Between February 2002 and January 2004 in the Adigrat Zonal Hospital, covering one-fifth of the large Tigray region of North West Ethiopia, there were 907 admissions with a diagnosis of abortion. Among these, 521 were induced by traditional, unsafe methods. Unsafe abortion was the leading cause of admission, accounting for 12.6% of all bed occupancy throughout this general hospital and 60.6% of the gynecological admissions. About 57% of patients admitted with unsafe abortions had serious complications, including tubo-ovarian abscess, vaginal laceration, uterine perforation, generalised peritonitis and renal failure. Three women died from complications of unsafe abortion. Five years later in the same hospital, between July 2009 and September 2010 unsafe abortion cases had declined, becoming the tenth cause of hospital admission. There were no deaths and no severe complications.
This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer 600mcg of oral misoprostol. In non-intervention areas women were referred to the nearest health facility. Of the 966 vaginal deliveries attended by TBAs, only 8.9% of those who took misoprostol prophylactically (n=485) needed additional intervention due to excessive bleeding compared to 18.9% of those who did not take misoprostol (n=481).The experience of symptoms among those who used misoprostol can be considered of minor relevance and self-contained. This study found that prophylactic use of misoprostol in home births is a safe and feasible intervention. Community health care workers trained in its use can correctly and effectively administer misoprostol and be a champion in reducing PPH morbidity and mortality (Afr J Reprod Health 2009; 13:87-95)
Letter in response to the Perspective “REPRODUCING IN CITIES” by Mace published in Science February 2008 in Science
In her Perspective “Reproducing in cities” (8 February, p. 764), R. Mace assumes that differences in birth rates between rural and urban areas largely represent the wishes of parents. Human beings in all societies have sexual intercourse hundreds or even thousands of times more often than is needed to conceive the number of children they want. Once individuals have access to the means and information to separate sex from childbearing, family size often falls rapidly (1). For rural women there are an astonishing number of barriers to access to modern contraception (2), while urban women are often better placed to overcome these barriers.
We suggest that birth rates fall in cities primarily because contraception and safe abortion are easier to obtain than in the countryside. For example, in rural Ethiopia only doctors and nurses are permitted to give contraceptive injections, so this popular method is denied to rural women. The total fertility rate (TFR) in Ethiopia as a whole is 5.4, while in Addis Ababa it is now thought to be below 2.0 children. Addis is unusual among African capitals in that safe abortion was available for several years before the recent liberalization of the abortion law. Tens of thousands of operations were performed annually and linked to effective post-abortion contraceptive advice.
We posit that fertility will fall in rural Ethiopia as contraception and safe abortion become more easily available. In Bangladesh, where many women now have access to modern contraception and reasonably safe abortion, two large predominantly rural areas (Khulna and Rajhashi) now have replacement-level fertility (3).
Published in Science, May 16 2008, 874