SAFE ABORTION PRACTICES

In earlier times, abortions were unsafe and exerted a heavy toll on women’s lives. Advances in medical practice in general, and the advent of safe and effective technologies and skills to perform induced abortion in particular, could eliminate unsafe abortions and related deaths entirely, providing universal access to these services is available.

In nearly all developed countries (as classified by the United Nations Population Division) safe abortions are legally available upon request or under broad social and economic grounds, and services are generally accessible to most women. With the exception of a few countries, access to safe abortion in developing countries is limited to a restricted number of narrow conditions. In countries where abortion is legally highly restricted, unequal access to safe abortion may result. In such contexts, abortions that meet safety requirements can become the privilege of the rich, while poor women have little choice but to resort to unsafe providers, which may cause disability and death. The health consequences of unsafe abortion depend on the facilities where abortion is performed; the skills of the abortion provider; the method of abortion used; the health of the woman; and the gestational age of her pregnancy.

Unsafe abortion is defined by the World Health Organization (WHO) 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. Unsafe abortion procedures may involve insertion of an object or substance (root, twig or catheter or traditional concoction) into the uterus; dilatation and curettage performed incorrectly by an unskilled provider; ingestion of harmful substances; and application of external force. In some settings, traditional practitioners vigorously pummel the woman’s lower abdomen to disrupt the pregnancy, which can cause the uterus to rupture, killing the woman. The consequences of using certain medicines, such as the prostaglandin analogue misoprostol, in incorrect dosages for inducing abortion are mixed, though there is some evidence that even an incorrect dosage can still result in lowering the number of severe complications and maternal deaths.

For every woman seeking post-abortion care at a hospital, there are several who have had an unsafe abortion but who do not seek medical care, because they consider the complication as not serious, or because they may not have the required financial means, or because they fear abuse, ill-treatment or legal reprisal.

When performed by skilled providers using correct medical techniques and drugs, and under hygienic conditions, induced abortion is a very safe medical procedure. Safe abortion is cost saving. The cost to health systems of treating the complications of unsafe abortion is overwhelming, especially in poor countries. Unsafe abortion and associated morbidity and mortality in women are avoidable. Safe abortion services therefore should be available and accessible for all women, to the full extent of the law.

Safe Abortion practices are a necessity across the world and in order to spread awareness regarding the same, here are some Methods of abortion

• The following methods are recommended for first trimester abortion:

– manual or electric vacuum aspiration, for pregnancies of gestational age up to 12–14 weeks;

– medical method of abortion, specifically, oral mifepristone followed by a single dose of misoprostol, for pregnancies of gestational age up to 9 weeks (63 days);

– medical method of abortion for pregnancies of gestational age over 9 weeks (63 days) – oral mifepristone followed by repeated doses of misoprostol; or

– where mifepristone is not available: misoprostol alone, in repeated doses.

• Dilatation and curettage* (D&C) is an obsolete method of surgical abortion and should be replaced by vacuum aspiration* and/or medical methods.

• For pregnancies of gestational age* more than 12–14 weeks, the following methods are recommended:

– dilatation and evacuation (D&E), using vacuum aspiration and forceps; or

– mifepristone followed by repeated doses of misoprostol*; or

– where mifepristone* is not available, misoprostol alone, in repeated doses.

• Cervical preparation before surgical abortion is recommended for all women with a pregnancy of gestational age over 12–14 weeks, although its use may be considered for women at any gestational age, in particular those at high risk for cervical injury or uterine perforation .

• Medication for pain management for both medical and surgical abortions should always be offered, and provided without delay to women who desire it. In most cases, analgesics, local anaesthesia and/or conscious sedation supplemented by verbal reassurance are sufficient. The need for pain management increases with gestational age.

• Local anaesthesia, such as lidocaine, can be used to alleviate women’s discomfort where mechanical cervical dilatation is required for surgical abortion. General anaesthesia is not recommended for routine abortion procedures, as it has been associated with higher rates of complications than analgesia and local anaesthesia.

• Standard precautions for infection control should be used, as with the care of all patients at all times, to reduce the risk of transmission of bloodborne infections.

Abortion does not impact the biological aspects of a female body but also has psychological impacts. In an attempt to help with that, a women undergoing abortion must be given information regarding:

• what will be done during and after the procedure;

• what she is likely to experience (e.g. menstrual like cramps, pain and bleeding);

• how long the process is likely to take;

• what pain management will be made available to her;

• risks and complications associated with the abortion method;

• when she will be able to resume her normal activities, including sexual intercourse; any follow-up care.

To ensure that every woman who is legally qualified has easy access to safe abortion treatment, an enabling environment is required. Women's human rights should be respected, protected, and fulfilled, and policies should be geared toward achieving positive health outcomes for women, providing high-quality contraceptive information and services, and meeting the specific needs of groups such as poor women, adolescents, rape survivors, and HIV-positive women.

1. Dilatation and curettage* is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette.

2. Vacuum or suction aspiration* is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix.

3. Gestational age* is the common term used during pregnancy to describe how far along the pregnancy is.

4. Mifepristone* is a drug that blocks a hormone called progesterone that is needed for a pregnancy to continue.

5. Misoprostol*: the medication softens and dilates the cervix, causes uterine contractions, and pushes pregnancy tissue out.