Abortion is a touchy, contentious and controversial issue with legal and moral measurements.
It is also a facet that brings up issues about essential convictions with respect to life and death, the holiness of life, the start of life, and women’s sexual and reproductive rights.
In the recent past, I happened to interact with a quack who sells over-the-counter pills that induce abortion. The pills in his possession were misoprostol, which he was selling at Ksh.3500 alongside some antibiotics. According to him, he makes countless deliveries around the city of Nairobi in a day, despite the fact that the dosage he offers is incomplete.
The percentage of governments permitting abortion increases gradually for all legal grounds, except to save a woman’s life. Notwithstanding general development in the legitimate justification for abortion, policies remain restrictive in numerous nations like Kenya.
The criminalization of abortions in Kenya has led to the rise of such quacks, which profit from the desperation of women and girls in need of quality healthcare at such times. Seven girls die every day in Kenya as a result of undergoing unsafe abortions.
Abortion is a major reproductive health issue that affects many women in their reproductive age; approximately one in four women will undergo an abortion at some point in their lifetime according to the World Health Organization.
Most of his clients are campus students who need an affordable means of ending an unintended pregnancy. While he doesn’t admit to any of his clients dying from the procedure, most of them have suffered the consequences of a botched abortion.
Most of his clients have had to deal with a missed or incomplete abortion, severe bleeding and other severe reproductive health conditions that result in extra expenses for the women and girls.
The legal justification for abortion Indicates lawful arrangements under which the government allows abortion in the nation. Induced abortions are those initiated by deliberate action taken with the intention of terminating a pregnancy; all other abortions are considered spontaneous.
Grounds on which abortions are permitted;
The distinguished grounds on which abortions are permitted are;
- To save a woman’s life
- To preserve a woman’s physical health
- To preserve a woman’s mental health
- In case of rape or incest
- Because of foetal impairment
- For economic or social reasons and
- On request.
The legal system for abortion in a given nation can be drawn from different sources;
- Including laws enacted by national assemblies or parliaments
- Guidelines made by regulatory organizations or agencies
- Court orders.
Many of these laws and approaches apply simultaneously.
The criminalization of abortions has resulted in unsafe abortions as the leading cause of maternal mortalities, yet it’s a preventable cause. Besides posing mental health risks of accessing these undignified means, they also waive financial strains on the woman, their households and the budgets of healthcare institutions.
Unsafe abortion is defined by WHO as any procedure to terminate an unintended pregnancy done either by people lacking the necessary skills (quacks) or in an environment that does not conform to minimum medical standards or both.
WHO recognized unsafe abortion as a serious public health predicament in 1967. The problem was reaffirmed in the Programme of Action of the International Conference on Population and Development in 1994, which underscored the dire need for countries to address the health implications of unsafe abortion and to provide safe abortion where it is not against the law.
The mortality and morbidities related to unsafe abortion are reliant on;
- On the facilities being used
- The expertise of the specialist
- The method and advancements utilized
- The overall well-being of the woman
- The stage of the pregnancy.
Worldwide, between 19- 20 million unsafe abortions occur every year, which is almost half of all induced abortions that stand at a 73million. About 7 million women are hospitalized for treatment of abortion-related complications, such as haemorrhage and sepsis, each year. A vast majority of women are unable to access treatment for serious complications from unsafe abortions.
The risks linked to induced abortions also depend on the availability of facilities for the management and treatment of complications. In some countries, half of all obstetric admissions are for complications of unsafe abortion.
According to the World Health Organization, nearly all abortions (92%) in developed countries are safe, and more than half (55%) of abortions in developing countries are unsafe. Overall, the majority of unsafe abortions (97%) occur in developing countries like Kenya.
The extents of unsafe abortion are higher in areas where abortion laws are more prohibitive and the neglected requirement for contraception is high. When properly administered by an expert, abortions are fourteen times safer than childbirth.
Consequences of Unsafe Abortion
Unsafe abortions play a key role in maternal morbidity and mortality, especially in countries that are developing. At least 67,000 women die from complications of unsafe abortion each year. Approximately 220,000 children lose their mothers each year from abortion-related deaths. In Kenya particularly, 7 women die from unsafe abortion complications every year.
Cost to women’ health
Every year, a huge number of women who resort to unsafe abortions die from complications. Notwithstanding costs identified with mortality, the expenses of morbidity come about because unsafe abortions are additionally high.
Survivors of unsafe abortions experience side effects. Unsafe abortion causes disability in an additional 5 million women. The methods used that pose the greatest threat to women undergoing an abortion include;
- Penetration by sharp objects (which can perforate the uterus)
- The insertion of contaminated materials into the cervix
- The use of unclean instruments.
Health problems resulting from unsafe abortions
- Incomplete or missed abortions
- Severe bleeding or haemorrhage
- Urinary tract infections
- Fertility complications
- Uterine perforation
- Damage to the genital tract
The stigma related to abortion in numerous countries of the world can be critical, particularly to young people and unmarried women.
Social and mental expenses include:
- Emotional distress for people that have been through an unsafe abortion
- The stigma experienced by the lady from family and friends for seeking a stealthy abortion
- Inadequacy to partake in the day-by-day household activities because of heavy bleeding and other side effects
- The inability to really focus on kids who, additionally, are at great risk of being orphaned if the woman or girl has other children.
- Infertility, a possible sequel of unsafe abortion, can also be psychologically traumatizing, stigmatizing a woman socially for the rest of her life.
The healthcare system also bears significant financial costs for treating complications resulting from unsafe abortions. In many African countries, a high proportion (15%– 30%) of hospital gynaecological admissions result from complications of unsafe induced abortion according to UNFPA.
Treatment for abortion-related complications consumes a large portion of hospital budgets for obstetrics and gynaecology and in some cases almost 50% of department budgets. Costs are much higher depending on the type of practitioner used, with physicians costing more to a health system than middle-level providers.
Given already strained resources in developing countries, the high costs of treating abortion complications have significant implications. Because complications to abortion are preventable and cost-effective interventions exist, these costs include the unnecessary diversion of financial and human resources.
Abortion is a human right
The right to safe, dignified, timely and affordable abortion is a fundamental human right protected under numerous international and regional human rights treaties and national-level constitutions around the world.
These instruments ground safe abortion in a constellation of rights including;
- The right to life
- To privacy
- To equality and non-discrimination
- To the highest attainable standards of health
- To benefit from scientific progress
- To decide when they want to have subsequent children and the number of children
- Freedom from torture, inhuman and degrading treatments and punishments.
Human rights bodies have repeatedly condemned restrictive abortion laws as being incompatible with human rights norms.
Despite the overall global trend of easing legal restrictions on abortion, legal strategies have emerged to introduce new types of barriers that impede women’s access to safe abortion services.
An increasingly global and coordinated movement which pronatalist and religious concerns have fueled in direct response to the worldwide trend toward abortion law liberalization—has instigated such strategies. Although in some countries progressive or retrogressive steps can be classified simply, in others, political tugs-of-war have led to measures that pull the specific elements of the legal status of abortion back and forth.
Retrogressive steps have been added that introduce new barriers to abortion access rather than altering the overall legal status of abortion, making the achievement of broader reform unrealistic because of the political context or established legal framework.
Legal restrictions on abortion do not result in fewer abortions, instead, they compel women to risk their lives and health by seeking out unsafe abortion care. The highest rates of abortion are found in countries with the most legal restrictions.
The wave of liberalization of abortion laws responds to public health evidence and, more recently, human rights arguments.
The ideologically and religiously motivated backlash against abortion is increasingly resorting to misrepresentations and avoidance of public health evidence, that a woman who became pregnant should persevere through the cycle of pregnancy and birth, regardless of upsetting or difficulties.
This is undermining human rights standards applicable in this context. Women have the right to control their bodies, they have the right to undergo abortions for any reason they want.
Abortion is an essential need listed on the essential healthcare services. But the overturning of Roe Vs Wade will impede access to comprehensive abortion care
Comprehensive abortion entails;
- Access to reliable and detailed information
- Abortion management
- Post Abortion care entails; spontaneous and missed abortions, induced abortions, incomplete abortions and fetal death.
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