Descriptive analysis of second trimester postabortion care patients in Malawi

Background: Malawi has high maternal mortality at 510 deaths per 100,000 live births, and unsafe abortion has been cited as a leading cause. Globally, second trimester abortions are responsible for a disproportionate amount of maternal mortality and morbidity. Due to a variety of factors, many women attempt termination of pregnancies outside the health system and at late gestations. Objective: to examine the socio-demographic factors, medical complications, and treatment of second trimester postabortion care (PAC) clients in Malawi and make recommendations to improve maternal mortality related to unsafe abortion. Data on women seeking PAC was collected over 30 days from 166 public tertiary and secondary facilities in Malawi in 2009. Results: Over 32% of PAC cases were already in their second trimester. Demographic predictors were low educational attainment and living in a rural location, even though the majority of the postabortion procedures for second trimester cases were at tertiary facilities in urban areas. These women were more likely to have severe complications than women in their first trimester, and 2.1 times more likely to die. Eighty-seven percent had uterine evacuation using dilation and curettage, which, although a WHO recommended method for second trimester PAC, is a riskier surgical procedure than manual vacuum aspiration which can be used for first trimester PAC. Conclusion: Improved access to safe abortion and family planning to prevent unwanted pregnancies, especially in rural Malawi could bring down the number of women who delay accessing PAC until well into their pregnancies and reduce maternal mortality in Malawi.