An Exploratory Study of Complications from CAC: Improvement of the Quality of Comprehensive Abortion Care (CAC) Services in Nepal(Completed 2008)

The PHD Group successfully completed a ground breaking study on abortion complication in Nepal. The study was conducted for FHD/TCIC, MoHP, Government of Nepal and supported by Ipas, North Carolina, USA, April to October. The stakeholders of the study were FHD/MOHP, Marie Stopes International/SunauloPariwar, FPAN and a number of private CAC service centres. The study was a national survey comprising of 30 CAC sites spread throughout the country.

Findings

Of the 7,386 clients listed during the three months period following the abortion procedures, 7,007 (93%) were followed up approximately two weeks post procedures to determine whether they had developed complications. The majority of clients sought care from Marie Stopes International/SunauloPariwar Nepal (MSI/SPAN) facilities, followed by Government clinics, FPAN and private sector clinics (Figure 1).

All patients received first-trimester CAC services using manual vacuum aspiration. The overall complication rate was 2 percent during either the procedure, the follow-up period or both. The most frequently reported post-procedural problems were retained products of conception. Using a modified version of the Jewkes scale to measure complication symptom severity, 89 of 131 clients with post procedure complications (1.3 %) experienced low-severity complication; 40 (0.57%) experienced moderate severity and two (0.03%) experienced high-severity complications.

Complication rates did not vary significantly by facility or individual patient characteristics such as parity, age or educational status. However, women receiving care at MSI/SPN clinics were significantly less likely to report complications than women receiving abortion care from all other clinics (p<.001).

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