Unsafe abortion or clandestine abortion is the term used to terminate an unwanted pregnancy performed by people who lack the necessary skills or in an environment lacking minimal medical standards. 1 2 3 It can also refer to the practice of self-induced abortion in poor hygienic and sanitary conditions and to induced abortion performed by health personnel who do not provide adequate post-abortion care or perform abortion in poor conditions. 4
The unsafe abortion pandemic
Unsafe abortion is one of the most important causes of maternal mortality and maternal morbidity in the world. The World Health Organization (WHO) notes that every year 42 million abortions are induced – by women facing an unwanted pregnancy – 20 million of which are considered unsafe abortions, especially in countries where Abortion is illegal. 5 6 7 According to the WHO and the Guttmacher Institute , approximately 68,000 women die annually from complications of unsafe abortion and between 2 and 7 million a year suffer from severe and prolonged complications and illnesses ( incomplete abortion , sepsis, generalized infection, bleeding and Injuries to internal organs, such as perforation or tearing of the uterus). 8 9 They also concluded that abortion is safe in countries where it is legal, but dangerous in countries where it is declared illegal and carried out clandestinely. The WHO reports that in most developed regions or regions, almost all abortions (92%) are safe, whereas in developing countries more than half (55%) are unsafe, compared to only 6% in The developed world. 6 10 11 In other words, almost half of all abortions in the world are insecure; And almost all unsafe abortions (98%) occur in developing countries. 12 According to WHO statistics, the risk of unsafe abortion is 1/270, according to other sources, unsafe abortion accounts for one in eight maternal deaths . 13 14 Most unsafe abortions occur in countries where the practice of induced abortion is illegal or penalized, 5 or in developing countries where skilled and affordable doctors and health care providers are not available, 15 16 17 or where methods Contraceptives are not available. Legalization does not always eliminate unsafe abortion. 18 The British Medical Journal reported in 2003 that 70,000 women a year die from unsafe abortion. 19 20 18 21 22 4 16 23
A 2010 World Health Organization article considers that access to safe and legal abortion should be a fundamental right of women regardless of their place of residence and considers the numbers of abortion unsafe and its consequences as an epidemic or pandemic Silent. 24 The article states that “ending the silent pandemic of unsafe abortion is an urgent public health and human rights imperative.” He also states that “access to safe abortion improves the health of the woman . No adequate legislation as has been documented is only needed in Romania during the regime of President Nicolae Ceausescu ” but also requires the real and practical access Be restricted by other barriers-economic, social, cultural, etc.-. Thus, for example, in some countries , such as India , where abortion has been legal for decades, access to adequate medical and health care is restricted because of other barriers. The World Reproductive Health Strategy , adopted by the World Health Assembly in May 2004, noted: “As an avoidable cause of maternal mortality and morbidity , unsafe abortion must be addressed within the framework of the Millennium Development Goals. Millennium Development Goals (MDGs): 25
The WHO Office for the Development and Research Training in Human Reproduction (HRP), whose research focuses on reproductive health and the sexual life of individuals , 26 have a global strategy to combat Unsafe abortion comprising four interrelated activities: 25
- To collect, synthesize and generate solid scientific evidence on the prevalence and practices of unsafe abortion;
- Develop improved technologies and implement interventions to make abortion safe;
- To transfer the scientific and technological evidences to the norms, instruments and guidelines;
- Assist in the development of programs and policies that reduce unsafe abortion and improve access to safe abortion and high-quality post-abortion care.
A 2007 study published in The Lancet found that while the overall abortion rate fell from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures continued to account for 48 percent of all abortions performed in 2003 “It also concluded that although the overall incidence of abortion in developed and developing countries is approximately equal, unsafe abortion is more prevalent in less developed countries. 27 Anti-abortion critics argue that the results of this article in The Lancet are deficient, as there are no accurate statistics on abortion in developing countries . 28 29 In a 2005 report, WHO itself states that more than one-third of the 204 countries or regions examined did not report the number of deaths by sex, not even once, for the period 1995-2003. About half did not report Deaths by causes, sex and age, at least once in the same period. On the other hand, from 1975 to 2003 there has been limited progress in reporting deaths and their causes. 30
A public health problem
Unsafe abortion is one of the leading causes of injury and death among women worldwide. Although the data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, 97% occurring in developing countries . 31 The practice of unsafe abortion causes about 69,000 deaths annually and millions of serious injuries and illnesses. 31 The legal status of illegality of abortion plays an important role in the greater frequency of unsafe abortion. 32 33 This was the case in 1996, when abortion was legalized in South Africa , an immediate positive impact was seen in reducing the frequency of abortion-related complications, 34 with a reduction in abortion-related deaths of more than 90 %. 35 The World Health Organization promotes a public health approach to addressing unsafe abortion, with a focus on legalizing abortion, training medical personnel, and ensuring access to reproductive health and family planning services . 33 1
Incidence by continent
The figures for unsafe abortions are as follows: 36
|Region||Number of unsafe abortions||Number of unsafe abortions per 100 births||Number of unsafe abortions per 1000 women|
|Latin America and the Caribbean||3,700,000||32||29|
|North America||No data||No data||No data|
- * Not including Japan
- ** Not including Australia and New Zealand
- Source: WHO 2006 37
Latin America and the Caribbean
Of the 4.4 million abortions performed in Latin America and the Caribbean in 2008, 95% were rated as unsafe. Abortion with medications usually based on misoprostol obtained from a variety of sources is becoming increasingly common throughout the region and has increased the safety of clandestine procedures. The use of this method is particularly common in Brazil, Colombia, Ecuador, Mexico, Peru and the Dominican Republic. Women with no resources or other disadvantages resort to unsafe methods and inadequately trained people or places. Among Guatemalan women who have had an abortion, the proportion of traditional midwives is three times higher in poor rural women than in better-off urban women (60% vs. 18%). According to the World Health Organization , in 2008, 12% of all maternal deaths in Latin America and the Caribbean (1,100 in total) were due to unsafe abortions. About one million women in Latin America and the Caribbean are hospitalized annually to be treated for complications from unsafe abortions. The legality of the practice of abortion without restriction causes is in force in Cuba , Guyana and Puerto Rico . In the rest of countries there are restrictions in different degree. 1 38
The methods used for the practice of unsafe abortion are very dangerous and can cause death of women, including include: 39
- The rupture of the amniotic sac in the uterus with a sharp object or wire (for example, a straightened wire, a hanger or a knitting needle). This method can lead to an infection, which can lead to sepsis , or injury to the internal organs (eg perforation of the uterus or intestines ), leading in many cases to death. 40 The uterus softens during pregnancy and is very easy to pierce, so the traditional method was to use a large pen. 41
- Introduction of toxic mixtures such as chili and chemicals such as alum , disinfectants and cleansers like Lysol , permanganate or herbicide in the woman’s body . These methods can cause women ‘s toxic shock syndrome and death. 42 Among the herbs, in addition to chile and saffron , rue is produced in very small quantities, because it is very toxic; the yew and juniper , which are also toxic. The tangle , which people in the field consider abortive, is recommended by Pío Font Quer in his 1987 book Medicinal Plants. The Dioscorides is renewed only to regularize the menstruation if taken in very precise doses. The use of herbs is so widespread that in Birmingham were found 31 products that were sold in herbalists as abortive. These plants act basically like purgantes, causing very strong contractions of the abdominal muscles, that cause the expulsion of the fetus. 39
- Induction of an abortive without medical supervision by self-administration of abortion drugs, over-the-counter medications, illegally obtained drugs, with drugs not indicated by abortion, but known to cause or can cause miscarriage or uterine contraction. Drugs that cause uterine contraction include oxytocin (synthetic forms of oxytocin and Syntocinon ), prostaglandins and ergot alkaloids . Risks include uterine rupture , heart rhythm disturbances , increased blood pressure hypertension , drop in blood pressure ( hypotension , anemia requiring blood transfusion , cardiovascular problems, pulmonary edema , and death and bronchospasm in women with asthma . 43
The most dangerous methods to interrupt pregnancy and cause abortion are the vaginal injections of different soap solutions, salts of lead, mercury, aluminum, potassium permanganate, alcohol and Coca-Cola. Half of the products injected into the vagina kill almost fulminantly. Air pumped into the uterus can cause a fatal embolism; Quinine pills can also have deadly effects. In cases where non-sterilized material is used, or parsley or ivy tails, to dilate the cervix, the most frequent risk is that of strong infections that may involve removal of the matrix. 39
It is called a safe abortion that is practiced with sufficient sanitary guarantees and qualified medical assistance. Today medical protocols establish two types of safe abortion, medical abortion and surgical abortion . 44
The psychological situation of women must be favorable. There should be reviews or follow-up visits. The woman must authorize the abortion and the necessary surgical interventions, if they were precise. There must be sufficient emotional support. They must be of legal age or if there is less authorization or legislation that allows it. The woman should not suffer from incompatible diseases or be in contraindicated medical treatment. 45 46
Abortion with medication
In the case of medical abortion, there must be primary health care, clinic or hospital services as needed. An initial diagnostic study should be performed, with sufficient counseling; Prescription and administration can be done in consultation or in a clinic or hospital. Emergency services should be accessible at all times of the day to adequately monitor and resolve any incidents that may occur. 47
The medical abortion is contraindicated or requires special vigilance in the case of smokers over 35, patients with anemia, when He should confirmar- suspected ectopic pregnancy or undiagnosed adnexal mass. When there is coagulopathy or treatment with anticoagulants or chronic adrenal insufficiency or medication with systemic corticosteroids; Also when there is uncontrolled hypertension, cardiovascular diseases such as angina pectoris, valvular disease, arrhythmias, severe renal disease, hepatic or respiratory diseases, glaucoma, uncontrolled epilepsy, allergy or intolerance to mifepristone / misoprostol or other prostaglandins and also when there is Lack of access to 24-hour emergency medical services.
As for surgical abortion, this should be performed by qualified and authorized medical personnel, in authorized clinics or hospitals. As in the case of medical abortion, an initial diagnostic study should be conducted, with sufficient counseling. Medical supervision is necessary and emergency services must be accessible 24 hours a day.
Abortion clandestine and illegal
Specifically, clandestine abortion is one that is routinely performed in countries where its practice is penalized or illegal. The purpose is to conceal their realization as well as the identity of women in order to avoid any penalties that may be imposed by the authorities. Clandestine abortion can be performed in the country where it is illegal or in others where its practice is legal or is less punished ( abortive tourism ). Clandestine abortion when performed in countries where it is illegal is usually practiced under conditions of health or legal insecurity; When carried out in other countries, can be carried out under health and legal security conditions. 48 49 50
Clandestine abortion not only causes the death of the fetus, but also causes serious bodily injury to the woman who often leaves her disabled to conceive in the future, and in other cases causes her death.
Illegal abortion is done in countries or territories where the practice of induced abortion is penalized or that performed outside the established legal and sanitary protocols. The practice of induced abortion is not reduced in countries with legal restrictions so that their practice is performed in poor sanitary conditions. 51 52
Debate on abortion
The debate on induced abortion or voluntary termination of pregnancy refers to the discussion, controversy and controversy about its practice, social and economic context in which it occurs – especially for women – as well as the legal and penal situation applicable in the Different countries and the different implementation of reproductive rights and access to family planning . The two ideological currents involved in the debate on abortion are the movements that defend the legalization of abortion and the movements that oppose its decriminalization .
- ↑ Jump to:a b c Henry Espinoza, Lizbeth López-Carrillo, Unwanted pregnancy and abortion as a public health problem. Unsafe abortion in Latin America and the Caribbean: definition of the problem and its prevention, Gac Méd Méx Vol.139, Supplement No. 1, 2003
- Back to top↑ Safe Abortion: Technical and Policy Guidance for Health Systems , page 12 (World Health Organization 2003): “a procedure for terminating an unwanted pregnancy Either by persons lacking the Necessary skill or in an environment lacking the minimum medical standards, or Both . “
- Back to top↑ Risk-free abortion: technical and policy guide for health systems , WHO, Department of Reproductive Health and Related Research, 2012
- ↑ Jump to:a b «Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003» . World Health Organization . 2007 . Retrieved on March 7, 2011 . »The estimates given in this document are intended to reflect induced abortions that carry greater risk than those carried out officially for reasons accepted in the laws of a country.» Error in quotation : Invalid label ; The name “WHO-unsafe-2007” is defined several times with different contents
- ↑ Jump to:a b Rosenthal, Elisabeth (October 2007). «Legal or Not, Abortion Rates Compare» . New York Times . Consulted on 2009-30-6 .
- ↑ Jump to:a b ” Preventing unsafe abortion ” (World Health Organization 2011): “Each year nearly 42 million women faced with an unplanned pregnancy have an abortion, and about 20 million of them resort to unsafe abortion – often self-induced or Obtained clandestinely. “
- Back to top↑ Emergency management of unsafe abortion, Mexico, 2005
- Back to top↑ Abortions in poor conditions kill 70,000 women a year, London, Reuters, 10/13/2009
- Back to top↑ 70,000 women die each year in clandestine abortions, El Páis, Spain, 10/14/2009
- Back to top↑ You win votes, they play life, The newspaper.es, 4/30/2013
- Back to top↑ The rate of unsafe abortions worldwide grew 5% between 1995 and 2008, 20 minutes, 1971/2012
- Back to top↑ Facts about induced abortion in the world , Guttmacher Institute
- Back to top↑ Nour NM (2008). An Introduction to Maternal Mortality. Reviews in Ob Gyn 1 : 77-81.
- Back to top↑ Maclean, Gaynor. “Dimension, Dynamics and Diversity; A 3D Approach to Global Maternal Apprenticeship and Neonatal Health Initiatives” , pages 299-300 in Trends in Midwifery Research by Randell Balin (New Publishers, 2005).
- Back to top↑ WHO warns on rising unsafe abortion in developing countries, WHO, January 27, 2012
- ↑ Jump to:a b Blas, Erik et al. Equity, social determinants and public health programs , pages 182-183 (World Health Organization 2010).
- Back to top↑ Chaudhuri, SK Practice of Fertility Control: A Comprehensive Manual , 7th Edition, page 259 (Elsevier India, 2007).
- ↑ Jump to:a b Singh, Susheela et al. Adding it up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations Population Fund 2009): “If women’s contraceptive needs were addressed (and assuming no changes in abortion laws) Number of unsafe abortions would decline by 73% from 20 million to 5.5 million. ” A few of the findings in that report were subsequently changed, and are available at: ” Facts on Investing in Family Planning and Maternal and Newborn Health ” (Guttmacher Institute 2010).
- Back to top^ Grimes, David A. (December 1, 2003). «Unsafe Abortion: The Silent Scourge» . British Medical Journal 67 (1): 99-113. doi : 10.1093 / BMB / ldg002 . Accessed November 3, 2012 .
- Back to top↑ Chaudhuri, SK Practice of Fertility Control: A Comprehensive Manual , 7th Edition, page 259 (Elsevier India, 2007).
- Back to top↑ The World Health Report 2005: Make Every Mother and Child Count , page 50 (World Health Organization 2005): “A major contribution of maternal death and disability reduction is through its potential to decrease unsafe abortions.”
- Back to top↑ Faúndes, Aníbal and Barzelatto, José. The Human Drama of Abortion: A Global Search for Consensus , page 21 (Vanderbilt University Press 2006).
- Back to top↑ Safe Abortion: Technical and Policy Guidance for Health Systems , page 15 (World Health Organization 2003).
- Back to top↑ «WHO: Unsafe Abortion – The Preventable Pandemic» . Archived from the original on November 25, 2015 . Accessed January 16, 2010 .
- ↑ Jump to:a b http://www.who.int/reproductivehealth/topics/unsafe_abortion/hrpwork/en/index.html
- Back to top↑ Development and Research Training in Human Reproduction – HRP, WHO
- Back to top↑ Sedgh, Gilda; Et al. (October 13, 2007). ‘Induced Abortion: Estimated Rates and Trends Worldwide’ . The Lancet 370 (9595): 1338-45. doi : 10.1016 / S0140-6736 (07) 61575-X . PMID 17933648 . Accessed May 31, 2009 .
- Back to top↑ Mosher, Steven (October 12, 2007). ‘Worldwide Illegal Abortion Study Relies on Bogus and Biased Statistics’ . LifeNews.com . Accessed October 31, 2007 .
- Back to top↑ Lyons, Stephanie (October 19, 2007). «Study shows abortions just as likely to happen in countries where it is illegal» . The Daily Vidette Online . Retrieved October 31, 2007 .
- Back to top↑ United Nations Department of Economic and Social Affairs (2006). The World’s Women 2005: Progress in Statistics (PDF) . New York: United Nations. ISBN 92-1-161482-1 . Accessed May 31, 2009 .
- ↑ Jump to:a b Grimes DA, Benson J, Singh S, et al. (November 2006). Unsafe abortion: the preventable pandemic . Lancet 368 (9550): 1908-19. doi : 10.1016 / S0140-6736 (06) 69481-6 . PMID 17126724 .
- Back to top↑ Berer M (November 2004). National laws and unsafe abortion: the parameters of change. Reprod Health Matters 12 (24 Suppl): 1-8. doi : 10.1016 / S0968-8080 (04) 24024-1 . PMID 15938152 .
- ↑ Jump to:a b Berer M (2000). Making abortions safe: a matter of good public health policy and practice . Bull. World Health Organ. 78 (5): 580-92. PMC 2560758 . PMID 10859852 .
- Back to top↑ Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 2005). “The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change”. BJOG 112 (3): 355-9. doi : 10.1111 / j.1471-0528.2004.00422.x . PMID 15713153 .
- Back to top↑ Bateman C (December 2007). «Maternal mortalities 90% down as legal TOPs more than triple». S.Affr. Med. J. 97 (12): 1238-42. PMID 18264602 .
- Back to top↑ Unsafe Abortion, WHO
- Back to top↑ David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah. “” Unsafe abortion: the preventable pandemic ” » . World Health Organization ( WHO ) . Accessed January 27, 2017 .
- Back to top↑ Facts on abortion in Latin America and the Caribbean, Guttmacher Institute, January 2012
- ↑ Jump to:a b c Clandestine abortion, origin of numerous deaths. The most dangerous methods , El País, May 13, 1985
- Back to top↑ Soubiran, Andre (1969). Diary of a Woman in White (English edition). Avon Books. Pp. 98-99. Citing Henri Modnor (1935). Fatal Abortions .
- Back to top↑ Avery (pseudonym), Martin (1939). «My Family Speaks». Confessions of an Abortionist: Intimate Sidelights on the Secret Human, Sorrow, Drama and Tragedy in the Experience of a Doctor Whose Profession to Perform Illegal Operations (First Edition). Haldeman-Julius Company. . Accessed 2012-12-14.
- Back to top↑ Andrew Walker (April 7, 2008). «Saving Nigerians from risky abortions» . BBC News . Accessed May 31, 2009 .
- Back to top↑ Rastegari EC, Uretsky S. Encyclopedia of Surgery: Uterine stimulants . Accessed 2012-12-14.
- Back to top↑ Information for Women, in ICMA, in Spanish
- Back to top↑ Requirements to be met for treatment to take effect – Abortion with medication
- Back to top↑ Precautions – Abortion with drugs, Women on waves
- Back to top↑ Medical methods for abortion in the first trimester, BSR, The WHO Reproductive Health Library
- Back to top↑ http://sociedad.elpais.com/sociedad/2013/05/04/actualidad/1367696230_791189.html To London or the abortion of the neighborhood, El País, 5/5/2013]
- Back to top↑ Clandestine abortion, Peru, Delicia Ferrando, 2006
- Back to top↑ Clandestine abortion, a Latin American reality , Guttmacher Institute , 1994
- Back to top↑ International Perspectives in Family Planning, special issue of 1999. The Incidence of World-Induced Abortion. By Stanley K. Henshaw, Susheela Singh and Taylor Haas
- Back to top↑ Preventing unsafe abortion – WHO