Induced abortion has been documented throughout recorded history. In earlier times, abortions were unsafe and exerted a heavy toll on women’s lives. Advances in medical practice in general, and the advent of safe and effective technologies and skills to perform induced abortion in particular, could eliminate unsafe abortions and related deaths entirely, providing universal access to these services is available. Yet, an estimated 22 million abortions continue to be unsafe each year, resulting in the death of an estimated 47 000 women.
Unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating an unintended pregnancy, carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. In nearly all developed countries (as classified by the United Nations Population Division) safe abortions are legally available upon request or under broad social and economic grounds, and services are generally accessible to most women. With the exception of a few countries, access to safe abortion in developing countries is limited to a restricted number of narrow conditions. In countries where abortion is legally highly restricted, unequal access to safe abortion may result. In such contexts, abortions that meet safety requirements can become the privilege of the rich, while poor women have little choice but to resort to unsafe providers, which may cause disability and death.
Each year, 22 million unsafe abortions are estimated to take place. Nearly all unsafe abortions (98%) occur in developing countries. The total number of unsafe abortions has increased from about 20 million in 2003 to 22 million in 2008, although the global rate of unsafe abortion has remained unchanged since 2000. Approximately 47 000 pregnancy-related deaths are due to complications of unsafe abortion. In addition, 5 million women are estimated to suffer disability as a result of complications due to unsafe abortion. Impressive gains in contraceptive use have resulted in reducing the number of unintended pregnancies, but have not eliminated the need for access to safe abortion.
An estimated 33 million contraceptive users worldwide are expected to experience accidental pregnancy annually while using contraception. Some of the accidental pregnancies are terminated by induced abortions, and some end up as unplanned births. Whether abortion is legally more restricted or available on request, a woman’s likelihood of having an unintended pregnancy and seeking induced abortion is about the same. However, legal restrictions, together with other barriers, mean many women induce abortion themselves or seek abortion from unskilled providers.
Health consequences of unsafe abortion:
The health consequences of unsafe abortion depend on the facilities where abortion is performed; the skills of the abortion provider; the method of abortion used; the health of the woman; and the gestational age of her pregnancy. Unsafe abortion procedures may involve insertion of an object or substance (root, twig or catheter or traditional concoction) into the uterus; dilatation and curettage 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 uterus to rupture, killing the woman . The consequences of using certain medicines, such as the prostaglandin analogue misoprostol, in incorrect dosages for inducing abortion are mixed, though there is some evidence that even an incorrect dosage can still result in lowering the number of severe complications and maternal deaths
Deaths and disability related to unsafe abortion are difficult to measure. Given that these deaths or complications occur following a clandestine or illegal procedure, stigma and fear of punishment deter reliable reporting of the incident. It is especially difficult to get reliable data on deaths from unsafe second-trimester abortions. Moreover, women may not relate their condition to a complication of an earlier abortion. Therefore, maternal deaths resulting from unsafe abortions are grossly underreported.
Complications of unsafe abortion include haemorrhage, sepsis, peritonitis, and trauma to the cervix, vagina, uterus and abdominal organs. About 20–30% of unsafe abortions cause reproductive tract infections and 20–40% of this result in infection of the upper genital tract. One in four women who undergo unsafe abortion is likely to develop temporary or lifelong disability requiring medical care.
For every woman seeking post-abortion care at a hospital, there are several who have had an unsafe abortion but who do not seek medical care, because they consider the complication as not serious, or because they may not have the required financial means, or because they fear abuse, ill-treatment or legal reprisal. Evidence shows that major physiological, financial and emotional costs are incurred by women who undergo unsafe abortion. Irrespective of every stigma, social structure, values and norms, we should stand against unsafe abortion in order to ensure women’s balanced physical and mental health condition.