Midwives and Post-abortion Care in Gabon: "Things have really changed".

Complications from spontaneous and induced abortion are a primary cause of death of women in sub-Saharan Africa. Le Réseau d'Afrique Centrale pour la Santé Reproductive des Femmes: Gabon, Cameroun, Guinée Équatoriale (the Middle African Network for Women's Reproductive Health, or GCG as it is commonly known) was founded in 2009 to identify and overcome obstacles to post-abortion care in Gabon. Research identified the main obstacle as lack of emergency skills and provisions among first-line health care providers. To fill the lacuna, GCG designed a program to train midwives in manual vacuum aspiration (MVA), misoprostol protocols, and the insertion of T-shaped copper IUDs. This article presents a nine-year retrospective (2009-2018) of the program. Qualitative and quantitative results confirm correlations between midwives' practice of MVA in health centers and spectacular decreases in treatment delays, with corresponding decreases in mortality from abortion complications. Our findings also demonstrate how these advances have been threatened by opposition to midwife practice in certain urban medical centers despite encouragement by the Gabon Ministry of Health to use the new protocols. Women's human right to the highest attainable standard of health, including access to safe abortion, is an assumption that GCG shares with the 40 African countries that have ratified the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa. The training program illustrates how a direct-action strategy can fully equip medical practitioners, especially those in peripheral sites with meager resources, to provide emergency post-abortion and abortion care even before governments legislate their human rights commitment.

Surgical and medical second trimester abortion in South Africa: a cross-sectional study.

BACKGROUND: A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province. METHODS: We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery. RESULTS: Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience. CONCLUSIONS: As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.

A week in the life of an abortion doctor, Western Cape Province, South Africa.

South Africa legalized abortion in 1996. I am originally from the Netherlands and came to South Africa in 2000, to assist in the Termination of Pregnancy programme. In March 2007, at an international conference on second trimester abortion, I described my life as an abortion doctor living in Cape Town, South Africa. I was urged to write down what my working life in the Western Cape is like, and this paper is the result. It is a diary of a typical work week, recorded in early 2008.