Charlotte DeLeo
Introduction
Unsafe abortion is one of the most neglected reproductive health problems in the developing world. Unsafe abortion accounts for 20% of pregnancy-related deaths in sub-Saharan Africa; 68,000 women die annually and over 5 million suffer morbidity from abortion complications (1). Performed by a skilled provider under sanitary conditions, abortion is one of the safest modern medical procedures (1). Of 42 million voluntary abortions occurring annually worldwide, 22 million are performed within formal healthcare system. The remaining 20 million abortions are unsafe- 98% of these occur in developing countries where there are restrictive abortion laws and/or limited access to trained providers (1,2). This paper argues legalization of abortion and a culture supportive of women’s reproductive rights -as seen in Tunisia- can be adopted by other developing countries- such as Kenya- where current policy, stigma and apathy for women’s rights cause unnecessary maternal death and disability.
Background on Unsafe Abortion
Unintended pregnancy affects 40% of reproductive-age women in sub-Saharan Africa (3). Consequently, abortion is often desired due to socioeconomic circumstances, maternal or fetal health, educational opportunities, desire for smaller families, unmarried status or rape. Unsafe abortion is defined as termination of pregnancy by an unskilled provider and/or occurring in an environment below minimum medical standards (4). Unsafe methods could include insertion of solid objects into uterus, dilation and curettage, ingestion of harmful substances, external force or consumption of pharmaceuticals (1). Complications include hemorrhage, sepsis, peritonitis, genital damage, abdominal injury and incomplete abortion; long-term complications include secondary infertility, subsequent pregnancy complications and chronic pelvic pain (5).
Incidence of unsafe abortion is affected by the legal framework within a country (1,6,7,8). Where abortion is illegal, women are more likely to obtain clandestine, dangerous abortions by backstreet providers or attempt themselves using hazardous and unhygienic techniques (1,2,4). Restrictive abortion laws disproportionately expose rural, young, poor and uneducated women to unsafe abortion due to poverty, ignorance and inequitable access to services.
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