Fatal necrotizing fasciitis in illegal abortion and the negligence tort.

The present paper is a case-based review on rare complications of illegal abortion, i.e., necrotizing fasciitis missed early by the treating gynecologists which landed up into a negligence tort against the physicians. The common complications of the abortion like incomplete abortion, haemorrhage, sepsis, etc. are usually handled successfully by the gynecologists; however, early detection often missed when a rare complication like necrotising fasciitis occurs. Eventually leading to litigations in case of death of the patient. The newer techniques have reduced the complications in medically terminated pregnancies (MTP); however, the deaths due to illegal abortions carried out by the clandestine abortion practitioners (CAP) poses a challenge, especially in rural areas. A 30-year-old woman went for an illegal abortion from a CAP to avoid social stigma. She developed sepsis & necrotising fasciitis (NF) of right lower limb due to intra-vaginal use of abortifacient herbs prescribed by the CAP. She was succumbed to the complications of necrotising fasciitis allegedly due to delayed diagnosis by the gynecologists. This led to a negligence tort filed by her family members against the treating gynecologists. The prudent medicolegal and medical steps are discussed here, that could have prevented such sequel.

[Clandestine abortion complications and street drugs in Brazzaville]. / Avortements clandestins compliqués et médicaments de la rue à Brazzaville.

INTRODUCTION: clandestine abortions increase maternal morbi-mortality in sub-Saharan Africa and are closely linked to restrictive legislation and low contraceptive prevalence. In Brazzaville street drugs are commonly used to induce abortion. The purpose of this study is to determine street drug prevalence and socio-demographic characteristics of these patients. METHODS: we conducted a longitudinal study of 67 patients with induced abortion complications admitted to the Talangaï Hospital from July to December 2018. (i) Socio-demographic (ii) and obstetrical (iii) characteristics as well as abortion features (procedure, Manganguiste involvement, abortion rank and cost) were collected and analyzed using EPI info 7 software. We compared the means using student's test, proportions with CHI-2, p value was set to < 0.05. RESULTS: the average age of patients was 25 years ± 6.6; 59.7% of them were attending college, 53.8% had no income-generating activity, 38.8% lived alone and in 15% of cases biological father had denied paternity. Street drugs had been used in 74.5% of cases, mean abortion cost was 3500 CFA (US$7) and 29500CFA (US$59) when it had been performed by health-care professionals. High school respondents were more likely (73.69%) to know at least contraceptive methods (p<0.05). Greater numbers of singles (p=0.000) and of those who knew a contraceptive method (p=0.003) expressed the intention to use contraception. Conclusion: combatting the use of street drugs and securing the right to safe voluntary abortion are necessary to limit complications due to clandestine abortions.

First case report of tuberculous meningitis secondary to endometrial tuberculosis following a clandestine abortion.

Tuberculous meningitis (TBM) is a medical emergency: it is the most severe, lethal and disabling clinical form of tuberculosis. We report the case of a 44-year-old woman who had undergone a clandestine abortion six weeks before admission. One week later, she had abnormal vaginal discharge. Three weeks prior to admission, headache, hyperpyrexia and mental alteration were added. At admission, a transvaginal ultrasound showed abnormalities of the uterine cavity. Sepsis and endometritis were diagnosed, and a hysterectomy was scheduled. During preoperative evaluation, meningeal signs were found. The first lumbar puncture (LP) showed a lymphomononuclear pleocytosis, hypoglycorrhachia and hyperproteinorrachia. After five days treatment with ceftriaxone, vancomycin and dexamethasone, only partial recovery occurred. A second LP showed AFB and PCR confirmed Mycobacterium tuberculosis. The histopathology of endometrial biopsy confirmed endometrial tuberculosis. Therapeutic response to anti-tuberculous treatment and corticosteroids was excellent. No other cause of immunosuppression apart from pregnancy was found. To the best of our knowledge, this is the first report of TBM secondary to endometrial tuberculosis and highlights an unusual clinical scenario in which severe and disseminated forms of TB could be present. TBM during and after pregnancy is rare, but compared with TBM in non-pregnant women, it has a poorer prognosis. Early diagnosis and treatment can be lifesaving in this life-threatening disease.

Abortion among adolescents in Africa: A review of practices, consequences, and control strategies.

BACKGROUND: Developing countries register 98% of unsafe abortion annually, 41% of which occur among women aged between 15 and 25 years. Additionally, 70% of hospitalizations due to unsafe abortion are among girls below 20 years of age. PURPOSE: This study unveils abortion practices in Africa, its consequences, and control strategies among adolescents. METHODS: Online databases that provided relevant information on the topic were searched. A Google Scholar search yielded 623 000 results, PubMed yielded 1134 results, African Journals Online yielded 110 results, and PsycINFO yielded eight results. A total of 25 studies published from 2000 to 2018 that met the Critical Appraisal Skills Programme (CASP) standard were thematically reviewed. FINDINGS: These studies indicated that abortion is a neglected problem in health care in developing countries, and yet decreasingly safe abortion practices dominate those settings. Adolescents who have unintended pregnancies may resort to unsafe abortion practices due to socio-economic factors and the cultural implications of being pregnant before marriage and the legal status of abortion. Adolescents clandestinely use self-prescribed drugs or beverages, insert sharps in the genitals, and most often consult traditional service providers. Abortion results in morbidities such as sepsis, severe anaemia, disabilities, and, in some instances, infertility and death. Such events can be controlled by the widening availability of and accessibility to contraceptives among adolescents, advocacy, and comprehensive sexuality education and counselling. CONCLUSION: Adolescents are more likely to use clandestine methods of abortion whose consequences are devastating, lifelong, or even fatal. Awareness and utilization of youth-friendly services would minimize the problem.

Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018. / Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018.

During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018 / Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018

RESUMEN Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

ABSTRACT During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

[Maltreatment and discrimination in induced abortion care: perception of women in Teresina, State of Piauí, Brazil]. / Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil.

Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.

Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil / Maltreatment and discrimination in induced abortion care: perception of women in Teresina, State of Piauí, Brazil

Resumo O tratamento das complicações do aborto provocado pode ser dificultado por atitudes de discriminação praticadas por profissionais de saúde nos hospitais e serviços de aborto. Este artigo recuperou histórias de violência institucional entre mulheres que provocaram o aborto em condições ilegais e inseguras. Foram entrevistadas 78 mulheres internadas em um hospital público de referência em Teresina por complicações do aborto provocado. Utilizou-se roteiro semiestruturado com perguntas sobre práticas e itinerários de aborto e violência institucional durante a internação. Práticas discriminatórias e de maus-tratos durante a assistência foram relatadas por 26 mulheres, principalmente entre aquelas que confessaram a indução do aborto. Julgamento moral, ameaças de denúncia à polícia, negligência no controle da dor, longa espera pela curetagem uterina e internação conjunta com puérperas foram os principais tipos de violência institucional narrados. As práticas de violência institucional na assistência ao aborto provocado violam o dever de acolhimento do serviço de saúde e impedem que as mulheres tenham suas necessidades de saúde atendidas.

Abstract Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka.

BACKGROUND: When faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women's long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka. METHODS: An unmatched case-control study was conducted in nine hospitals among 171 women admitted for care following an unsafe abortion (Cases) and 600 women admitted to same hospitals for delivery of an unintended term pregnancy (Controls). Interviewer-administered-questionnaires assessed their socio-economic, reproductive and fertility (decisions on family size, family completion) characteristics, contraceptive method last used (traditional, modern), reasons for discontinuation/never-use, and contraceptive practices assessed at different time points. Using several regression models, the risk of abortion was assessed for 'non-use' of contraception against 'ineffective use' at conception; for non-use further categorised as 'never-use', 'early-discontinuation' (discontinued before last birth interval) and 'late-discontinuation' (discontinued during last birth interval); and for any interaction between the contraceptive practice and contraceptive method last used among the ever-users of contraception. RESULTS: At conception, 'non-use' of contraception imparted a two-fold risk for abortion against ineffective use (adjusted-OR = 2.0; 95% CI: 1.2-3.2). The abortion risk on 'non-use' varied further according to 'early' (adjusted-OR = 1.7; 95% CI: 1.1-3.1) and 'late' (adjusted-OR = 2.3; 95% CI: 1.5-3.6) discontinuation of contraception, but not with 'never-use' (crude-OR = 1.1; 95% CI: 0.6-2.3). Among the ever-users, the risk of abortion varied within each contraceptive practice by their last used contraceptive method and reasons for discontinuation. A significant interaction between modern contraceptives and early discontinuation (adjusted-OR = 1.4; 95% CI = 1.1-3.1) demonstrated a seven-fold abortion risk for early discontinuation of modern methods against its ineffective use. In particular, hormonal methods seemed to be responsible for this risk (51.1% cases versus 42.5% controls). CONCLUSIONS: Long-term contraceptive practices showed varying risk for abortion, and was further modified by early discontinuation of modern contraceptives. This knowledge should be applied during postnatal visits by public-health staff.

Induced abortion.

Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.

Cost of abortions in Zambia: A comparison of safe abortion and post abortion care.

Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

Relationship of family formation characteristics with unsafe abortion: is it confounded by women's socio-economic status? - A case-control study from Sri Lanka.

BACKGROUND: Literature shows that choice for unsafe abortion is often driven by poverty. However, factors related to the family formation behaviour of women are also implied as determinants of this decision. This study assessed which family formation characteristics of women are associated with the risk of unsafe abortion, without being confounded by their low socio-economic status among Sri Lankan women admitted to hospital following post-abortion complications. METHODS: An unmatched case-control study was conducted in nine hospitals in eight districts in Sri Lanka among 171 women with post-abortion complications following unsafe abortion (Cases) and 600 postpartum mothers admitted to same hospitals during the same period for delivery of term unintended pregnancies (Controls). Interviewer-administered-questionnaires obtained demographic, socio-economic and family formation related characteristics. Risk factors of abortion were assessed by odds-ratio (OR), adjusted for their socio-economic status in logistic regression analysis. RESULTS: Low socio-economic status, characterised by low-education (adjusted OR = 1.5; 95 % CI = 1.1-2.4) and less/unskilled occupations (2.3; 1.4-3.6) was a significant risk factor for unsafe abortion. Independent of this risk, being unmarried (9.3; 4.0-21.6), failure in informed decisions about desired family size (2.2; 1.4-3.5), not having a girl-child (2.2; 1.4-3.4) and longer average birth intervals (0.7 years; 0.6-0.8) signified the vulnerability of women for unsafe abortion. Cases were as fast as the controls in their family completion (4.3 versus 4.5 years; p = 0.4), but were at increased risk for abortion, if their average birth intervals (including the last one) were longer. Previous contraceptive use, age at reproductive events or partners' characteristics did not impart any risk for abortion. CONCLUSIONS: Low socio-economic status is not the most influencing risk factor for unsafe abortions leading to complications, but many other factors in relation to their family formation characteristics that are independent of their low socio-economic status.

The cost of post-abortion care in developing countries: a comparative analysis of four studies.

Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology-the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30-60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52-68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3-12% of the average cost of treating a PAC patient.

Knowledge on legislation of abortion and experience of abortion among female youth in Nepal: A cross sectional study.

BACKGROUND: Abortion has been legal in Nepal since 2002 and the country has made striking progress in rolling out induced abortion services. It led to well-known changes in reproductive behavior, however knowledge about legislation and abortion experience by female youth has been least investigated. This paper is an attempt to examine knowledge about legislation of abortion and abortion experiences among female youth in Nepal. METHODS: This paper uses data from the Nepal Demographic and Health Survey (NDHS 2011). The analysis is confined to female youth aged 15-24 (n = 5050). Both bivariate and multivariate analyses have been performed to describe the knowledge about law and experience of abortion. The bivariate analysis (chi-square test) was applied to examine the association between dependent variables and female youth's demographic, socioeconomic, and cultural characteristics. Besides bivariate analysis, the net effect of each independent variable on the dependent variable after controlling for the effect of other predictors has also been measured through multivariate analysis (logistic regression). RESULTS: Only two-fifth (41%) female youth was aware of abortion legislation in the country. Knowledge on at least one condition of abortion law is even lower (21%). Less than two percent (1.5%) female youth reported that they ever had an abortion. The multivariate analysis found that the knowledge and experience of abortion varied with different settings. Youth aged 20-24 [adjusted odds ratio (aOR) = 1.3; 95% CI 1.7-5.0)], who have higher education (primary aOR = 1.89, ; 95% CI 1.5-2.5 secondary aOR = 4.6; 95% CI 3.7-5.9), who were from rich households (aOR = 1.5; 95% CI 1.2-1.7), who had high autonomy (aOR = 1.29; 95% CI 1.02-1.64) were more likely to be aware compared to their counterparts about legislation of abortion. In the other hand, female from Dalit (aOR = 0.55; 95% CI 0.5-0.7 and Janajati aOR = 0.72; 95% CI 0.6-0.8) caste, who were married (aOR = 0.80; 95% CI 0.7-0.9), who were from Muslim (aOR = 0.54; 95% CI 0.3-0.9) and who resided in Hill (aOR = 0.63 ; 95% CI 0.5-0.8) and Terai/plain area (aOR = 0.74; 95% CI 0.6-0.9) were less likely to be aware about the law. Similarly, female youth who have knowledge on abortion law (aOR = 2.8; ; 95% CI 1.6-4.8), who have primary (aOR = 5.2; 95% CI 1.6-16.9) and secondary education (aOR = 3.8; 95% CI 1.2-12.8), married (aOR = 7.7; 95% CI 3.8-12.9), who had higher number of children ever born [1-2 children aOR = 1.9; 95% CI 1.1-3.6 and 3 or more children aOR = 3.4; 95% CI 1.1-10.9), who were from rich households (aOR = 2.62 ;95% CI 1.3-5.4), who have high autonomy (aOR = 3.0; 95% CI 1.6-5.8), who had experienced sexual violence (aOR = 1.91; 95% CI 1.1-8.7) were more likely to undergone abortion compared to their counterparts. CONCLUSION: Knowledge about legislation of abortion and conditions of abortion law is low among female youth. Awareness program should target these youth as they are more likely to be sexually active. There is a need of comprehensive education about abortion to these youth which can help eventually reduce unsafe abortion that take a large toll on women's life.

Insights from an expert group meeting on the definition and measurement of unsafe abortion.

Until recently, WHO operationally defined unsafe abortion as illegal abortion. In the past decade, however, the incidence of abortion by misoprostol administration has increased in countries with restrictive abortion laws. Access to safe surgical abortions has also increased in many such countries. An important effect of these trends has been that, even in an illegal environment, abortion is becoming safer, and an updated system for classifying abortion in accordance with safety is needed. Numerous factors aside from abortion method or legality should be taken into consideration in developing such a classification system. An Expert Meeting on the Definition and Measurement of Unsafe Abortion was convened in London, UK, on January 9-10, 2014, to move toward developing a classification system that both reflects current conditions and acknowledges the gradient of risk associated with abortion. The experts also discussed the types of research needed to monitor the incidence of abortion at each level of safety. These efforts are urgently needed if we are to ensure that preventing unsafe abortion is appropriately represented on the global public health agenda. Such a classification system would also motivate investment in research to accurately measure and monitor abortion incidence across categories of safety.

Abortion experiences among Zanzibari women: a chain-referral sampling study.

BACKGROUND: In Zanzibar, a semi-autonomous region of Tanzania, induced abortion is illegal but common, and fewer than 12% of married reproductive-aged women use modern contraception. As part of a multi-method study about contraception and consequences of unwanted pregnancies, the objective of this study was to understand the experiences of Zanzibari women who terminated pregnancies. METHODS: The cross-sectional study was set in Zanzibar, Tanzania. Participants were a community-based sample of women who had terminated pregnancies. We carried out semi-structured interviews with 45 women recruited via chain-referral sampling. We report the characteristics of women who have had abortions, the reasons they had abortions, and the methods used to terminate their pregnancies. RESULTS: Women in Zanzibar terminate pregnancies that are unwanted for a range of reasons, at various points in their reproductive lives, and using multiple methods. While clinical methods were most effective, nearly half of our participants successfully terminated a pregnancy using non-clinical methods and very few had complications requiring post abortion care (PAC). CONCLUSIONS: Even in settings where abortion is illegal, some women experience illegal abortions without adverse health consequences, what we might call 'safer' unsafe abortions; these kinds of abortion experiences can be missed in studies about abortion conducted among women seeking PAC in hospitals.