Unsafe Abortion, Its Determinants and Associated Factors: The Case of Malawi. A Systematic Literature Review.

INTRODUCTION: Unsafe abortion is a public health problem globally, but disproportionately affects the developing world. Interventions aimed at addressing the determinants and risk factors of unsafe abortion have proven to be effective in the reduction of unsafe abortion-related maternal mortality. Identification of determinants of unsafe abortion is important in intervention planning and implementation. AIM: To determine whether religion, marital status and mother’s level of education are related to unsafe abortion practices in Malawi, and find which categories are associated with reduction rates in seeking unsafe abortion. METHODS: Relevant online publications were identified from selected databases, then critically appraised. Study methodologies as well as reported data were examined with focus on post-abortion care (PAC) mother’s marital status, education and religion. RESULTS: Majority of studies were cross-sectional and hospital-based. The largest proportion of PAC mothers were married, educated and Christians. Educated mothers, single or unmarried mothers are more likely to seek unsafe abortion. DISCUSSION: Health facility and community level stigma deters unmarried women from accessing contraception and PAC services. Increased number of unsafe abortion among educated mothers (most of whom were current students) than their counterparts could be explained by the desire to remain in school. These findings could also be attributed to improved health-seeking behavior among this group in comparison with the uneducated who may not have sought care. The role of religion in influencing the likelihood of seeking unsafe abortion has not been studied in Malawi. CONCLUSION: Complications of unsafe abortion includes heavy bleeding, infection, reproductive tract injury, and death. Abortion-related deaths account for about 23.5% of all maternal deaths in Malawi. The single or unmarried, and educated (attained at least primary education) Malawian women are more likely to have unwanted pregnancy and subsequent unsafe abortion than their counterparts