Low Socioeconomic Status Leading to Unsafe Abortion-related Complications: A Third-world Country Dilemma

Abstract

IntroductionAn unsafe abortion is a persistent, preventable dilemma. It is a procedure where an unintended pregnancy is terminated either by untrained individuals, or in an environment not meeting medical standards, or both, as defined by the World Health Organization (WHO). It endangers women in developing countries, where abortion is restricted either by law and culture or legally permitted but not easily accessible. Induced abortions are usually performed by unqualified and untrained individuals or are self-induced. Such incidents take place in unhygienic conditions and involve inappropriate methods or administration of medications. Even if carried out by medical experts, a clandestine abortion carries an additional risk, medical coverage is not immediately available in an emergency and the woman may not receive appropriate post-abortion attention. Induced abortion-related complications happen and the woman may hesitate to seek medical care. Unsafe abortion-induced complications contribute a major burden, such as increased hospital stay, drug costs, and an unusual delay of other operations on gynecological services in developing countries. The purpose of this study was to seek an association between low socioeconomic status and complications related to unsafe abortion.Materials and methodsA total of 296 female patients of child-bearing age presented between 2012 and 2015 in the emergency department (ED), Nishtar Hospital, Multan, after an unsafe abortion, were included. Spontaneous miscarriages and abortions cases carried out on legal or medical grounds were excluded. Patient or their attendants (who usually present the real picture of incidents leading towards unsafe abortion) were interviewed for determinants leading to unsafe abortion. A detailed clinical assessment of the patient was done and complications like hemorrhage, uterine perforation, and bowel perforation were recorded along with basic demographic information such as age, gestational age, parity, and weight.ResultsThere were 296 female patients in the study with a mean age 28.391 ± 4.57 (Range: 13-40 years). In a majority of patients, gravida and parity were 5-6. The mean weight was 60.283 ± 9.31 kilograms and the mean gestational age was 7.733 ± 2.45 weeks. The determinant in the shape of poor economic status was 71.6%. Hemorrhage was seen in 30.1% of the patients followed by uterine perforation (49.3%) and bowel perforation (45.6%).ConclusionOur results indicate that unsafe abortion is a major cause of maternal morbidity, mostly because the service is being sought from untrained healthcare providers in unhygienic conditions secondary to poor socioeconomic status. Since maternal morbidity due to unsafe abortion is a violation of a woman's basic human right: the right to life, there is a dire need to prevent these unwanted complications by improving the quality of the family planning program and providing safe abortion services.

The needs of women who have experienced “maternal near miss“: A systematic review of literature

“…[23] On the other hand, maternal morbidity is an inequality and discrimination in woman's human right: the right to life and survival; there is a dire need to prevent these unpleasant morbidities by improving the quality of care such as providing safe abortion services. [24] In addition, to provide quality services, the maternal morbidity-avoidable factors in hospitals should be identified and understood better, which can be cited for emergency obstetric causes such as preeclampsia, eclampsia, hemorrhage, sepsis, and thromboembolism. [2526]…”

No woman should be left behind: A decomposition analysis of socioeconomic inequalities in unsafe abortion among women presenting for abortion care services in Lusaka and Copperbelt provinces of Zambia

“…In this regard, a study from Ghana showed that about 60% of women under 25 years were more likely to have unsafe abortion [12] and in other parts of Africa [13]. Similarly, other studies have found that unmarried, lower education level and poverty are predictors of unsafe abortion [10, 12, 14, 15]. Also, some pregnancy-related factors such as being unaware that abortion is free, unwanted pregnancy, unmet need for modern contraceptive methods, and being unaware that abortion is legal have contributed to inequalities in unsafe abortion [16-19].…”

‘I guess we have to treat them, but … ’: health care provider perspectives on management of women presenting with unsafe abortion in Botswana

“…Approximately 17 million abortions that take place in LMICs are deemed unsafe (Alkema et al, 2016). Many of these unsafe abortions are either performed by unqualified and untrained individuals or are self-induced by the women themselves (Zafar, Ameer, Fiaz, Aleem, & Abid, 2018), with the highest incidence reported in sub-Saharan Africa where unsafe abortion occurs at rates of 18-39 per 1,000 women (Rasch, 2011).…”

“…Post-abortion, these women typically delay in seeking care, further increasing the risk of complications including bleeding, infection and uterine rupture. Evidence in the literature shows that these complications constitute a major burden of disease and contribute to prolonged hospitalisation as well as an increase in the cost of care (Zafar et al, 2018). Evidence also suggests that the direct costs of treating complications of abortion is a huge burden for LMICs and its indirect costs are catastrophic for families and communities (Grimes et al, 2006).…”