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Abortion in Africa

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					 Abortion in
   Africa
    Marijke Alblas,
Medical Consultant, S.A.
Maternal mortality is the
  most dramatic health
inequality on the planet,
  even more than child
       mortality.
   In the developed countries,
  about 1 in 7,300 women are
likely to die from a pregnancy-
  related cause. One in 7,300.
  In eastern Asia, that's one in
 1,200. In North Africa, one in
   210. South Asia, one in 61.
     And finally, sub-Saharan
        Africa, one in 22."
One of the MDG is to reduce
 the maternal mortality: 75%
  cut in the MM rate by 2015
    However, in many sub-
Saharan African countries the
  numbers have been rising
    instead of going down.
 Every minute, a woman dies
    from pregnancy-related
   complications. Most likely,
these deaths could easily be
  prevented if every woman
had access to basic primary
  and emergency obstetric
    care, including (post)
        abortion care
Why?
Major causes of maternal death

           0ther                                           Hemorrhage
            27                                                25%




   Obstruction
      8%                                                         Sepsis
                                                                  15%


                 Abortionn
                  13%                 Eclampsia
                                         12%

                             World Health Organization (WHO). Mother Baby Package: Implementing Safe Motherhood in Countries.
                             WHO/FHE/MSM/94.11. Department of Reproductive Health and Research, Geneva: WHO;1994.
              Background
• Unsafe abortion is a worldwide problem
  with 95% occurring in developing countries
• Death rate from unsafe abortion is
  hundred times higher in developing
  countries than in developed countries
• Developed regions: 0,2-1,2 death per
  100.000 abortions
• Developing regions: 330 death per
  100.000 abortions
• Sub-Saharan Africa: 680 death per
  100.000 abortions
    Women are dying due to
illegal, back street abortions (
deaths form abortions are the
  third biggest cause of MM).
   But abortion is still such a
     controversial issue and
 therefore difficult to mobilize
    the public and politicians
   A study, Testing Community Level
    Strategies to Reduce Unwanted
   Pregnancy and Unsafe Abortion in
   Western Kenya, is an outcome of a
 research conducted in Suba, a remote
   area in western Kenya. Conducted
   between 1999 and 2004, the study
 sought to find out if communities could
be effective in reducing abortion-related
                  deaths.
 The study reveals that communities
      in Suba were able to reduce
     abortion-related mortality. This
  followed community education and
                    the
training of informal community health
      workers to administer first aid
      measures to women who had
    terminated pregnancies, as they
              ensured timely
     referrals to nearest clinics with
       trained medical personnel.
   "There was a significant decline in
   abortion-related mortality from 87
percent in 2001/2002 to 13 percent in
   2003/2004," says the study. It was
conducted by the regional office of the
    U.S.-based Centre for the Study
of Adolescents, the U.S.-based Pacific
    Institute for Women's Health and
  the Kenya Medical and educational
       Trust, a non-governmental
                organisation.
 to deny a woman an abortion is a
violation of her human rights. There
     are four human rights that
      specifically deal with the
  need for safe and legal abortion
  which are: Women's Right to life
                  and
Survival, Health, Nondiscrimination
        and Reproductive Self
           Determination.
KHRC has organized a tribunal on 26th
    June 2007 on abortion rights in
    Kenya to publicize the negative
  consequences of criminalization of
                 abortion.
 This was the first to be organized in
 Africa, the tribunal was modeled on
 similar hearings often organized at
 international meetings to document
   violations of and women's human
                  rights.
 "The mock tribunal wanted to
seek to dispel the myths about
         illegal abortions
 that have pushed the stories
  and pictures of women hurt
             and killed
through illegal abortions out of
 sight," said Ms Cynthia Mugo
              (KHRC).
But Kenya did not succeed in
changing their restricted law:
 abortion is only allowed to
    save a woman’s life.
  In Nigeria only 6 to 8 % of
       women is using
contraceptives (Saudi Arabia
            33%!)
 ± 15.000 die each year from
  botched abortions, but the
issue of abortion is a NO-GO
             area.
   Example of another African
       countrie: Ethiopia
• In 2005: 673 deaths per 100.000 live births
  (in most developed/ transition nations MM
  rates have gone down to an average of 10
  per 100.000
• at least 55 percent of all maternal deaths are
  abortion- related, and unsafe terminations are the
  second biggest killer of women of child-bearing
  age after AIDS, according to a study by the New
  York-based Center for Reproductive Rights.
   Ethiopia has, after South
Africa, decided to change their
restricted abortion law in May
             2005
  Incomplete Abortions in South
              Africa

• A study by MRC in 1994 estimated
  44686 women with ICA in public
  hospitals per year
• An estimated 425 women die as result
  of unsafe abortions
• Total annual cost was R18 7000 000 in
  1994 for treating complications
• Included sepsis, haemorrhage, infertility
Rees et al SAMJ 1997
 Choice on Termination of Pregnancy
      Act 1996 Act 92 of 1996

• After much debate and support from
  research & academic institutions showing
  the burden of ill health and deaths from
  septic abortions parliament passed the act
• The Act aims to give the right to choose
  safe early TOP & stress that it should not
  be used as a method of contraception

                              Government Gazette
Choice on Termination of Pregnancy
     Act 1996 Act 92 of 1996
• First twelve weeks - termination of pregnancy on request.
• 13- 20 weeks:
   – Pregnancy as a result of incest or rape.
   – Continued pregnancy – risk to physical or mental
     health of woman.
   – Continued pregnancy – risk to physical or mental health
     of fetus.
   – Continued pregnancy – cause major social or economic
     problems for woman.
• Post 20 wks – health of mother or fetus.
   Overview of CTOPA (2)

• First trimester – Abortion trained registered
  midwife/nurse.
• Second trimester –medical practitioner.
• No consent from parent or partner required.
• Designated facilities.
• Penalties:
   – Outside of provisions.
   – Obstructing women accessing their rights.
     Impact of CTOP Act

Maternal mortality due to backstreet abortion
 reduced more than 90%!!

In spite of the opposition and conscientious
  objection.

				
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