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Maternal Health
About 19 million of the estimated 45 million induced
abortions performed annually are unsafe (done by
untrained people in less-than-hygienic circumstances);
nearly 70,000 women die as a result, representing 13
per cent of pregnancy-related deaths.(47)
Many national health services dedicate a high
percentage of beds in second- and third-level facilities
to accommodate the large number of women who
require post-abortion emergency treatment. In sub-
Saharan Africa, up to 50 per cent of gynaecological
beds are occupied by patients with abortion
complications.(48)
The ICPD, in a groundbreaking consensus, called
for all women to have access to treatment for abortionrelated
complications, post-abortion counselling,
education and family planning services, regardless
of the legal status of abortion.(49)
Post-abortion care is cost-effective, reduces repeat
abortions and helps individuals meet their reproductive
intentions.(50) Many countries now recognize the
contribution it can make to saving women’s lives.
For example, Kenya’s 1997 reproductive health service
guidelines state, “The prompt treatment of post-abortion complications is an important part of health care that
should be available at every district-level hospital.” (51)
An international consortium has adopted a postabortion
care model, which aims to help women avoid
further unwanted pregnancies and other reproductive
health problems in addition to providing for their
emergency needs. First developed by the NGO Ipas,
the model includes: emergency treatment for complications
of miscarriage or induced abortion; family
planning counselling and services; management of
sexually transmitted infections; counselling tailored
to each woman’s emotional and physical needs; and
community and service provider partnerships.(52)
At least 40 countries have initiated post-abortion
care programmes since the ICPD, including Honduras,
Malawi, Mexico and Zimbabwe.(53) Facilities offering
post-abortion care in Egypt increased significantly
between 1999 and 2001,(54) and treatment of complications
of incomplete abortion is now part of essential
obstetric care protocols.(55)
Myanmar’s Department of Health integrated postabortion
care and contraceptive services into existing
health care at the township level. Midwives now
make follow-up home visits to women with abortionrelated
complications and provide family planning
methods when requested.(56)
SERVICES FALL SHORT. Yet, lack of access to treatment
for incomplete abortion remains a major
problem. A study in Ethiopia found that only 16 of
120 health centres were able to respond with
emergency transport to assist a woman needing
post-abortion care.(57) Documenting the need for postabortion
care is difficult. One hospital study in Kenya
found abortion was an important cause of admission
but was rarely recorded as the cause in the death register,
“a fact likely due to the stigma attached to
abortion-related mortality”. (58)
The social taboos surrounding abortion(59) and the
penalties for both women who seek abortions and
those who provide them are further challenges in
many countries, even where post-abortion care is
legal. A study in Zimbabwe found that the most
common reason given for not seeking prompt medical
attention for abortion complications was fear of being
reported to the police.(60)
Adolescents undergo a major share of illegal abortions.
For them, stigma, shame and disapproval from
providers can be intense and may discourage many
from seeking treatment.
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