Women's Experiences with Abortion Complications in the Post War Context of South Sudan
For 21 years (1983-2004), the civil war in Sudan concentrated in the South resulting in massive population displacements and human suffering. Following the comprehensive peace agreement in 2005, the government of South Sudan is rebuilding the country's infrastructure. However, the post war South Sudan has some of the worst health indicators, lack of basic services, poor health infrastructure and severe shortage of skilled labor. The maternal mortality ratio for example is 2,054/100,000 live births, currently the highest in the world. Abortion complication leads among causes of admission at the gynecology units. This research contributes nursing knowledge on reproductive health among populations affected by war. The purpose was to explore the experiences of women with abortion complications in the post war South Sudan. Using qualitative descriptive methodology, in-depth interviews were conducted with 26 women following treatment for abortion complications at the gynecology unit of a county hospital. Data was collected from March 2nd to April 26th, 2008. Spontaneous abortion was the most common among study participants. Post abortion care was nonexistent at the community level health facilities, but present at the hospital. The women interviewed were reluctant to reflect in-depth about their experiences with abortion complications. They described the process, signs, symptoms and the events that led to the pregnancy loss, and were more concerned about regaining their reproductive function, a societal expectation of a married woman in South Sudan. A female child in South Sudan is assigned a "special" role in the family and community - that of getting married, attracting a high bride wealth paid as dowry to her parents and delivering children for the husband. Arranged and/or forced early marriage is common. A woman's world view about reproductive health and experiences with abortion complications is therefore influenced by this cultural context. Implications of these findings include the need to develop the nurse midwifery profession in South Sudan. Nurse midwives can lead in providing gender and culturally sensitive reproductive health services including post abortion care. Plans for care must include opportunities to listen to women's perspectives.