Research: Prevalence of Induced Abortions

• Shahida Abbasi

Literature Review: Prevalence of induced abortion

Prevalence of inducedd Abortion in KP, Pakistan

Introduction: Maternal morbidity and mortality (MMR) due to complication of unsafe inducedd abortion constitute a major public health concern in many countries. It is assumed that most of the induced abortions are performed by unskilled personnel. Opting unsafe abortion may lead to severe morbidity and infection which results in affecting quality of life. The ultimate result of unsafe abortion is death, which is one of the contributing factors to increase MMR. Low literacy levels, ineffective use of contraceptive and high unmet need are major contributing factors for unintended pregnancies. World Health Organization (2008) most recent report estimated that each year 80 million unintended pregnancies occurs, of these 33 million are caused by ineffective use of a contraceptive methods. The World Health Organization defines” unsafe abortion as a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both”(p.1). Nearly all unsafe abortions (97%) are in developing countries. Grimes, et.al. (2006) estimated that 68 000 women die worldwide as a result of complications due to unsafe abortion. In addition, it is estimated that in 2008, in developing countries the rate of inducedd abortion has been increased from 78% to 86% in 1985. South-Central Asia accounts for 200 deaths per 100,000 abortions.

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In our country the actual data related to induced abortion are scarce due to under reported cases because of legal implications. Naqvi and Edhi (2013) revealed that Pakistan is among the top six countries where atmost half of the world’s all maternal deaths occur. Grimes, et.al. (2006) reported that in Pakistan, abortion rate was estimated 29 per 1000 women per yea.

Unlike other causes of MMR, death due to induced abortion is absolutely preventable. It is hypothesized that abortion rate is to be higher in the communities with poor socioeconomic status where contraceptive use is lower and rate of unwanted pregnancies is higher.

Significance of the study: There is scarcity of community base studies of induced abortions, especially in KP. Most of the studies on prevalence of induced abortion have been conducted in hospital setting. Only women, who develop complications after induction, visit for treatment. Consequently the hospital studies do not represent the true profile of the abortion seekers living in community level. Moreover, findings of this study will purely represent the profile abortion seeker and determinants which will enable the health professionals to plan safe and better care for them. Finally, findings of this study will be used to improve the standards of care in terms of knowledge and practice for induced abortion.

Purpose: The purpose of the study is to determine the profile of abortion seeker, prevalence of inducedd abortion, determinants, complication in the community level. In addition, this study also aims to identify standards of safe abortion care provided in the clinic in community level.

Study Question: To explore the prevalence and determinants of induced abortion in the community level in the Khyber Pakhtoonkhwa Pakistan.

1. What is the prevalence rate of induced abortion in the community level?
2. What is the level of knowledge of the women who seeks induced abortion?
3. What are the standards of safe abortion care in the abortion clinic?

Search Strategies: Pub Med, CINAHL and Mosby’s Nursing Consult used as data source for this paper. Studies published between February 2000 and February 2014 on the topic “induceds abortion” were included. To retrieve relevant literature, electronic databases were searched using a combination of the key terms, namely: (MMR), inducedd abortion, unsafe abortion, causes and complication. Net search was also extended to Google scholar, Population Council of Pakistan and WHO web search to capture the relevant studies. Search generated 150 articles, and through a selection process, 100 were rejected after reading the title and abstract of the article.

Inclusion Criteria:

Articles with the same key words published after 2000.

Exclusion Criteria:

Articles were excluded if the study explored:

(1) Abortion due to fetal anomalies

(2) Illegal abortion

(3) Abortion when the mother health is in danger

Critical Review Analysis/ Synthesis

Determinants of inducedd abortion: Rehan, Inayatullah, and Chaudhary, (2001) and Shah, Hossain, Noonari, and Khan,(2011) Study conducted in 32 clinics 452 women were interviewed to find out characteristics of Pakistani women seeking abortion. A majority of the women (36.6%) were aged 35 years, 61.0% had given birth to 5 children, among them only 40.2% were illiterate. among them (62.8%) were illiterate. The major cause for abortion were “multi-gravidity” (64.4%), contraceptive failure was the second highest cause (20.3%). Most of the abortions were performed by incompetently trained persons. Saleem and Fikree (2005) study also substantiate these findings (e.g., example multiparous). Most of the women irrespective of their education who undergone for induced abortion wanted a small family. Similar study conducted by Shah, Hossain, Noonari, and Khan,(2011) reported that n= 43 women who were admitted for treatment of induced abortion related complications. Of these (35%) died due to abortion related complications which accounts for 9.7% of total MMR. D&C is the most preferred method used for unsafe abortion (68.4%) despite the fact that manual vacuum aspiration (MVA) is safest technique for induced abortion. Most of the inducedd abortions were performed by untrained abortion providers (84.6%). It is assumed by the researcher that most of the doctors refuse to perform abortion because of having inadequate knowledge. On the contrary Rehan, (2003) reported that among 114 health professionals all of them were aware of the country abortion law. Of these 67.3% have negative attitude towards the induced abortion. One study conducted in field sites by Saleem and Fikree (2005) reported that the causes for unplanned pregnancies were ineffective use of contraceptive and desire to have small family size. The profile of abortion seeker is similar to reports from Rehan, et.al. (2001).

Complication of unsafe abortion:

A case study of a 29-year old woman who underwent for an unsafe abortion for unintended pregnancy reported by Naqvi and Edhi, (2013) that the unskilled person perforated the uterus during D&C and pulled out the intestine through vagina. Another study conducted by Shah, Hossain, Noonari, and Khan(2011) identified that septicemia was the most common complication (79%) followed by uterine perforation or bowel perforation (30.2%). Hemorrhage accounts for third frequent complication (20.9%). Shaikh, Abbassi , Rizwan, and Abbasi (2010) conducted a study n=230 on admitted patients with complication due to unsafe abortion. induced abortion for 80% of the women were performed by the trained health professionals while for 20% abortion performed by Traditional Birth Attendant (TBA). Major complications included uterine perforation and gastrointestinal injury, observed in (54.0%) women. Hemorrhage was observed in (26.0%) women. Of these 50 women, (12.0%) women died due to septicemia developed because of delay to avail health services after having unsafe abortion and related complications. Saleem and Fikree (2005) study findings shows that 61% of the women reported heavy vaginal bleeding and fever. 19 of these admitted for treatment due to complication of unsafe abortion. (7/19) received blood transfusion. D&C was the most frequent method for induction. This report indicates that induced abortion is a significant reproductive health problem causing morbidity and fatality, which needs special attention of the policy makers. Moreover, Rahim, Shafqat, and Faiz, (2011) study findings revealed that 9 women out of 268 died due to unsafe abortion in Peshawar, Pakistan, which accounts for 3.4% MMR.

Gap analysis: Despite the fact that induceds abortion is prohibited by the law and religion findings of the studies suggest that it fairly prevalent in the country. Majority of women, who develop complications, seek treatment from public hospital. Consequently the hospital studies do not represent the true profile of the abortion seekers living in community level. Moreover, findings of this study will purely depict profile abortion seeker and their problems which will enable the health professionals to plan safe and better care for them. Emphasis should be placed on improving the technical expertise of the health professionals in order to enable them to provide safe abortion care and treat unsafe abortion related complication. All those facilities which provide abortion care should be monitored against the WHO standards. Post abortion family planning counseling should be the part of the service.

By preventing abortions related complications and deaths we can save our children from becoming motherless.

References

Grimes, D. A., Benson, J., Singh, S., Romero, M., Ganatra, B., Okonofua, F. E., & Shah, I. H. (2006). Unsafe abortion: the preventable pandemic.The Lancet,368(9550), 1908-1919.

Khan, A. (2013). inducedd Abortion in Pakistan: Community Based Research.JPMA. The Journal of the Pakistan Medical Association,63(4 Suppl 3), S27-32.

Korejo, R., Noorani, K. J., & Bhutta, S. (2003). Sociocultural determinants of inducedd abortion. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP, 13(5), 260.

Ǻhman, E., & Shah, I. H. (2011). New estimates and trends regarding unsafe abortion mortality.International Journal of Gynecology & Obstetrics,115(2), 121-126.

Naqvi, K. Z., & Edhi, M. M. (2013). The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman.Patient safety in surgery,7(1), 1-4.

Rahim, R., Shafqat, T., & Faiz, N. R. (2011). An analysis of direct causes of maternal mortality.Journal of Postgraduate Medical Institute (Peshawar-Pakistan),20(1).

Rehan, N. (2003). Attitudes of health care providers to inducedd abortion in Pakistan. J Pak Med Assoc, 53(7), 293-6.

Rehan, N., Inayatullah, A., & Chaudhary, I. (2001). Characteristics of Pakistani women seeking abortion and a profile of abortion clinics. Journal of women’s health & gender-based medicine, 10(8), 805-810.

Saleem, S., & Fikree, F. F. (2005). The quest for small family size among Pakistani women-is voluntary termination of pregnancy a matter of choice or necessity?. quest.

Sathar, Z. A., Singh, S., & Fikree, F. F. (2007). Estimating the incidence of abortion in Pakistan.Studies in Family Planning,38(1), 11-22.

Shah, N., Hossain, N., Noonari, M., & Khan, N. H. (2011). Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan.JPMA-Journal of the Pakistan Medical Association,61(6), 582.

Shaikh, Z., Abbassi, R. M., Rizwan, N., & Abbasi, S. (2010). Morbidity and mortality due to unsafe abortion in Pakistan. International Journal of Gynecology & Obstetrics, 110(1), 47-49.

“WHO, Unsafe abortion: Global and regional estimates of the …” 2011. 22 Feb. 2014 <http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf>

World Health Organization. “Unsafe abortion incidence and mortality – World Health Organization.” 2012. <http://apps.who.int/iris/bitstream/10665/75173/1/WHO_RHR_12.01_eng.pdf>

“Unsafe Abortion: Unnecessary Maternal Mortality.” 2009. 22 Feb. 2014 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/>

“Safe and unsafe inducedd abortion – World Health Organization.” 2014. 22 Feb. 2014 <http://apps.who.int/iris/bitstream/10665/75174/1/WHO_RHR_12.02_eng.pdf?ua=1>

Newhouse, RP. “Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review.” 2011. <https://www.nursingeconomics.net/ce/2013/article3001021.pdf>

Rehan, N, Attiya Inayatullah, and Iffat Chaudhary. “Characteristics of Pakistani women seeking abortion and a profile of abortion clinics.” Journal of women’s health & gender-based medicine 10.8 (2001): 805-810.

Shah, Nusrat et al. “Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan.” JPMA-Journal of the Pakistan Medical Association 61.6 (2011): 582.

Shah, Nusrat et al. “Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan.” JPMA-Journal of the Pakistan Medical Association 61.6 (2011): 582.

Rahim, Rehana, Tanveer Shafqat, and Nasreen Ruby Faiz. “An analysis of direct causes of maternal mortality.” Journal of Postgraduate Medical Institute (Peshawar-Pakistan) 20.1 (2011).

“Maternal and Perinatal Health in Developing Countries.” 22 Feb. 2014 <http://books.google.com/books?id=tPi0-hLbTtEC&pg=PA112&lpg=PA112&dq=Shaikh,+Abbassi+,+Rizwan,+and+Abbasi+(2010)&source=bl&ots=crdQlY4AHg&sig=1ZNnZdi8q-99Pg7_vd1BOC0Gock>