Chapter 4

Unsafe Abortion
 At the end of this session the students will be able to:

• Define abortion and unsafe abortion

• Differentiate the different classes of abortion
• Describe the public health importance of
abortion
• Identify the reasons for seeking abortion
• Discuss the current legal status of abortion in
Ethiopia
 Definitions

• Abortion is the termination or initiation of

termination of pregnancy before reaching
viability (before 20 weeks or <500grams)
(WHO) or
• It is termination or initiation of termination of
pregnancy before 28 weeks of gestation or
less than 1kg fetal weight (Ethiopia and UK).
• Abortion is more than a medical issue, or an
ethical issue, or a legal issue. It is, above all,
a human issue, involving women and men as
individuals, as couples, and as members of
societies (Tietze, 1978).

• Pro-choice Vs pro-life
 Trends of abortion

• First estimates of worldwide abortion levels since 1995

Key findings include the following:
• The global abortion rate has declined modestly
• Abortion rates have declined more in developed than in
developing countries
• Rates have declined most sharply in countries in the former
Soviet bloc
• The proportion of all abortions that are unsafe has
increased
• Almost 42 million abortions occurred in 2003, compared
with 46 million in 1995
 The legal status of abortion does
not predict its incidence

• The lowest abortion rates in the world—less

than 10 per 1,000 women of reproductive age
—are in Europe, where abortion is legal and
widely available
• By contrast, in Africa and Latin America and
the Caribbean, where abortion law is most
restrictive, the regional rates are 29 and 31,
respectively
 Legislation and policies
• When abortion is illegal
• It is most difficult for a woman to obtain
• Society is generally against abortion
• The psychological trauma is generally great
• Evidence shows that restrictive legislation is
associated with higher rates of unsafe abortion
and correspondingly high mortality
 Changes in abortion law between
1995 and 2007
• Seventeen countries liberalized their laws to
increase access to safe abortion: Albania,
Benin, Bhutan, Burkina Faso, Cambodia, Chad,
Colombia, Ethiopia, Guinea, Mali, Nepal,
Portugal, Saint Lucia, South Africa, Swaziland,
Switzerland and Togo
• Three countries tightened restrictions on
abortion: El Salvador, Nicaragua and Poland
 Definition of unsafe abortion
• The World Health Organization defines unsafe
abortion as a procedure for terminating an
unintended pregnancy carried out either by
persons lacking the necessary skills or in an
environment that does not conform to
minimal medical standards, or both.
 Trends in unsafe abortion
• Because the overall abortion rate has
declined, the proportion of all abortions that
are unsafe has increased from 44% to 48%.
• The unsafe abortion rate was essentially
unchanged between 1995 and 2003 (15 and
14 abortions per 1,000 women aged 15-44,
respectively).
 Examples of unsafe abortion
methods used

• Drinking turpentine, bleach or tea made with

livestock manure
• Inserting herbal preparations into the vagina
or cervix
• Placing a foreign body, such as a stick, coat
hanger or chicken bone, into the uterus
• Jumping from the top of stairs or a roof
 Complications of unsafe abortion
• An estimated five million women are hospitalized
each year for treatment of abortion-related
complications, such as hemorrhage and sepsis.
• Complications from unsafe abortion procedures
account for 13% of maternal deaths, or 67,000
per year.
• Approximately 220,000 children worldwide lose
their mothers every year because of abortion-
related deaths.
 Additional consequences
• Additional consequences of unsafe abortion
include loss of productivity, economic burden
on public health systems, stigma and long-
term health problems, such as infertility
 Public Health Impact of Abortion
1. Abortion-related morbidities and mortalities
 Unsafe abortion is a global problem
 Every day, 55,000 unsafe abortions take place s 95 % of
them in developing
 More than 200 women died daily
 Every year, 68,000 deaths and about 5 million
disabilities occur globally due to unsafe abortion
 Many women fail to seek treatment for abortion-
related complication
 However, unsafe abortion is one of the most easily
preventable
 Cont.….
• Between 20 and 50 % of all women who undergo
unsafe abortions need hospitalization for complications
such as:
Long-term Complications
 Chronic pelvic pain
 Pelvic inflammatory disease
 Tubal blockage and secondary infertility
 Ectopic pregnancy
 Increased risk of spontaneous abortion or
 premature delivery in subsequent pregnancies
 Cont.…
•Acute Complications
• Incomplete abortion
• Sepsis
• Hemorrhage
• Uterine Perforation
• Bowel injury
 Cont.…
2. Impact on the public health system
❖ Treatment of abortion-related complications:
•Often require several days of hospitalization
and staff time, as well as
•Blood transfusions, antibiotics, pain control
medications and other drugs.
Magnitude of Abortion in Ethiopia
• Accurate estimates are not available.
• But it is clear that abortion is widespread and
generally performed by untrained persons.
• It is the leading cause of maternal mortality.
• In a community-based study, abortion
accounted for 54.2% of the direct causes of
maternal deaths.
• Unsafe abortion accounts for nearly 60% of all
gynecologic admissions
 Why women find themselves with
unwanted pregnancy?
❖Non-use of contraception
The majority of unwanted pregnancies occur due to non
use of CO.
• Despite the fact that family planning services are more
effective and available than ever before;
• 350 million couples lack access to information about CO
• 105 million married women have unmet need for family
planning
• 12 to 15 million women may also lack access to services
 Cont.….
• After unsafe abortion, many women leave hospitals
without any counseling on how to prevent future
pregnancies
❖Contraceptive failure
• May be either from inconsistent or incorrect use of
family planning methods or method-related failure.
❖ Sexual coercion or rape
• ^Rape or sexual coercion which carries about 5% risk
of pregnancy in those in reproductive age unless
emergency contraceptives given
Why does induced Abortion occur?
• World experience; 80 million unwanted pregnancies
• Nearly 42 million decide to have an abortion s 20
million of them undergo unsafe abortion.
• The need to terminate the pregnancy may emanate
from the following factors:
• Social factors
• Cultural attitudes toward family size
• Religious attitudes strongly affect the decision
• Personal and interpersonal reasons for continuing the
pregnancy
• Age and martial status are important factors
 Inadequate services
o In many developing countries, safe abortion
services are not available to the full extent
permitted by law
o When women experience complications due
to unsafe abortion, appropriate medical care
is often unavailable or inaccessible.
o Lack of protocols for post-abortion care,
misdiagnosis, negative attitudes on the part of
health care providers
 What can be done about unwanted
pregnancies and unsafe abortions?
• Ensure universal access to FP
• Increase the availability of safe abortion
services to the extent allowed by law
• Improve the quality and accessibility of post-
abortion care
• Educate communities about reproductive
health and unsafe abortion
 QUIZ(10%)
1. List and describe the elements of PAC?
2. state the abortion law in Ethiopia?