The right to abortion is one of the burning issues in Croatia, as well as many other parts of the world. The term termination of pregnancy or abortion means the complete expulsion or removal of the fetus, fetal membranes, and placenta from the uterus before the fetus has reached gestational age (the age of the fetus) sufficient for an independent life outside the mother’s body. In many developed countries, restrictive abortion laws are a thing of the past, but stigmatization remains a major problem we face in today’s society. Therefore, many studies have been conducted that answer the question of how restrictive laws and the stigmatization of abortion affect women’s health.
Intentional (induced) abortion is a common procedure in the world, and approximately 56 million are performed annually. The World Health Organization divides induced abortion into safe and unsafe given the safety of the procedure and the conditions in which it is performed. Safe abortion is one that is performed by appropriate methods, when the person performing the abortion is educated for it and when it is carried out in an appropriate health institution. Unsafe abortion is any abortion performed by a non-professional or inexperienced person, which is carried out by unsafe methods and in conditions that do not meet health standards.
RESTRICTIVE POLICY AND MATERNAL MORTALITY
Countries with restrictive abortion policies have much higher maternal mortality rates. Approximately half of all induced abortions are performed via unsafe methods. It is estimated that 47,000 women worldwide die each year from complications associated with unsafe abortion. Of the countries where induced abortion is strictly prohibited, 93% are developing countries. In these countries, most women who want to terminate their pregnancies cannot afford a safe procedure, so their only option is to perform the abortion in an unsafe way. For those purposes, women and non-professionals use a number of methods. Not only do these practices often not meet expectations, but they also often lead to various health complications. Some of the methods by which intentional abortions are performed or attempted are as follows:
- insertion of various foreign bodies via vaginal route, e.g., tree roots, chicken bones, pencils, wires, hangers, knitting needles, broken bottles, etc.
- oral ingestion of detergents, fabric softeners, bleaches, castor oil, turpentine, herbal concentrates, etc.
- vaginal intake of various fluids
- use of various pharmaceutical products such as aspirin, painkillers, laxatives, chloroquine, quinine, oral hormonal drugs, oxytocin, etc.
- various methods of self-harm.
MEDICAL CARE AFTER THE PROCEDURE
In developing countries, about 5 million women end up hospitalized each year due to complications arising from unsafe abortions. These complications can be mild, such as prolonged mild bleeding, but also very severe, such as sepsis and organ failure. In many countries with very strict abortion laws, the quality of post-abortion medical care is far from WHO guidelines.
Women who face complications due to unsafe abortions need urgent medical attention following the procedure. The lack of post-abortion health care is very pronounced in developing countries and is contributed by stigmatization, fear of legal penalties, and discriminatory attitudes of medical staff towards women who have had abortions, which manifest in neglect and ill-treatment. In such conditions, women often do not seek help until these symptoms become life-threatening. The longer they remain without treatment, the worse the outcome. A large portion of deaths related to induced abortions can be attributed to delaying much-needed health care.
The most common complication caused by intentional termination of pregnancy is bleeding, and it depends on the method used and the damage done to the genitals or the surrounding organs. Induced abortion can also result in infection caused by leftover parts of the fetus and non-sterile techniques. If left untreated it can lead to sepsis, septic shock, and other major complications.
Traumatic genital injuries most often occur due to the insertion of various objects, such as a hanger. If internal bleeding occurs, then it is difficult to estimate the total amount of blood lost.
Complications can also be caused by taking medications and various other chemicals. These can include local damage, as well as liver and kidney damage. In some cases, the termination of the pregnancy is unsuccessful, and the pregnancy continues with the damaged or undamaged fetus.
The fact that restrictive abortion laws do not reduce the number of abortions, as well as the consequences of such restrictions on women’s health point to the growing need to decriminalize abortion.
The editorial board distances itself from all political polemics and deals with this topic from a strictly scientific standpoint.
Translated by: Josipa Radeljak
2. Moseson H. et al. Self-managed abortion: A systematic scoping review. Best Practice & Research Clinical Obstetrics & Gynaecology, 2020, 87-110.
3. Abortion Worldwide 2017: Uneven Progress and Unequal Access, 2018., https://www.guttmacher.org, pristupljeno 8.3.2021.
4. United Nations, Department of Economic and Social Affairs, Population Division (2014). Abortion Policies and Reproductive Health around the World (United Nations publication, Sales No. E.14.XIII.11).