Unsafe abortion: The dangers & the answers

Girl having consultation in Bolivian clinic

Induced abortion is a safe medical procedure when carried out by skilled practitioners in hygienic environments

Liberalize abortion laws, ensure you have the professional health system to support safe abortion – and you can reduce deaths from abortion by 91%. At least, that’s what was the experience in the 5 years following South Africa’s liberalization of abortion law in 1996.

Restrict abortion, and it’s a green light for untrained providers working in unsanitary conditions to carry out the unsafe abortions which have major impacts on health, and can lead to death.

So what are the risks? Immediately: severe bleeding, uterine perforation, tearing of the cervix, severe damage to the genitals and abdomen, internal infection of the abdomen and blood poisoning.

In the medium to  long-term possible repercussions of unsafe abortion  include reproductive tract infections (RTI – a 2 20 to 30% chance), and pelvic inflammatory disease (PID), chronic pain and infertility (20 to 40%). Then there’s the risk of ectopic pregnancy, miscarriage or premature delivery in subsequent pregnancies.

Looking into the detail, studies in public hospitals in Kenya and South Africa found that over one-third of patients seeking treatment for abortion complications presented after a second trimester abortion, when complication rates are higher than in the first trimester.

So what are the lessons? Self-induced abortion, abortion by traditional (non-medically trained practitioners), and lack of speedy access to proper care all put women at the greatest risk.

What works? Use trained midwives (as safe as physicians in providing first trimester abortion); opt for medical abortion (i.e. the use of drugs) as the alternative to first trimester abortion; after 12 weeks, preferred options include dilation, and evacuation, mifepristone, followed by repeated doses a prostaglandin, or prostaglandins alone.

Finally, services offered at the lowest level of the health care system and close to women’s homes offer the best prospects for rapid diagnosis, treatment and referral of abortion complications, and women seeking treatment for complications need to receive rapid, high quality care upon arrival at a health facility.