Limited access to post-abortion care
Women who want an abortion in Burkina Faso face great risk. Since abortion is restricted, women are obliged to resort to unsafe procedures. Unsafe abortions can result in many complications and expensive treatment. Stigmatisation can be one reason for some health providers’ bad treatment of women who have had an illegal abortion.
Patients outside the University Hospital in Bobo-Dioulasso, Burkina Faso.
Photo: Katerini T. Storeng
Costs of abortion
After paying for an abortion that exposes the woman to many dangers, she might have to pay to have subsequent complications treated in hospital as well.
Few studies have reported the costs to households of abortion and post-abortion care in Burkina Faso, where legal restrictions and stigma constitute serious hurdles to investigating such costs. It will therefore be interesting to see the findings of PhD-candidate Patrick Ilboudo’s research, which focuses on abortion and post-abortion care costs in Burkina Faso.
Preliminary results show that the median cost of treating a spontaneous abortion was USD 87, whereas the median price is more than double for induced abortion services and post-abortion care when complications arise. Abortion and post-abortion thus constitute a huge drain on households’ fragile incomes.
Access to post-abortion care
The government has made major efforts to make post-abortion care available in order to prevent deaths and illness from unsafe abortions. Despite the government’s stated commitment, women’s access to post-abortion care is constrained by numerous factors.
Post-abortion treatment is legal, but can be very expensive. Only manual vacuum aspiration is subsidised - for the treatment of incomplete abortion. Vacuum abortion is the most common abortion method in countries where abortion is legal. But many complications (such as haemorrhage, infections/sepsis, uterine laceration or perforation and anaemia) after an unsafe abortion require other forms of treatment that are not subsidised. The women who are unfortunate enough to suffer these complications often have to stay in hospital longer, resulting in increased bills.
In the waiting room at the hospital in Ouagadougou, Burkina Faso.
Photo: Katerini T. Storeng
As part of his project, Mphil student Seydou Drabo followed 20 women who were admitted to hospital in Ouagadougou, Burkina Faso, for treatment of abortion complications. Two of these women died from complications not covered by subsidies. Many of the other women experienced difficulties in paying their hospital bill.
– The system is discriminatory! Only some complications are subsidised and the people who need support the most, don’t benefit from subsidies. It seems as if the government has forgotten about the reality of unsafe abortions when they decided to subsidise only some post-abortion care treatments, says Seydou.
Patrick explains that there is another link between reproductive health and poverty:
–We find that post abortion care is not available in most primary care centres and poor people have difficulties in paying for transportation to the hospital. Treatment is sometimes delayed, because the family has financial problems. Even if it’s a spontaneous abortion, which is almost three times less costly compared to induced service plus post-abortion care, households sometimes struggle hard to raise money to pay for qualified care.
Some women will die
Many unsafe abortions are carried out because of the woman’s context of pregnancy, for instance when a young girl doesn’t want her parents to know she is pregnant, or if a woman gets pregnant with a man who is not her husband. Sometimes such women come alone to the hospital and have trouble in paying.
Sometimes a woman will not be given treatment before she pays, even if her complications are life-threatening. During his research, Seydou met a girl who waited for nine hours for one member of her family to come and pay, before she was treated. In the beginning, she did not want her family to know about the abortion, but she had to call her mother to get money for the treatment.
In the case of emergency obstetric care (like post-abortion care, treatment of obstetric complications and caesareans), the government decided in 2003 that women can get treatment without prepayment. The example above shows that this policy had not been implemented in the hospital where Seydou did his research.
Advice on family planning
By showing policy-makers the costs of treating unsafe abortions, Patrick hopes action will be taken to address this issue and especially reduce women’s necessity to resort to illegal abortion. He also wants to advocate for more contraceptives. Despite the fact that information on contraception has been demonstrated as being effective in preventing unwanted pregnancies, people are not given systematic information from health personnel after post-abortion care. One consequence of this is that the same women often come back to the health service for another unsafe abortion.
Researchers have found that many women are unable to access hormonal contraceptives because they are not available in the pharmacy or hospital. Using condoms, which are available, was considered unacceptable, especially within marriage. In addition, some people have misconceptions about the use of contraceptives.
– After post-abortion care, I asked a young girl if she would use contraception in the future. She told me that contraception is only for women who already have a lot of children. Another girl said that contraception would make her fat, says Seydou. He hopes that communication of information on the use of contraception can be improved.
Bad treatment
One opportunity for communicating information about family planning is counselling a week after post-abortion care. Unfortunately, not all girls return to the hospital for this appointment. According to Seydou, one of the reasons for not having access to post-abortion care is bad treatment.
A young girl came to the primary health centre. Since they could not treat her there, the health provider should have referred her to the hospital. The girl was bleeding onto the floor. Instead of treating her, the health provider asked her parents to pay for soap to clean up the girl’s blood. When they come with the soap, the nurse? took the loincloth off the young girl to clean the floor.
– You make our floor dirty. Next time, if you come like this, I will not treat you, I will let you die, said the health provider.
When the girl finally arrived at the hospital the health providers wanted to know if she had undergone an illegal abortion. Instead of just doing a clinical diagnosis and giving her the care she needed, the health providers tried to find out if it was an illegal abortion and made the girl confess to her ‘crime’. Seydou observed that the most cooperative patients are treated faster than the less cooperative. Because of this bad treatment, the girl refused to return for counselling on family planning.
About the researchers
Patrick Illboudo and Seydou Drabo
Photo: Anbjørg Kolaas
Patrick Ilboudo is currently pursuing a PhD in Health Economics at The Institute of Health and Society, UiO. His PhD is part of a larger study, led by Johanne Sundby and Katerini T. Storeng, investigating the social and economic costs of reproductive healthcare in West Africa.
Seydou Drabo is currently an Mphil student working on the same project as Patrick.