What women can teach us about maternal morbidity and mortality prevention in Botswana: Trajectories from unplanned pregnancy to post-abortion care
Awarded 2017
Small Research Grants
Kristen Daskilewicz, MPH
University of Cape Town

Abortion is a leading cause of maternal mortality in Botswana, where legal abortion is restricted. Post-abortion care services are provided by government hospitals for complications following unsafe abortion. The health services are flooded with women presenting with diagnoses of spontaneous, threatened, or incomplete abortion, accounting for more than half of admissions to gynecology wards. Recent research documents that while most women receiving post-abortion care in Botswana report spontaneous abortion, the high rate of complications suggests unsafe, induced abortion is prevalent. This under-reporting of induced abortion is likely due to a mix of stigma and fear of legal consequences. Against this backdrop, very little is known about women’s experience of induced abortion in Botswana, as there has been no research directly with women. Guided by women’s self-described experiences, we seek to explore gaps along the care continuum, from prevention of unwanted pregnancy to post-abortion care, and to identify missed opportunities to prevent abortion-related morbidity and maternal mortality. In-depth interviews with women after post-abortion care will explore her: circumstances of pregnancy, knowledge of reproductive rights in Botswana, decision- making and health seeking behaviors, and experience of care received. Interviews will be conducted sensitively, anonymously, and confidentially. The findings will identify opportunities for risk reduction within the current standard of care in a setting where legal abortion is restricted. This data may also assist advocacy efforts for abortion law reform and highlight gaps in knowledge for future research.