Hesperian Health Guides
Chapter 9: Preventing Deaths from Unsafe Abortion
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- cannot care for another child
- pregnancy or birth too dangerous
- want to finish school
- no partner
- need to work
Around the world, most people agree that a woman should not have to die because of being pregnant.
Health workers often witness the difficulty or desperation a woman faces when she is pregnant and does not want to be. Many women in this situation decide to end the pregnancy. When a woman or another person does something to end a pregnancy or restore monthly bleeding, this is called "abortion."
A pregnancy can also end naturally, or because of serious illness or other problems, such as trauma or exposure to toxic chemicals. When a pregnancy ends for one of these reasons, it is called "miscarriage" or "spontaneous abortion." The danger signs after an abortion and after a miscarriage are the same.
Women have always known about ways to end pregnancy. Today, women in every country in the world — young and old, married and unmarried, with and without children — have abortions, even where abortion is restricted or prohibited by law.
Abortion can be safe for women, but often the abortions available to most women are not safe. Doctor Aruna Uprety, who helped us write this chapter, has spent much of her life working to end unsafe abortion in Nepal. Here is part of her story:
A mother’s death in Nepal
When I first became a doctor, I worked at a maternity hospital in Nepal. One day, a very sick woman lay on the examining table in front of me. She and her husband had walked for 3 hours from her village to get to the hospital. Her pulse was weak and she was very pale. As a new doctor just out of medical school, I was so sure I could save her. But she died in front of my eyes. Later, her husband told me their story:
They already had 5 children and neither of them wanted more. When she became pregnant again, they visited a healer in a nearby village. People said that the healer could end the pregnancy for very little money. The healer put herbs in his wife’s vagina with a stick. By the next day, the pregnancy had ended, but she continued to bleed, and she developed a fever. Three days later, she was very sick, and she fainted. Her husband decided to take her to the hospital.
I could not stop thinking about this woman’s story. Nothing in my training had prepared me for this. Abortion was illegal in Nepal, and women who had abortions could be put in prison. Later that night, I stopped a senior doctor in the hallway to ask her advice. She said, "Aruna, this is not unusual. We see 3 or 4 cases each month." She explained that most women with an infection from unsafe abortion recover in the hospital, but "in other cases, there is little we can do. Sometimes they die within the hour. Sometimes, they arrive here already dead."
I thought, "There must be something I can do to change this!"
For the rest of Aruna’s story, see The long struggle for legal and safe abortion in Nepal.
Many health workers like Aruna have become supporters of safe, legal abortion because they were unable to save the lives or health of women in their care who were harmed by unsafe abortions.
Access to family planning prevents unsafe abortion
If all women have access to family planning methods that work for them, fewer women will have unintended pregnancies or unsafe abortions. There would be fewer abortions if:
- family planning methods were freely available to anyone who wants them.
- each woman could choose the family planning method she prefers.
- both men and women took responsibility for using family planning.
Adolescents and young unmarried women are especially at risk for unintended pregnancy and unsafe abortion. They may have greater difficulty getting access to birth control, or do not try to get it because they don’t want anyone to know they are having sex. Or they may not have the power to insist that the men they are with use condoms. If they become pregnant, they may wait too long to get help because they are afraid to tell anyone or because they do not know the signs of pregnancy.
For more information about how to address these issues and make family planning methods available to all women who want to use them, please see Chapter 4: Sexuality and Sexual Health, and Chapter 7: Protecting Women’s Health with Family Planning.