Unsafe abortion happens when there is not enough access

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Map showing access to abortion services around the world. (Source: WHO)

By Devina Samaroo

Jane Doe (not real name) was 15 years old when she found out she was pregnant.

At that time, she was about to write the Caribbean Secondary Education Certificate (CSEC) examinations, and her boyfriend was scared of his parents’ reaction to the situation.

Becoming a mother was out of the question. She needed an abortion.

“I wasn’t scared prior to doing it simply because I thought it would be a quick and painless process. On the contrary, it was the absolute opposite,” Jane recalled.

At such a young age, she knew nothing about abortions. There was not much information available and talking about it was always taboo.

“I did the abortion with pills my boyfriend acquired from a pharmacy,” Jane explained, admitting that she did not even know what medication she was using and the effects it would have on her body.

“I inserted two tablets into my vagina at 20:00hrs and went to bed. By 01:00hrs, I was awakened by strong abdominal pains that I tried to ignore but, eventually, I couldn’t.”

“I ended up over the toilet in beads of perspiration and tears as the pain was so severe. I was over the toilet the entire time in excruciating pain as the remains of the baby came out in the form of massive blood clots. This lasted for over four hours,” Jane recounted.

Today, she is 35 years old and a proud mother of four children.

Unfortunately though, many others who conducted unsafe abortions did not live to tell their tale.

In 2015, 41-year-old Carol Bollers, a mother of five, died as a result of an unsafe abortion. The woman was admitted to the Georgetown Public Hospital Corporation (GPHC) after complaining of intense abdominal pains, however, doctors were unable to save her life.

In 2012, 18-year-old Karen Badal, a mother of two, died after sustaining injuries during an unsafe abortion.

Globally, some 25 million unsafe abortions occurred every year between 2010 and 2014, according to a study by the World Health Organisation (WHO) and the Guttmacher Institute.

The majority of unsafe abortions, equating to 97 per cent, occurred in developing countries in Africa, Asia and Latin America.

In developed regions, it is estimated that 30 women die for every 100,000 unsafe abortions. That number rises to 220 deaths per 100,000 unsafe abortions in developing regions.

Abortion access

But why are there so many unsafe abortions?

According to the WHO, any woman with an unwanted pregnancy who cannot access safe abortion is at risk of unsafe abortion. Moreover, women living in low-income countries and poor women are more likely to have an unsafe abortion.

Dr Bela Ganatra, a scientist in the WHO Department of Reproductive Health and Research, also believes it is as a result of inaccessibility to abortion services.

“When women and girls cannot access effective contraception and safe abortion services, there are serious consequences for their own health and that of their families. This should not happen. But despite recent advances in technology and evidence, too many unsafe abortions still occur, and too many women continue to suffer and die,” Dr Ganatra said in a WHO news release in September 2017.

Salima Bacchus-Hinds, Programme Manager at GRPA

This point was underscored by Salima Bacchus-Hinds, a Programme Manager at the Guyana Responsible Parenthood Association (GRPA) – a non-governmental organisation dedicated to promoting positive sexual health.

“Unsafe abortions happen when there isn’t access,” Bacchus-Hinds noted.  And in Guyana, access is still very limited.

An independent investigation by this publication found that the Georgetown Public Hospital Corporation in the capital city and the New Amsterdam Public Hospital in the ancient county of Berbice are perhaps the only public health institutions which offer termination of pregnancy services.

When contacted, Chief Medical Officer (CMO) Dr Shamdeo Persaud refused to name which public health facilities offer these services.  He was concerned that anti-abortion groups would stage protests and threaten hospital staff.

Dr Shamdeo Persaud, Guyana’s Chief Medical Officer

While the services are also offered privately, it is often costly and mostly only available in Georgetown.  This means that persons in the hinterland regions and other far-flung areas are placed at a disadvantage.

The GRPA, also based in the capital city, offers abortion services and has helped a large number of persons.  Bacchus-Hinds said the number of persons accessing abortion services at that facility has decreased, and she likened it to persons being more informed about contraceptives and family planning as well as improved access.

However, there is still a long way to go to ensure universal access.

This limited access coupled with lack of knowledge as well as the stigma attached to getting an abortion are the main reasons why persons resort to unsafe methods.

Director at the Obstetrics and Gynecology Residency Programme, Dr Natasha France recognised that many persons opted to “self-administer” the treatment, resulting in a variety of health complications.

“Most times they would have used misoprostol (or Cytotec), which would have been obtained from a pharmacy. Sometimes they would have used other concoctions to induce an abortion,” Dr France explained in a short film produced by the GRPA.

 

Several patients would usually be admitted and some would have to be treated for an infection, need blood transfusions while others may end up losing their uterus.

The WHO reported that in Latin America, only 1 in 4 abortions is safe, though the majority was categorised as “less safe,” as it is increasingly common for women in the region to obtain and self-administer medicines like misoprostol outside of formal health systems.

“[That is why] we generally discourage you from going to pharmacies and getting medication and inserting them or drinking them. A lot of the times, the medication that is prescribed to you is not the correct type … or a lot of the times the medication you are getting is the incorrect dosage,” Dr France explained.

Stigma and permission

Although abortion is a common experience around the world, it is still widely stigmatised.

This is because some people view abortion as taking a life; others believe it can result in medical complications later in life.

And this stigma is another reason why many women prefer to self-administer, putting themselves in danger.

On September 22, 2019, thousands of anti-abortion protesters rallied in the Slovak capital, Bratislava, against a law allowing terminations until the 12th week of pregnancy, which has been in force in the heavily Catholic country since communist times.

But getting an abortion is not a moral issue, said Bacchus-Hinds.

“It isn’t a moral issue or anything like that. It’s just a healthcare,” she explained, noting that it is completely safe when done by trained medical personnel and certified doctors.

In Guyana, abortions have been legal since 1995.

There is no need for a patient to have any form of consent. For persons up to eight weeks pregnant, no reason is needed for the abortion and it can be done under one doctor’s supervision.

From eight to twelve weeks, termination of pregnancy will be granted for reasons such as rape, incest, HIV positive, health complications, or as a result of failed contraceptives.

For twelve to sixteen weeks, patients will need two doctors to agree that the procedure is safe. After sixteen weeks, there needs to be approval from three doctors and the procedure will be done if the pregnancy can cause permanent harm.

In 2015, Guyana’s Public Health Ministry recorded some 800 cases of abortions, the CMO had announced.

So how can society break the stigma attached to getting abortions? Bacchus-Hinds believes people need to talk about it more often, and women need to support other women.

“Even if you don’t support abortions, at least respect someone’s right to choose,” she said.

For Jane, she believes if getting an abortion was not so stigmatised and there was more access at the time, she could have saved herself hours of excruciating pain and potential harm.

She is grateful to be one of the lucky ones to survive an unsafe abortion, and she supports a woman’s right to choose, and to have access to safe abortion services.

“It’s your body, your right, your choice,” she said.