HEALTH: Nearly half of all abortions in the world are ‘unsafe’

Close to half of the approximately 56 million abortions performed every year worldwide are unsafe. All but a relative handful of those 25.5 million risky abortions — which can endanger the lives of mother, child or both — occurred in Africa, Asia and Latin America, researchers reported in The Lancet medical journal.

In many African countries, less than 15 per cent of procedures to terminate pregnancy met minimum medical standards, according to data used to compile the global analysis.

The findings also highlight a strong link between abortion laws and safety.

“The highest proportions of safe abortions were seen in countries with less restrictive laws, high economic development and well developed infrastructures,” said lead author Bela Ganatra.

The study was based on data covering the 2010-2014 period.

14.4 % FELL INTO “LEAST SAFE”

In North America, 99 per cent of abortions were classified as safe, followed by northern Europe (98 per cent), western Europe (94 per cent), and southern Europe (91 per cent).
Unlike previous estimates, the new study divides the category of unsafe abortions into two groups, “less” and “least” safe.

“Less safe” abortions — accounting for 30.7 per cent of the total — include those induced with the drug misoprostol without the support of professional health providers, or those performed by trained personnel using outdated methods, such as scraping the lining of the uterus with a surgical tool.

Some 14.4 per cent of all recent abortions — more than eight million per year — fell into the “least safe” group, meaning those provided by untrained individuals using dangerous or invasive methods.
“The vast majority of unsafe abortions in Africa were categorised as ‘least safe’, and were associated with high rates of death,” the researchers said in a statement.
The share of safe abortions exceeded 50 per cent in only three developing world regions: southeastern Asia (60 per cent), western Asia (52 per cent), and southern Africa (74 per cent).

In countries where abortion is available upon request, more than 87 per cent of abortions were deemed safe.
In the 62 countries where the procedure is banned or allowed only to save a women’s life, barely 25 per cent of abortions were safe.

“Our findings call for the need to ensure access to safe abortions to the full extent of the law, particularly in low-income regions,” said Ganatra.

In Kenya, the constitution permits an abortion when in the opinion of a trained health professional there is need for emergency treatment or the life or health of the pregnant woman is in danger, or if permitted by any other written law.

However, there have been concerns that this has not increased access to safe abortions for women who need them, because no guidelines have been issued to clarify the basis for legal abortion as provided for by the law.

Moreover, the Penal Code has not been revised to reflect the new reality for permitted abortions; it still lists self-induced abortion and any other type of unlawful abortion as felonies punishable with a seven to 14-year jail term.

Regular statistics on abortion are hard to come by, but at the most recent count in 2013, a survey by the African Population and Health Research Centre showed that 464,690 abortions were procured in Kenya in 2012.

A previous 2002 estimate based on women treated in public hospitals for abortion-related complications over a three-month period, showed that abortions occur at the rate of 46 out of 1,000 women of reproductive age and that there are 266 deaths for every 100,000 women who attempt unsafe abortions in Kenya.

While the Ministry of Health is supposed to issue guidelines and training on legal abortions for healthcare workers, work on the Guidelines for Reducing

Morbidity and Mortality from Unsafe Abortion is still ongoing, with little knowledge on the timelines for issuing them.

As a result, the Federation of Women Lawyers (FIDA), went to court to compel the Ministry of Health to issue the guidelines and give clarity on permitted abortion as per the law. The case is still in court.