I.

Definition :

Bad effect to women’s lives

VII. The consequences of abortions for women’s lives

Unsafe abortions have different consequences on women’s health and lives. Beyond the fact that they pose a
major public health problem, they can affect the living conditions of women and their families, and
strain family budgets (Langer, 2003; Leone et al., 2016; Singh et al., 2009).

1. Unsafe abortions: a cause of maternal mortality

The annual number of deaths in the world due to an abortion has decreased over the last decades, from
69,000 deaths in 1990 to 56,000 in 2003, and then 47,000 in 2008 (WHO, 2011), the most recent year
for which a figure is available. The decline in mortality due to abortions follows a parallel trend to
that of maternal mortality overall: the number of maternal deaths went from 523,000 in 1990 to
289,000 in 2013 (WHO, 2014). In 2011, the WHO estimated that the proportion of maternal deaths
caused by an abortion remained relatively stable between 1990 and 2008, at around 13% (WHO,
2011).

But this type of result is sensitive to the methods used. According to a more recent WHO estimate of
the distribution of maternal deaths by cause between 2003 and 2009 in 115 countries (produced using
a hierarchical Bayesian model), only 8% of maternal deaths are due to abortion (Say et al., 2014). The
authors emphasized that this result cannot be compared to the previous figure of 13% because of the
divergence in the methods used in the two cases. The same year, a team from the University of Washington
published yet another different estimate, this one for the year 2013, using a distinct dataset and Bayesian
model (Kassebaum et al., 2014). They concluded that 15% of maternal deaths are due to abortion.

Only the WHO estimate for 2008 (WHO, 2011) provides the case fatality rate – the ratio of the
number of deaths caused by an abortion to the number of abortions – which was 220 per 100,000
abortions worldwide (or one death for every 455 abortions). The case fatality rate is extremely high in sub-
Saharan Africa (520 deaths per 100,000 abortions), relatively low in Latin America and Eastern Europe (30),
and virtually nil in developed countries and in East Asia, with the rates in other regions of Asia at
intermediate levels (between 70 and 200). The situation in the Polynesian islands is also concerning
(400 deaths per 100,000 abortions). Variations in case fatality rate between world regions result from
differences in the safety of abortions and the effectiveness of obstetric emergency services, which in turn
highly depend on the legal conditions of abortion, level of socioeconomic development, women’s financial
resources, available abortion techniques, and the stigma that surrounds the practice (Ganatra et al.,
2017). This mortality is distributed unequally among women and particularly affects the most
disadvantaged women in the poorest countries (Grimes et al., 2006).

2. Medical complications from unsafe abortions

Finally, in addition to the costs paid by individuals, particularly the poorest, postabortion complications also
carry high costs for healthcare systems, notably in the least advanced countries

While the number of women dying from unsafe abortions is shrinking, complications remain frequent.
The most common problems are incomplete abortions, haemorrhage, infections, and, in rarer and more
serious cases, septic

shock, uterine and intestinal perforation, and peritonitis. These problems are treatable, but the later the
treatment, the more serious the consequences. Abortion can also have long-term effects on women’s
health, such as sterility, anaemia, persistent weakness or pain, and inflammations of the pelvis or the
reproductive tract.
(p53,54….)

Real situation ( in some countries)

Medically, an abortion is defined as the expulsion or extraction from the uterus of a product of
conception that is presumed to be non-viable, i.e that has not reached a certain period of gestation
(less than 22 weeks, according to the WHO, 1977) or, in some cases, a certain weight (500 grams,
according to the WHO) or height. These norms vary depending on the definition used in each country,
and the criteria defining viability can also vary between countries depending on progress in medical
technology (Pignotti, 2009).

3. Psychological consequences of abortion

Ending a pregnancy is always a difficult decision for women to make, even more so when it is
prohibited and/or socially stigmatized. It is a source of tension for women and for couples, who are
torn between the social and sometimes religious norms that reject abortion and a personal (material,
emotional, work) situation that pushes them towards it (Arslan Özkan and Mete, 2010; Palomino et
al., 2011). In countries with easy access to modern contraception, women often feel responsible for an
unplanned pregnancy, which they consider avoidable (Bajos and Ferrand, 2011). The decision to abort is still
more difficult and stressful in contexts where the act is illegal because in addition to the health risks,
women may be punished by law or stigmatized by health professionals and the community.

(p56

4. The criminalization of abortion: punishing women

Abortion is often punishable for reasons prohibited by law; without the woman’s consent; and if
performed outside legally sanctioned contexts or beyond the gestational limit. These punishments
mainly affect women, but also the health professionals or other people who help them by providing
information or abortifacient products.

(p56,57)

( Document A.1. Definitions and types of abortions ,p.64, Document A.1. Abortion around the
world,…)