Women's experiences of emergency post-abortion care at Kawempe National Referral Hospital, Uganda - A qualitative phenomenological study

In many parts of the world, a pregnancy that ends before it is full term is not just a medical event; it is a moment of profound vulnerability. When a woman suffers a miscarriage or a dangerous complication from an unsafe procedure, she often faces a race against time to reach a hospital. This is where emergency post-abortion care comes in. It is the urgent medical treatment given to stop bleeding, clear the womb, and save a life when a pregnancy ends in crisis. While the primary goal of this care is survival, the experience of receiving it is complex. It happens in a high-stress environment where a patient is in pain, often frightened, and sometimes carrying the heavy weight of social shame or legal fear. In places where abortion is restricted and stigmatized, the way a woman is treated by doctors and nurses can be just as critical to her recovery as the surgery itself. Understanding these experiences is vital because a woman who survives a medical emergency but feels humiliated, ignored, or terrified may lose trust in the health system, making her less likely to seek help in the future.

A team of researchers set out to understand exactly what this journey feels like for women in Uganda. They conducted a study at Kawempe National Referral Hospital in Kampala, one of the country's busiest public facilities for obstetric emergencies. The hospital handles more than 200 cases of emergency post-abortion care every month. The researchers did not look at medical charts or survival rates; instead, they sat down with sixteen women who had recently been treated there. These women, ranging in age from 18 to 45, came from diverse backgrounds and had all been discharged within the two weeks prior to their interviews. The researchers listened to their stories in private, asking them to describe everything from the moment they arrived at the hospital to the days after they went home. The goal was to hear, in their own words, what made the care feel good or bad, and what factors shaped their experience from the moment of crisis until their recovery.

The most immediate and powerful finding was that for these women, the definition of "good care" was almost entirely tied to survival. When asked to evaluate their treatment, the women's first and strongest reaction was gratitude for being alive. If the bleeding stopped and the pain subsided, they felt the care had been successful. One woman described feeling like a "different person" once she was told she could go home, while another said the relief was like having a heavy weight removed from inside her. The speed at which the medical team responded also mattered deeply. When doctors and nurses rushed to her side, asking questions and preparing for examination immediately, it signaled to the patient that her life was being taken seriously. In the face of a life-threatening emergency, this clinical rescue was so overwhelming that it temporarily overshadowed other aspects of the experience, such as whether the staff was kind or the room was private.

However, once the immediate danger of death had passed, the other dimensions of the experience came sharply into focus, often revealing deep distress. The physical pain of the procedure was intense and, for many, traumatic. Several women described the sensation of the medical instruments inside them as excruciating, with one comparing the feeling to her insides being pulled out. This physical suffering was often accompanied by a paralyzing fear of death, especially for those who arrived with severe bleeding. The emotional toll was equally heavy. Many women carried feelings of guilt, shame, or self-blame, which were sometimes worsened by the way they were spoken to. While some doctors offered calm reassurance and took time to explain what was happening, others were dismissive or judgmental. One woman recalled a doctor questioning why she was alone and why she had become pregnant at a young age, which made her feel ashamed on top of her physical pain. In a society where abortion is heavily stigmatized, such comments felt like a moral condemnation, adding a layer of humiliation to the medical trauma.

The environment in which this care took place played a massive role in shaping these experiences. The hospital was often overcrowded, and resources were scarce. Women described waiting for hours while bleeding, sometimes without a doctor checking on them, and having to ask repeatedly for help. In some cases, they were treated in open areas without curtains, leaving them feeling exposed and embarrassed in front of other patients and staff. The financial burden was another significant stressor; although the emergency treatment itself was free, women were often forced to pay out of pocket for ultrasound scans and medications that were out of stock. For many, the journey to the hospital was already a struggle, involving transfers from smaller clinics that lacked blood or equipment. By the time they reached the national referral hospital, some had been moving between facilities for hours, growing weaker with every mile.

The story did not end when the women left the hospital. The researchers found that the experience of care extended well beyond discharge, often into a period of uncertainty and isolation. Many women left with lingering pain or bleeding but received no follow-up calls or instructions on what to expect next. They were left to wonder if their symptoms were normal or if they should return for help. Questions about their future fertility also lingered unanswered, with some women anxious about when it would be safe to try to conceive again. Socially, the recovery was often a lonely process. Due to the stigma surrounding abortion, many women chose to hide the truth from their families and communities, telling their mothers they were simply "fine" rather than explaining the medical emergency they had survived. This silence meant they lacked the emotional and practical support needed for a full recovery.

The study concludes that improving emergency post-abortion care requires looking beyond just the technical success of saving a life. While survival is the most critical outcome, it is not enough on its own. The researchers suggest that hospitals must integrate respectful communication, effective pain management, and strict privacy protections into their emergency protocols. They emphasize that the way a provider speaks to a patient can be a therapeutic tool in itself, helping to calm fear and reduce trauma. Furthermore, the health system needs to address the structural barriers that cause delays and financial stress, such as ensuring blood and medicines are available and coordinating better referrals between clinics. Finally, care should not stop at the hospital door; structured follow-up and counseling are essential to help women navigate their physical recovery and the emotional aftermath of their experience. By addressing these human and systemic factors, the quality of care can be transformed from a mere life-saving intervention into a truly supportive and dignified experience.