Unsafe abortion: a global health crisis

We’d like to introduce you to Aminata*.

“I’m only 24 years old, unmarried still, and yet I have already had two abortions. In Senegal too, where sex, especially outside of marriage, is an enormous taboo, and where abortion is strictly illegal. So both my abortions happened in the deepest secret. The first one was performed when I was only 16 years old, in an expensive private clinic, under safe circumstances. It was over quickly and I had no complications. It was a huge family drama though. My mother was incredibly angry with me.

It was the second abortion that nearly killed me. I couldn’t put my mother through all that shame for a second time, so I told her nothing. I had already borrowed the 130,000 francs ($252) necessary to go back to the same clinic, when a friend suggested another option. She knew a guy that only cost 35,000 francs ($66). She wanted 25,000 francs ($48) though, for the tip she gave me.

The guy told me to undress and lie down on his filthy bed. I did, and he slid a thin, long plastic tube in my vagina. It was over in a minute. He then told me that the tube would come out by itself within three days. He also gave me an injection and prescribed me antibiotics. A few hours later, I began to bleed heavily. It didn’t stop for a whole week. On the seventh day, when the tube came out, I had immense pains in my lower stomach and contractions so strong they took my breath away. When I called the guy, he told me this was normal.

During the night though, the pain became unbearable. My parents still knew nothing, so I woke my niece, who lived in the same house. Her parents immediately rushed me to the hospital. In the first hospital, they examined me and told me I had to go to another, better equipped hospital, as my case was very serious. In the second hospital, they didn’t want to admit me, as there were already too many patients. It was only thanks to the intervention of my uncle, who is an influential army colonel, that they finally admitted me. The next day, a doctor examined me. He said what he was going to do would be very painful. He called a gorilla of a man, who held me so tight I couldn’t move a muscle. Then the doctor went inside me with his hand and removed at least a litre of crusty blood. The foetus also came out, which he then showed to me. He said I had lost dangerous amounts of blood, and I was in incredible pain. During the following days, though, I slowly recovered.

Of course, my mother found out everything. She refused to even look at me for a long time. Now everything is ok between us, but we never, ever talk about what happened. I don’t even want to be near guys anymore.1

The World Health Organisation defines unsafe abortion as ‘the termination of a pregnancy by people lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.’2

Each year, an estimated 210 million women throughout the world become pregnant and of them, approximately one in five get an abortion.3 Out of 46 million abortions performed annually, 19 million are estimated to be unsafe, indicating that a worryingly large proportion of women are in desperate circumstances with inability to access, or utilise, safe abortion services.3 

The burden of unsafe abortion is predominantly felt in the developing world, where 99% of procedures occur. The highest rates are located in Africa, Latin America and the Caribbean, followed closely by South-East Asia.3 On the other end of the spectrum, the rate of unsafe abortion in Europe and North America is almost negligible.3

uaworldmap
Estimated annual number of unsafe abortions per 1000 women aged 15-44 years, by subregions (WHO, 2008)

Methods of unsafe abortion include; drinking toxic fluids such as bleach, inflicting direct or external injury and procedures performed in unhygienic settings resulting in infections and uterine perforations.2

Some of the most dangerous and deadliest methods women have used over time include;

  • Consuming ergot – a fungus, which was believed to be effective at terminating pregnancies, however also causes gangrene, psychosis and even death
  • Bathing oneself in scalding hot water
  • Putting a leech, or cayenne pepper, up one’s vagina
ergot
An ergot fungus.

Despite unsafe abortion being one of the most easily prevented causes of maternal mortality, it remains one of the three leading causes, along with haemorrhage and sepsis from childbirth.3 Legal abortions, performed by properly trained individuals, are one of the safest procedures with minimal morbidity and negligible risk of death; women admitted for emergency post-abortion care therefore impose a preventable burden on the public health system by using up money, time and resources – all of which are available in finite quantities and need to be carefully distributed between patients in need. It is also vital to acknowledge the huge emotional, physiologic and financial cost on women and their families, as well as the widespread economic toll on countries through its burden on the health system and accumulation of lost productivity. 

For some, the distinction between unsafe and safe abortions is meaningless because they may consider abortion unacceptable regardless of safety. For others, this blog will hopefully inspire their commitment and interest in improving the quality of healthcare for women. Despite this, all must surely confront the lengths to which women will go and the risks they face when a pregnancy is unintended. The brunt of these costs is felt by women, their families and ultimately, society.

Check out this video from Marie Stopes International to paint a visual picture of the issue: 

*= fictional name used – the woman requested for her real name not to be included.

References

  1. Marie Stopes International (AU). Case Studies: my unsafe abortion experience [Internet]. Melbourne, VIC (Australia): Marie Stopes International (AU); 2017 [cited 2017 February 10]. Available from: http://www.mariestopes.org.au/case-studies/my-unsafe-abortion-experience/
  2. Ganatra B, Tuncalp O, Johnston HB, Johnson BR, Gulmezoglu AM, Temmerman M. From concept to measurement: operationalising WHO’s definition of unsafe abortion. Bulletin of of the World Health Organisation. 2014; 92(1): 155
  3. Haddad LB, Nour NM. Unsafe abortion: Unnecessary Maternal Mortality. Reviews in obstetrics and gynecology. 2009 Spring; 2(2): 122-126
  • Cover image: https://www.everymothercounts.org
  • Coat hanger protest sign [image]: http://www.medscape.com/viewarticle/849869
  • Ergot fungus [image]: https://www.flickr.com/photos/annkelliott/7844747364
  • Estimated number of abortions [graph]: Department of Reproductive Health and Research, World Health Organization. Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 [Internet]. WHO [cited 2017 February 09]. Figure 10, Estimated annual number of maternal deaths due to unsafe abortion per 1000 live births, by subregion, 2008; p.29. Available from: http://apps.who.int/iris/bitstream/10665/44529/1/9789241501118_eng.pdf
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