ConferencepresentationatFIAPACLisbon,October14th 2016

IngridH.SolheimMedicalResearchTrack Student

Departmentof GlobalPublicHealthandPrimary CareUniversity of Bergen

Seekingclandestineabortion safely:Unwantedpregnancyandmedicalabortionamong

youngwomeninDares Salaam,Tanzania

(Ref.3and4)

Abortion inTanzania:

• Induced abortion rateof 36abortionsper1,000women (3)

• Unsafe abortion:

- 16-23%of maternalmortality (4) (5)

- 40%of hospitalizations duetoobstetric complications (6)

- Disproportinately affects young women (7)

Misoprostol inTanzania:

• Registered inTanzaniain2007

•Mentioned asanabortion method inrecent studies

• Available off-label (?)

Ø Underwhich conditions are women accessingmedicalabortion?

Ø Howismedical abortion affecting the situation ofwomen with unwanted pregnancies?

DaresSalaam,Tanzania

Study aim:

Concerning medical abortion,explore:

• Community knowledge

• Accessibility

• Experiences fromuse

Study methods:

In-depth interviews- Women (<26years)afterMA(15)- Healthworkers (17)- Drug cellers(10)

Focus group discussion- Youngwomen inlow-income areas(7)

- Students(3)

Informativeinterviews- NGOs(15)

- Authorities (6)

Fieldnotes- Smallinterviews

- Everyday conversations

- Media

Clientsimulation study (63)

Findings:

o «Miso»acommon andwell-known methodoWide availability,fromdrugstores andhealth workers

“Itiseasy.Shecangotothepharmacyorhospitalandtalktothedoctorforhelp.”(Schoolgirl,15years.)girl,15years)

o Varied andsub-optimalsafe-use instructionso Lack of aprotocolo Profit-seeking providers

“Becausethey'renotqualified(thedrugvendors),theysellitlikearice:"Takethisanduseit!"Nomoreexplanations.WhatIcansayisthatourgovernmentregulationsarealsohinderingthewomentobeopen,andthesellersofdrugstogivewideexplanationonhowtopracticesafeabortion.”

(Drugstoreowner)

o Highacceptability

• Saferalternative

• Accessible

• Lesspainful andmore‘natural’

• Private

“Ithinkit’sgood(misoprostol),becauseitseffectsarenotasbadastheonesI’veheardotherscanhave.Likeifyougotothehospital,theymightinjureyouruterusandbeatriskofbeinginfertile.Buttheysaythismethodisbetterthantherest.”(Youngwoman,20years)

Discussion:

- ‘Safer’unsafe abortions- Onwomen’s own terms- Moreaffordable

- Howabout outside DaresSalaam?

References(1/3):(Map)CenterforReproductiveRights.2014. TheWorld'sAbortionLawsMap.[ONLINE]Availableat:http://www.reproductiverights.org/document/the-worlds-abortion-laws-map.[Accessed10October2016].

(Ref.1)2nd AfricanUnionAssembly.ProtocoltotheAfricanCharteronHumanandPeoples’RightsontheRightsofWomeninAfrica,Art.14(2)(c).Maputo,Mozambique:2nd AfricanUnionAssembly;2007Mar3

(Ref.2)WorldHealthOrganization.Trendsinmaternalmortality:1990to2013.EstimatesbyWHO,UNICEF,UNFPA,theWorldBancandtheUnitedNationsPopulationDivision.Geneva,Switzerland:WorldHealthOrganization;2014.

(Ref.3)Keogh SC,Kimaro G,Muganyizi P,Philbin,J,Kahwa A,Ngadaya E,etal.(2015)Incidence of InducedAbortionandPost-AbortionCareinTanzania.PLoS ONE10(9):e0133933.doi:10.1371/journal.pone.0133933

(Ref.4)Msiwa Ret.Al.Community-basedmonitorin of safemortherhood intheUnitedRepublicof Tanzania.NewYork,USA:CenterforReproductive Rights;2012.

(Ref.5)Sorensen B.L.etal.Substandard emergency obstetric care – aconfidential enquiryintomaternaldeaths ataregionalhospitalinTanzania.TropMedIntHealth2010Aug:15(8):894-900.doi:10.1111/j.1365-3156.2010.0255.xPMID:20545917

References(2/3):

(Ref.6)RaschC.etal.Alongitudinalstudy on differentmodels of postabortion care inTanzania.ActaOcstet Gynecol Scan 2004Jun;83(6):570-5.PMID:15144340

(Ref.7)Rasch V,Kipingili R.UnsafeabortioninurbanandruralTanzania:method,providerandconsequences.Tropicalmedicine&internationalhealth:TM&IH.2009;14(9):1128-33.(Ref.8)MarieStopesTanzania.UnintendedPregnancyamongTeenagersinArushaandZanzibar,Tanzania:ASituationAnalysis.2013.

(Ref.8)PlummerM.L.etal.Abortiong andSuspendingPregnancyinRuralTanzania:AnEthnographyofYoungPeople’sBeliefsandPractices.Stud inFam Plann, 2008Dec;39(4):281-92.

(Ref.9)Sherris J,BinghamA,BurnsMA,Girvin S,WestleyE,GomezPI.Misoprostoluseindevelopingcountries:resultsfromamulticountry study.Internationaljournalofgynaecologyandobstetrics:theofficialorganoftheInternationalFederationofGynaecologyandObstetrics.2005;88(1):76-81.

(Ref.10)MaternowskaMCetal.,Teenagepregnancy,unsafeabortionandpost-abortioncareinArushaandZanzibar,unpublishedreport,SanFransisco,CA,USA:BixbyCenterforGlobalReproductiveHealth,2012.(Ref.11)NorrisA.etal.AbortionexperiencesamongZanzibari women:achain-referralsamplingstudy.ReproductiveHealth. 2016Mar11;13:23.

References(3/3):(Ref.12)JamiiForums.2006. Tanzania:Abortionpillsnowsoldoverthecounter!.[ONLINE]Availableat:http://www.jamiiforums.com/threads/tanzania-abortion-pills-now-sold-over-the-counter.101251/.[Accessed10October2016].(Ref.13)Ipas.2014.Outofthefireofanger:Awomen’scenterinTanzaniaopensapharmacytobringmisoprostoltoruralcommunities.[ONLINE]Availableat: http://www.ipas.org/en/News/2014/March/Out-of-the-fire-of-anger--A-women-s-center-in-Tanzania-opens-a-pharmacy-to-bring-misoprost.aspx.[Accessed8October2016].(Ref.14)Newsarticle inMtanzania:«Misoprostol:Dawa ya vidonda vya tumbo inayotoamimba.»insection Jamii Yetu,published 2013,september5;page 17.(Ref.15)MillerS.etal.Misoprostol anddeclining abortion-relatedmorvidity inSntoDomingoDomnincan Republic:atemporalassociation.BJOG2005,112:1291-1296.(Ref.16)Faundes A.et.al.Post-abortion complicationsafter interruptionof pregnancy withmisoprostol.AdvContracept 1996,2:1-9.(Ref.17)Sherris J.etal.Misoprostol use indevelopingcountries:results fromamulticountrystudy.IntJGynecol Obstet 2005,88:76-82.

(Ref.18)HarperC.C.etal.Reducingmaternalmortality duetoelective abortion:Potentialimpact ofmisoprostol inlow-resourse settings.IntJGynecolOcstet200.98:66-69.

(Ref.19)Gynuity HealthProjects.Providingmedical abortion inlow-resourse settings:Anintroductore guidebook.2ndedition.NewYorkGynuity HealthProjects;2009.

Acknowledgements:

Thank you toallsupervisors:

University of Bergen,Norway:Prof.AstridBlystad,DepartmentofGlobalHealthandPrimaryCareProf.KarenMarieMoland,CentreforInternationalHealth

MUHAS,Tanzania:Dr.AndreaBarnabasPembe,DepartmentofObstetrics/Gynaecology

CSKResearchSolutions,Tanzania:Dr.CatherineKahabuka

Thank you toallresearch assistants inDaresSalaam:DeborahLusenga,DeborahMaufi,SoniaKimora,AlexMoshi,DavidNyongani andLucyHiza.

Questions?

Doyou want toknow moreabout this particular project?ingrid.solheim@live.no

Thisresearch ispartof astudy between academics inEthiopia,Tanzania,ZambiaandNorway,called:Competingdiscoursesimpactinggirls’andwomen’srights:FertilitycontrolandsafeabortionDoyouwanna knowmore?http://www.uib.no/en/rg/gha/99428/safezt