Improving the survival of pregnant drug user women and their children by an harm reduction project conducted by Médecins du Monde in Abidjan, Ivory Coast (RCI)

Charlotte Deze, Mathieu Hié, Sandrine Dié, Jerome Evanno, Felicien Tia Yomi, Claudine Duvivier, Renaud Boulet

Background
In 2014, a study on 450 precarious crack/heroin drug-users at Abidjan where drug use is punished showed that 10% of this population was women. Living in very precarious conditions, they are even more vulnerable and then resort to sex work and undergo many violence. We observed prevalence for HIV of 26% and for tuberculosis 10 times higher than the general population. Without right to abortion in RCI, they have many unintended pregnancies and due to limited access to health care, an increasing maternal and infant mortality.
Methodology
Since late 2015, MdM, university hospitals (CHU) and community health centers in Abidjan have established a care protocol of pregnancy and newborn and family planning including post-abortions care.
Results
In one year, the project reached 10% to 15% of pregnant UD women Abidjan, the care had included: a repairing obstetric surgery following an illegal abortion, 8 women had benefited from harm reduction and support to decrease drug-use. Among the nine children borned, 5 received neonatal care for high preterm, pulmonary disorders or severe anemia leading to one death. The opioid withdrawal syndrome among newborns was managed by the phenobarbital according the Finnegan score. There was no postpartum complication. Every mother-infant pairs were given social support and by a peer, conducting family reconciliations for 3 and 2 support in childcare for vulnerable populations. All then offered contraception.
Conclusion
Although this protocol has improved the survival of pregnant UD women and their children, it needs to be strengthened to reduce unintended pregnancies by more systematic use of family planning and postpartum follow up to better manage the welfare of women and children in the long term. An awareness video clip targeted the DU pregnant women was created and could be presented at the conference.