Magnitude of postabortion care complications in Malawi

Mortality due to unsafe abortion disproportionately affects African women. This is particularly true in Malawi, a country with restrictive abortion laws and limited access to safe services for women. 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. Proportions are weighted to represent all PAC cases at PAC facilities in Malawi. Of 2546 cases in 166 facilities, 50.1% were in government facilities, 35.5% were in NGO facilities and 10.4% were in private facilities. Over 50% of the women were less than 25 years old, 71.5% were married, and 55.5% lived in rural areas. Only 20.6% women reported currently using a contraceptive at time of pregnancy. When PAC morbidities were classified, 16.5% were severely ill (such as sepsis, high temperature, organ failure, or shock), 7.2% had moderate illness (such as moderate temperature, tender uterus) and 76.4% had low morbidity complications. Eight women (0.8%) died. While abortion is illegal except to save the life of a woman, provision of PAC is legal. Women, especially young women, need to be educated about contraception to prevent unwanted pregnancy and access to PAC, if necessary. Women need to obtain care early to reduce morbidity and save lives. In response to concern about women's health as an undeniable right for women, an advocacy group is being formed to use this context-specific data to advocate for changes in the law and increase access to safe abortion where indicated.