By Belinda Munyeza.
Worldwide, abortions have progressively become safer since the 1990s due to improved clinical facilities and protocols being made available to women seeking abortions (1). Even in regions with restrictive laws and where clandestine abortions are prevalent, abortions have become safer due to increased access to less invasive methods, such as the use of medical abortion pills (1). However, safe abortions are still not accessible enough.
According to the Guttmacher Institute (2), only an estimated 55% of abortions that occur worldwide are safe (2). In those countries with restrictive or unregulated termination laws, safe methods of abortion are still inaccessible to the vast majority of women. Which means that while the incidence of unsafe abortion has decreased over the decades, it is still very much prevalent, and unsafe abortions remain a threat to women’s health.
In South Africa for instance, restrictive and unregulated laws around abortion have allowed health-care practitioners to deny women access to abortion services due to personal bias or stigma. Even though abortion is legal in South Africa (with some restrictions), there are a significant number of cases that have arisen of women being denied access to abortion services by health-care providers (3), and this barrier to access of safe abortion caused by restrictive laws is further compounded by the fact that there is generally a lack of information for women about safe abortion methods. In many cases, without access to professional, clinical care and with little knowledge about safe abortion methods, women resort to unsafe methods that lead to health complications. According to The Guttmacher Institute (2017), in 14 developing countries in the world where abortion laws are restrictive, 40% of women who seek abortions experience health complications, with a worldwide annual estimation of 6.9 million women needing medical attention due to these complications (1).
In order to minimize the effect of this risk to women’s health, it is helpful to educate women on the unsafe and safe methods of abortion so that those who do have access to safe methods are aware of their options.
Unsafe Abortion Methods
A common method of unsafe abortion that women have had to resort to, is taking multiple pills, unprescribed by a health-care professional, and ingesting toxic substances or herbs, orally or inserted through the vagina. These two methods are very common in countries such as Zimbabwe, which has restrictive termination laws and an abortion black market where women can access abortion pills and herbal mixtures from unregulated providers, which often leads to complications (4). According to a 2016 PLOS ONE study (5), 4 out of 10 Zimbabwean women who seek abortions experience complications and only half are treated for them. This leaves the other 20% of women who seek abortions in this unsafe way in a very dire medical condition, and a lot of these women often don’t survive.
Some other unsafe abortion methods include the insertion of sharp objects into the uterus through the vagina and cervix. According to Medecins Sans Frontieres (6), this method is extremely dangerous as it can lead to medical complications such as sepsis, uterine perforation, severe haemorrhaging, and damage to the internal organs. Women who survive these complications can still have lasting reproductive effects as the trauma caused to the uterus due to this method of abortion may require removal of the uterus in order to be treated.
All of these serious effects can be avoided through improved global access to the safer methods of abortion.
Safe Abortion Methods
One safe method of abortion is medical abortion through taking the abortion pills, Mifepristone and Misoprostol, provided by a doctor or nurse in a medical facility. The procedure involves taking the first pill, Mifepristone, which blocks progesterone in the body and stops the pregnancy from growing, and then taking the second pill 48 hours later to allow the release from the uterus (7). This abortion method is 87%–98% effective (depending on gestational age) and has a very low likelihood of serious complications (7). The procedure is also noninvasive and can be done in any environment the woman seeking it feels comfortable, which makes it a very common option for women seeking safe abortion services.
Another safe method of abortion is Manual Vacuum Aspiration (MVA). This is a minor surgical procedure and is hence a little more invasive (8). MVA involves the use of suction to remove uterine tissue associated with pregnancy and is performed by a trained health-care practitioner. However, the procedure can only be performed within the first trimester and is less accessible than the abortion pill, which makes it a less common option. Nonetheless, consulting a trained health-care practitioner to determine which method is best for you is advised.
There is a lot that needs to change in terms of the restrictive laws surrounding abortion around the world, which lead to health risks for women who seek termination services. However, staying informed and educated on the options available and their implications can hopefully improve women’s access to the safest resources and, over time, this can lead to less health complications for women.
(1) Susheela, S., et al. “Abortion Worldwide 2017: Uneven Progress and Unequal Access.” Guttmacher Institute, 2018, www.guttmacher.org/report/abortion-worldwide-2017. Accessed March 2021.
(2) “Unintended Pregnancy and Abortion Worldwide.” Guttmacher Institute, 2020, www.guttmacher.org/fact-sheet/induced-abortion-worldwide. Accessed March 2021.
(3) “South Africa: Women and girls risk unsafe abortions after being denied legal services.” Amnesty International, 2017, www.amnesty.org/en/latest/news/2017/01/south-africa-women-and-girls-risk-unsafe-abortions-after-being-denied-legal-services/. Accessed March 2021.
(4) Muperi, Wendy. “Inside the illegal abortion market: ‘I nearly touched hell.” Bhekisisa Centre for Health Journalism, 2019, bhekisisa.org/article/2019-01-29-00-illegal-abortions-zimbabwe-shut-down-what-is-the-gag-rules-impact-contraception/. Accessed March 2021.
(5) Sully, E., et al. “Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016.” PLOS ONE, 2018, journals.plos.org/plosone/article?id=10.1371/journal.pone.0205239. Accessed March 2021.
(6) “Unsafe abortion: A forgotten emergency.” Doctors Without Borders, 2019, www.doctorswithoutborders.org/what-we-do/news-stories/story/unsafe-abortion-forgotten-emergency. Accessed March 2021.
(7) “The Abortion Pill – Get the facts.” Planned Parenthood, www.plannedparenthood.org/learn/abortion/the-abortion-pill. Accessed March 2021.
(8) “Vacuum Aspiration for Abortion.” Michigan Medicine, www.uofmhealth.org/health-library/tw1078. Accessed March 2021.