Aim of the sessionThe aim of the session is to provide an overviewof the unit including the objectives
Unit objectives• Discuss the nature and scope of abortion in young people• List the factors that contribute to unsafe abortion in young people• Identify the consequences of unsafe abortion in young people• Recognise the implications for the diagnosis and management of unsafe abortion• Consider what needs to be done to prevent unsafe abortion
The Nature and Scope of Unsafe AbortionAim of the session• To discuss the nature and scope (both globally and locally) of unsafe abortion among young people.
How common is unsafe abortion among young people in your district or community• Very common• Fairly common• Not at all common
• (Why do you think there is such disagreement about how common unsafe abortion is?)• How do you, as health service providers become aware of the problem of unsafe abortion
Percentage of women aged 15 – 19 with unwanted or mistimed last births in the preceding five yearsCountry (yr) Total (a) Married (a) UnmarriedMalawi (2004) 31Botswana (1986) 81 39 88Uganda (1988/9) 35 30 65Ghana (1993) 68 61 90Senegal (1992/3) 31 93 78a) Includes both unwanted and mistimed pregnancies
Why do adolescent girls often resort to unsafe abortion?
FACTORS CONTRIBUTING TO UNSAFE ABORTION IN YOUNG PEOPLEAim of the sessionTo discuss various factors which contribute to unsafe abortion in young people.
How do the following factors affect unsafe abortion in young girls in your district No impact Adds to the Reduces the problem problemAccess to contraceptive informationAccess to sexual and reproductivehealth informationLife skills trainingAccess to safe abortion practicesAttitudes and behaviours of healthcare providersCommunity normsLaws and policies on sexual andreproductive health of adolescentsOther factors
Factors that could help reduce unsafe abortion in young people• Availability and accessibility of contraceptive information and services• Availability and accessibility of safe abortion services• Health-care providers are helpful and non- judgmental• Community norms permit open and frank discussion about sexuality in young people• National laws and policies facilitate the provision of reproductive health information and services that young people need
Diagnosis, Management and Consequences of Unsafe Abortion in Young PeopleAim of the session• To discuss the diagnosis, management and consequences of unsafe abortion in young people.
Compared with adults, young people with an unsafe abortion are more likely to:• Delay seeking help• Come alone, or with a friend, rather than the partner• Have ingested substances that interfere with treatment• Have more entrenched complications
Compared with adults, young people with an unsafe abortion are more likely to:• Be unmarried and outside a stable relationship• Be primi gravida• Have a longer gestation up to the time of abortion• Have used dangerous methods to terminate pregnancy• Have resorted to illegal providers
Key aspects in the Management of Unsafe Abortions• Emergency resuscitation as necessary• Evacuation of the uterus• Treatment of any complications.• Post-abortion counseling• Follow-up
Consequences of Unsafe Abortion in Young People• Medical – Morbidity and mortality• Psychological – Depression and• withdrawal• Social – Ostracism• Economic – Health-care costs and lost investments in education
Major Short Term Complications• Tetanus• Haemorrhage• Localized or generalized infection• Injuries (genital lacerations, perforations of organs)
Major Long Term Complications• Chronic pelvic infection• Secondary infertility• Subsequent spontaneous abortion• Increased likelihood of ectopic pregnancy• Increased likelihood of premature labor
• Which of the listed consequences apply in your community?• Are influential gatekeepers (such as political and religious leaders) aware of these consequences?• If they are aware, what if anything are they doing to reduce the occurrence of unsafe abortion?
Preventing Unsafe AbortionGroup Work (group discussions)