ALL PASSENGERS DIEDALL PASSENGERS WERE PREGNANT WOMEN
ReproductiveHealthChallengesAgendaReproductive Health Challenges and MDG 5• An introductionUnsafe abortions• A reproductive health challengeThe World SummitYouth Award Festival 2011Graz, AustriaNanna Maaløe, MD
Each yearthere are…200.000.000 pregnancies80.000.000 unwanted pregnancies50.000.000 induced abortions24.000.000 unsafe abortions360.000 deaths of women during pregnancy and child birth7.000.000 still births and early neonatal deaths
Pregnancy and birth related mortality Risk of dying during Life expectancy: pregnancy or child 82 years birth: 1:17.000 Risk of dying during Life expectancy: pregnancy or child 39 years birth: 1:35
MDG 5: Improve Maternal Healtha. Reduce maternal mortality with 75% between 1990 and 2015b. Achieve, by 2015, universal access to reproductive health • Contraceptive prevalence • Antenatal care coverage • Unmet need for family planning • Adolescent birth rate
Causes of maternal deaths Causes of maternal deaths:Background causes:Childhood malnutritionToo early marriagePoverty and illiteracyHarmful practicesDenied equal rightsDenied access to familyplanning / maternal healthservices
Reproductive healthchallenges Abortions Sexual Traditional transmitted harmful infections practices Maternal and HIV/AIDS Reproductive perinatal health Health Cervical Family cancer planning Violence Childlessness against women - And women’s empowerment
Unsafe abortions…The most easily preventable cause to maternal deaths?
Unsafe abortions A procedure for terminating an unwanted pregnancy• either by persons lacking the necessary skills• or in an environment lacking the minimal medical standards• or both Grounds on which abortion is permitted around the world:
The example of Romania: Effects of the introduction in Romania in November 1966 of an anti-abortion law, and legalization of abortion in December 1989: Maternal deaths per 100 000 live births Abor4on deaths per 100 000 live births
Abortion laws:Denmark TanzaniaEvery woman aged 18 and over has a Illegal abortion carries sentences:right to pregnancy interruption in apublic hospital at no cost to her • up to 14 years for the abortionistwithout stating any reasons, providingshe is resident in Denmark and theinterruption is performed before the • up to 7 years for the woman herselfend of the 12th week of gestation. • up to 3 years for any person supplying drugs or instruments
Characteristics of womenhaving unsafe abortion362 women with illegal abortionin Tanzania:88% were aged 15-24 years93% were single56% were still attending school79% had never used a contraceptive method51% had, in relation to their first pregnancy,had an induced abortion• The girls were involved in unstable relationships• Their partners were often twice their age andalready married• Many had unprotected sex with multiplepartners• 14% had previously been affected by a sexuallytransmitted infectionRasch V., Muhammad H., Urassa I., Bergström S.Am J Public Health 2000
ContraceptionMany couples in the world have noaccess to contraceptives• especially in Sub-Saharan AfricaA study from Malawi found…• Only 50% of young people knew that abstinence, faithfulness and condoms prevent infections• 40% of the women believed that if having sex in a standing position, there was no risk of getting pregnant
! This is 1. Emergency treatmentaccepted by 2. Contraceptive counseling, STI evaluation and treatmentall countries 3. Community involvement In Tanzania, more than half of the patients admitted at gynecolological wards attend because of complications to unsafe abortion.
Post-abortion careManual Vacuum Aspiration (MVA)! A life saving intervention
Post-abortion careIf pregnant and signs of infection,excessive bleeding, or in a criticalcondition:Clinical management imedeately!!Yet, several studies report:• Severe delays in life saving urgent management• Missing awareness and utility of evidence-based guidelines of best and achievable clinical management• Missing use of simple and low cost life saving clinical interventions
Thank you forhelping to…1. Develop new ways to achieve the fifth Millennium Development Goal2. Improve sexuality education and family planning3. Avoid unsafe abortions4. Improve post-abortion care services at health centers ! Sexual and reproductive healthand rights is one key to development!