Unsafe Abortion (Warning Graphic Details, Graphic Imagery)

Russian Abortion Poster circa 1925, National Library of Medicine

Translation of text at top: "Miscarriages induced by either trained or self-taught midwives not only maim the woman, they also often lead to death." Caption for upper-left picture: "Visiting the self-taught midwife" Upper-right picture: "Consequences of miscarriage" Lower picture: "Death from miscarriage" Text at lower left: "Any miscarriage is harmful." Text at lower right: "Any trained or self-taught midwife who induces a miscarriage is committing a crime."

I have been shocked to learn that my youngest child, who is 16, did not fully understand the consequences of unsafe abortion. I hadn't really planned to talk much further on the matter right now because my piece on Submissiveness and Backsliding on women's reproductive rights is pretty much self-contained and it's not a piece that's just about abortion, but rather a piece about women's rights. (Although, I was very annoyed to find that I forgot to mention US Representative Richard Hanna, R-NY, speaking last month at an ERA anniversary rally on the Mall in Washington, D.C. telling women to contribute to Democrats, not Republicans, because their hard-won rights were under attack.)

Anyway, here's the deal. I'm now aware that there are at least a generation of young people out there who are so far removed from the days before legalization and Roe v. Wade (1973) that they haven't heard what it was like, what could happen to women who got desperate, to women who couldn't afford to be pregnant, either because of their social or financial or familial circumstances. That's a generation of people who don't understand what the image below represents to women of my age and older. So I'm going to post some info on unsafe abortion. It won't be pretty, people.

Image from: The Coat Hanger Project

Unsafe Abortion- Here, There, Everywhere

The best source for examining what happens with unsafe abortions is to look at abortion in developing countries (think much of Africa), or even developed countries where abortion is largely illegal (think developed countries in Latin America).


First, let's deal with the basic and indisputable facts about abortion. Later, we'll get to the above mentioned graphic details.

Guttmacher Foundation is an organization whose stated mission is "advancing sexual and reproductive health worldwide through research, policy analysis and public education." They work in frequent collaboration with the World Health Organization. Directly from their policy brief, 

Facts on Induced Abortion Worldwide (emphasis mine):

ABORTION LAW

• Highly restrictive abortion laws are not associated with lower abortion rates. For example, the abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America—regions in which abortion is illegal under most circumstances in the majority of countries. The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds. [1]

• Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is typically unsafe. In developing countries, relatively liberal abortion laws are associated with fewer negative health consequences from unsafe abortion than are highly restrictive laws. [2] [3]

• In South Africa, the annual number of abortion-related deaths fell by 91 % after the liberalization of the abortion law. [2]

• In Nepal, where abortion was made legal on broad grounds in 2002, it appears that abortion-related complications are on the decline: A recent study in eight districts found that abortion-related complications accounted for 54% of all facility-treated maternal illnesses in 1998, but for only 28% in 2008–2009. [3]

• Between 1997 and 2008, the grounds on which abortion may be legally performed were broadened in 17 countries: Benin, Bhutan, Cambodia, Chad, Colombia, Ethiopia, Guinea, Iran, Mali, Nepal, Niger, Portugal, Saint Lucia, Swaziland, Switzerland, Thailand and Togo. Mexico City and parts of Australia (Capital Territory, Victoria, Tasmania and Western Australia) also liberalized their abortion laws. In contrast, El Salvador and Nicaragua changed their already restrictive laws to prohibit abortion entirely, while Poland withdrew socioeconomic reasons as a legal ground for abortion.

UNSAFE ABORTION

• The World Health Organization defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.

• Between 1995 and 2008, the rate of unsafe abortion worldwide remained essentially unchanged, at 14 abortions per 1,000 women aged 15–44. [1]

• During the same period, the proportion of all abortions that were unsafe increased from 44% to 49%. [1]

• In 2008, more than 97% of abortions in Africa were unsafe. Southern Africa is the subregion with the lowest proportion of unsafe abortions (58%) [1]. Close to 90% of women in the subregion live in South Africa, where abortion was liberalized in 1997.

• In Latin America, 95% of abortions were unsafe, a proportion that did not change between 1995 and 2008. Nearly all safe abortions occurred in the Caribbean, primarily in Cuba and several other countries where the law is liberal and safe abortions are accessible. [1]

• In Asia, the proportion of abortions that are unsafe varies widely by subregion, from virtually none in Eastern Asia to 65% in South Central Asia. [1]

• In Western Asia, the proportion of abortions that are unsafe increased from 34% to 60% between 2003 and 2008. [1]This increase is likely due to improved measurement of unsafe abortions and to a steady decline in abortions (partly due to the increasingly widespread use of effective contraceptives) in countries where abortion is legal and safe.

• Worldwide, medication abortion (a technique using a combination of the drugs mifespristone and misoprostol, or misoprostol alone) has become more common in both legal and clandestine procedures. Increased use of medication abortion has likely contributed to declines in the proportion of clandestine abortions that result in severe morbidity and maternal death.

CONSEQUENCES OF UNSAFE ABORTION

• The estimated annual number of deaths from unsafe abortion declined from 56,000 in 2003 to 47,000 in 2008. Complications from unsafe abortion accounted for an estimated 13% of all maternal deaths worldwide in both years. [4]

• Declines since 2003 in the annual number of deaths from unsafe abortion, along with concurrent increases in the annual number of unsafe abortions performed, indicate that the risks associated with clandestine procedures may be decreasing.

• In the United States, legal induced abortion results in 0.6 deaths per 100,000 procedures. Worldwide, unsafe abortion accounts for a death rate that is 350 times higher (220 per 100,000), and, in Sub-Saharan Africa, the rate is 800 times higher, at 460 per 100,000. [4]

• Almost all abortion-related deaths occur in developing countries, with the highest number occurring in Africa.

• Unsafe abortion is a significant cause of ill-health among women in the developing world. Estimates for 2005 indicate that 8.5 million women annually experience complications from unsafe abortion that require medical attention, and three million do not receive the care they need. [5]

• Treating medical complications from unsafe abortion places a significant financial burden on public health care systems in the developing world. According to a 2009 study, the minimum annual estimated cost of providing postabortion care in the developing world is $341 million. [6]

• In developing countries, poor women have the least access to family planning services and the fewest resources to pay for safe abortion procedures; they are also the most likely to experience complications related to unsafe abortion.

• Unsafe abortion has significant negative consequences beyond its immediate effects on women’s health. For example, complications from unsafe abortion may reduce women’s productivity, increasing the economic burden on poor families; cause maternal deaths that leave children motherless; cause long-term health problems, such as infertility; and result in considerable costs to already struggling public health systems.

UNINTENDED PREGNANCY: THE ROOT OF ABORTION

• The uptake of modern contraceptive methods worldwide has slowed in recent years, from an increase of 0.6 percentage points per year in 1990–1999 to an increase of only 0.1 percentage points per year in 2000–2009. In Africa, the annual increase in modern contraceptive use fell from 0.8 percentage points in 1990–1999 to 0.2 percentage points in 2000–2009. [7]

• An estimated 215 million women in the developing world have an unmet need for modern contraceptives, meaning they want to avoid a pregnancy but are using a low-efficacy traditional family planning method or no method. [8]

• Some 82% of unintended pregnancies in developing countries occur among women who have an unmet need for modern contraception. [8]

• In the developing world, women’s reasons for not using contraceptives most commonly include concerns about possible side-effects, the belief that they are not at risk of getting pregnant, poor access to family planning, and their partners’ opposition to contraception.

• Reducing unmet need for modern contraception is an effective way to prevent unintended pregnancies, abortions and unplanned births.

References cited in this paper can be found in the article itself, at the bottom of the page.

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Many Pro-Life supporters may likely say that if a woman is grievously harmed or dies as a result of an unsafe, prohibited abortion that she deserves what she gets. (I note for the umpteenth time that Pro-Choice women believe women should have a choice in pregnancy: keep their baby, keep their pregnancy and offer their baby for adoption, or terminate their pregnancy. Pro-Choice is about having those choices, not all about abortion. Many Pro-Choice women have never had an abortion and might never choose to have one but feel the right to control your body is every woman's right, just like it's every man's right.)

What are some of these complications of unsafe abortions? Pretty Horrifying.

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Abortion I. F. Noel from the National Library of Medicine

Complications of Unsafe Abortion.

Well, I'm sure any woman who can envision sticking something inappropriate into her  vagina, trying to get it through a tight cervical opening and neck and then swirlingly that object around a bit to scrape her uterine walls as if she was getting a nice D&C, can envision a myriad of things going wrong with an unsafe abortion. Cynical Nymph found this article by Dr. Jenny Gunter to describe an experience with a woman who came into an ER with a perforation that ruptured the uterine artery, an often fatal complication in which the woman bleeds out. (You can read further about the severity and fiscal cost of unsafe abortions at Guttmacher Foundation, here.) 

Taking a nice, neutral British source, we find the following, from an Education for Choice Fact Sheet for British Teens:

(Figures sourced from the World Health Organization, 2008)

• Between two million and seven million women (worldwide) each year survive unsafe abortion, but sustain long-term damage or disease.

• The most frequent complications are incomplete abortion, infection (sepsis), haemorrhage and injury to the internal organs, such as puncturing or tearing of the uterus.

• Long-term health problems include chronic pain, pelvic inflammatory disease and infertility.

• About 95% of unsafe abortions take place in developing countries.

• In many African countries, up to 70% of women treated for abortion complications are under 20 years old.

• Unsafe abortion is responsible for one in eight maternal deaths.

It is rather startling to read these figures and remember that they are largely talking about developing countries, and are not contemplating countries that are among the largest and most successful in the history of this planet. Should they be? Hmmm. Go back and read that first fact from Guttmacher on Abortion Law:

Highly restrictive abortion laws are not associated with lower abortion rates.

This is because women who are desperate not to have a child do desperate things. How does it go when things really go wrong? You can die. You can be maimed. And you can end up in situations in which what the physician delivers is something like this: (Don't you DARE look away!)

Resected gangrenous intestinal segment that escaped through perforated uterus.

(Source: Journal of Family and Community Medicine)
Caution is strongly advised before following the link!

The 30 year old Indian mother of 6 children, who formerly was attached to this  intestine, miraculously survived, after major surgery to remove three feet of small intestine, two days on a ventilator, 3 units of packed RBCs, and 14 days in the hospital on broad spectrum antibiotics. What a hale and hearty soul. Most women would have died. Still, I wonder how she absorbs nutrients, since I'm more than passingly familiar with the damaged small intestine nutritional problems. (Celiac issue) Her desperation not to have a seventh child may yet claim her life.

Let's think about how much that same level of botched-abortion healthcare would cost in the USA, shall we? 

Of course, it's possibly cheaper than a state raising a child given up at birth. Not betting on it, though. A woman may have further, long-term complications, beyond just the acute ones of an unsafe abortion. Or she may die. But hey, it's only a woman, and if she dies having a backstreet abortion, she probably deserved it. She was wrong for having sex (even if raped or victim of incest) if she didn't want to get pregnant and wrong for not wanting to stay pregnant if she got pregnant, and wrong for not having enough money to pay for all the expenses of her legal abortion even if you made it as expensive as possible for her to get, and finally wrong for not having enough wherewithal to just get herself to some state or country where she could get an affordable abortion. Wrong, wrong, wrong.

So I'm going to close this entirely wrong post now. With a few very wrong links. I know it's almost as wrong of me as the wrongness of wanting control over my body (which is so very wrong of me...) and wishing the same for my wrong-headed daughter.

Support Planned Parenthood. Last I checked, affordable and accesible contraception prevents abortions.

Join Emily's List and support women for elected office who promote women's reproductive rights and choices, and legislation that improves the lives of women and families nationwide. Even if you're a man, you can join. Know who you're voting for.

And know what's going on out there. Track legislative proposals that infringe on women's reproductive rights at Trust Women. It's a PAC. When I find other women's rights PACs, I'm going to contribute to them, too.

But that's because I'm am irredeemably wrong.

© Bright Nepenthe, 2012