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What the WHO and IHME Research Tells Us About Unsafe Abortion

By: Manuelle Hurwitz, Senior Adviser, Abortion, International Planned Parenthood Federation; Rebecca Wilkins, Programme Officer, Abortion, International Planned Parenthood Federation

IPPF welcomes the research released by IHME and the WHO providing new estimates of maternal mortality and its causes. The research provides a lot of food for thought and areas for discussion, in particular around the recording and reporting of data on unsafe abortion.

While these findings are not directly comparable to previous estimates of maternal mortality due to unsafe abortion, currently given as 13% [1], the findings suggest that maternal deaths due to unsafe abortion have been reduced. If accurate, this is in no small part due to the tireless efforts of many service providers and advocates working around the world, often in challenging environments, to increase women’s access to post-abortion care and safe abortion services and the rise in the use of misoprostol, particularly in Latin America and the Caribbean, which may be replacing other less safe methods of “unsafe abortion”. However, the data requires closer consideration and while these new findings suggest good progress in preventing maternal deaths due to unsafe abortion, we must bear in mind that the reality is likely to be much different.

The WHO research acknowledges the challenges in collecting accurate data on maternal mortality due to unsafe abortion, challenges which make it highly likely that the number of maternal deaths due to unsafe abortion are consistently under reported. In many countries, abortion is subject to legal restrictions making it very difficult for women to access the safe and legal abortion services they need. Even in countries where legislation makes abortion more accessible, stigma around the issue may result in women using methods of abortion which are unsafe. These challenges can prevent women from telling friends and family about their attempts to end a pregnancy. Therefore any maternal death resulting from unsafe abortion may not be reported as such, leading to the under-representation of this issue in its contribution to maternal mortality.

It is also important to note that in this research the categorization of maternal mortality due to abortion includes all induced abortion, miscarriage, and ectopic pregnancy. While we acknowledge that this methodology was chosen due to the ICD-10 reporting category definition of deaths due to “pregnancy with abortive outcome”, we need to recognize both the limitations and the potential for misinterpretation of this categorization. The major concern is that this categorization may lead to the results of the study being communicated in such a way that unfairly and inaccurately implies that all abortions are risky. We know that when performed under the correct conditions abortion is one of the safest medical procedures and carries very minimal risks to a woman’s health and life. The complications and risks to women – which have been well documented – arise from abortions performed unsafely.

These statistics highlight two things. Firstly, there continues to be a need for further research in this area looking specifically into the incidence and outcomes of unsafe abortion, to provide a more up-to-date and accurate picture on the impact of unsafe abortion worldwide. Secondly, governments need to make abortion safe, legal and accessible to all women who need it. Abortion stigma also presents a real barrier to women accessing safe abortion services, and deserves equal attention by advocates, service providers and policy makers. Only by addressing these issues, will we see further reductions in preventable maternal mortality and morbidity resulting from unsafe abortion.

Efforts to achieve this took a step forward in March 2014, when global leaders signed up to a declaration calling for universal access to safe legal abortion after a key two-day meeting that was co-sponsored by Ipas, the International Planned Parenthood Federation, and the Center for Reproductive Rights.

Would you like to share your thoughts on the new maternal mortality estimates? Contribute to our blog series by sending a submission of 400-600 words to Katie Millar.

[1] Ahman E, Shah IH. New estimates and trends regarding unsafe abortion mortality. International Journal of Gynecology and Obstetrics. 2011;115:121–126

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