Reproductive health characteristics of young Malawian women seeking post-abortion care

Abortion is illegal in Malawi except when the pregnancy endangers the mother's life, yet complications of abortion account for the majority of admissions to gynecological wards. This study collected data on all post-abortion care (PAC) cases reporting to all PAC-providing health facilities in Malawi over a 30 day period from August to September 2009. This analysis describes characteristics of very young (age 12-17) and youth (age 18-24) presenting for PAC. Of a total of 2543 PAC clients, 7.7% were very young and 43.1% were youth. The majority of women aged 12-17 years were single (56.1%) compared to 65.1% of married women aged 18-24. Only 4.1% of women aged 12-17 years and 16.6% of women aged 18-24 years reported modern contraceptive use, compared to the 2000 Malawi contraceptive prevalence rate of 31%. Only one very young woman reported a previous abortion (0.05%) compared to 4.1% of those aged 18-24 years. Marital status, contraceptive use, and previous abortion were associated with age (p ≤ 0.01). Marital status was associated with previous abortion among those aged 18-24 (p ≤ 0.01). More than 50% of PAC abortion services were accessed by women under 25 years old, with an important proportion reporting repeat abortions. This shows lack of access to modern contraception and may indicate young women's sexuality is stigmatized, impeding their access to education and services. Further research is needed to understand how to increase access to pregnancy prevention services and what is needed to protect them from unsafe abortions.