Abortion-most Wowen Die Anually

I came across this and i thought it would be helpful to us.





One serene Thursday afternoon late last year, Miss Franca Nzeako, a 23 year old single unemployed National Teachers Institute (NTI) graduate and the second in the family of seven was rushed to the Federal Medical Centre, Owerri, Imo State with a referral from another hospital.

On examination, she presented with abdominal pain, distension, and oliguria of two weeks duration. It was also discovered that17 days prior to presentation; she had terminated an eight week old pregnancy by unsafe means. The procedure reportedly carried out was dilatation and sharp curettage at a chemist’s shop in River State. During the procedure she bled significantly.

A day following the abortion, there was abdominal distension which progressively increased in size and passing of frequent stool. Franca was so weak she could hardly walk unaided. Her urinary output reduced remarkably despite adequate intake of food and water. For this, she presented to a hospital where she first received some medications which included antibiotics and infusions. After more than one week, she was not getting better and her parents who were now in the picture took her to another hospital in Imo State. She spent three days there before she was referred to the Federal Medical Centre.

At presentation, she was wasted, very pale, feverish and dehydrated. She had fast breathing, fast pulse and a low blood pressure. The abdomen was distended and very tender. She had a lower abdominal distension the size of a 22 week pregnancy. The vulva was smeared with blood, the cervix was hyperemic and open.

A provisional diagnosis of septic abortion, severe anemia and renal compromise were made. Ultrasound revealed pelvic abscess and bilateral renal failure. Her hemoglobin concentration was 6.2g/dl, and the renal function test was impaired. She was co-managed by the medical team and was transfused three units of blood before surgery was carried out on her.

At surgery, more than 700mls of pus was drained out of her peritoneal cavity. All her pelvic organs and intestines were bound down by adhesions and were not readily mobilisable. The vulva was smeared with blood, the cervix was hyperemic and open. Following surgery, she continued to have fever, vomiting and later developed fits, hallucinations and irrational behaviour. The renal function deteriorated with uraemia of 140 mg/ml.

The relations were informed on the need for dialysis but they declined, not because they did not wish Franca well, but for lack of finance. Her mother was already down with diabetes and subsistence farmer father and relations cannot afford the money. By the 30th day on admission, she deteriorated and passed on. The cause of death was renal failure secondary to septic abortion.

The story of Franca is not new and is one of the isolated cases. Research shows that many young women and even married women die massively every year as a result unsafe abortion in Nigeria. Only few who procure abortion from non-professionals and in an unhygienic environment survive it. An estimated 46 million pregnancies end in induced abortions each year and about 20 million of these are unsafe. About 13 per cent of pregnancy-related deaths have been attributed to unsafe abortions and 67,000 deaths annually.

According to World Health Organisation, about 211 million women worldwide become pregnant each year and that about two-third of them, or approximately 136 million deliver live infants. The remaining one-third of pregnancies ends in miscarriage, stillbirth, or induced abortion.

Of the estimated 46 million induced abortions each year, nearly 19 million are performed in unsafe conditions and or by unskilled providers and result in deaths of an estimated 68,000 girls and women. This represents about 13 per cent of all pregnancy-related deaths. Almost all unsafe abortions, according to WHO, take place in developing countries, and this is where 99 per cent of abortions-related deaths occur.

In Nigeria, 760,000 abortions occur annually despite the nations restrictive abortion laws, while unsafe abortion is one important reason that Nigeria reports one of the world's highest maternal mortality ratios at 1,000 deaths per 100,000 live births. About 95 per cent of unsafe abortions happen in developing countries and nearly half of all deaths resulting from unsafe abortion happen in countries like Malawi, Uganda, Zambia, Kenya, and Nigeria. Of the 210 million pregnancies that occur yearly, about 46 million (22 per cent) end in induced abortion, even when a vast majority of women would have had at least one abortion by the age of 49 years.

The burden is that every six minutes a woman dies needlessly as a result of an unsafe illegal abortion, obstructed labour or hemorrhage. And for every woman that dies 20 others are maimed for life. When a mother dies, the mortality rate of the under fives rise very sharply.

Abortion can be described as the termination of a pregnancy before the age of viability that is before 28 weeks gestation in Nigerian setting and before 24 weeks in the United Kingdom or before the baby attains a weight of 500g in the United States of America. It may occur spontaneously (on its own) as in miscarriage or it could be induced. Spontaneous abortion may be complete or incomplete, may be a missed abortion or inevitable or threatened while induced abortion may be complete or incomplete

From the beginning of time, when women make up there minds against a pregnancy they have been known to go to any extent to end it. Stories abound on the use of several dangerous methods like herbs, clothes hanger, cassava sticks, bamboo shoots, lime, potash , heavy alcohol to mention but a few to procure abortion. This has usually left them with serious morbidity and very frequently mortality.

Abortion procedure may be in two methods—surgical and medical methods. The surgical methods are through vacuum aspiration, which may be manual, pedal and hand pump or electric, sharp curettage (dilatation and sharp curettage), dilatation and evacuation, the World Health Organisation (WHO) recommends the manual vacuum aspirator. Medical methods are by misoprostol and mifepristone.

Abortion may be safe when the procedures are performed by trained health care providers with proper equipment, correct technique and sanitary standards, while it is unsafe when the procedure for terminating an unwanted pregnancy is done either by persons lacking the necessary skills or in an environment lacking the minimal standards or both, according to the WHO.

Complications arising from unsafe abortion could be classified as immediate and late. Immediate complications include bleeding, shock abdominal pain, fever, infection, uterine perforation, intra abdominal injury and death. Late complications include pelvic abscess, intestinal obstructions, pelvic adhesions, infertility, chronic pelvic pain, cervical incontinence, cervical stenosis, psychological problems, uterine synaechiae, dyspareunia and chronic vaginal discharge

According to Dr. Akuabia Nzeribe, gynaecologist and obstetrician, properly provided services for early abortions, save women’s lives and also avoid the often substantial cost of treating preventable complications of unsafe abortions.

One can not discuss about unsafe abortion and leave out the issue of maternal mortality, which has been described as the “…death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy from any cause related or aggravated by the pregnancy.”

Apart from the direct causes of maternal mortality which were highlighted earlier, some of the indirect causes include socio-economic factors, poverty, illiteracy ignorance political factors, cultural reasons and health system factors. These causes are being compounded by what some medical doctors described as the three delays models: delay in seeking medical care, delay in reaching health facilities and the delay in obtaining services at the facilities.

Interestingly, reduction of maternal mortality has been one of the major goals of several recent international conferences and has been included in the Millennium Development Goals (MDGs). However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult.

In recent years, new ways of measuring maternal mortality have been developed, bearing in mind the needs and constraints of developing countries in particular. As a result, there is considerably more information available today than was the case even a few years ago.

Nonetheless, problems of under-reporting and misclassification are endemic to all methods, and estimates that are based on household surveys are subject to wide margins of uncertainty because of sample size issues. For all these reasons, it is difficult to compare the data obtained from different sources and to assess the overall magnitude of the problem.

In response to these challenges and in order to improve the information base, World Health Organisation (WHO), United Nations International Children Emergency Fund (UNICEF) and United Nations Population Fund (UNFPA) developed an approach to estimating maternal mortality that seeks both to generate estimates for countries with no data and to correct available data for under-reporting and misclassification.

A dual strategy is being used which involves adjusting available country data and developing a simple model to generate estimates for countries without reliable information. The approach, with some variations, was used to develop estimates for maternal mortality in 1990 and 1995 and has been used again for generating these estimates for the year 2000 and subsequent years.

On the basis of the present exercise, the estimated number of maternal deaths in 2000 worldwide was 529,000. These deaths were almost equally divided between Africa (251,000) and Asia (253,000), with about four per cent (22,000) occurring in Latin America and the Caribbean and less than one per cent (2,500) in the more developed regions of the world. In terms of the maternal mortality ratio (MMR), the world figure is estimated to be 400 per 100,000 live births. By region, the MMR was highest in Africa (830), followed by Asia (330), Oceania (240), Latin America and the Caribbean (190), and the developed countries (20).

The country with the highest estimated number of maternal deaths is India (136,000), followed by Nigeria (37,000), Pakistan (26,000), the Democratic Republic of the Congo and Ethiopia (24,000 each), the United Republic of Tanzania (21,000), Afghanistan (20,000), Bangladesh (16,000), Angola, China and Kenya (11,000 each), Indonesia and Uganda (10,000 each). These 13 countries account for 67 per cent of all maternal deaths.

However, the number of maternal deaths is the product of the total number of births and obstetric risk per birth, described by the MMR. On a risk-per-birth basis, the list looks rather different. With the sole exception of Afghanistan, the countries with the highest MMRs are in Africa.

The highest MMRs of 1,000 or greater, are, in order of magnitude, Sierra Leone (2,000), Afghanistan (1,900), Malawi (1,800), Angola (1,700), Niger (1,600), the United Republic of Tanzania (1,500), Rwanda (1,400), Mali (1,200), Central African Republic, Chad, Guinea-Bissau, Somalia and Zimbabwe (1,100 each), and Burkina Faso, Burundi, Kenya, Mauritania and Mozambique (1,000 each).

The maternal mortality ratio is a measure of the risk of death once a woman has become pregnant. A more dramatic assessment of risk that takes into account both the probability of becoming pregnant and the probability of dying as a result of that pregnancy cumulated across a woman’s reproductive years is the lifetime risk of maternal death. The table shows that the lifetime risk of death is highest in sub-Saharan Africa, with as many as one woman in 16 facing the risk of maternal death in the course of her lifetime, compared with one in 2,800 in developed regions.

The purpose of these estimates is to draw attention to the existence and likely dimensions of the problem of maternal mortality. They are indicative of orders of magnitude and are not intended to serve as precise estimates. In addition, these estimates can help to stimulate greater awareness of and attention to the challenge of measuring maternal mortality. Following the publication of the 1990 and 1995 estimates, a number of countries have been undertaking special studies to assess the completeness and adequacy of their vital registration and health information systems. For other countries, particularly where the only source of data is from sisterhood surveys, the estimates can be used to highlight the potential pitfalls associated with such indirect measurement techniques.

The margins of uncertainty associated with the estimated MMRs are very large, and the estimates should not, therefore, be used to monitor trends in the short term. In addition, cross-country comparisons should be treated with considerable circumspection because different strategies are used to derive the estimates for different countries, making it difficult to draw comparisons.

In recent years, the issues of unsafe-abortion and maternal mortality have remained controversial and have been able to win large number of sympathisers, depending on the divide the person is. The pro-life or anti-abortionists as well as the church frown at the procurement of abortion, saying that it is tantamount to committing murder (the unborn). However, some medical experts and local and international organisations that are campaigning for safe abortion and reduction of maternal mortality in the country say that a woman should have the right to terminate a pregnancy if it is the appropriate choice for her.

Medical experts like Nzeribe and Dr. Ejike Oji, the country director of Ipas International believe strongly that a woman should be given the opportunity to make a choice about her reproductive life. That a woman should be able to choose to keep or terminate a pregnancy and if she wants to terminate it, the services of a professional and not a quack should be made available to her, while the professionals or experts would be allowed by the law of the land to render such services to her.

Both Nzeribe and Oji told ThisDay in Owerri recently that there is need to make information available to women on unsafe abortion and safe abortion so that they can make informed choice whether to go for termination of an abortion or not. They also agreed that the existing law on abortion should be reformed and made more liberal so that care givers would be able to render services to women who chose to seek for their services without being constrained by the law. Oji and Nzeribe further argued that what is killing the women is lack of information available to them. For example, they said if Franca and other women/adolescents had been empowered with information on their sexual and reproductive health and rights, some of these deaths would have been reduced drastically.

Unfortunately, the existing abortion law is not favourable to women’s reproductive health and the attempt to amend the law to make it liberal and promote other women’s reproductive health last year was thrown out at the National Assembly largely due to ignorance and other moral grounds that on their own have not in anyway promoted women’s reproductive health.

At various occasions, the National Council of Women’s Societies, Nigeria have called for the reform of the existing laws on abortion to include more indicators for the safety of both the service and the women, especially in cases of rape, incest and other health conditions. They also called for the sponsor of relevant health and social bills that support women’s reproductive health rights.

It is rather unfortunate that while the nation play politics with the laws that supposed to promote women’s health, women, especially the adolescents are dying in large numbers. Like Ejike asked recently: “must we continue to allow our women die emasse as a result of the opposition of some few Nigerians?”