What is meant to you when you hear the word “Abortion”? One side of coin says that it is a right of every girl and other side of the same coin says the opposite – because to some girls, it is scary enough. There is a large group of unmarried adolescents who are sexually active but their reproductive health right; family planning need and right to safe abortion are still unmeet and untold due to social stigma, unavailable services for unmarried sexuality active group of people and the list goes on. If you think that SAFE ABORTION is a fundamental right of every girl, you are reading it right.
Over the past two decades, the health evidence, technologies and human rights rationale for providing safe, comprehensive abortion care have evolved greatly. Despite these advances, an estimated 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47 000 women and disabilities for an additional 5 million women. Almost every one of these deaths and disabilities could have been prevented through sexuality education, family planning, and the provision of safe, legal induced abortion and care for complications of abortion. In nearly all developed countries, safe abortions are legally available upon request or under broad social and economic grounds, and services are generally easily accessible and available. In countries where induced abortion is legally highly restricted and/or unavailable, safe abortion has frequently become the privilege of the rich, while poor women have little choice but to resort to unsafe providers, causing deaths and morbidities that become the social and financial responsibility of the public health system.
Safe abortion methods: The World Health Organization (WHO) recommends three methods of safe abortion, depending on how far along the pregnancy is.
- Medical abortion (MA),
- Manual vacuum aspiration (MVA)
- Dilatation and evacuation (D&E)
- Medical abortion (MA):
Medical abortion is the use of mifepristone and misoprostol pills, or misoprostol pills alone, to induce an abortion. This method can be used up to 24 weeks of pregnancy, but different doses and regimens apply, depending on the duration of pregnancy.
Some of the advantages of medical abortion are that it avoids a surgical procedure. It is like having a spontaneous miscarriage, the pills are used by the woman and the abortion can safely take place at home through 10 weeks of pregnancy. After that, it is safer to use this method in a clinical setting, especially in the second trimester of pregnancy.
The disadvantage of medical abortion is that it takes from several hours to several days for the abortion to be complete. Most of the bleeding with medical abortion is within the first 1-2 days, but it may continue for some days or even a couple weeks after that. The misoprostol causes cramping as it makes the uterus contract, and it can also cause nausea and vomiting.
The combination of mifepristone + misoprostol in the right doses causes a complete abortion in 96-98% of cases. Mifepristone is only available in about 60 countries; however, misoprostol is available in almost all countries because it has other medical uses in addition to abortion. Misoprostol alone is not as effective as the combination of mifepristone + misoprostol, so women may need to take a repeat dose several times to achieve a complete abortion. Most women seem to know when the abortion is complete, or within a few days that they are still pregnant.
- Vacuum aspiration (VA):
Vacuum aspiration (VA) involves evacuation of the contents of the uterus, either manually by the use of a hand-held plastic aspirator (MVA) or with an electric vacuum pump (EVA). This can also be done with an electric vacuum pump (EVA). This method has a success rate of 95-100% up to 14 weeks of pregnancy. Depending on the duration of pregnancy, abortion with vacuum aspiration takes from 3 to 10 minutes to complete, and can be performed at primary level on an outpatient basis using a local anesthetic. Most women feel well enough to go home after 30 minutes.
The advantage of vacuum aspiration abortion (a simple surgical method) is that it only takes a few minutes. In addition, most of the blood, fluids and tissue that must come out naturally with medical abortion are collected with an aspirator during vacuum aspiration.
- Dilatation and evacuation (D&E):
Dilatation and evacuation (D&E) requires a skilled, experienced provider. It is used in the second trimester usually after 14 weeks of pregnancy. A D&E procedure can usually be performed on an outpatient basis. General anesthetic is not required and can increase risk. A D&E procedure usually takes no more than 30 minutes to perform.
Food for mind: Both medical abortion and vacuum aspiration cause cramping and pain, which can be controlled with simple painkillers, taken in advance of starting the procedure. Non-steroidal inflammatory drugs such as ibuprofen are recommended. Medication for nausea with medical abortion can also be taken.
Based on the new WHO guideline on health worker roles in providing safe abortion care, medical abortion and vacuum aspiration can be provided at the primary health care level, by a wide range of non-specialist providers.
It is always best to have the support of a health care provider for abortion where possible. However, women in legally restricted settings are using abortion pills on their own. Although serious complications are rare, they do happen e.g. incomplete abortion, infection or very heavy bleeding, and women may need access to medical help.
If you are uncertain or concerned in any stage in this process, seek help.
A surgical procedure called dilatation and curettage (D&C) is still widely used for first and second trimester abortions in a large number of global South countries. This method has not been recommended by the WHO for more than a decade because medical abortion and aspiration abortion are both far safer.
Safe abortion is a right to every girl irrespective of everything. In the name of abortion, death, disability, disruption of both physical and mental health condition is completely unexpected. An open disruption on stigma related to abortion must be brought into light for the future generation and for the sake of nurturing a healthy mental health condition.