Introduction According to the WHO, abortion accounts for about 8% (4.7–13.2) of maternal mortality worldwide. In 2010, the WHO Multi-Country Survey (MCS) on Maternal and Newborn Health collected data on over 300 000 women who were admitted in health facilities to receive pregnancy-related care. Abortion data were partially captured by centring on severe maternal outcomes (ie, near-miss or maternal deaths). Building on the experiences of the prior MCS as well as current WHO reproductive health projects, we are undertaking a multi-country survey to better capture the burden and severity of abortion-related complications and management among women presenting to the health facilities.
Methods and analysis This is a large cross-sectional study with prospective data collection. It will be implemented in health facilities in 30 countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia and Western Pacific. Countries and facilities will be identified through a multistage sampling methodology. Data collection will be at both the facility and individual levels, involving review of medical records and exit surveys with eligible women using audio computer-assisted self-interview. All women presenting to the health facilities with signs and symptoms of abortion complications will comprise the study population. Online data entry and management will be performed on a web-based data management system. Analysis will include prevalence of abortion-related complications and descriptive frequencies of procedural/non-procedural management and experience of care.
Ethics and dissemination Ethical issues of the consent process are addressed. Dissemination plans will involve the participating facilities and communities to further strengthen abortion-related research capacity within the MCS on Abortion (MCS-A) countries. Furthermore, dissemination of results will be an iterative process at both the facility and national level to potentially propagate positive changes to abortion-related policies and practices.
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Handling editor Soumitra Bhuyan
Collaborators WHO MCS-A Research Group: Listed in random order: Hailemichael Gselassi Ganania, Ipas Africa Alliance, Nairobi, Kenya; Seni Kouanda, Institut de Recherche en Science de la Sante, Ouagadougou, Burkina Faso; Cassimo Bique, Department of Obstetrics and Gynaecology, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Veronique Filippi, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Daniel Giordano, Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Clementine Rossier, University of Geneva, Geneva, Switzerland; Luis Gadama, College of Medicine, University of Malawi, Blantyre, Malawi; Sourou Béatrice Goufodji Kèkè, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Bénin; Nafissa Osman, Department of Obstetrics and Gynaecology, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Nafiou Idi, Faculte des Sciences de la Sante, Niamey, Niger; Zahida Qureshi, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Philip Guest, Institute for Population and Social Research, Mahidol University Salaya, Nakhon Pathom, Thailand; Sally Griffin, International Centre for Reproductive Health-Mozambique, Maputo, Mozambique; Jean-Jose Wolomby-Molondo, Department de Gynecologie et Obstetrique, Cliniques, Universitaires de Kinshasa, Kinshasa, DRC; Rodolfo Gomez Ponce de Leon, CLAP/ PAHO/WHO Montevideo Uruguay; Joao Paulo Souza, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland; R Marie Charlemagne Ouedraogo, Obstetrics and Gynecology of Universities, Ouagadougou, Burkina Faso; Scott Sughrue, Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, USA; Rajani Ved, National Health Systems Resource Center, New Delhi, India; Ausbert Msusa, College of Medicine, University of Malawi, Blantyre, Malawi; Ndema Habib, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland; Katherine Ba-Thike, University of Medicine 1, Yangon, Myanmar; Thierry Madjadoum, Department of Obstetrics and Gynaecology, Regional Hospital of Koumra, N'Djamena, Chad; Kidza Yvonne Mugerwa, Department of Obstetrics & Gynaecology, Makerere University, Kampala, Uganda; Anand Tamang, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal; Bukola Fawole, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Richard Adanu, School of Public Health, University of Ghana, Accra, Ghana.
Contributors All of the authors participated in the formulation of the study methodology. CRK wrote the first draft of the protocol and the manuscript. ÖT assisted in the editing and writing of the protocol and manuscript. BG and AMG assisted in the editing of the protocol and manuscript. All members of the MCS-A Research Group contributed to the editing of the manuscript.
Funding This study is funded by UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).
Competing interests None declared.
Ethics approval WHO Research Review Panel and Ethics Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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