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One death every seven minutes

by Rebecca Gomperts
Each year, 42 million women choose to have an abortion for all sorts of private reasons, according to the World Health Organisation. Abortion is and will always be the single most performed medical intervention. In countries with restrictive laws, women are likely to seek for methods that are unsafe – often with lethal consequences. Women on Waves, WoW, a feminist organisation based in the Netherlands, tries to prevent unsafe abortion by informing and treating women. [ By Rebecca Gomperts ]

The Netherlands has one of the lowest abortion rates in the world; and yet 30,000 women decide to end their pregnancy every year. One out of five Dutch women will have an abortion during her life. Worldwide statistics show that on average every woman will abort at least once. But due to the taboo, shame and social pressure most women experiencing an unwanted pregnancy think that they are an exception.

In countries where abortion is illegal, women are forced to resort to unsafe abortion services. Approximately 25 % of the world population still live in countries with restrictive laws that either ban abortion entirely or permit it only to save the life of the pregnant women – mainly in Africa, Asia and Latin America, but also Ireland, Poland and Malta. Abortion was recently made legal in Mexico City, Colombia and Portugal. It was made totally illegal in Nicaragua, where it is no longer allowed even to safe a woman’s life.

Making abortion illegal does not reduce abortion rates, but only forces women to risk their lives and health to end their pregnancies. Women with the financial means can always find a doctor or travel abroad. The poorer and less informed women are, the more likely it is that they approach someone without medical training or attempt to provoke an abortion themselves with knitting needles, soap solutions or blows to the abdomen – all of which can lead to severe complications.

Unsafe abortions result in the unnecessary death of 70,000 women every year. In other words, every seven minutes somewhere in the world a woman dies un­necessarily because of an illegal, unsafe abortion. Statistically, 1 out of every 300 women who have unsafe abortions dies. Half of the women who end their pregnancy are mothers with children. More than 220,000 children loose their mother because of unsafe and illegal abortion. These deaths and tragedies are totally preventable.

When abortion is made legal, it is a very safe medical procedure – much safer than childbirth, an injection of Penicillin or using Viagra. In Europe, one of each 10,000 women dies during childbirth, while less than one per 500,000 dies from an early abortion. Competent early abortions are a way of saving women’s lives.

There are two methods of abortion: surgical abortion (vacuum aspiration) and medical abortion. A vacuum aspiration can be done under local anaesthesia and takes 10 to 15 minutes. In countries where abortion is still illegal, the development of medical abortion has been very important to reduce maternal mortality.

Life-saving drugs

A medical abortion can be done by using a medicine called Misoprostol alone, or by combining Mifepristone with Misoprostol. Scientific research has shown that women can safely do a medical abortion by themselves at home. The risks are the same risks as in the case of spontaneous miscarriage. The WHO added Mifepristone and Misoprostol to the list of essential medicines in 2005. It saves lives to increase the access to information and support of self-administration of medical abortions. The risks of a medical abortion are the same risks as a miscarriage: 20 % of all pregnancies end in a miscarriage.

In Europe a medical abortion has a mortality of less then one per 500,000 while the mortality of unsafe abortion is one per 300. Even though legalisation of abortion is very important, medical abortion now enables women to take their fates into their own hands, irrespective of the legal situation and the availability or willingness of doctors.

Scientific research has shown that women themselves, if provided with proper instructions, are capable of
– assessing the duration of pregnancy,
– self-administering a medical abortion correctly, safely and effectively at home and
– estimating the success of the intervention in settings where safe abortion is otherwise not available.
They only need access to hospitals in case of complications – as is the case for miscarriages.

Research done by the World Health Organisation has shown that the best way to do a medical abortion is by using Mifepristone combined with Misoprostol. This is effective in more than 95 % of the cases. Mifepristone, however, is only registered in the countries where abortion is legal.

Where Misoprostol (Cytotec) is available, women use this medicine to do abortions themselves. It was originally designed to protect the stomach from side-effects of painkillers used by rheumatism patients. Applied correctly and in the right dose, this drug is to almost 90 % effective in ending a pregnancy. Misoprostol is registered in most countries of the world, except for Africa, and that is one of the reasons why the number of deaths caused by unsafe abortions in Africa remains the highest in the world.