____________________________________

Inaugural Commonwealth Nurses Conference

Our health: our common wealth 10-11 March 2012 London UK

In collaboration with the 9th CNF Europe Region Conference

Supported by the Royal College of Nursing UK

Mr NDARUKWA PISIRAI

Factors contributing to abortion at Chitungwiza Population Service, Zimbabwe Reproductive

Health Clinic

A study to determine factors contributing to abortions among patients reporting at Chitungwiza Population Service Zimbabwe Reproductive Health Care Clinic.

AUTHOR MR PISIRAI NDARUKWA MPH Student (AU)/BSc Ned (CUT)/RMN/RGN.

SENIOR TUTOR AND RESEARCH COORDINATOR CHITUNGWIZA SCHOOL OF NURSING AND MIDWIFERY , ‘ISO CERTIFIED HOSPITAL’.

MS Tecla Fashu- Gundumuro

BSNS/DCN/SCM/RGN

CHITUNGWIZA POPULATION SERVICE ZIMBABWE REPRODUCTIVE HEALTH CARE CLINIC.

Abortion is a major public health problem across the globe due to the higher incidence and severity of its complications such as severe per vaginal bleeding, incomplete abortion, septic abortion, Ill health, infertility and death of the woman. Guttmacher Institute, (2009) states that globally around 70,000 women die each year from the effects of unsafe abortions, a figure that barely changed in the last 10 years. An estimated 8 million women annually experience complications and need medical treatment, but only 5 million actually get that care. These abortions however, include incomplete abortions and septic abortions. This can lead to complications like haemorrhage and damage to the internal genital organs. Magowan (2003) further went on to say that,”every hour of every day at least thirty women die from complications of pregnancy in Sub-Sahara Africa and these complications include septic abortions. Kaneda (2008) states that, “each year 42 million women decide whether they should continue with pregnancy or seek abortion.”

In Zimbabwe, abortion is available under in a limited set of circumstance. IRIN (2005) reports that 70,000 illegal abortions took place across the country. However, abortion is controversial issue because of the illegal aspect associated with it. The legality, prevalence and actual aspect of abortion vary substantially around the world. Guttmacher (2004) states that 26 million abortions occur in countries where they are legalised and 20 million abortions occur in countries where the procedure is illegalised such as Zimbabwe. An overall 46 million abortions occur every year worldwide and these contribute to high maternal morbidity and mortality rates.

Johnston (2008) estimated that about 28% of US women ages 15-40 have had abortions. He reported that, this figure had risen from 2, 8% in 1973 to 11% in 1980, and 19% in 1987. In 1994, 24%, 2001, 27%.In 2008, women ages 40-55, about 40% have had abortions in their lifetime. Johnston links abortions to legal and illegal factors that are related to country policy on abortion as reflected in the paragraphs below.

An estimated 30-50% of maternal deaths in Africa are due to abortion. In 2004, a study in Egypt by Kabir found that abortion consumed about 50% of the budget of one maternity hospital. In South-Africa, abortion was legalised but services remain inaccessible to most women because of stigmas, provider resistance and lack of trained health services providers. Abortion is a time-restricted service because after twelve weeks the woman cannot have it done due to risks that may be encountered after this period and most women are denied it. The 1996 Abortion Act states that a pregnancy may be terminated upon a woman’s request during the first 12 weeks of gestation. If the pregnancy is beyond 12 weeks termination is illegal.

Zimbabwe only legalize the abortion when it is meant to save life of the at risk mother. Women who perform an illegal abortion face criminal convictions. UNICEF (2005) noted that the onset of sexual activity among the youths in Zimbabwe occurred at an average of 14 years, but they were often uninformed where pregnancy was concerned. This lead to high incidence of abortion amongst the teenage age group which is 40% of the total pregnancy of teenagers. Kasule (2005) pointed on the gap which was between the uptakes of oral contraceptives (56%) to increased rates of unplanned pregnancy that could contribute to abortions.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage (Smith, 1998). Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage Potts, Malcolm (2002). One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld Potts, Malcolm (2002).

There are disturbing numbers of patients who seek post abortal care services at Chitungwiza (PSZ) Reproductive Health Care Clinic since January 2010.This is a major concern since this can contribute to an increase in maternal mortality and morbidity rates due to complications associated with abortion. Therefore, there is need to determine the factors that contribute to abortions among patients who report for post abortal care at Chitungwiza (PSZ)Reproductive Health Care clinic.

This research have answered the following objectives;- •To assess the knowledge of patients about abortions amongst patients reporting at Chitungwiza PSZ Reproductive Health Care Clinic. •To determine the patients’ attitudes torwards abortions amongst patients reporting at Chitungwiza PSZ Reproductive Health Care Clinic. •To identify practices on abortions amongst patients reporting at Chitungwiza PSZ Reproductive Health Care Clinic.

The purpose of the study was to determine factors contributing to abortions among patients reporting at Chitungwiza Population Service Zimbabwe Reproductive Health Care Clinic.

Study Design This study made use of the quantitative descriptive

survey design. Sample and Sampling Methods The study made use of 50 respondents who were

selected using the purposive sampling method. Instrument This study made use of a structured interview

schedule with both open and closed ended questions to collect data from the respondents.

Data Analysis Data was analysed using manual tallying, tables

and graphs and descriptive statistics.

Age (Years) Frequency Percentage

14-20 7 14%

21-25 20 40%

26-35 10 20%

36-45 13 26%

Total 50 100%

Table 2: Analysis of the respondents by age

Real Class Limits Frequency Class Width Frequency Density Midpoint

13.5-20.5 7 7 1 17

20.5-25.5 20 5 4 23

25.5-35.5 10 10 1 30.5

35.5-45.5 13 10 1.3 40.5

Table 4: Marital Status of respondents N=50

Marital Status Frequency Percentage

Single 9 18%

Married 21 42%

Separated 1 2%

Widowed 16 32%

Divorced 3 6%

Total 50 100%

Fig 1: Pie chart for marital status

Table 5: Level of Education according to age group of respondents N = 50

Age

Grou

p

Level of Education Frequency Percentage

Prima

ry

ZJC ‘O’

Level

‘A’

Level

Tertia

ry

14-20 0 2 3 2 0 7 14%

21-25 0 1 18 0 1 20 40%

26-35 0 0 9 0 1 10 20%

36-45 0 7 5 1 0 13 26%

Total 0 10 35 3 2 50 100%

Table 6: Religion and employment status

N = 50

Religion Frequency Percentage

Traditional African 10 20%

Christianity 40 80%

SDA 4 8%

Methodist 14 28%

Johane Masowe 6 12%

Oasis of life 1 2%

AFM 13 26%

RC 12 24%

Moslem 0 0%

Employment

Formally employed 15 30%

Informally employed 20 40%

Unemployed 15 30%

Total 50 100%

SECTION B: FACTORS CONTRIBUTING

TO ABORTION Table 7: Factors contributing to abortions

Variable Responses Total Percentage

Yes No Not sure

Alcohol use 16 22 12 50 100%

Smoking 16 11 23 50 100%

Use of over the counter

drugs

7 43 0 50 100%

Use of perfumes 18 32 0 50 100% Table 8: Variable used for cooking during pregnancy N = 50

Variable Frequency Percentage

Firewood 3 6%

Paraffin stove 9 18%

Coal/charcoal 2 4%

Electricity 36 72%

Total 50 100%

Table 4.9: Showing Hb range.

Hb Frequency Percentage

4.5-6.5 8 16%

6.6-8.5 6 12%

8.6-10.5 15 30%

10.6-12.5 11 22%

12.5-15.0 10 20%

Total 50 100%

The majority 20 (40%) were in the age group 21-25 years . The mean age was 28.2 years with a sd of 8.3. the CI at P< .05 and was significant. The modal age was 23.1years and the median was 25years.

The majority 21 (42%) of the respondents were married. Those

respondents who had ‘O’ Level had the highest frequency of 35(70%) responses. Christianity religion had the majority 40 (80%) of respondents who reported with abortion. Those informally employed represented the highiest number 20(40%) of the respondents.

On which condition that could contribute to abortion, malaria had the highest respondents of 43 (86%) followed by anaemia which had 41 (86%), HIV infections had 35 (70%) respondents and was the third common cause of abortion according to respondents. Genital tract disorders, syphilis, hypertension in pregnancy, renal disorders and diabetes mellitus had 21 (42%), 20 (40%), 17 (34%), 17 (32%) and 4 (8%) respondents respectively.

The following conditions were prevelant amongst the respondents, Anaemia ,29(58%), HIV 23(46%) and Malaria 14(28%).

Most 34 (68%) did not associate alcohol, any form of per vaginal bleeding and smoking respectively with abortions.

Half of the respondents 25 (50%) were not happy about the loss of pregnancy. Thirteen (26%) were happy about the loss of the pregnancy whilst the other 12(24%) respondents were not sure whether they were happy or not. Forty one (82%) felt that it was not good as their religion was against it.

Forty one (82%) sought treatment of their abortions at Chitungwiza Population Service Reproductive Health Care Clinic after passing through traditional and faith healers. The other 9(18%) failed to come early because of monetary issues.

Results showed that most women who had abortion were marriedand were Christians and aged between 21-25 years. Some women are not aware that any form of bleeding per vagina during early pregnancy is abnormal. Most women delay seeking professional care putting their lives at risk. Most women are not happy with their pregnancies and pregnancy loss.