Hospital admission following induced abortion in Eastern Highlands Province, Papua New Guinea – A descriptive study

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Study Justification:
– Abortion is restricted under the Criminal Code Act in Papua New Guinea, leading to limited access to safe abortions for women.
– Unsafe abortions are a major cause of maternal mortality in the country.
– This study aims to identify complications requiring hospital treatment for post-abortion care and explore the circumstances surrounding unsafe abortion.
Highlights:
– The study found that 24% of women admitted to the Eastern Highlands Provincial Hospital for post-abortion care had undergone induced abortions.
– Women who had induced abortions were more likely to be younger, single, in education, and reported the pregnancy as unplanned and unwanted.
– The most common method used for induced abortions was illegally obtained misoprostol, followed by physical and mechanical means and traditional herbs.
– The study highlights the need for increased access to contraceptive information and services to prevent unintended pregnancies and unsafe abortions.
– The findings emphasize the strain on the healthcare system due to unsafe abortions and the need for safe and effective means of abortion.
Recommendations:
– Improve access to contraceptive information and services for all reproductive-age women to avoid, postpone, or space pregnancies.
– Increase availability of safe and effective means of abortion to prevent women from resorting to unsafe methods.
– Strengthen the healthcare system to better handle the increased demand for post-abortion care.
Key Role Players:
– Government health departments and policymakers
– Healthcare providers and facilities
– Non-governmental organizations (NGOs) working in reproductive health
– Community leaders and educators
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on contraceptive counseling and safe abortion procedures
– Development and distribution of educational materials on contraception and safe abortion methods
– Procurement and distribution of contraceptives and safe abortion medications
– Upgrading healthcare facilities to handle increased demand for post-abortion care
– Awareness campaigns and community outreach programs on reproductive health and family planning

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a six-month prospective study and reviewed case notes of women presenting for post-abortion care. The findings indicate that induced abortion accounted for at least 24% of admissions, and women who had induced abortions were more likely to be younger, single, and report an unplanned and unwanted pregnancy. The study also identified the methods used for induced abortion. However, the abstract does not provide information on the sample size or the specific methods used for data collection and analysis. To improve the evidence, the abstract could include more details on the study design, sample size, and the specific methods used for data collection and analysis.

Background: In Papua New Guinea abortion is restricted under the Criminal Code Act. While safe abortions should available in certain situations, frequently they are not available to the majority of women. Sepsis from unsafe abortion is a leading cause of maternal mortality. Our findings form part of a wider, mixed methods study designed to identify complications requiring hospital treatment for post abortion care and to explore the circumstances surrounding unsafe abortion. Methods: Through a six month prospective study we identified all women presenting to the Eastern Highlands Provincial Hospital following spontaneous and induced abortions. We undertook semi-structured interviews with women and reviewed individual case notes, extracting demographic and clinical information. Findings: Case notes were reviewed for 56% (67/119) of women presenting for post abortion care. At least 24% (28/119) of these admissions were due to induced abortion. Women presenting following induced abortions were significantly more likely to be younger, single, in education at the time of the abortion and report that the baby was unplanned and unwanted, compared to those reporting spontaneous abortion. Obtained illegally, misoprostol was the method most frequently used to end the pregnancy. Physical and mechanical means and traditional herbs were also widely reported. Conclusion: In a country with a low contraceptive prevalence rate and high unmet need for family planning, all reproductive age women need access to contraceptive information and services to avoid, postpone or space pregnancies. In the absence of this, women are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk and putting an increased strain on an already struggling health system. Women in this setting need access to safe, effective means of abortion.

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Based on the provided description, here are some potential innovations that could improve access to maternal health in Papua New Guinea:

1. Comprehensive reproductive health education: Implementing comprehensive reproductive health education programs that provide accurate information about contraception, family planning, and safe abortion methods can help women make informed decisions about their reproductive health.

2. Accessible and affordable contraception: Ensuring that a wide range of contraceptive methods are readily available and affordable can help women prevent unintended pregnancies and reduce the need for unsafe abortions.

3. Safe and legal abortion services: Expanding access to safe and legal abortion services can help reduce the number of women resorting to unsafe methods. This could involve revising the existing laws and regulations to allow for safe abortions in certain situations, as well as training healthcare providers to perform abortions safely.

4. Telemedicine and mobile health solutions: Utilizing telemedicine and mobile health solutions can help overcome geographical barriers and provide women in remote areas with access to reproductive health services, including information, counseling, and consultations with healthcare providers.

5. Strengthening healthcare infrastructure: Investing in healthcare infrastructure, particularly in rural areas, can improve access to maternal health services. This includes ensuring that healthcare facilities have the necessary equipment, supplies, and trained healthcare providers to provide quality maternal healthcare.

6. Community-based interventions: Implementing community-based interventions, such as community health workers or peer educators, can help raise awareness about reproductive health, provide counseling, and connect women to appropriate services.

7. Partnerships and collaborations: Collaborating with international organizations, NGOs, and local communities can help mobilize resources, share best practices, and support initiatives aimed at improving access to maternal health services.

It is important to note that the implementation of these innovations should be context-specific and take into account the cultural, social, and legal considerations of Papua New Guinea.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health and address the issue of unsafe abortions in Papua New Guinea is to develop and implement comprehensive reproductive health programs that focus on the following:

1. Education and Awareness: Increase awareness among women of reproductive age about contraceptive methods, family planning, and the risks associated with unsafe abortions. This can be done through community outreach programs, school-based education, and media campaigns.

2. Access to Contraceptives: Ensure that a wide range of contraceptive methods are readily available and accessible to women in both urban and rural areas. This includes providing information, counseling, and affordable options for contraceptives such as condoms, oral contraceptives, intrauterine devices (IUDs), and implants.

3. Training and Capacity Building: Provide training and capacity building programs for healthcare providers, including doctors, nurses, and midwives, on safe abortion procedures, post-abortion care, and counseling. This will enable them to provide accurate information, safe abortion services, and appropriate post-abortion care to women who need it.

4. Strengthening Health Systems: Improve the overall healthcare infrastructure, including facilities, equipment, and supplies, to ensure that safe abortion services and post-abortion care are available and accessible in both urban and rural areas. This may involve increasing the number of healthcare facilities that provide these services and ensuring that they have the necessary resources and trained staff.

5. Legal and Policy Reforms: Advocate for legal and policy reforms to decriminalize abortion in certain situations, such as cases of rape, incest, fetal abnormalities, and when the mother’s life is at risk. This will help reduce the stigma associated with abortion and ensure that women have access to safe and legal abortion services.

6. Collaboration and Partnerships: Foster collaboration and partnerships between government agencies, non-governmental organizations (NGOs), and international organizations to pool resources, share best practices, and coordinate efforts to improve access to maternal health services, including safe abortion services.

By implementing these recommendations, it is expected that access to safe and effective means of abortion will be improved, reducing the incidence of unsafe abortions and maternal mortality rates in Papua New Guinea.
AI Innovations Methodology
To improve access to maternal health in Papua New Guinea and address the issue of unsafe abortions, here are some potential recommendations:

1. Increase availability of safe abortion services: Work towards legal reforms to expand access to safe and legal abortions in certain situations, as well as ensure that healthcare facilities are equipped to provide safe abortion services.

2. Strengthen family planning services: Improve access to contraceptive information and services to help women avoid unintended pregnancies and reduce the need for abortions.

3. Enhance education and awareness: Implement comprehensive sexual and reproductive health education programs to increase awareness about contraception, safe abortion methods, and the risks associated with unsafe abortions.

4. Improve healthcare infrastructure: Invest in healthcare facilities, particularly in rural areas, to ensure that they have the necessary resources, equipment, and trained healthcare providers to offer safe abortion services and post-abortion care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather data on the current state of maternal health, including rates of unsafe abortions, maternal mortality, contraceptive prevalence, and access to reproductive healthcare services.

2. Modeling: Develop a simulation model that incorporates the various recommendations mentioned above. This model should consider factors such as population demographics, healthcare infrastructure, availability of services, and the potential impact of each recommendation.

3. Parameter estimation: Estimate the parameters required for the simulation model, such as the effectiveness of family planning services, the potential reduction in unsafe abortions with increased access to safe abortion services, and the impact of education programs on contraceptive use.

4. Scenario analysis: Run the simulation model with different scenarios, varying the implementation levels of each recommendation. This will help assess the potential impact of each recommendation individually and in combination.

5. Evaluation: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This evaluation should consider outcomes such as reduced rates of unsafe abortions, decreased maternal mortality, increased contraceptive use, and improved access to reproductive healthcare services.

6. Policy recommendations: Based on the simulation results, provide evidence-based policy recommendations to stakeholders, policymakers, and healthcare providers to guide decision-making and prioritize interventions that will have the greatest impact on improving access to maternal health.

It is important to note that the methodology described here is a general framework and may need to be adapted based on the specific context and available data in Papua New Guinea.

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