‘I guess we have to treat them, but … ’: health care provider perspectives on management of women presenting with unsafe abortion in Botswana

ABSTRACT

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services.

KEYWORDS:

• Maternal health
• abortion
• health care provider
• Botswana
• low- and middle-income countries

Acknowledgements

This research was conducted as part of the Master’s in Public Health training of the first author. We would like to thank the Ministry of Health and Wellness, Botswana for granting us permission to conduct this study. We are also indebted to all the health care providers who took out time from their busy schedule to partake in this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).