State.
Research Objectives
The specific objectives were to:
- Determine what women understandas post abortion care
- Determine the extent to which women use post abortion care services
- Identify reasons for non-use of post abortion care services among women of reproductive age.
Research Questions
- What do women understand as post abortion care?
- To what extent do women of reproductive age use post abortion care services?
- What are the reasons for non-use of post abortion care services among women of reproductive age?
Hypotheses
- There is no significant difference in the women’s knowledge of post abortion care based on their educational qualification.
- There is no significant difference in the women’s use of post abortion care services based on their occupation.
Significance of the Study
Findings of this study will giveHealth care providers an insight into the knowledge and utilization of post abortion care services and will reveal reasons why these women are not making proper use of post abortion care services.
This information will also be used by Healthcare providers including Midwives in the planning and designing of different programmes that will improve their knowledge and help these women to make better use of post abortion care services. This could be done by integrating such services into already existing treatment programmes and reinforcing education on post abortion care so as to improve women’s level of knowledge that may change their attitude.
Findings will also expose areas of gap which will enable stakeholders in maternal and child health such as midwives to educate and counsel the women appropriately as well as correct misconceptions if any concerning PAC services.
Findings will help in strengthening management systems through quality supervision and budgetary controls by the Ministry of Health to all health facilities in order to promote PAC services.
It will also provide opportunities for further research studies using other modes of inquiry such as qualitative designs. The implementation of the findings of this study will help in reducing maternal morbidity and mortality rates in Cross River State specifically and Nigeria in general.
Scope of the Study
The study was delimited to women of reproductive age (15 – 49 years) in Obanliku Local Government Area of Cross River State. It was also confined to the following variables, assessment of knowledge, extentof utilization and reasons for non use of post abortion care services.
Operational Definition of terms
For the purpose of this study the following terms were defined:
Knowledge of post abortion care services: Refers to the information and understanding that women of reproductive age (15 – 49 years) have regarding post abortion care services such as emergency treatment of incomplete abortion and its complications, family planning counseling and services.
Utilization of post abortion care services: The extent to which women make use of post abortion care services thatare located within their reach. Such services include emergency treatment of incomplete abortion and its complications, family planning counseling and services.
Women of Reproductive Age: Women between the ages of 15 – 49 years.