Abortion-Related Morbidity and Mortality in Sierra Leone: Results from a 2021 Cross-Sectional Study.

Abstract

Unsafe abortion remains a significant driver of maternal morbidity and mortality. We aimed to assess the severity of abortion complications among post-abortion care (PAC) clients in Sierra Leone and factors associated with more severe complications. We applied the Prospective Morbidity Survey (PMS) among PAC patients and their providers in 142 facilities in Sierra Leone between August and October 2021. We administered a total of 522 patient PMS surveys and 513 provider PMS surveys. To assess post-abortion complication severity, we utilized a five-level severity classification system ranging from mild to maternal death. Our findings showed that Compared to regional and global estimates, the burden of abortion-related complications in Sierra Leone is high. The recent effort to liberalize abortion law is promising; this potential legal reform must be paired with the expansion of safe abortion services to reduce abortion-related morbidity and mortality in the country. In the absence of legal change, our analysis also emphasizes the need to ensure PAC services are always free of cost, that women are aware of the availability and legality of PAC, and that facilities have the human and material resources needed to handle these cases.