Saturday, February 16, 2008
Unsafe abortions - The silent pandemic
published: Sunday | February 17, 2008
Heather Little-White, Ph.D., Contributor
Click here for article
As advocacy for increased access to safe, legal abortion continues in Jamaica, arguments for or against it are usually well presented. Unplanned or unwanted pregnancies are a reality of life, so Sheronbelieves that abortion should be made legal so that it can be safe for those who need to have one done. Sheron, 38, a victim of unsafe backdoor abortion, tells her story.
"I remember visiting the country at age 20 to visit my ailing grandmother. My grandmother had to be hospitalised and most times I was alone in the house. One day my uncle came home from work early, to my surprise. He always had 'eyes for me' but I used to tell him how disgusted I was with his behaviour. Later that day as I was taking a shower, I heard the bathroom door open, it was my uncle, naked as the day he was born ... he pushed me against the shower, and forced himself on me, raping me despite my pleas to stop. I could not fight him off with my small frame as he was a tall, heavyset man.
"I felt dirty and ashamed. Days later, I eventually found the courage to tell my mother, who did not believe me and accused me of telling lies on her brother. I cried even more. Weeks passed, I missed my period and realised that I was pregnant, I decided that no way could I carry a child for my uncle ... when my mother discovered that was I pregnant, she was alarmed and offered to take me to a 'doctor' in town.
"I remember ascending a flight of stairs to a dusty room where I was asked to lay on a table behind a black curtain. Today the visit is still vivid in my mind. I was given a cup of warn drink and soon felt drowsy. Later, the middle-aged 'doctor' asked me to spread my legs, he pressed my stomach hard, asked me to take a deep breath and I could feel a cold instrument being inserted into my vagina, then a piercing pain, after about an hour or so I was released in pain and blood, the bleeding continued for three days despite the doctor's promise of a couple hours. I realised that I had an abortion which resulted in infections and my inability to conceive later in life and the psychological effect is like a nightmare."
Sheron's story concurs with similar stories from an estimated 20 million women around the world who have unsafe abortions annually (Allan Guttmacher Institute, 1999). However, some victims of unsafe abortion do not live to tell the tale. Anti-abortionists argue that women should not find themselves in the position where they end with unplanned or unwanted pregnancies, even though these may occur for a number of reasons.
Like Sheron, pregnancy could result from incest or rape or from failure to use contraceptive, pressure from a partner not to use contraceptive, contraceptive failure and changes in circumstances that make a pregnancy unwanted, such as abandonment, relationship problems with husband or partner, risks to maternal health and financial difficulties. Women may also want to pursue educational or career goals and will want to postpone childbearing. The number of unplanned pregnancies illustrates the unmet needs of family planning.
The World Health Organisation (WHO) defines an unsafe abortion as a procedure to terminate an unintended pregnancy by untrained persons who are styled as 'doctors', and usually in unsanitary conditions that do not conform to medical standards. In the United States, a slang term for unsafe abortions is back alley abortions, characterised by the use of a coat hanger. The magnitude of unsafe abortions in the United States led to Roe vs Wade Supreme Court decision 1973 to legalise abortion in America.
In developing countries, unsafe abortion places women at risk because abortion is highly restricted by law, or where it is legally permitted safe abortion is not easily accessible. According to WHO, an estimated 20 million unsafe abortions are performed each year with 95 per cent in developing countries. Simply put, unsafe abortions are performed at a rate of eight per hour.
Unsafe abortion use self-induced methods which are crude, dangerous and even fatal. These include taking teas and herbal remedies, such as boiled avocado or basil leaves, wine boiled with cinnamon and raisins, boiled celery water with aspirin and bitter concoctions; ingesting alcohol and toxic solutions such as turpentine, detergent solutions, bleach and acid; pushing objects into the uterus, such as a stick, wire, coat hanger, knitting needle, ballpoint pen, bicycle spoke, rubber tubing; air blown in the vagina by a syringe and physical damage such as an abdominal or back massage, lifting heavy weight or falling or jumping from the top of stairs or roof when there is no other way to end an unwanted pregnancy. Pharmaceuticals administered include uterine stimulants, such as misoprostol or oxytocin, and quinine or chloroquine used for treating malaria.
On the contrary, safe abortions are performed by trained professionals in sterile conditions using safe methods like pharmaceuticals, suction curettage and induced labour. When performed in sanitary conditions, legal abortions are one of the safest procedures in contemporary medicine. However, the cost of safe abortions is usually prohibitive, which causes poor women to delay getting an abortion until later into the pregnancy when the risk is greater. Regardless of the legal status of abortion, the data show that poor women are at greater risk for undergoing unsafe abortions using primitive, unsafe methods for self-induced abortions.
Morbidity complications resulting from unsafe abortions include incomplete abortion, infection (sepsis), haemorrhage and trauma to the cervix, vagina and uterus and injury to internal organs, such as puncturing or tearing of the uterus. Long- term damage includes chronic pain, pelvic inflammatory disease (PID) and infertility. Death is also a consequence of unsafe, illegal abortions. Globally, WHO estimates that 68,000 women die each year from unsafe abortions. Teenagers comprise a significant proportion of victims of unsafe abortion because they tend to wait to seek abortion later than do older women and are at greater risk of complication.
Abortions conducted in unsafe conditions put the lives of many women at risk and present a grave public health problem to governments. Consensus from the IV World Conference of Women in Beijing 1995, posited that the majority of deaths, injuries and abortion-related health problems could have been prevented with improved access to health services, including safe and effective methods of birth control and gynaecological care.
Public health issue
At the 1994 International Conference on Population and Development (ICPD), nations around the world agreed that societies must ensure high-quality, compassionate treatment for complications resulting from unsafe abortions; provide access to family planning; reform restrictive laws that limit the availability of safe services and trained professionals and ensure safe abortion services. Public health record indicates that safe, legal accessible abortion improves health. The ICPD conference resolved that governments should work to eliminate unsafe abortions by an integrated, comprehensive approach involving health workers, policymakers and advocates.
Name changed for privacy