ABORTION

Parejas, Nathan
Puno, Lyka
Rayala, Jomhel
Masamoc, Merry Grace
Mabanan, Arishka
Cañonera, Judy Ann
Learning Objectives
At the end of the chapter, the student is expected to:

• Understand the magnitude of abortion

• Identify reasons behind unplanned pregnancy
• Define Unsafe abortion and know contributing factors
• Understand different components of post abortal care
• Know the revised Penal Code of Ethiopia on Safe
abortion.
 ABORTION
is the termination or initiation of termination of
pregnancy before reaching viability (before 20weeks or
<500grams according to WHO or before 28 weeks of
gestation or less than 1kg fetal weight in Ethiopia and
UK).
It can be spontaneous where termination is not
provoked deliberately or induced when there is a
deliberate interference with the pregnancy for the sake
of terminating it.
Clinical stages of spontaneous abortion
are:
•threatened
•inevitable,
•incomplete,
•complete
•missed abortion.
If any of the stages mentioned get infected it is
called “septic abortion”.
About 15% of all clinically recognizable
pregnancies end in spontaneous abortions. It is
estimated that 30 to 50 million induced abortions are
performed annually in the world and about half of
these are performed illegally.
WHO characterizes unsafe abortion by the lack of
skilled providers, safe techniques, and/or sanitary
facilities. Unsafe abortion is the commonest cause of
maternal mortality.
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 a member of the society.
"Public Health Importance of Abortion"

Abortion-related morbidities and mortalities

• Unsafe abortion is a global problem. Millions of women around

the world risk their lives and health to end an unwanted
pregnancy. Every day, 55, 000 unsafe abortions take place–95 %
of them in developing countries-and lead to the deaths of more
than 200 women daily. Globally, one unsafe abortion takes place
for every seven births.
"Public Health Importance of Abortion"

Abortion-related morbidities and mortalities

• Every year, 68,000 deaths and about 5 million disabilities

occur globally due to unsafe abortion. One out of every eight
maternal deaths is due to abortion related complications. In
some settings a quarter or more of all maternal deaths are
abortion-related.
"Public Health Importance of Abortion"

Abortion-related morbidities and mortalities

• Many women fail to seek treatment for abortion-related

complications, leading to countless-and uncounted- deaths
outside of health care systems. Unsafe abortion is, however,
one of the most easily preventable and treatable causes of
maternal death and disability.
"Public Health Importance of Abortion"

Abortion-related morbidities and mortalities

• Between 20 and 50 % of all women who undergo unsafe

abortions need hospitalization for complications.
 Long-term Complications
Acute Complications • Chronic pelvic pain
• Incomplete abortion • Pelvic inflammatory disease
• Sepsis • Tubal blockage and
secondary infertility
• Hemorrhage • Ectopic pregnancy
• Uterine Perforation • Increased risk of
• Bowel injury spontaneous abortion or
premature delivery in
subsequent pregnancies.
Acute Complications
Acute Complications:
Incomplete Abortion
 Acute Complications:
Sepsis

Bacterial infections (most common by gram-negative bacilli &

gram-positive cocci):

-lungs (pneumonia)
-digestive system (stomach)
-urinary system (kidneys, bladder)
-infection after a surgery
Acute Complications:
Hemorrhage
 Acute Complications:
Uterine Perforation

is a potential complication of any

intrauterine procedure. It may be
associated with injury to surrounding
blood vessels or viscera such as the
bladder or intestine. If not diagnosed at
the time of the procedure it can
occasionally result in massive
hemorrhage or sepsis
Acute Complications:
Bowel Injury
Long-Term Complications
Long-Term Complications:
Chronic Pelvic Pain
Long-Term Complications:
Pelvic Inflammatory Disease
Long-Term Complications:
Tubal Blockage and Secondary Infertility
Long-Term Complications:
Ectopic Pregnancy
 Long-Term Complications:

Increased risk of spontaneous abortion or

premature delivery in subsequent pregnancies.

These complications can limit women’s productivity inside and outside

the home, constrain their ability to care for children and adversely
affect sexual life.
 WHY WOMEN FIND
THEMSELVES WITH
UNWANTED PREGNANCY?
Sexual assault
Some women have been
sexually abused or
molested, and they are
more likely to become
pregnant unintentionally.
Lack of parental care
Teenage or young girls are engaging in sexual
activity with people of the opposite sex
without using contraception because their
parents are not providing them with guidance,
which might result in an unwanted pregnancy.
Non-use of Contraception
Majority of unwanted pregnancies occur in non-
users of contraceptive methods. Despite the fact
that family planning services are more effective,
estimates suggest that, worldwide:

350 million couples lack access to information.

105 million married women
have unmet need for family
planning.
12 to 15 million women lack
access to services.
Many women leave hospitals
without any counseling.
Contraceptive Failure
Results in 8 to 30 million
pregnancies each year.
Sexual coercion or rape
Twenty to fifty percent of women and girls report sexual Abuse, rape or
sexual coercion which carries about 5% Risk of pregnancy in those in
reproductive age unless emergency contraceptives given.
Other factors include:
• Lack of control over contraception;
• Young age or single marital status;
• Abandonment or unstable relationship;
• Mental or physical health problems;
• Severe malformation of the fetus; and
• Financial constraints.
Why does induced Abortion Occur?
Each year women around the world
experience 80 Million unwanted pregnancies.
Out of these mothers, Nearly 42 million
decide to have an abortion and about 20
million of them undergo unsafe abortion.
A woman’s decision to get an abortion is not made in a vacuum,
but is bound up in society’s feelings about abortion as well as
her feelings about the pregnancy:
• Several social factors influence the emotional decision of
obtaining abortion
• The cultural attitudes toward family size also influence
woman’s perception of abortion. When large families are the
norm, she is viewed as, at best, odd. However, as norms change
and children become more of an economic burden, this should
remove another source of external pressure.
• Religious attitudes strongly affect the decision.
• Personal and interpersonal reasons for continuing the
pregnancy can be a great source of conflict. Often,
pregnancy is the unwanted byproduct of wanted sexual
relations, while a Pregnancy that is desired to prove her
ability as a Woman may have little relationship to desire
for the actual child.
• Age and martial status are important factors in the
decision along with number of other children already
born.
In some instances abortion is the first responsible decision the
woman has made, and often the effect is beneficial to other
children in a large family or to the woman planning an unwise
marriage. Counseling helps the outcome. A large benefit of
legalized abortion is the opportunity to talk with a trained
counselor.

Unsafe abortion is a public health problem, particularly among

young women since:
• Poor access to family planning information and Services
→ unplanned pregnancy
• They are less likely than older women to have the social
contacts and financial means to obtain a safe abortion
• Young women are more likely to delay seeking help and
hence seek terminations at more advanced stages of
gestation when the risks of morbidity and mortality are
higher.

In many African countries, up to 70 % of all women

hospitalized for abortion complications are younger than 20
Legislation and policies
National laws and policies on abortion
vary widely. In 98% of the world’s
countries; danger to the woman’s life is
recognized as a legal basis for
terminating a pregnancy.
When abortion is illegal,
• It is most difficult for a woman to obtain it,

• Society is generally against abortion, and

• The psychological trauma is generally great.

Once abortion is legalized, a supportive relationship
can be established and the decrease in external stress
will be accompanied by a similar decrease in negative
feelings.
• Up to 23 unsafe abortion/1000 women restrictive
laws compared to 2/1000 in permissive laws
• Mortality 34/1000 live births in restrictive countries
compared to 1 or less per 1000 live birth in liberal laws
Inadequate service's
Many developing countries lack adequate safe
abortion services. Healthcare workers often lack
the necessary knowledge and skills, and post-
abortion care is insufficient. This leads to
dangerous complications and delays in treatment,
further endangering women's health and lives.
What can be done about unwanted pregnancies and unsafe
abortions?
• Ensure universal access to family planning
• 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; and
• Work for changes in policies to safeguard women’s
reproductive health.
Contraceptive services and information.

• Prevent unwanted pregnancies through

comprehensive, client-oriented reproductive
health services especially family planning.
• During service provision one must be nonjudgmental in
attitudes,
• Confidential counseling and quality family planning
information and services, including emergency contraception,
should be universally accessible to all women,
• Special attention should be given to the needs of young
people, marginalized women, women living in situations of
conflict, and women at risk of sexual abuse, rape and violence.
Providing high quality appropriate services.
In more than 131 developing countries, induced
abortion is permitted in certain circumstances.
In countries where abortion is legal:

• Services should be safe and available

• Service providers must be carefully trained to
offer high quality services and compassionate
counseling.
• Providers must be well-informed about the legal
status of abortion and protocols for providing
services, so that women who are eligible can
access services quickly and without unnecessary
delays or bureaucratic procedures.
Offering post-abortion care.
Whatever the legal status of abortion, high quality services for
treating and managing complications of abortions should be
accessible to all women to reduce related maternal death. The
recently promoted abortion care approach is women-centered
approach of provision of the services. In the woman –centered
approach, the provider asks for and focuses on woman’s
concerns and interests and takes a comprehensive approach to
meeting every woman’s medical and psychological needs at the
time of treatment.
Key elements of post abortion care include:
1. Treatment of incomplete and unsafe abortion;
2. Counseling;
3. Family planning services;
4. Links to comprehensive reproductive health
services; and
5. Community and service provider partnerships.
Educating communities.
Education is critical for reducing the public
health problem of unsafe abortion. Health
education messages should be based on the
incidence and impact of unsafe abortion within
communities, and be sensitive to people's beliefs,
attitudes and practices.
Supportive laws and policies.
When laws are modified to allow greater access to
abortion- related services, such as legal changes,
must be accompanied by changes in the health
service structure.
• Development of appropriate service delivery
standards; protocols, guidelines and administrative
procedures;
• Restructuring of the health system to ensure
that high quality, safe services are available at
the lowest levels compatible with good quality
care.
• Staff must be trained and willing to provide
services; and
• Supplies of necessary equipment and drugs
must be available
• Requisite funds must be allocated for all these activities.
Policies and laws can contribute to unsafe abortion by
impeding women's ability to protect their sexual and
reproductive health.
Examples:
- Prohibitions on contraceptive delivery to unmarried
women and adolescents
- Requirements for spousal consent for the use of family
planning services.
Grounds on which Abortion is Permitted, revised abortion law of
Ethiopia, ( House of Parliament, 2005)

• When the pregnancy puts the woman's life at risk

• Fetal impairment or deformity
• When pregnancy follows Rape or incest( based on the woman's
complaint only)
• When pregnancy occurs in minors ( stated maternal age <18 years)
• The woman is physically and mentally unable to care for the
would- be born child
THANK Y O U!