(October 2002) About 13 percent of maternal deaths worldwide are due to complications related to unsafe abortion,1 although in some areas the figure is as high as one-third. Many of these deaths occur in countries where abortion is legally restricted, leading to procedures performed under unsafe conditions. The World Health Organization estimates that 19 out of every 20 unsafe abortions take place in the less developed regions of the world.2 These statistics may be underestimates, because unsafe abortion is probably responsible for many deaths that are attributed to nonmaternal causes.

Contraceptives prevent maternal deaths by reducing the number of times women go through pregnancy and childbirth.3 They also provide significant protection for women by preventing unintended pregnancies, which often end in unsafe abortions. These in turn can threaten the life of the mother or lead to infertility and related social stigma, such as the threat of abandonment. Contraceptives also allow women to delay motherhood, space births, and protect themselves from sexually transmitted infections — including HIV/AIDS (with condoms).

Regardless of the legal status of abortion, high-quality postabortion services for treating and managing the complications of abortion can save many lives.4 Women who undergo unsafe abortions may need medical care for complications such as sepsis, hemorrhage, and trauma. Long-term health problems include pelvic inflammatory disease and infertility.5 Postabortion care reduces maternal mortality and morbidity by providing emergency treatment of abortion complications, family planning counseling and services, nondiscriminatory treatment, and links to reproductive health services.

In Egypt, a project improved postabortion medical care and increased the use of family planning by postabortion patients in the obstetrics and gynecology wards of two hospitals.6 The project encouraged the use of manual vacuum aspiration under local anesthesia, which has been shown to be the most cost-effective and medically sound treatment for incomplete abortion. The project also increased providers’ and patients’ knowledge about the danger signs of complications associated with incomplete abortion and improved counseling of patients by hospital staff about obtaining contraceptive methods. While few patients were counseled about family planning options before the study intervention, more than half of the patients discussed contraception with their providers afterward. The project also had a strong positive impact on infection control procedures. For example, while the preintervention survey found that only 60 percent of physicians performed surgical procedures using sterile gloves, the practice of using them became nearly universal after the study.


Elizabeth Ransom is policy analyst, International Programs at PRB. Nancy Yinger is director of International Programs at PRB.


References

  1. Ann Starrs, The Safe Motherhood Action Agenda: Priorities for the Next Decade (Washington, DC: Family Care International, 1998): 56.
  2. “Unsafe Abortion — A Major Public Health Problem,” Safe Motherhood 28, no. 1 (2000): 4.
  3. Barbara Shane, Family Planning Saves Lives (Washington, DC: Population Reference Bureau, 1997): 1.
  4. Jerker Liljestrand and Kristina Gryboski, “Maternal Mortality as a Human Rights Issue,” in Reproductive Health and Rights: Reaching the Hardly Reached (Washington, DC: PATH and the Women’s Reproductive Health Initiative, 2001).
  5. “Unsafe Abortion a Worldwide Problem,” Safe Motherhood 28, no. 1 (2000): 1.
  6. Dale Huntington et al., “Improving the Medical Care and Counseling of Postabortion Patients in Egypt,” Studies in Family Planning 26, no. 6 (1995): 350-62.

Excerpted from PRB’s report Making Motherhood Safer: Overcoming Obstacles on the Pathway to Care (PDF: 734KB).