Unsafe abortion

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Soviet poster circa 1925. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both.[1] For example, an unsafe abortion may refer to an extremely dangerous life-threatening procedure that is self-induced in unhygienic conditions, or it may refer to a much safer abortion performed by a medical practitioner who does not provide appropriate post-abortion attention.[2]

Unsafe abortion is a significant cause of maternal mortality and morbidity in the world. Most unsafe abortions occur where abortion is illegal,[3] or in developing countries where affordable well-trained medical practitioners are not readily available,[4][5] or where modern contraceptives are unavailable.[6] About one in eight pregnancy-related deaths worldwide is associated with unsafe abortion.[7]

Overview[edit]

The World Health Organization (WHO) published an estimate that in 2003 approximately 42 million pregnancies were voluntarily terminated, of which 20 million were unsafe.[8] According to WHO and Guttmacher, approximately 68,000 women die annually as a result of complications of unsafe abortion; and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection (sepsis), haemorrhage, and injury to the internal organs, such as puncturing or tearing of the uterus). They also concluded abortion is safer in countries where it's legal, but dangerous in countries where it's outlawed and performed clandestinely. The WHO reports that in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe. According to WHO statistics, the risk rate for unsafe abortion is 1/270; according to other sources, unsafe abortion is responsible for one in eight maternal deaths.[9] Worldwide, 48% of all induced abortions are unsafe. The British Medical Bulletin reported in 2003 that 70,000 women a year die from unsafe abortion.[10] Incidence of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".[11][12]

An article pre-printed by the World Health Organization called safe, legal abortion a "fundamental right of women, irrespective of where they live" and unsafe abortion a "silent pandemic".[11] The article states "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative." It also states "access to safe abortion improves women’s health, and vice versa, as documented in Romania during the regime of President Nicolae Ceaușescu" and "legalisation of abortion on request is a necessary but insufficient step toward improving women’s health" citing that in some countries, such as India where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO’s Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: "As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets."[13] The WHO's Development and Research Training in Human Reproduction (HRP), whose research concerns people's sexual and reproductive health and lives,[14] has an overall strategy to combat unsafe abortion that comprises four interrelated activities:[13]

  • to collate, synthesize and generate scientifically sound evidence on unsafe abortion prevalence and practices;
  • to develop improved technologies and implement interventions to make abortion safer;
  • to translate evidence into norms, tools and guidelines;
  • and to assist in the development of programmes and policies that reduce unsafe abortion and improve access to safe abortion and highquality postabortion care

A 2007 study published in The Lancet found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. It also concluded that, while the overall incidence of abortion in both developed and developing countries is approximately equal, unsafe abortion occurs more often in less-developed nations.[15]

According to a new study in the The Lancet that focused on data from 2010 to 2014, nearly 55 million pregnancies are terminated early and of that 55 million, nearly half, 25.5 million are deemed as unsafe.[16] The World Health Organization and the Guttmacher Institute in New York, stresses the need for access to a safe abortion for all women and that unsafe methods must be replaced. Africa, Asia and Latin America account for almost 97 percent of them of unsafe abortions. These regions are often poorer and underdeveloped and lack the access to safe abortion methods. Out of all abortions in these regions only 25% are considered safe. In developed countries these numbers improve drastically. Nearly all abortions in North America (99%) are considered safe. Overall nearly 88% of abortions in developed countries were actually considered safe, with the number of safe abortions in Europe slightly lower.

Conflating illegal and unsafe abortion[edit]

Unsafe abortions often occur where abortion is illegal.[3] However, the prevalence of unsafe abortion may also be determined by other factors, such as whether it occurs in a developing country that has a low level of competent medical care.[17]

Unsafe abortions sometimes occur where abortion is legal, and safe abortions sometimes occur where abortion is illegal.[18] Legalization is not always followed by elimination of unsafe abortion.[4][19] Affordable safe services may be unavailable despite legality, and conversely women may be able to afford medically competent services despite illegality.[20]

When abortion is illegal, that generally contributes to the prevalence of unsafe abortion, but it is not the only contributor. In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.[6]

Illegality of abortion contributes to maternal mortality, but that contribution is not as great as it once was, due to medical advances including penicillin and the birth control pill.[21]

Incidence by continent[edit]

Region Number of unsafe abortions (thousands) Number of unsafe abortions per 100 live births Number of unsafe abortions per 1000 women
Africa 4200 14 24
Asia* 10500 14 13
Europe 500 7 3
Latin America and the Caribbean 3700 32 29
North America Negligible incidence Negligible incidence Negligible incidence
Oceania ** 30 12 17
World 19000 14 14
* Excluding Japan
** Excluding Australia and New Zealand

Source: WHO 2006[22]

Abortion in the U.S. before 1973 (Roe v. Wade)[edit]

In 1973, the Supreme Court ruled 7–2 that laws prohibiting an abortion violated a woman’s right to privacy. The landmark case, Roe v. Wade, changed abortion in the United States. Prior to Roe v. Wade, early abortion laws really only prohibited the use of toxic chemicals that were used to cause a miscarriage.[23]

In 1821 Connecticut passed the first law that regulated abortion, by barring the use of toxic chemicals.[23]

Prior to 1973 the authority to legalize abortion rested with the state governments. Up through the 1960s 44 states had laws that outlawed abortions regardless if the abortion threatened the well-being of the mother.[24]

In the 1940s records show that more than 1,000 women died each year from abortions that were labeled as unsafe. Many of these abortions were self-induced. Unsafe abortion practices were such a concern in the United States that nearly every large hospital had some type of “septic abortion ward” that was responsible for dealing with the complications that accompanied an incomplete abortion. Incomplete abortions were the leading cause for OB-GYN services across the United States.[25] In the 1960s, the National Opinion Research Center found that hundreds of women were attempting to self-abort with coat hangers, knitting needles and ballpoint pens, and by swallowing toxic chemicals like bleach and laundry detergent.[25]

Incidents in the U.S. after 1973[edit]

In 2005, the Detroit News reported that a 16-year-old boy beat his pregnant, under-age girlfriend with a bat at her request to abort a fetus. The young couple lived in Michigan, where parental consent is required to receive an abortion.[26][27][28] In Indiana, where there are also parental consent laws, a young woman by the name of Becky Bell died from an unsafe abortion rather than discuss her pregnancy and wish for an abortion with her parents.[29][30]

In 2011, Kermit Gosnell, a licensed doctor who provided abortion services in the American state of Pennsylvania, was indicted by a grand jury on murder charges after a woman died in his clinic. The grand jury found that the conditions in Gosnell's clinic were not only unsanitary and that Gosnell staffed his clinic with unlicensed individuals, he had also commonly conducted the lesser known practice of severing the spinal cords of newly born babies.[31]

Methods[edit]

Methods of unsafe abortion include:

Health risks[edit]

Unsafe abortion is a major cause of injury and death among women worldwide. It is estimated that nearly 25 million unsafe abortions take place annually.[36] Of this 25 million it is estimated that anywhere from 4.7% to 13.2% of maternal deaths come from a direct result of unsafe abortion practices, which disproportionately affect developing countries that lack safe abortion practices.[37] 97% of these abortions take place in developing countries.[38] Unsafe abortion is believed to result in approximately 69,000 deaths and millions of injuries annually.[38] The legal status of abortion is believed to play a major role in the frequency of unsafe abortion.[39][40] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[41] with abortion-related deaths dropping by more than 90%.[42] Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services.[40]

An unsafe abortion can lead to wide range of health risks that can affect the well-being of women. The major and most life threatening complications that stem from unsafe abortions are infection, hemorrhaging and injury to internal organs.[43]

Abortion symptoms that can lead to additional health risks:

  • To provide the necessary treatment, an accurate assessment of an unsafe abortion is critical. Some signs and symptoms that require immediate attention by a licensed health care provider include, but are not limited too: abdominal pain, vaginal infection, abnormal vaginal bleeding, shock (collapse of the circulatory system).[43]
  • It is difficult to diagnose complications that result from an unsafe abortion. A woman with an extra-uterine or ectopic pregnancy may have symptoms similar to those of incomplete abortion. Therefore it is important for health care providers to refer individuals they are unsure about to a facility where a definitive diagnosis can be made and care can be provided. [44]

Complications and their treatments include:

  • Infection: antibiotics prescribed by a health care provider and removing tissue from the affected area.
  • Hemorrhage: swift treatment by a health care provider is imperative, as delays can be fatal.

Damage to the genital tract or internal organs: Admission to a health care facility is imperative, any delay can be fatal.[45]

Treatment for abortion complications[edit]

Regardless if an abortion was legal or illegal, health care providers are required by law to provide medical care to patients, as it may be life-saving. In some cases, treatment for abortion complications may be administered only when the woman provides information about the abortion and provides information about any and all persons that were involved.[46]

It is difficult to get a confession from a women seeking emergency medical care as a result of an illegal abortion because it puts women's lives at risk. However, it is a legal requirement for doctors to report cases of women who have undergone any type of abortion. Any delay in care increases the risks to women’s health and lives. [46]

Illegal abortion[edit]

An illegal abortion may be called a "back-alley", "backstreet", or "back-yard" abortion.

The wire coat hanger method was a popularly known illegal abortion procedure, although they were not the norm. Mary Calderone, former medical director of Planned Parenthood, said, in a 1960 printing of the American Journal of Public Health:

Abortion is no longer a dangerous procedure. This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions as done by physician. In 1957 there were only 260 deaths in the whole country attributed to abortions of any kind, second, and even more important, the conference [on abortion sponsored by Planned Parenthood] estimated that 90 percent of all illegal abortions are presently being done by physicians. Whatever trouble arises usually arises from self-induced abortions, which comprise approximately 8 percent, or with the very small percentage that go to some kind of non-medical abortionist. Abortion, whether therapeutic or illegal, is in the main no longer dangerous, because it is being done well by physicians.[47]

Herbal abortions (when done illegally) can also be described as an unsafe abortions because they are not induced in a medical facility.

See also[edit]

References[edit]

  1. ^ Safe Abortion: Technical and Policy Guidance for Health Systems, page 12 (World Health Organization 2003): "a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skill or in an environment lacking the minimum medical standards, or both."
  2. ^ "Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003" (PDF). World Health Organization. 2007. Retrieved March 7, 2011. The estimates given in this document are intended to reflect induced abortions that carry greater risk than those carried out officially for reasons accepted in the laws of a country. 
  3. ^ a b Rosenthal, Elisabeth (October 2007). "Legal or Not, Abortion Rates Compare". New York Times. Retrieved 2009-06-30. 
  4. ^ a b Blas, Erik et al. Equity, social determinants and public health programmes, pages 182-183 (World Health Organization 2010).
  5. ^ Chaudhuri, S.K. Practice Of Fertility Control: A Comprehensive Manual, 7th Edition, page 259 (Elsevier India, 2007).
  6. ^ a b Singh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations Population Fund 2009): "If women’s contraceptive needs were addressed...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn Health" (Guttmacher Institute 2010).
  7. ^ Maclean, Gaynor. "Dimension, Dynamics and Diversity; A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives", pages 299-300 in Trends in Midwifery Research by Randell Balin (Nova Publishers, 2005).
  8. ^ "Unsafe abortion Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, pg2" (World Health Organization 2011): "It was estimated that in 2003 approximately 42 million pregnancies were voluntarily terminated: 22 million safely and 20 million unsafely."
  9. ^ Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Ob Gyn. 1: 77–81. 
  10. ^ Grimes, David A. (2003-12-01). "Unsafe Abortion: The Silent Scourge". British Medical Bulletin. 67 (1): 99–113. doi:10.1093/bmb/ldg002. Retrieved 2012-11-03. 
  11. ^ a b Grimes, David A. "Unsafe Abortion - The Preventable Pandemic*". Retrieved 2010-01-16. 
  12. ^ Nations, MK (1997). "Women's hidden transcripts about abortion in Brazil". Soc Sci Med. 44 (12): 1833–45. doi:10.1016/s0277-9536(96)00293-6. PMID 9194245. 
  13. ^ a b "Preventing unsafe abortion". WHO. Retrieved 2014-03-28. 
  14. ^ "New findings from the WHO Multicountry Survey on Maternal and Newborn Health". WHO. Retrieved 2014-03-28. 
  15. ^ Sedgh, Gilda; et al. (2007-10-13). "Induced Abortion: Estimated Rates and Trends Worldwide". The Lancet. 370 (9595): 1338–45. doi:10.1016/S0140-6736(07)61575-X. PMID 17933648. Retrieved 2009-05-31. 
  16. ^ Welch, A. (2017, September 27). Report finds nearly half of all abortions worldwide are unsafe. Retrieved December 05, 2017, from https://www.cbsnews.com/news/report-finds-nearly-half-of-all-abortions-worldwide-are-unsafe/
  17. ^ Chaudhuri, S.K. Practice Of Fertility Control: A Comprehensive Manual, 7th Edition, page 259 (Elsevier India, 2007).
  18. ^ Faúndes, Aníbal and Barzelatto, José. The Human Drama of Abortion: a Global Search for Consensus, page 21 (Vanderbilt University Press 2006).
  19. ^ "Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003" (PDF). World Health Organization. 2007. Retrieved March 7, 2011. In several countries, the legalization of abortion has not been followed by elimination of unsafe abortion. 
  20. ^ Safe Abortion: Technical and Policy Guidance for Health Systems, page 15 (World Health Organization 2003).
  21. ^ "Abortion Distortions: Senators from both sides make false claims about Roe v. Wade", FactCheck.org (2005-08-22): "Sen. Boxer claimed that overturning Roe v. Wade would cost the lives of more than 5,000 pregnant women a year. That might have been true before the invention of penicillin and the birth control pill, but it's not true now. The best evidence indicates that the annual deaths from illegal abortions would number in the hundreds, not thousands."
  22. ^ WHO pre-print copy of Grimes, David A; Benson, Janie; Singh, Susheela; Romero, Mariana; Ganatra, Bela; Okonofua, Friday E; Shah, Iqbal H. "Unsafe abortion: the preventable pandemic". The Lancet. 
  23. ^ a b CNN, By Jacque Wilson, (22 January 2013). "Before and after Roe v. Wade - CNN". CNN.com. Retrieved 7 December 2017. 
  24. ^ Kliff, Sarah (22 January 2013). "CHARTS: How Roe v. Wade changed abortion rights". Retrieved 7 December 2017 – via www.WashingtonPost.com. 
  25. ^ a b "What Americans Have Forgotten About The Era Before Roe v. Wade". ThinkProgress.org. Retrieved 7 December 2017. 
  26. ^ Cardenas, Edward; George Hunter (5 January 2005). "Boy Faces Felony in Baseball Bat Abortion". Detroit News. 
  27. ^ White, Pamela (January 13–21, 2005). "Baseball Bat Abortion". Boulder Weekly. Retrieved 2009-05-31. 
  28. ^ "Michigan: Restrictions on Young Women's Access to Abortion". NARAL Pro-Choice America. Retrieved 2009-05-31. 
  29. ^ "Pacifica Radio". 2003-01-22. Retrieved 2009-05-31. 
  30. ^ Platner, Jon (2006-09-15). "Remembering Becky Bell". Planned Parenthood Golden Gate. Retrieved 2009-05-31. 
  31. ^ "Investigation of the Women's Medical Society Grand Jury Report". Phila.gov. Retrieved 7 December 2017. 
  32. ^ Soubiran, Andre (1969). Diary of a Woman in White (English ed.). Avon Books. pp. 98–99.  citing Henri Modnor (1935). Fatal Abortions. 
  33. ^ Avery (pseudonym), Martin (1939). "My Family Speaks". Confessions of an Abortionist: Intimate Sidelights on the Secret Human, Sorrow, Drama and Tragedy in the Experience of a Doctor Whose Profession it is to Perform Illegal Operations (First ed.). Haldeman-Julius Company. . Accessed 14 December 2012.
  34. ^ Andrew Walker (7 April 2008). "Saving Nigerians from risky abortions". BBC News. Retrieved 31 May 2009. 
  35. ^ Rastegari E.C., Uretsky S. Encyclopedia of Surgery: Uterine stimulants. Accessed 14 December 2012.
  36. ^ Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z, Alkema L. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017 Sep
  37. ^ Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.
  38. ^ a b Grimes DA, Benson J, Singh S, et al. (November 2006). "Unsafe abortion: the preventable pandemic" (PDF). Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724. 
  39. ^ Berer M (November 2004). "National laws and unsafe abortion: the parameters of change". Reprod Health Matters. 12 (24 Suppl): 1–8. doi:10.1016/S0968-8080(04)24024-1. PMID 15938152. 
  40. ^ a b Berer M (2000). "Making abortions safe: a matter of good public health policy and practice". Bull. World Health Organ. 78 (5): 580–92. PMC 2560758Freely accessible. PMID 10859852. 
  41. ^ Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 2005). "The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change". BJOG. 112 (3): 355–9. doi:10.1111/j.1471-0528.2004.00422.x. PMID 15713153. 
  42. ^ Bateman C (December 2007). "Maternal mortalities 90% down as legal TOPs more than triple". S. Afr. Med. J. 97 (12): 1238–42. PMID 18264602. 
  43. ^ a b "Preventing unsafe abortion". World Health Organization. Retrieved 7 December 2017. 
  44. ^ Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports 59).
  45. ^ L Haddad. Unsafe Abortion: Unnecessary Maternal Mortality. Rev Obstet Gynecol. 2009 Spring; 2(2): 122–126.
  46. ^ a b Human Rights Committee; Committee Against Torture; Committee on the Elimination of Discrimination Against Women.
  47. ^ Butler, J. Douglas (8 December 2011). Abortion, Medicine, and the Law. Fideli Publishing Inc. p. 64. ISBN 978-1-60414-445-1. 

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