Kele’s boyfriend wanted to have sex, but she was not in the mood. He tried penetrating her but she struggled to resist him. A few weeks later, she got ill. She went to the hospital and was told she was pregnant. She confronted her boyfriend, but he denied the pregnancy. She was so scared and all alone. Her boyfriend then took her to an unskilled provider who carried out a surgical procedure on her at 12 weeks. It was painful and was done in a dirty environment. She thought she would lose her life due to the pain she experienced. Two months later she was ill again and went back to the hospital; a scan revealed that she was 20 weeks pregnant. She carried the pregnancy and eventually had a stillbirth at 37 weeks. She later found out that she was infected and spent a lot of money treating.
Stories like that of Kele are common around the world and with relevant knowledge such situations can be avoided. Let’s take a look at what abortion is all about.
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the womb. Abortions include various clinical conditions such as spontaneous and induced abortion (both viable and non-viable pregnancies), incomplete abortion and intrauterine fetal demise.
Abortions are safe if they are done with a method recommended by WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained. However, unsafe abortion is a major cause of maternal death, especially in the developing world.
Unsafe abortion occurs when a pregnancy is terminated either by unskilled personnels or in an environment that does not satisfy the minimal medical standards or both.
Unsafe abortion procedures may involve the insertion of an object or substance (root, twig, or catheter or traditional concoction) into the womb; dilatation and curettage (D&C) performed incorrectly by an unskilled provider; ingestion of harmful substances; and application of external force.
In some settings, traditional practitioners vigorously pummel the woman’s lower abdomen to disrupt the pregnancy, which can cause the womb to rupture, killing the woman. Women, including adolescents, with unwanted pregnancies often resort to unsafe abortion when they cannot access safe abortion.
Statisically, around 25 million unsafe abortions were estimated to have taken place worldwide each year, almost all in developing countries. Among these, 8 million were carried out in the least- safe or dangerous conditions. Over half of all estimated unsafe abortions globally were in Asia.
3 out of 4 abortions that occurred in Africa and Latin America were unsafe. The risk of dying from an unsafe abortion was the highest in Africa.
Around 7 million women are admitted to hospitals yearly in developing countries, as a result of unsafe abortion.
What are the barriers to accessing safe abortion?
- Restrictive abortion laws: Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available.
- Inadequate contraceptive use and sexual education.
- High cost of safe abortion.
- Social and moral stigma.
- Poor availability of services.
- Conscientious objection of health-care providers.
What are the contributing factors to unsafe abortion?
- Lack of knowledge of safe abortion services.
- Socio-economic conditions as a perceived influence for unsafe abortion practices.
- Safe abortion as a perceived religious and cultural taboo in some countries.
- Stigma of unplanned pregnancy.
- A desire to bear children only after marriage.
- Avoiding parental/guardian disappointment and resentment.
- A desire to pursue education.
Methods of unsafe abortion
Methods of unsafe abortion include
- Drinking toxic fluids such as turpentine, bleach, or drinkable concoctions mixed with livestock manure.
- Inflicting direct injury to the vagina or elsewhere—for example, inserting herbal preparations into the vagina or cervix; placing a foreign body such as a twig, coat hanger, or knitting needles into the womb or placing inappropriate medication into the vagina or anus.
- Unskilled providers also improperly perform dilation and curettage in unhygienic settings, causing uterine perforations and infections.
- Methods of external injury are also used, such as jumping from the top of stairs or a roof, or inflicting blunt trauma to the abdomen.
- Inducing an abortion without medical supervision by self-administering abortifacient (causing abortion) over-the-counter drugs or drugs obtained illegally or by using drugs not indicated for abortion but known to result in miscarriage or uterine contraction.
What are the Health Risks of Unsafe Abortion?
Unsafe abortion is a leading cause of maternal mortality worldwide. One in four women who undergo an unsafe abortion is likely to develop temporary or lifelong disability requiring medical care. The risk of abortion related -death surges when the rates of unsafe abortion increases. Complications of unsafe abortion includes:
- incomplete abortion (failure to remove or expel all of the pregnancy tissue from the womb)
- haemorrhage (heavy bleeding)
- uterine perforation (caused when the womb is pierced by a sharp object)
- damage to the genital tract and internal organs by inserting dangerous objects such as sticks, knitting needles, or hangers into the vagina or anus.
Signs and symptoms of complication
The critical signs and symptoms of complications that require immediate attention include:
- abnormal vaginal bleeding
- abdominal pain
- shock (collapse of the circulatory system).
Treatment of complications
Irrespective of the legality, health care providers are required by law to provide medical care to patients, as it may be life-saving.
Complications arising from unsafe abortions and their treatments include:
- Haemorrhage: early treatment of heavy blood loss is crucial, as delays can be life threatening.
- Infection: treatment with antibiotics along with eremoval of any remaining pregnancy tissue from the womb as soon as possible.
- Injury to the genital tract and/or internal organs: Admission to a health care facility is important, any delay can be fatal.
The way forward
Unsafe abortion can be prevented through comprehensive sexuality education, prevention of unintended pregnancy through use of effective contraception, including emergency contraception and provision of safe, legal abortion.
In addition, deaths and disability from unsafe abortion can be reduced through the timely provision of emergency treatment of complications.
- “Preventing unsafe abortion”. www.who.int. Retrieved 19 April2019.
- Ganatra B, Tunçalp Ö, Bart H. From concept to measurement : operationalizing WHO ’ s definition of unsafe abortion. Bull World Health Organ. 2014;92:155 Available from: https://www.scielosp.org/article/bwho/2014.v92n3/155-155/, https://doi.org/10.2471/BLT.14.136333.
- “Contributing factors to unsafe abortion practices among women of reproductive age at selected district hospitals in the Ashanti region of Ghana”. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0759-5