Saving women s lives: the health impact of unsafe abortion

Transcription

1 Saving women s lives: the health impact of unsafe abortion - worldwide and in emergency settings SRHR in Emergencies: from policy commitment to implementation, DGD, Brussels, 18 October 2012 Thérèse Delvaux, ITM, Antwerp

2 Causes of maternal deaths Indirect causes 19% Severe bleeding 24% Other direct causes 8% Unsafe abortion 13% Obstructed labour 8% Eclampsia 13% Infection 15% 1 in 8 maternal deaths globally and 1 in 5 maternal deaths in Eastern Africa continue to be attributable to unsafe abortion

3 Definition: Unsafe abortion* Unsafe abortion is a procedure for terminating an unwanted pregnancy either: by persons lacking the necessary skills or in an environment lacking the minimal standards (dangerous methods or unhygienic conditions) or both * Abortion = termination of pregnancy before 22 weeks (up to 28 weeks ) Source: WHO

4 The health impact of unsafe abortions Each year, 22 Million unsafe abortions 47,000 women die each year from the effects of unsafe abortion 5 million women with temporary or permanent disability ews/2012/10/04/index.html

5 (Unsafe) abortion case-fatality rate highest in Africa Maternal deaths per 100,000 unsafe abortions Source: Guttmacher Institute Africa Asia LAC More developed

6 Poor women are most likely to experience serious abortion complications Of women having abortions, % experiencing serious complications Poor Nonpoor 20 0 Guatemala, 2003 Mexico, 2007 Pakistan, 2002 Uganda, 2003

7 Abortion occurs, worldwide Millions of women lack information and/or access to contraception = Unmet need for contraception; leads to millions of unintended pregnancies As long as there are unintended pregnancies, regardless of whether it is legal or safe or admitted by religion Contraceptive failure; gender and sexual violence Women in emergency settings are vulnerable and at-risk populations: Lack of resource, lack of access to contraception, sexual violence, selling sex for money

8 Making abortion illegal does not decrease its numbers Western Europe, abortion available on request, sexual education, high contraceptive prevalence 11 safe abortions per 1,000 women aged Africa, Asia, Latin America, restricted access to abortion and poor quality of care 33 mostly unsafe abortions

9 Barriers to safe abortion in emergency settings Women if in a foreign country might be unaware Of when abortion is permitted under local law Of availability of safe, legal abortion care services Health care practitioners not fully informed of broader indications for abortion (i.e. in the case of rape and incest) how a broader interpretation of protecting physical and mental health would permit them to provide a legal abortion Many clinics in emergency settings are not organised for abortion services, only offered at a referral centre located off-site Gaining access to them could still be a problem because of transport, organisational, financial or communication difficulties Many relief agencies are religiously affiliated, religious standards and practice might affect range of services Lehmann / Reproductive Health Matters 2002;10(19):

10 Intervention strategies: Everywhere 1. Family planning = Prevention of unwanted pregnancies = Reduction of need of abortion + Prevention of sexual and gender based violence 2. Offer appropriate post-abortion care Post abortion care is part of basic emergency obstetric care 4 important components : 1) Technical component; 2) Counselling (FP, STI); 3) Access to other RH services (STI) 4) Community mobilisation

11 IAWG - RH kits UNFPA since 1998 Subkit N Name of the kits 0. Training and Administration 1. Condom 2. Clean Delivery 3. Emergency Contraception 4. Oral and Injectable Contraception 5. STD Drug 6. Delivery 7. IUD 8. Management of complications of abortion 9. Suture of Cervical and Vaginal Tears 10. Vacuum Extraction 11. Referral Level 12. Transfusion

12 Intervention strategies 3. If induced abortion is legal: Offer quality services (same as post-abortion care), with sufficient accessibility (including financial) 4. If context of restricted laws regarding abortion In almost all countries, the law permits abortion to save the woman s life; in the majority of countries abortion is allowed to preserve the physical and/or mental health of the woman Provide services is the only option to save woman s life

13 Recent evolution: Medical abortion 50 countries registered mifepristone, 46 since 1999 Misoprostol: recognized for gynecoobstetrical use and post-partum hemorrhage

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16 NEW Edition! Recent: Video in English, French & Spanish 4/index.html 4/fr.html n/2011wallchart.pdf s/unsafe_abortion/en/