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Unsafe abortions around the world

January 15, 2011

Unsafe abortions have been getting lots of media coverage recently. Here’s a round-up of a few articles I’ve come across in the last few days:

In India (this Lancet article is part of a great series recently published about public health in India):

In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate…

Despite the liberalisation of abortion services since the early 1970s, access to safe abortion remains restricted, particularly in rural areas. Of the estimated 6·7 million abortions per year, only 1 million are thought to be provided by certified cadres at authorised centres. The typical woman seeking an abortion is married and aged 20—29 years, but a large number are young and unmarried, often seeking abortion in the second trimester. Many factors affect access to safe abortion services. The distribution of registered abortion facilities and certified providers is uneven across and within states. Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh together have 40% of the population but less than 17% of all approved abortion facilities. Moreover, most abortion facilities are located in urban areas, whereas more than 70% of Indian women live in rural areas. Aside from the inaccessibility of facilities, other obstacles include a lack of trained providers, perceived poor-quality care, little awareness that women are legally entitled to abortion, cost, and for young and unmarried women there is the fear of disclosure.

In Gulu District, Uganda:

GULU district registers more than 1,600 cases of unsafe abortions carried out by mothers and school girls every year, Sister Jane Rose Okilangole, the assistant district health officer, has said. “The Government must take action and increase funding towards reproductive health. Our parliamentarians should advocate for more funding to reduce maternal deaths ,” she said. Okilangole said statistics showed that in 2007/2008, a total of 1,982 mothers and school girls had abortions, in 2008/2009 1,160 aborted and in 2009/2010 1,681 aborted in Gulu district. Okilangole said some of the abortions were as a result of health complications, while others were done deliberately by school girls. She said only 20% out of Gulu’s population of 3,574,000, use family planning methods. “Last year, only 16,096 couples enrolled for family planning methods, an increase from 12,975 in 2008/2009,” she said. Okilangole said few men had adopted family planning methods. “Last year, 8 men enrolled for vasectomy, an increase from one in 2009,” she noted.

Here in Cambodia:

Authorities have long cited a lack of healthcare services in rural and remote areas as one of the major obstacles to reducing the Kingdom’s maternal mortality rate which, based on 2008 census data, is pegged at 461 deaths per 100,000 live births and is widely cited as among the highest in the region. Up to a quarter of these deaths are related to unwanted pregnancies, meaning that “roughly one woman dies every 10.5 hours from unsafe abortion”, according to the NGO Marie Stopes International.

In Nigeria:

Nigeria Country Representative of maternal health proponent, Ipas, Dr. Ejike Oji, notes that unwanted pregnancy and unsafe abortion are critical public health problems in Nigeria. “The very low use of modern contraceptives, the restrictive laws which only allows the termination pregnancy to save the life of a woman, the social stigma attached to abortion has caused many people to seek abortion from the wrong places leading to more deaths in the process,” Oji told Daily Independent. A finding by the researchers is that an increasing number of women in Africa, including those living in Nigeria want to delay their first birth and limit family size. “Unless the uptake of family planning can keep pace with these demands, it is likely the incidence of unsafe abortion and the total abortion will increase over the coming year,” the researchers wrote.

You’ll notice that every article mentioned of effective family planning and contraceptive use as a main cause of unsafe abortions. Here’s a chart showing how they compare with other countries worldwide with contraceptive use in 2005 (unfortunately more recent data isn’t available for all four countries in the same year):

(Thanks to this post at Brown Pundits for reminding me how cool the charts at Google Public Data are.)

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