Decrease in use of manual vacuum aspiration in postabortion care in Malawi: a cross-sectional study from three public...

Area of Science:

• Reproductive Health
• Gynecology
• Public Health

Background:

• Postabortion care is crucial for managing complications of unsafe abortions.
• Manual vacuum aspiration (MVA) is recommended internationally for uterine evacuation.
• Sharp curettage (SC) is an alternative surgical method for managing incomplete abortions.

Purpose of the Study:

• To investigate trends in the use of manual vacuum aspiration (MVA) versus sharp curettage (SC) for postabortion care in Malawi.
• To analyze the utilization patterns of MVA and SC between 2008 and 2012.

Main Methods:

• Retrospective cross-sectional study analyzing gynecological ward records from 2008-2012.
• Data collected from Queen Elisabeth Central Hospital and two district hospitals in Malawi.
• Included 5121 women undergoing surgical uterine evacuation for incomplete abortion.

Main Results:

• Manual vacuum aspiration (MVA) was used for only one-third of first-trimester abortions.
• MVA use increased from 2008 to 2009 but declined sharply from 2010 to 2012 (19.7% to 4.9%).
• Sharp curettage (SC) use increased significantly during the same period, contrasting with international recommendations.

Conclusions:

• The utilization of manual vacuum aspiration (MVA) in Malawian postabortion care is low and decreasing.
• Increased reliance on sharp curettage (SC) deviates from current international guidelines for managing incomplete abortions.
• There is a need to re-evaluate and promote evidence-based postabortion care practices in Malawi.