UNSAFE ABORTION: A Preventable International Killer
Unsafe abortion is a leading cause of maternal death. In places where abortion is not legal or adequately provided, women die in large numbers due to botched abortions and the subsequent complications. Women seeking post-abortal care often experience discrimination at the hands of health care providers and suffer tremendously as a result. It is a professional responsibility to treat all injured women when possible, and a matter of sexual and reproductive rights to provide women with the ability to decide when and how to plan their families. The tragic results of unsafe abortion have devastating impacts on families, communities and nations and deserve the required action to prevent these needless deaths.
What Constitutes an Unsafe Abortion:
‘Unsafe abortions are frequently performed by unqualified and unskilled providers, or are self-induced; such abortions often take place in unhygienic conditions, and involve the use of dangerous methods or incorrect administration of medications.’ (WHO) If complications arise there is often no assistance available.
Health care providers report having treated women whose unsafe abortions have been induced through the insertion of sharp objects such as sticks, hot iron rods, harsh chemicals such as bleach, by drinking various poisonous substances or through severe pelvic pummeling. If complications arise following such a painful and dangerous procedure, women may arrive at the hospital only to experience maltreatment or neglect on the part of health care providers who are against abortion or fear persecution from local authorities. Actions need to be taken to protect health care providers and encourage professional responsibility. Unsafe abortion is not synonymous with illegal abortion and takes place both inside and outside the legal framework. Depending on the context, the medical standards and skill of the provider can vary.
‘They put iron inside me, it pains a lot, I was vomiting, and felt sad.’
– Nigerian Woman to the BBC.
Who is affected?
According to reproductiverights.org, every minute 40 women undergo an unsafe abortion, 10 of whom are girls between the ages of 15 and 19. Moreover, 95 percent of all unsafe abortions take place in the developing world.
Disproportionate impact. More than half of the world’s women live in countries where they cannot access safe abortion. In addition, many of these women have limited access to contraceptives and in some cases difficulty in negotiating the circumstances of their sex lives. A quarter of all unsafe abortions are undergone by adolescent women who are more likely to be uneducated about family planning and experience greater shame and stigmatization by becoming pregnant. In some societies being unmarried and pregnant may in fact be life threatening. Young women are also more likely to take longer in making the decision to access an abortion, only increasing their risks.
Women living in conflict zones, as refugees and as internally displaced persons experience an even harsher reality. They are often cut off from health supplies, including those related to family planning. Adding complexity to this issue is the practice of rape as a weapon of war. In situations of conflict and ethnic cleansing, rape and gang rape can be widespread, with the common consequence being the ostracization of the women from her community due to the violation and the subsequent child. Having undergone an unsafe abortion, women are also less likely to access post-abortal care. UNFPA has found that 25-50% of maternal deaths in refugee camps are due to unsafe abortion.
Why do women seek unsafe abortions?
It is not a simple choice, if a choice at all. There are many reasons a woman may seek an abortion. Perhaps she already has many children; she may have been assaulted; she may be unable afford the cost of raising the baby; or she may just not want a child. In countries like Canada where abortion is not illegal and is practiced by skilled health care providers, it is extremely rare to hear of a woman dying from an abortion. However, in the developing world, an unwanted pregnancy can often lead to an untimely death. Before abortion was decriminalized in Canada, women were forced to procure unsafe abortions with devastating consequences.
Rarely do women take the issue of abortion lightly. Depending on the circumstances under which she became pregnant, a woman may realistically perceive that the danger to her from members of her family or community for being pregnant can outweigh the risk of an unsafe abortion. Even in cases where abortion is legal, or legal in specific instances, women may still seek unsafe abortions. High costs, a lack of providers, deficiencies in equipment or an inability to demonstrate or meet the criteria needed to obtain the abortion may contribute to her decision to access an unsafe abortion.
Medical Abortion: The Many uses of Misoprostol
‘Medical abortion’ is defined as the use of drugs to terminate a pregnancy. It is sometimes also called non-surgical abortion or voluntary interruption of pregnancy. Commonly a regimen involving mifepristone and misoprostol is used; however, if need be, misoprostol can be used alone (it is also significantly cheaper). These drugs cause a woman to miscarry by blocking progesterone (mifepristone) and contracting the uterus (misoprostol). Medical abortions are a non-invasive procedure that can make abortion earlier, more accessible, safer, less medicalized and less expensive. No surgery or anesthesia is involved. Misoprostol is also a drug used to prevent and treat post-partum hemorrhage. While seen by some as a potential partial solution to unsafe abortion, in countries where abortion is illegal, the use of misoprostol may be limited or forbidden in hospitals, clinics and offices.
What is the Mexico City Policy, a.k.a. The Global Gag Rule (GGR)?
'The GGR restricts any US family planning funds to any foreign nongovernmental organization that uses its money to provide legal abortion services or counseling, gives referrals on safe abortion options, provides facts about the consequences of unsafe abortion, or participates in public debate, no matter how informal, that might improve access to safe abortion services. The GGR does not prohibit speech against abortion. The policy applies even if abortion is legal and if organizations use non-US money for any of the activities listed above.' (www.iwhc.org)
The Global Gag Rule was first imposed in 1984 by President Ronald Reagan and, while lifted under Clinton, the rule was re-imposed by President George W. Bush on the first full day of his presidency. The conditional US funds subject to the GGR harm some of the world’s most vulnerable women, including victims of rape and sexual violence. This policy has led to the closing of many women’s health centers and projects of which discussing abortion was only a small part of the mandate. The majority of these centers and projects promoted and provided access to family planning services such as sexual health information and contraception as well as pregnancy related information and care. The GGR has also resulted in the inability of organizations to diversify their funding; by accepting money from the President’s Emergency Plan for AIDS Relief (PEPFAR) they are unable work with or accept funding from organizations that discuss abortion.
What can de done?
Access to Family Planning: A logical first step is helping women access the means to control their fertility. Access to family planning, including information, contraception and other reproductive health supplies are necessary to ensure that every child is a wanted child.
Training Health Professionals: Train health professionals to provide abortions as well as post-abortal care. This includes the complications that may arise from unsafe abortion as well as the provision of the necessary supplies.
Documentation: Recording incidences of unsafe abortion and documenting the negative impacts through techniques such as maternal death audits can help encourage evidence-based responses on the part of governments and policy makers.
Encourage Research-Based Policy and Programming: The evidence tell us that regardless of legal provision women will seek abortions. It is important for actions and policies in the name of women’s health reflect the evidence.
Abortion is Between a Woman and her Doctor: Advocate to make abortion a private issue between a woman and her doctor, free from state interference.
Protect Health Care Providers: Advocate to enact and develop policies and laws that protect health care workers who provide abortions or post-abortal care.
Advocate: Policies such as the Global Gag Rule are harmful to women. Lobbying governments and decision makers for solutions to the problem of unsafe abortion applies important social pressure, preventing the issue from remaining unpublicized.
A Sexual and Reproductive Rights Approach: Sexual and reproductive rights are human rights and deserve priority. Health care providers have a responsibility to care for women regardless of her personal choices and as such are required to provide post-abortal care.
Access for Vulnerable Populations: Considering poor women are most severely impacted by unsafe abortion, efforts should be made to subsidize the cost of the procedure and treatment of complications when an unsafe abortion has been induced when it cannot be freely provided.
For More Information:
'The evidence is clear. Restrictive laws on abortion have clearly been shown to increase maternal mortality… Can we come to a place of understanding so that we can save women’s lives literally and broadly? Women who resort to unsafe abortion are desperate… How does blaming women and prosecuting them solve this problem? Does society care less about the lives of poor women? Working with our member societies in partnership with our collaborating agencies will provide thoughtful avenues for progress.'
– Dr. Dorothy Shaw President, International Federation of Gynecology and Obstetrics
- Of the estimated 42 million abortions that take place every year, only 22 million occur in a safe and legal environment.
- Almost 80,000 women die each year due to unsafe abortion and millions more are seriously injured.
- In Latin America 21 percent of all maternal deaths are caused by unsafe abortion.
Considering the clandestine nature of unsafe abortions, it is very difficult to track and report on their frequency. The numbers above are approximates; however, experts consider them to be only the ‘tip of the iceberg’ and argue that many more unsafe abortions are in fact taking place, resulting in greater numbers of mortality and morbidity.