Unsafe abortion

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Soviet poster c. 1925. Title translation: "Abortion induced by grandma or midwife not only maims the woman, but also often leads to death." RussianAbortionPoster.jpg
Soviet poster c. 1925. Title translation: "Abortion induced by grandma or midwife not only maims the woman, but also often leads to death."

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. [1] An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. [2] About 25 million unsafe abortions occur a year, of which most occur in the developing world. [3]

Contents

Unsafe abortions result in complications for about 7 million women a year. [3] Unsafe abortions are also one of the leading causes of deaths during pregnancy and childbirth (about 5–13% of all deaths during this period). [3] Most unsafe abortions occur where modern birth control is unavailable, [4] or in developing countries where affordable and well-trained medical practitioners are not readily available, [5] [6] or where abortion is illegal, [7] with the more restrictive the law, the higher the rates of death and other complications. [8]

Overview

The World Health Organization (WHO) estimated that for the time period of 2010-14 there were 55.7 million abortions worldwide each year. Out of these abortions, approximately 54% were safe, 31% were less safe, and 14% were least safe. That means that 25 million (45%) abortions each year between 2010 and 2014 were unsafe, with 24 million (97%) of these in developing countries. [9] In 2003 approximately 42 million pregnancies were voluntarily terminated, of which 20 million were unsafe. [10] According to WHO and the Guttmacher Institute, at least 22,800 [11] women die annually as a result of complications of unsafe abortion, and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection, sepsis, bleeding, and injury to the internal organs, such as puncturing or tearing of the uterus). They also concluded abortion is safer in countries where it is legal, but dangerous in countries where it is outlawed and performed clandestinely. The WHO reports that in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe. According to WHO statistics, the risk rate for unsafe abortion is 1/270; according to other sources, unsafe abortion is responsible for at least 8% of maternal deaths. [12] [11] Worldwide, 48% of all induced abortions are unsafe. The British Medical Bulletin reported in 2003 that 70,000 women a year die from unsafe abortion. [13] Incidence of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation". [14] [15]

An article pre-printed by the WHO called safe, legal abortion a "fundamental right of women, irrespective of where they live" and unsafe abortion a "silent pandemic". [14] The article states "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative." It also states "access to safe abortion improves women's health, and vice versa, as documented in Romania during the regime of President Nicolae Ceaușescu" and "legalisation of abortion on request is a necessary but insufficient step toward improving women's health" citing that in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO's Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: "As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets." [16] The WHO's Development and Research Training in Human Reproduction (HRP), whose research concerns people's sexual and reproductive health and lives, [17] has an overall strategy to combat unsafe abortion that comprises four interrelated activities: [16]

A 2007 study published in The Lancet found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. It also concluded that, while the overall incidence of abortion in both developed and developing countries is approximately equal, unsafe abortion occurs more often in less-developed nations. [18]

According to a new study in The Lancet that focused on data from 2010 to 2014, nearly 55 million pregnancies are terminated early and of that 55 million, nearly half, 25.5 million are deemed as unsafe. [19] The WHO and the Guttmacher Institute stress the need for access to a safe abortion for all women and that unsafe methods must be replaced. Africa, Asia and Latin America account for almost 97 percent of unsafe abortions. These regions are often poorer and underdeveloped and lack the access to safe abortion methods. Out of all abortions in these regions only 25% are considered safe. In developed countries these numbers improve drastically. Nearly all abortions in North America (99%) are considered safe. Overall nearly 88% of abortions in developed countries were actually considered safe, with the number of safe abortions in Europe slightly lower.

Conflating illegal and unsafe abortion

Unsafe abortions often occur where abortion is illegal. [7] However, the prevalence of unsafe abortion may also be determined by other factors, such as whether it occurs in a developing country that has a low level of competent medical care. [6]

Unsafe abortions sometimes occur where abortion is legal, and safe abortions sometimes occur where abortion is illegal. [20] Legalization is not always followed by elimination of unsafe abortion. [5] [21] Affordable safe services may be unavailable despite legality, and conversely, women may be able to afford medically competent services despite illegality. [22]

When abortion is illegal, that generally contributes to the prevalence of unsafe abortion, but it is not the only contributor. In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally. [4]

Illegality of abortion contributes to maternal mortality, but that contribution is not as great as it once was, due to medical advances including penicillin and the birth control pill. [23]

Frequency by continent

RegionNumber of unsafe abortions (thousands)Number of unsafe abortions per 100 live birthsNumber of unsafe abortions per 1000 women
Africa42001424
Asia*105001413
Europe50073
Latin America and the Caribbean37003229
North AmericaNegligible incidenceNegligible incidenceNegligible incidence
Oceania **301217
World190001414
* Excluding Japan
** Excluding Australia and New Zealand

Source: WHO 2006 [24]

Abortion in the U.S. before 1973 (Roe v. Wade)

In 1973, the Supreme Court ruled 7–2 that laws prohibiting an abortion violated a woman's right to privacy. The landmark case, Roe v. Wade , changed abortion in the United States.

Early abortion laws generally only prohibited the use of toxic chemicals that were used to cause a miscarriage. The first such law was passed in Connecticut in 1821. [25]

Prior to 1973, the authority to legalize abortion rested with the state governments. Up through the 1960s, 44 states had laws that outlawed abortions unless the health of the pregnant patient was at stake. [26]

In the 1940s, records show that more than 1,000 women died each year from abortions that were labeled as unsafe. Many of these abortions were self-induced. Unsafe abortion practices were such a concern in the United States that nearly every large hospital had some type of "septic abortion ward" that was responsible for dealing with the complications that accompanied an incomplete abortion. Incomplete abortions were the leading cause for OB-GYN services across the United States. In the 1960s, the National Opinion Research Center found that hundreds of women were attempting to self-abort with coat hangers, knitting needles and ballpoint pens, and by swallowing toxic chemicals like bleach and laundry detergent. [27] However, the number of deaths declined significantly into the 1960s and 1970s. The Centers for Disease Control and Prevention estimates that in 1972, 130,000 women attempted self-induced abortions or obtained illegal abortions, resulting in 39 deaths. [28]

In 2005, the Detroit News reported that a 16-year-old boy, at his pregnant, under-age girlfriend's request, repeatedly beat her abdomen with a bat to abort the fetus. The young couple lived in Michigan and were evading a state law requiring a minor to receive a parent's or a judge's consent to obtain a legal abortion. [29] [30] [31] In Indiana, where there were also parental consent laws, 17-year-old Becky Bell died from an unsafe abortion in 1988 rather than discuss her pregnancy and wish for an abortion with her parents. [32] [33] [ better source needed ]

Methods

Methods of unsafe abortion include:

Health risks

Unsafe abortion is a major cause of injury and death among women worldwide. It is estimated that nearly 25 million unsafe abortions take place annually. [9] WHO estimates that at least 7.9% of maternal deaths are due to unsafe abortion, with a greater proportion occurring in Latin America, the Caribbean, and sub-Saharan Africa and a lesser proportion in East Asia where access to abortion is generally legal. [39] 97% of these abortions take place in developing countries. [40] Unsafe abortion is believed to result in at least 22,800 deaths and millions of injuries annually. [40] The legal status of abortion is believed to play a major role in the frequency of unsafe abortion. [41] [42] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications, [43] with abortion-related deaths dropping by more than 90%. [44] Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services. [42]

An unsafe abortion can lead to wide range of health risks that can affect the well-being of women. The major and most life-threatening complications that stem from unsafe abortions are infection, hemorrhaging and injury to internal organs. [45]

Abortion symptoms that can lead to additional health risks:

Complications and their treatments include:

Damage to the genital tract or internal organs: Admission to a health care facility is imperative, any delay can be fatal. [8]

Treatment of complications

Regardless if an abortion was legal or illegal, health care providers are required by law to provide medical care to patients, as it may be life-saving. In some cases, treatment for abortion complications may be administered only when the woman provides information about the abortion and any and all persons that were involved. [47]

In areas where abortion is illegal, people seeking care for complications of illegal abortions may face legal consequences. This may deter people from seeking life-saving care. [47]

Globally, there is a high burden of complications from unsafe abortions. [48] The costs of treating the complications can be significant in developing countries, where, in 2011, 98% of unsafe abortions occurred. [49] An estimated 5.3 million women worldwide have developed complications or disabilities from unsafe abortion, which may be either temporary or permanent. [50] Unsafe abortions cause an estimated 5 million lost disability-adjusted life years each year by women of reproductive age. [51]

See also

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reason women give for having an abortion is for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

<span class="mw-page-title-main">Maternal death</span> Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while they are pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

Women's health differs from that of men's health in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organisation as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

Hysterotomy abortion is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section. The procedure is generally indicated after another method of termination has failed, or when such a procedure would be medically inadvisable, such as in the case of placenta accreta.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life.

Abortion has been legal in India under various circumstances with the introduction of the Medical Termination of Pregnancy (MTP) Act, 1971. The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception.

Septic abortion describes any type of abortion, due to an upper genital tract bacterial infection including the inflammation of the endometrium during or after 20 weeks of gestation. The genital tract during this period is particularly vulnerable to infection, and sepsis in most cases is caused by a combination of factors both due to facility conditions and/or individual predispositions. The infection often starts in the placenta and fetus, with a potential complication of also affecting the uterus, that can result in sepsis spreading to surrounding organs, or pelvic infections.

<span class="mw-page-title-main">Reproductive rights in Latin America</span>

Latin America is home to some of the few countries of the world with a complete ban on abortion and minimal policies on reproductive rights, but it also contains some of the most progressive reproductive rights movements in the world. With roots in indigenous groups, the issues of reproductive rights include abortion, sexual autonomy, reproductive healthcare, and access to contraceptive measures. Modern reproductive rights movements most notably include Marea Verde, which has led to much reproductive legislation reform. Cuba has acted as a trail-blazer towards more liberal reproductive laws for the rest of Latin America, while other countries like El Salvador and Honduras have tightened restrictions on reproductive rights.

Abortion is illegal in Bangladesh under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman is in danger.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

Abortion in Cambodia is legal upon request within the first twelve weeks of pregnancy.

Abortion is a controversial topic in Nigeria. Abortion in Nigeria is governed by two laws that differ depending on geographical location. Northern Nigeria is governed by The Penal Code and Southern Nigeria is governed by The Criminal Code. The only legal way to have an abortion in Nigeria is if having the child is going to put the mother's life in danger. However, sex-selective abortion has long had acceptance in Nigeria.

<span class="mw-page-title-main">Joy Lawn</span>

Joy Elizabeth Lawn is a British paediatrician and professor of maternal, reproductive and child health. She is Director of the London School of Hygiene & Tropical Medicine Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre. She developed the epidemiological evidence for the worldwide policy and programming that looks to reduce neonatal deaths and stillbirths and works on large-scale implementation research.

<span class="mw-page-title-main">Abortion in Kenya</span> Termination of pregnancy in Kenya

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

<span class="mw-page-title-main">Maternal mortality in India</span> Overview of maternal mortality in India

Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods. Different countries and cultures have different rates and causes for maternal death. Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.

Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as how the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.

Chaniece Wallace, a black woman and physician, died at 30 years of age from complications of pregnancy two days after giving birth. Her death is seen as preventable and is viewed in the context of high rates of maternal mortality in the United States, particularly among the African American population. It is cited as an example in medical and scholarly publications to call for improved health outcomes in the black U.S. population. Wallace died despite several factors seen as protective: she was "highly educated, employed as a health care practitioner, had access to health care, and had a supportive family."

In 2005, the Ethiopian Parliament liberalised the abortion law to grant safe abortions to women in specific circumstances.

References

  1. ↑ Safe Abortion: Technical and Policy Guidance for Health Systems. World Health Organization. 2003. p. 12. ISBN   9789241590341. a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skill or in an environment lacking the minimum medical standards, or both.
  2. ↑ "Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003" (PDF). World Health Organization. 2007. Retrieved March 7, 2011. The estimates given in this document are intended to reflect induced abortions that carry greater risk than those carried out officially for reasons accepted in the laws of a country.
  3. 1 2 3 "Preventing unsafe abortion". www.who.int. Retrieved 19 April 2019.
  4. 1 2 Singh S, Darroch JE, Ashford LS, Vlassoff M (2009). Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (PDF). New York: Guttmacher Institute and United Nations Population Fund. If women's contraceptive needs were addressed...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million. A few of the findings in that report were subsequently changed, and are available at: Facts on Investing in Family Planning and Maternal and Newborn Health (PDF). Guttmacher Institute. 2010. Archived from the original (PDF) on 2012-03-24.
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  51. ↑ Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH (November 2006). "Unsafe abortion: the preventable pandemic". Lancet. Sexual and Reproductive Health 4. 368 (9550): 1908–1919. doi:10.1016/S0140-6736(06)69481-6. PMID   17126724. S2CID   6188636.
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