Best practices amid local realities: Treating abortion complications within the context of Senegal's abortion law

Background: In spite of existing evidence of best practices in service organization and technology related to post-abortion care (PAC), little is known about what it means to practice PAC in settings where abortion is restricted. This study explores the daily practice of PAC in state hospitals in Senegal, where induced abortion is prohibited. Findings suggest that even when best practices are in place, the daily practice of PAC is profoundly shaped by the local context of the abortion law. Methods: I conducted a multi-sited, institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included 88 in-depth interviews, observation of PAC services and records at 3 hospitals, and an archival review of abortion using medical, social science, media and legal sources. I used grounded theory to triangulate multiple sources of data. Findings: Medical providers attempt to differentiate between spontaneous and induced abortion through a calculus of social and physiological indicators. These practices may subject women suspected of induced abortion to extensive interrogations, delays and threats to withhold treatment. Patients participate in this process by divulging or withholding information from providers. Providers manage suspected cases of induced abortion as spontaneous unless the patients confess to inducing abortion. Conclusion: Daily PAC practices may not always align with best practices for PAC as defined by public health experts. In Senegal, PAC practices reflect providers' strategies to avoid the involvement of criminal justice authorities in the hospital.