title: Provision of harm-reduction services to limit unsafe abortion in Tanzania.
abstract: OBJECTIVE
  To investigate the feasibility of providing harm-reduction services to reduce unsafe abortion in Tanzania.
  
  
  METHODS
  A cross-sectional study was conducted among 110 women who received harm-reduction counseling at a public health center in Dar es Salaam between February 10 and October 10, 2014. Background and clinical information was collected for all women; a subgroup (n=50) undertook a semi-structured survey that measured the type of services women received, women's perception of the services, and pregnancy outcome. The main study outcomes were attendance at the follow-up visit, type and quality of information women received on both visits, and misoprostol use for pregnancy termination.
  
  
  RESULTS
  Overall, 55 (50.0%) women attended follow-up services. Misoprostol was used for induced abortion among 54 (98.2%); 38 (70.4%) of these women had obtained contraception at the follow-up visit. Likelihood of attendance for follow-up was increased among women who were older than 34 years (odds ratio [OR] 2.2, 95% confidence interval [CI] 0.1-35.8), were married (OR 2.1, 95% CI 0.8-5.7), and had a post-primary education level (OR 2.0, 95% CI 0.8-5.3). On average, 44 (87.0%) women received all required information at the initial counseling session and none reported major complications that required hospitalization.
  
  
  CONCLUSIONS
  Harm-reduction services for unsafe abortion are feasible and acceptable, and could provide an excellent opportunity to fight abortion-related morbidity and mortality in Tanzania.
authors.affiliation: CSK Research Solutions, Dar es Salaam, Tanzania.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kahabuka
authors.affiliation: Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pembe
authors.affiliation: International Planned Parenthood Federation/Western Hemisphere Region, New York, NY, USA.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Meglioli
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000494:pharmacology*; D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D040261:Harm Reduction; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D016595:Misoprostol / Q000494:pharmacology*; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Clandestine abortion; Contraception; Counseling; Harm reduction; Maternal mortality; Misoprostol; Unintended pregnancy; Unsafe abortion