Unsafe abortion

This paper draws the connection between the changes in the American perspectives on abortion in the second half of the twentieth century and shifts in the cultural, social and legal status of the society. The major change occurred in 1973, when it was ruled by the Supreme Court in Roe v. Wade that it was unconstitutional to restrict abortion by law for it violated a woman’s right to privacy. The law, however, left many special cases unaddressed, such as when a fetus becomes a person or when the government has the right to step in and claim protection over "human" life. The ambiguity of the laws left the debate over the legality of abortion open, and movements continued into the twenty-first century in attempt to both undo the ruling and to secure the reproductive rights of women. As perspectives are shaped by reproductive rights issues of the past, the issue continues into the twenty-first century with more unanswered questions.

Unsafe induced abortion in Myanmar is a hidden public health problem accounted for 10
per cent of total maternal deaths each year. The legal restrictions and the unavailability of the
contraceptive methods are the main barrier and the main reason for the women to access the safe
abortion services. The prevention of unwanted pregnancies by various family planning methods will
be the most feasible action legally and culturally. Moreover, the expansion of the legal limit to
certain conditions and accessible PAC services will save the women lives and improve the
wellbeing.

Menurut WHO (2020) Lebih kurang 10 juta kehamilan yang tidak diinginkan terjadi setiap tahun diantara remaja berusia 15-19 tahun di negara berkembang. Sekitar 5,6 juta aborsi yang terjadi setiap tahun pada remaja perempuan berusia 15-19 tahun, 3,9 juta termasuk aborsi tidak aman yang berkontribusi terhadap kematian ibu

The purpose of the research is to demonstrate how the practice of abortion in India involves state intervention in women’s personal lives. I demonstrate how significant contradictions arise in state practice towards women’s access to abortion. I discuss the implications of these contradictions for women. Moreover the sensitive issue of female feticide, which is the product of gender inequality, has been highlighted to show how this practice is culturally embedded and are generated indirectly by some of the state policies.
This research shows how abortions in India are often a breach of reproductive rights of women, and merely serve as a tool to address the concern about population explosion. Moreover the state has imposed the 1994 Pre Conception and Pre-natal Diagnostic Techniques Act to prohibit sex selective abortions from above, without bringing changes from below, which is making the law stringent implications ineffective.

Background: Globally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services.

Methods: This qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework.

Results: Thematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society.

Conclusion: Effective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised.

Background: Unplanned pregnancy is one of the major reasons that expose women for unsafe abortion in most developing countries. Unplanned pregnancies have negative consequences on the women themselves, for their children, siblings and the societies as a whole. So far, no study was conducted in the zone related to the prevalence and associated factors of unplanned pregnancy. Therefore, this study assessed the prevalence of unplanned pregnancy and associated factors among pregnant mothers attending antenatal care at Bale Zone Hospitals, Oromiya Region, Southeast Ethiopia. Methods: A facility-based cross-sectional study design was employed among 362 randomly identified mothers visiting Bale Zone Hospitals for antenatal care in May 2014. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0 software. Descriptive, bivariate and multivariate analyses were used to determine prevalence and identifying associated factors of unplanned pregnancy by considering p-value of 0.05. The results were presented in a narrative forms, tables and graphs. Abstract-Background: Unplanned pregnancy is one of the major reasons that expose women for unsafe abortion in most developing countries. Unplanned pregnancies have negative consequences on the women themselves, for their children, siblings and the societies as a whole. So far, no study was conducted in the zone related to the prevalence and associated factors of unplanned pregnancy. Therefore, this study assessed the prevalence of unplanned pregnancy and associated factors among pregnant mothers attending antenatal care at Bale Zone Hospitals, Oromiya Region, Southeast Ethiopia.

Aim: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion.

Methodology: This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented.

Findings: After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma.

Conclusions: The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting.

This paper was a written Contribution on General Comment for the Right to Life to United Nations Committee for Human Rights with special regard on abortion. In general it is inadmissible to solve social problems by killing innocent humans. If any difficult circumstances of a mother do not allow her to kill her toddler, then the same child may not be killed before its birth as well, by the same reasons. Therefore any legalization of abortion presumes that an unborn is not accepted as a human being in its full sense. After a discussion of different approaches to recognize humans I recommend 3 criteria, as these are together necessary and sufficient for that. All humans and only on humans are confirmed by 1) they live at least in a biological sense, 2) they come from humans and will evolve typically human, according to their hereditary and DNA, 3) they are characteristically different from all other people, in particular in the genetic information. These above 3 characteristics are present since conception. Starting with that date everyone is a complete and wholesome human being, because nothing else lacks. Furthermore human dignity can't grow and can't shrink, as it is independent on all properties or abilities. The meaning of human dignity is investigated as a mainly needed precondition for all Human Rights. As all humans starting with their conception up to their dead may claim their dignity to be inviolable, they may claim furthermore Equal Rights. This means a protection of their life in an equal way without any discrimination, by the same laws, due to the same reasons and with equal consequences on any violation. Finally the protection by law is discussed. A basic result is, that any Human Right that can be violated without any penalty is none. The penalty on any violation of the Rights to Life shall be independent of the person of the victim. Any dependence between the degree of protection and the victims person is a serious discrimination.

Introduction
Past outbreaks and the current pandemic show
that sexual and reproductive health and rights
(SRHR) are affected in times of crisis. With a global
shortage of contraceptives, rise in domestic violence, job loss and income insecurity, there is an
even greater need for abortion to be accessible
now. However, abortion laws and access vary
across the globe, and the current COVID-19 pandemic has further exposed SRHR inequalities.
Some European countries, such as England, Ireland, and France, have rightly moved to telemedicine for early medical abortions. Others capitalise
on the pandemic to promote far-right, anti-SRHR
policies and further restrict human rights. For
example, the parliament in Poland, where abortion access is very limited, attempted to pass an
anti-abortion bill at a time when mass protests
could not take place. In other jurisdictions, residents never had these rights to begin with. In
Malta, EU’s smallest member state, barriers have
always existed; COVID-19 has laid them bare.

Background: Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh.

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O Brasil vivencia uma realidade de pratica recorrente do aborto inseguro, configurando-se em um problema de saude publica, pois a mesma pode colocar em risco a vida e integridade fisica e emocional das mulheres que a realiza. Levando em consideracao esse contexto, foi desenvolvida uma revisao sistematica para compilar, apresentar e discutir dados produzidos nos ultimos 20 anos em pesquisas nacionais acerca das associacoes entre o tema do abortamento induzido e da saude mental. Espera-se que esta pesquisa contribua para a compreensao a respeito da producao nacional acerca das condicoes de saude das pessoas que abortam no Brasil, promovendo subsidios para uma atencao integral e humana a saude sexual e reprodutiva das mulheres.

Unsafe abortion represents a preventable yet major cause of maternal mortality and morbidity in India. Majority of these unsafe abortions are carried out by untrained persons and in unhygienic environment so leads to complication requiring tertiary care. Unsafe abortions are more common in countries with restricted abortion laws than the countries allow abortions. It is mainly observed in low socio-economic and especially in rural areas of developing countries. It is usually carried out by sharp metallic instrument, a common practice by untrained personnel. They do not have proper training and knowledge of anatomy of reproductive organs leading to various complications like infection, bleeding and even perforation of uterus. Uterine perforation, some time involve urinary bladder or intestine also.  Intestinal injury, although a rare complication but not rare in India, occurs when uterus is perforated through its posterior wall. Here, a case of unsafe abortion with a posterior uterine wall perforation, injury to the illeum and septic peritonitis and its consequences and preventive measures were discussed. It was found that as in this present case lack of education, social stigma attached to abortion, female feticide and law to restrict abortion compelled her to seek illegal methods for termination of pregnancy by unskilled personnel. So to prevent these unsafe abortions proper health education, awareness about various methods of contraception and easy accessibility to safer methods of abortion should be promoted.

Objective: To understand beliefs about unintended pregnancy and abortion and perceptions about male roles related to pregnancy decision-making among men in the Philippines.

Methods: Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being “afraid or troubled” or “afraid and planned to terminate” in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method.

Results: In-depth interview data from 15 men—each interviewed twice—and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the “sin” of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an
induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the “sin” of induced abortion.

Conclusion: Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated “sin”. This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.

Abortion stigma can be defined as a shared understanding that abortion is morally wrong and/or socially unacceptable. The stigma of abortion manifests within multiple levels, including media, law and policy, institutions, communities, relationships, and individuals. Abortion stigma is experienced through a) negative attitudes, affect, and behaviors related to abortion and b) inferior status experienced by women who seek abortions or who have abortions, abortion providers, and others involved in abortion care. Abortion stigma leads to the social, medical, and legal marginalization of abortion care around the world and is a barrier to access to high quality, safe abortion care.

Abortion stigma is a major barrier to adequate reproductive health care for women and a primary challenge for service delivery providers to address. Stigma contributes to legal restrictions on abortion that are accompanied by criminal penalties directed at women and abortion providers. In addition to the legal barriers, stigma shames and silences women who seek abortion services, marginalizes abortion providers, and contributes to myths and misperceptions about abortion in communities. Abortion stigma appears in many parts of the world, though it manifests differently according to law, culture, and religion. It is within these stigmatizing environments that organizations, communities, and individuals are engaged in innovative service-delivery programs to bring safe abortion services to women. Dedicated people, sometimes in incredibly difficult circumstances, conduct these programs.

Family planning was high on the agenda of governments during the first thirty years of Pakistan, resulting in a significant slowing down in the population growth rate during that period.  However, the advent of a regressive and reactionary government in the seventies resulted in viewing family planning as ‘un-Islamic’, leading to decreasing budgets and disbanding of national media campaigns for child spacing and use of contraceptives. As a result the steady growth in contraceptive practices and decreasing family size slowed down, and Pakistan was left far behind other Muslim and Asian countries with regard to population control.

The project ‘Abortion Stigma, The Unseen Barrier to Young People’ was designed to address the manifestations of stigma at the individual, community and organizational level that prevents young women / girls from accessing abortion services.  The specific objectives were:

i) Sharing, learning, developing IEC material & advocacy with community and service providers;
ii) Encourage young people through frequent visits, sensitization sessions to feel free and comfortable in accessing services with frequent interactive session
iii) Overcome socio-cultural barriers through capacity building training conducted with providers, peer educators and counselors on VCAT & de-stigmatization, and
iv) Documentation and dissemination of project outcome and learning.

The project corroborates the evidence emerging from research studies that there is a high unmet need for contraceptive services in families - in 2012 46% of all pregnancies in Pakistan were unwanted.  The state’s failure to meet its constitutional obligation of providing free quality health care to its citizens is reflected in the meagre budget for health care, most of which is spent on tertiary rather than primary health, with an emphasis on curative as opposed to preventive health, and regressive laws, which leave no room for abortion of unwanted pregnancies.

The gap is mainly filled by private providers, many of whom lack the skills, commitment, and resources to provide the required services, while many take advantage of weaknesses in the abortion laws to provide clandestine services of dubious quality at a high cost, putting women, families and babies both at health and financial risks.

The project has shown that the issue is complex, and needs to be tackled at multiple levels, including education of the community, access to safe and low cost abortion services which protect all client rights (e.g. privacy, confidentiality, informed decision making, choice of number of children, child spacing, and contraceptive method), involvement of youth and peer educators, encouraging satisfied clients to bring new clients to the service.

The project has been strategic in focusing on services which are legal and non-controversial (e.g. unwanted pregnancies of married couples, women whose life is at risk, etc.), while avoiding highly controversial issues (e.g. abortion of pregnancies resulting from extra-marital sex).  At the same time the project did not adopt a simple legalistic approach; rather it used a rights based approach where women and families desiring to abort pregnancies for valid reasons (e.g. rape, family complete, need for spacing, non-affordability, health reasons) were provided necessary services in a discreet manner.  Also when women had legitimate and urgent reasons to get an abortion but were not in a position to disclose it to their in laws or get their permission, the project provided women the space to make their own choices and to get safe abortion services in a discreet manner.

The presence of a large number of satisfied clients and peer educators has created a positive momentum which, if maintained and supported, could lead to shifts in societal attitudes towards abortion and other SRH issues which could, in the long term, lead to changes in the country’s legal structure as well.  However, this would be a long and arduous journey, and would require champions at many levels to see such a movement grow and flourish.  A close collaboration between government agencies, civil society actors, SRH providers, and community leaders can go a long way in building and sustaining a movement for the improved health of mother and children in Pakistan.

The pandemic of unsafe abortion in Nigeria caused partly by the restrictive nature of the law which prohibits induced abortion except to save a pregnant woman’s life and which has led to a denial of abortion in public hospitals or within the ambit of the law thereby compelling most women who are determined to terminate their unwanted pregnancies to resort to clandestinely unsafe abortion in the hands unskilled health care providers and more often than not in unsanitary conditions. The problem is an urgent public-health and ethico-legal issue in that like most other health issues the scourge of unsafe abortion continues to threaten women particularly in developing world, Nigeria inclusive. For instance, recent researches have revealed that of the approximately 19-20 million unsafe abortions are done yearly world, that nearly all 97% of such are in developing countries and, that an estimated 68000 women die as a result. In addition, millions more have to contend with short or long term complications. Accessibility to modern subsidise contraceptives can dispel the need for abortion in the first place while availability of abortion within the ambit of the law can reduce the soaring rate of unsafe abortion. To do otherwise is to continue to contend with the rising incidence of maternal mortality and/or be overburden by the cost of taking care of complications from unsafe abortions thereby over burden the already impoverished health care systems. As grave as the issues are, controversies based on individual’s nuances, perception and attitude persist to overshadow the public health impact of the problem. Be that as it may, this long essay studies the laws regulating abortion in Nigeria, a country with restrictive law and high incidence of clandestine and unsafe abortion and; in Australia which a country with a relatively liberal law on the concept and by far comparatively low incidence of the problems associated with unsafe abortion view to seeing what could be imported from that country in bid to fashioning law to deal with the harshness of the situation caused by the extant abortion laws in Nigeria.

O Brasil vivencia uma realidade de pratica recorrente do aborto inseguro, configurando-se em um problema de saude publica, pois a mesma pode colocar em risco a vida e integridade fisica e emocional das mulheres que a realiza. Levando em consideracao esse contexto, foi desenvolvida uma revisao sistematica para compilar, apresentar e discutir dados produzidos nos ultimos 20 anos em pesquisas nacionais acerca das associacoes entre o tema do abortamento induzido e da saude mental. Espera-se que esta pesquisa contribua para a compreensao a respeito da producao nacional acerca das condicoes de saude das pessoas que abortam no Brasil, promovendo subsidios para uma atencao integral e humana a saude sexual e reprodutiva das mulheres.

The implementation of a pre- and post-abortion health care strategy, adopted
in 2004 in Uruguay within a restrictive legal context prior to the decriminalization of
abortion in 2012, opened a window of opportunity to link women facing unwanted
pregnancies and abortion to health services in order to prevent unsafe abortion practices.
This article looks into the tensions generated by the change of focus from maternal-child
health to health and sexual and reproductive rights, and how those tensions operate.
Using semi-structured interviews and focus groups, the practices and perception and assessment
frameworks of professionals in their care of women facing unwanted pregnancy
and abortion in the National Integrated Health System in Montevideo are analyzed. The
results offer insights into some of the barriers and difficulties that can currently be observed
in the implementation of the new law.

Background The burden of surgical complications from unsafe abortion affects both health facilities and patients in most developing countries. This study aimed to determine the nature of surgical complications from unsafe abortion treated at the JFKMC, Liberia, and the estimated cost burden on facility and patient.MethodThis was a retrospective study of the medical records of patients who had exploratory laparotomy for complications of induced abortion and presented at the JFKMC from June 15, 2018, to December 15, 2019.ResultsThe medical records of 44 out of the 49 patients who had exploratory laparotomy for unsafe abortion were captured and analyzed. Surgical complications from unsafe abortion accounted for 17.8% out of the 276 gynaecological surgeries at the JFKMC, Liberia. The case fatality was 22.4%. The mean age of subjects was 29.00 ±6.06 years. About 1/3 of the subjects were in their teens, over 4/5 were single, and half were students. Almost 60.0% of the subjects terminated ...

Medical abortion (MA) is the mechanism by which the administration of one or more drugs willingly interrupts a pregnancy. Around 46 million induced abortions occur annually worldwide. About half of these are unsafe abortions and they occur in developing countries. With the goal of decreasing the number of maternal deaths due to unsafe abortions, the Medical Termination of Pregnancy (MTP) Act of India (1971) was adopted to legalise abortions. Medical method involving ingestion of oral drugs is an accepted mode of MTP. However, self-administration of MTP pill carries number of risks. This study was carried out on women who presented with complaints following self-administration of abortion pills.An observational study was carried out in 100 women who reported with complaints seeking medical help following consumption of abortion pills to the Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences and Pradyumna Bal Memorial Hospital (PBM), Bhubaneswar between Sep...

Background: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70,000 women die globally as a result, with majority occurring in the developing world. This study aims to determine the pattern of complicated unsafe abortions in Niger delta

Background: Unplanned pregnancy is one of the major reasons that expose women for unsafe abortion in most developing countries. Unplanned pregnancies have negative consequences on the women themselves, for their children, siblings and the societies as a whole. So far, no study was conducted in the zone related to the prevalence and associated factors of unplanned pregnancy. Therefore, this study assessed the prevalence of unplanned pregnancy and associated factors among pregnant mothers attending antenatal care at Bale Zone Hospitals, Oromiya Region, Southeast Ethiopia. Methods: A facility-based cross-sectional study design was employed among 362 randomly identified mothers visiting Bale Zone Hospitals for antenatal care in May 2014. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0 software. Descriptive, bivariate and multivariate analyses were used to determine prevalence and identifying associated factors of unplanned pregnan...

The implementation of a pre- and post-abortion health care strategy, adopted in 2004 in Uruguay within a restrictive legal context prior to the decriminalization of abortion in 2012, opened a window of opportunity to link women facing unwanted pregnancies and abortion to health services in order to prevent unsafe abortion practices. This article looks into the tensions generated by the change of focus from maternal-child health to health and sexual and reproductive rights, and how those tensions operate. Using semi-structured interviews and focus groups, the practices and perception and assessment frameworks of professionals in their care of women facing unwanted pregnancy and abortion in the National Integrated Health System in Montevideo are analyzed. The results offer insights into some of the barriers and difficulties that can currently be observed in the implementation of the new law.

Summery  Background: The Sub-Saharan Africa countries, overshadowed by unsafe abortion complications related to mortalities, have the highest maternal mortality ratio (MR) of any region in the world 900/100,000 live births. Even though there were a different article published on unsafe abortion in sub- Saharan African countries  on magnitude and determinants on unsafe abortion
Objective: To assess the magnitude, determinants, and prevalence of unsafe abortion in SSA (sub-Saharan African) countries. Method: We searched Pubmed central, Biomed central, Bio online international, Google scholar, African journal and Lancet, for studies on between 2008 and 2013. A search on unsafe abortion, we searched articles that focused on the current magnitude, determinants, prevalence and complications of unsafe abortions in SSA (sub-Saharan African countries).
Result: prevalence of unsafe abortion worldwide accounts for 13% of all maternal deaths with 20% of disability-adjusted life years (DALYs), 24% of all unsafe abortions occurred in Sub-Sahara African (SSA) countries. Each day, 192 women died due to unsafe abortion complications; that means one woman died in every 8 minutes in developing countries.

Keywords: unsafe abortion, maternal mortality in Sub-Sahara, post-abortion care, determinants of unsafe abortion & prevalence of unsafe abortion.