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| Features | | Post abortion care gets some valuable attention | YUMIMI PANG
Daily News; Wednesday,February 04, 2009 @20:00
| MRS Misoji Lygata was cultivating maize in her ‘shamba’ when she was struck by searing pain. She was bleeding. Mrs Lygata, 45 and a resident of Nduha village, was eight weeks pregnant with her seventh child. She travelled 14 kilometres of dirt roads by bicycle with her mother-in-law to the Misasi Health Centre.
For Mrs Lygata, the strenuous labouring in the fields was too much and resulted in a miscarriage. She was in critical condition with vaginal bleeding and blood clots. Just six months ago, the 17-bed Misasi Health Centre would not have been able to treat women in Mrs Lygata’s condition.
Instead she would have been referred to a 28-kilometre journey, by bicycle or cow-driven cart, to the Misungwi District Hospital. From last June staff at the Misasi Health Centre has been trained in comprehensive post-abortion care, courtesy of the USAID-funded NGO, Engender Health.
Care includes community involvement, counselling for reasons and complications of abortion, family planning, integration with other services such as HIV/AIDS or sexually transmitted infections and a referral system. The programme meant that since Mrs Lygata’s pregnancy was less than three months, staff at the health centre was able to treat her incomplete abortion in-house.
They were using a simple, less invasive method called Manual Vacuum Aspiration (MVA), to remove remaining tissue in the uterus. Incomplete abortion is a very common complication, which can cause bleeding and infection. “If there is emergency treatment, counselling for the problems, management of the causes and counselling for family planning, we prevent occurrences of abortion,” said Mrs Ngosso.
Medically unnecessary abortions remain illegal in Tanzania and cases treated by the comprehensive post abortion care programme include spontaneous abortions as well as induced abortions. No matter the cause, comprehensive post abortion care helps to reduce maternal mortality. In Tanzania, 15 per cent of pregnancies end in abortion and of those another 13 to 15 per cent result in death.
“With no services here, what will happen to this woman?” asked Engender Health field worker Mrs Lawrencia Ngosso. Spared from a long, arduous journey to the nearest hospital in a critical condition, the procedure likely saved Mrs Lygata’s life. Since the project was piloted in Geita in 2005, more centres in the Mwanza and Shinyanga areas have benefited from a decentralization of post abortion care services.
The community is being mobilized to understand the signs and symptoms of abortion complications. At the Buzuruga Health Centre, women are seeking medical attention sooner, decreasing the number of septic abortions. The procedure likely saves countless lives. In the Misasi Health Centre alone, 29 MVAs have been performed since June.
Almost 40 kilometres away in the Mwawile dispensary, 11 MVAs have been performed since May in the Mwawile area with a population of 4200. “I’m just alone and Misungwi Hospital is so far. There is no transportation,” explained Mr Peter Buhele, Mwawile Dispensary’s sole clinical officer. Prior to receiving training on MVA, his incomplete abortion patients had to travel to Misungwi, 65 kilometres away.
“Before this service, women with incomplete abortion ended up with severe complications. Now, the moment they have problems, they report here,” said Mr Buhele. The procedure is quick and women with no complications can be in and out, in as little as three hours.
From October 2007 to September 2008, in all 10 districts where comprehensive post abortion care is available, district hospitals were responsible for 282 post abortion care cases, while dispensaries and health centres accounted for 1280.
This means that hospitals had 1280 fewer MVAs in their surgical theatres, presumably allowing them to concentrate on other procedures. Even in district hospitals, the implementation of the programme has meant positive changes including short wait time for women to access MVA services that used to only be available in surgical theatres.
“It reduces a lot of complications,” said Dr Felista Mwailondele with the Magu District Hospital. Dr Mwailondele noted that since training was completed at the hospital in comprehensive post abortion care, women can be treated within half an hour, which greatly decreases infection rates.
The comprehensive post abortion care programme is an initiative of the Ministry of Health. Currently it is active in six districts in Mwanza and four in Shinyanga. The goal is to offer the programme in all eight districts in Mwanza and eight in Shinyanga. “Before all mothers were treated without family planning counselling and there were repeated unsafe abortions.
Because of family planning, we can reduce unwanted pregnancies and unsafe abortions,” said Mrs Ngosso. To this end, after women are counselled they may choose a family planning method, which can range from Depo-Provera injections to the birth control pill to condoms.
In the end, the programme may not only save lives but may save money. According to a 2006 paper by the World Health Organization (WHO) published in ‘The Lancet’, the cost per woman to health systems to treat abortion complications in Tanzania is more than seven times the overall Ministry of Health budget per head of the population.
(Yumimi Pang is a Canadian journalist currently on an internship at TSN. This work was carried out with the aid of a grant from the International Development Research Centre in Ottawa, Canada.) | | | | |
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