Abortion: its contribution to maternal mortality

Abstract

Every year between 100,000 and 200,000 women die from illicit abortion. In this paper the magnitude of the problem is described, those most at risk are identified and methods of preventing unwanted pregnancy are suggested. It is argued that midwives have a major role to play in family planning counselling and the provision of contraceptive services. Midwives can also reduce maternal mortality by resuscitating women when emergencies arise from incomplete abortion. This paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop is Kobe, Japan, October 1990.

PIP: 500,000 women die each year in pregnancy and childbirth, of which 100,000-200,000 are estimated to be the result of a poorly performed abortion. Inadequate abortion techniques also contribute to future reproductive problems. 40-60 million legal and illegal abortions are estimated to be performed annually. Latin American estimates of maternal deaths from illegal abortion amount to 50%. Recent evidence from urban areas in Africa shows a current problem with illegal abortion where none existed 10 years ago. Prevention of unwanted pregnancies is key to reducing legal and illegal abortions and maternal mortality. Pregnancy is a risk for younger women, older, high-parity women, and women with short birth intervals. Many cultural norms and values promote early marriage and pregnancy soon after marriage. Some societies have ambivalent attitudes toward adolescent sexuality. Cultural taboos and religious beliefs contribute to a lack of understanding of reproductive health among young people and families. The consequences are particularly important in the context of HIV infection and AIDS. The problems of older women are exacerbated by health systems which ignore their health needs, i.e., unavailability of suitable contraceptives. Low-birth-weight babies and anemia are caused by exhaustion from constant pregnancy, particularly at young ages. Promotion of breast feeding and the availability of appropriate contraceptives for birth spacing are needed. Midwives are often unaware of the problems associated with unwanted pregnancy and unsafe abortion, i.e., morbidity and mortality. Birth spacing information needs to be provided in pre- and post-natal care. Midwives also may not be trained or allowed to provide triage for incomplete or septic abortion. The public health system has failed to provide acceptable methods of birth control. Education and regulatory processes are needed to allow midwives to provide contraceptives.