The Danger of Unsafe Abortions: Their Causes and Complications
An unsafe abortion refers to an unhygienic or unhealthy abortion, performed by an unskilled or untrained birth attendant and involving inappropriate methods. According to World Health Organization (WHO) (2011), “An unsafe abortion is a procedure for terminating an unintended pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.”
Unsafe methods of abortion include: insertion of a sharp instrument into the uterus, use of high-dose medicine such as antimalarials and birth control pills, flushing the vagina with liquids such as bleach, physical abuse such as jumping from high places, severely prolonged sexual intercourse, and hard and prolonged massage to manipulate the uterus.
The main causes behind unsafe abortions are unwanted or unplanned pregnancies (most commonly), forced abortions, rape, inadequate counseling from guides (medical professionals, NGOs, etc.) and pregnancy-related abuse and violence. According to Shah et al., “It has been estimated that 37% of all pregnancies are unwanted in Pakistan.”
According to WHO (2015), “An estimated 21.6 million unsafe abortions took place worldwide in 2008 — almost all of which were in developing countries,” and, “One in ten pregnancies ends with an unsafe abortion worldwide,” (WHO, 2011). In developing countries, unsafe abortions occur at an incidence of two in five women under 25 years of age and about one in seven women under 20 years of age. “Every year, 890,000 induced abortions are performed (29 per 1000 women aged 15-49 years) in Pakistan,”(Shah et al., 2011, p.582).
There are a number of social, physical and biological issues which lead to unsafe abortions and associated complications.
The social issues may include cultural beliefs and practices, lack of hospital resources, lack of transport systems and a low socioeconomic status due to which most people refer unskilled birth attendants. Some people allow limited mobility to women due to the concept of ‘pardah’ and consider it inappropriate for women to go to hospital. Instead, they give preference to a ‘Dai’, who mostly uses manual methods and unsterilized instruments in an unhygienic environment, hence leading to complications such as sepsis, infertility, hemorrhage, etc.
Some women who cannot afford a proper abortion may try to terminate the pregnancy themselves, possibly by using sharp instruments, physical violence and drugs. They often lack awareness about the consequences of an unsafe abortion. Instrumentation is the most frequent method used in Pakistan (64.4%) (Shah et al., 2011). In addition, most women opt for unsafe abortions when they don’t want any more children; they use abortion as a family-planning method.
The main reason for this lack of social resources is corrupt leadership and a government which does not provide resources according to the needs of the population. Many Dais, nurses and midwives in our society are unskillful and run their own clinics by calling themselves doctors. Furthermore, many gynecologists refuse to perform terminations because of their own personal beliefs and the social stigma associated with abortion, hence forcing women to go to unreliable street clinics for termination of pregnancy.
Among the biological issues, age is an important factor. Adolescents are vulnerable to sexual abuse, violence, rape and unwanted pregnancy due to their sexual desires peaking at this young age and their immaturity. As a result of lack of sexual knowledge and awareness, they usually engage in unprotected and unsafe sex in their unmarried lives, which leads to unwanted pregnancies. Such pregnancies are usually terminated by Dais with unhygienic methods, leading to complications such as septicemia, uterine perforation, bowel perforation, and bladder perforation.
An unsafe abortion can potentially create life-threatening complications. According to WHO (2011), 25% of women who have such complications need emergency medical care. These complications include incomplete abortion, heavy bleeding, infection, uterine perforation, etc. In Pakistan, a high prevalence of abortion-related complications is reported with sepsis (79%), uterine perforation (13%) and hemorrhage (9%) (Shah et al., 2011). These complications lead to increased deaths of women and children; approximately 70,000 women die each year and 192 women die each month due to these complications (Åhman & Shah, 2011).
Preventing and overcoming the problem of unsafe abortions entails changes at levels of government, community and individuals. The government should introduce strict laws to prohibit unsafe abortions, and anyone disobeying these rules should be duly punished. The government should also provide basic facilities of transport, medical healthcare and fully trained TBAs.
At a community level, awareness sessions should be conducted and unskilled workers should be trained. At individual level, nurses and midwives should provide pamphlets and flyers to youth and married couples regarding preventive measures. They can educate young girls about unsafe practices, their prevention and safety precautions, and encourage them to further educate the community about unsafe abortions. In addition, it is our responsibility to enable uneducated people to seek the help of NGOs and demand the government to provide for their needs, and also to make people aware of healthy practices.
An unsafe abortion can be prevented by providing sexual awareness and education, access to safe and legal abortion, and use of contraceptives and other family-planning methods (WHO, 2014).
In conclusion, unsafe abortions are one of the main reasons for maternal morbidity and mortality in Pakistan. A woman can encounter social, physical and biological problems which collectively lead to intricate complications. To overcome these complications, strategies such as awareness of good sexuality and effective practices should be put into use.
Shah, N., Hossain, N., Noonari, M., & Khan, N. H. (2011). Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan. Journal of the Pakistan Medical Association, 61(6), 582-586.
Shah, I., & Ahman, E. (2009). Unsafe abortion: global and regional incidence, trends, consequences, and challenges. Journal of Obstetric Gynecology Canada, 31(12), 1149-1158.
Åhman, E., & Shah, I. (2011).Unsafe abortion. Geneva, Switzerland: World Health Organization.
World Health Organization. (2011). Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008.
WHO (2015). WHO | Preventing unsafe abortion. Retrieved 5 February 2015, from http://www.who.int/mediacentre/factsheets/fs388/en/
Mesce, D., & Clifton, D. (2011). Abortion: Facts and figures.
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