2. At the end of the chapter, the student is expected to:
Discuss unwanted and unplanned pregnancy
Understand the definition of abortion
Identify legal frameworks in abortion
Explain comprehensive abortion care(safe and post abortion
cares)
Understand value clarification and attitude transformation for
abortion
Sunday, February 18, 2024 2
3. An unintended pregnancy is a pregnancy that is either
unwanted, Or the pregnancy is mistimed, such as the
pregnancy occurred earlier than desired.
The concept of unintended pregnancy helps in understanding
the fertility of populations and the unmet need for
contraception.
Most unintended pregnancies result from not using
contraception or from not using it consistently or correctly.
Unintended pregnancy is associated with an increased risk of
problems for the mother and baby
4. Abortion is the termination or initiation of termination of
pregnancy before reaching viability (before 20weeks of gestation
or <500grams according to WHO or before 28 weeks of gestation
or less than 1kg fetal weight in Ethiopia and UK).
Sunday, February 18, 2024 4
5. 1. Spontaneous abortion where termination is not provoked
deliberately or
2. Induced abortion when there is a deliberate interference with the
pregnancy for the sake of terminating it.
Clinical stages of spontaneous abortion are: threatened, inevitable,
incomplete, complete or missed abortion.
septic abortion is If any of the stages mentioned get Infected.
Sunday, February 18, 2024 5
6. According to WHO unsafe abortion is characterize by the lack of
skilled providers, safe techniques, and/or sanitary facilities.
Unsafe abortion is the commonest cause of maternal mortality
accounting for up to 32% of all maternal deaths in Ethiopia.
Sunday, February 18, 2024 6
7. Abortion is more than a medical issue, or an ethical issue, or a legal
issue.
It is above all a human issue, involving women and men as
individuals, as couples and as a member of the society.
Sunday, February 18, 2024 7
8. Abortion-related morbidities and mortalities
Unsafe abortion is a global problem.
Millions of women around the world risk their lives and health to
end an unwanted pregnancy.
Every day, 55, 000 unsafe abortions take place 95 % of them in
developing countries-and lead to the deaths of more than 200
women daily.
Sunday, February 18, 2024 8
9. Globally, one unsafe abortion takes place for every seven births.
Every year, 68,000 deaths and about 5 million disabilities occur
globally due to unsafe abortion.
One out of every eight maternal deaths is due to abortion related
complications.
Sunday, February 18, 2024 9
10. Unsafe abortion is, however, one of the most easily preventable
and treatable causes of maternal death and disability.
The complications can be:
1. Acute complications
2. Long-term complications
Sunday, February 18, 2024 10
12. Long-term Complications
Chronic pelvic pain
Pelvic inflammatory disease
Tubal blockage and secondary infertility
Ectopic pregnancy
Increased risk of spontaneous abortion or premature delivery in
subsequent pregnancies.
Sunday, February 18, 2024 12
13. Treatment of abortion-related complications:
Often require several days of hospitalization and staff time, as well as
Blood transfusions, antibiotics, pain control medications and other
drugs.
Sunday, February 18, 2024 13
14. Accurate estimates are difficult to get, but it is clear that abortion is
widespread and generally performed by untrained persons.
It is the leading cause of maternal mortality.
In a community-based study, abortion accounted for 54.2 % of the
direct causes of maternal deaths.
Sunday, February 18, 2024 14
15. It is one of the top ten causes of admissions among
women.
Unsafe abortion accounts for nearly 60 % of all
gynecologic admissions and almost 30 % of all obstetric
and gynecologic admissions.
In a study done in Addis Ababa; abortion hospital
occupancy rate among mothers was 32. 2 %.
Sunday, February 18, 2024 15
16. 1. Non-use of contraception
The majority of unwanted pregnancies occur in Non-
users of contraceptive methods.
2. Contraceptive failure
Contraceptive failure results in 8-30 million pregnancies
each year either from inconsistent or incorrect use of
family planning methods or method-related failure.
Sunday, February 18, 2024 16
17. 3. Sexual coercion or rape
20 to 50% of women and girls report sexual abuse, rape
or sexual coercion which carries about 5% risk of
pregnancy in those in reproductive age unless emergency
contraceptives given.
Sunday, February 18, 2024 17
18. 4. Other factors include:
Lack of control over contraception;
Young age or single marital status;
Abandonment or unstable relationship;
Mental or physical health problems;
Severe malformation of the fetus; and
Financial constraints.
Sunday, February 18, 2024 18
19. Each year women around the world experience 80
million unwanted pregnancies.
Out of these mothers, nearly 42 million decide to have an
abortion and about 20 million of them undergo unsafe
abortion.
Several social factors influence the emotional decision of
obtaining abortion
Sunday, February 18, 2024 19
20. The cultural attitudes toward family size also influence
woman’s perception of abortion.
Religious attitudes strongly affect the decision
Personal and interpersonal reasons for continuing the
pregnancy can be a great source of conflict.
Sunday, February 18, 2024 20
21. Age and martial status are important factors in the
decision along with number of other children already
born.
Unsafe abortion is a public health problem, particularly
among young women since:
Poor access to family planning information and services
→unplanned pregnancy
Sunday, February 18, 2024 21
22. They are less likely than older women to have the social
contacts and financial means to obtain a safe abortion
Young women are more likely to delay seeking help and
hence seek terminations at more advanced stages of
gestation when the risks of morbidity and mortality are
higher.
Sunday, February 18, 2024 22
23. National laws and policies on abortion vary widely.
In 98 % of the world’s countries; danger to the woman’s
life is recognized as a legal basis for terminating a
pregnancy
Sunday, February 18, 2024 23
24. When abortion is illegal,
It is most difficult for a woman to obtain it,
Society is generally against abortion, and
The psychological trauma is generally great.
Sunday, February 18, 2024 24
25. Up to 23 unsafe abortion/1000 women restrictive laws
compared to 2/1000 in permissive laws
Mortality 34/1000 live births in restrictive countries
compared to 1 or less per 1000 live birth in liberal laws
In Romania, for example, abortion-related deaths
increased sharply when the law became very restrictive in
1966 (to 148/100,000), and fell after 1990 with a
return to less restrictive legislation (9/100,000) in 2002.
Sunday, February 18, 2024 25
26. The legal provisions of abortion services in
Ethiopia
Sunday, February 18, 2024 26
27. The FMOH developed Guidelines for Safe Abortion
Services in 2006
The intent of the guideline was:
◦ To reduce maternal morbidity & mortality from unsafe
abortion and
◦ To take action by the government to fulfill its
commitments to wards ICPD &MDGs
Sunday, February 18, 2024 27
28. Article 551 of the Penal Code of FDRE allows TOP under
the following conditions.
1. TOP by a recognized medical institution within the period
permitted by the profession is not punishable where:
a. Rape or incest
b. Endangers the health or life of the mother or the child
c. The fetus has an incurable and serious deformity
d. Physical or mental deficiency and unfit to bring up
the child
Sunday, February 18, 2024 28
29. 2. In the case of grave & imminent danger which can
be averted only by an immediate intervention, an
act of TOP in accordance with the provisions of Art.
75 of this code is not punishable
Sunday, February 18, 2024 29
30. Art. 551-1-a (Rape or incest)
◦On disclosure of the woman
◦Not required to submit evidence
◦Not required to identify the offender
Sunday, February 18, 2024 30
31. Art 551-1-b (life threatening risk)
◦ Follow the knowledge of standard medical
indications
◦ Woman shall not necessarily be in state of ill health
◦ Continuation of the pregnancy or the birth of the
fetus poses a threat to her health or life
Sunday, February 18, 2024 31
32. Art 551-1-c (fetal deformity)
◦ Necessary tests
Sunday, February 18, 2024 32
33. Art 551-1-d (physical or mental deficiency, or minority)
◦ Stated age on the medical records (<18 yrs)
◦ Disability definition-physical or mental
◦ Determine in good faith that the woman is disabled
Sunday, February 18, 2024 33
34. Art 551-2 (grave & imminent danger)
◦ Providers authorized to perform TOP on women
whose medical condition warrant immediate action
Sunday, February 18, 2024 34
35. Ensure universal access to family planning
Increase the availability of safe abortion services to the extent
allowed by law
Improve the quality and accessibility of post abortion care
Educate communities about reproductive health and unsafe
abortion; and
Work for changes in policies to safeguard women’s reproductive
health.
Sunday, February 18, 2024 35
36. 1. Contraceptive services and information about it.
2. Providing high quality appropriate services
3. Offering post-abortion care
4. Educating communities
5. Supportive laws and policies
Sunday, February 18, 2024 36
37. Making pregnancy safer includes the provision of or referral for
safe abortion services to the full extent allowed by the applicable
law and timely and appropriate management of unsafe and
spontaneous abortion for all women.
Women and girls in humanitarian settings may be at increased
risk of unintended pregnancy and unsafe abortion and require
access to safe and legal abortion services:
Women and adolescents may not be able to continue with their
contraceptive method because they lost it during displacement.
38. Families may want to delay childbearing until their security and
livelihoods are assured, but not have access to contraceptives due to
disruption of health services.
Rape and other forms of sexual violence are increasingly
documented in conflict settings
Comprehensive abortion care (CAC) includes all of the elements
of PAC as well as safe induced abortion for all legal indications (i.e.
as allowed by national law).
These elements all contribute to reductions in maternal mortality
39. Key elements of post abortion care include:
1. Treatment of incomplete and unsafe abortion;
2. Counseling;
3. Family planning services;
4. Community and service provider partnerships; And
5. Links to comprehensive reproductive health services.
Sunday, February 18, 2024 39
40. 1.Treatment
Treat incomplete , unsafe abortion and potentially life threatening
complications.
2.FP services
Help women prevent an unwanted pregnancy or practice birth spacing.
3. Community & service provider partnerships
Prevent unwanted pregnancies and unsafe abortion.
Mobilize resources to help women receive appropriate and timely care
for complications from abortion.
Ensure that health services reflect and meet community expectations and
needs. Sunday, February 18, 2024 40
41. Identify and respond to women’s emotional and physical
health needs and other concerns.
Link to Other RH services.
Preferably provide on-site, or via referrals to other
accessible facilities in providers’ networks
Sunday, February 18, 2024 41
42. Abortion values clarification and attitude transformation
(VCAT) is an intervention that is grounded in values theory
and the Transtheoretical Model and builds on similar
interventions in other fields.
Abortion VC was first implemented in South Africa and then
developed by Turner into a global VCAT toolkit
VCAT addresses some of the root causes of stigma-related
barriers to abortion service delivery, access and quality
43. The VCAT theoretical framework posits that values play a critical
role in determining how people make decisions and ultimately act
The abortion VCAT process takes place within existing cultural and
social structures and norms, which are extremely influential in
shaping people’s attitudes and values.
“Valuing occurs when the head and the heart unite under the direction
of action.”
Values tend to have persistence, assume a pattern in our lives and
impact our attitudes and behaviours
44. This framework places the process of VC within a larger context
of attitude transformation, behavioural intentions and, ultimately,
behavior or performance.
Three main stages of values clarification:
Making an informed value choice,
Affirming that choice, and
Acting on the chosen value,
The framework hypothesizes that, after undergoing the values
clarification process, participants' attitudes are expected to be
consistent with their clarified, affirmed values.
45. Attitudes and beliefs influence behavioural intentions, which in
turn predict behaviours.
These constructs of personal attitude and behavioural intention
have been successful in predicting health workers’ behaviours
Strategies based on the abortion VCAT framework focus on the real
consequences of abortion stigma: unsafe abortion, which can result
in women’s injury or death.
Participants in the VCAT process often move along a progressive
continuum from obstruction to tolerance to acceptance to provision
or support, and for some, to advocacy for high quality,
comprehensive abortion care for all women
An unintended pregnancy is a pregnancy that is either unwanted, such as the pregnancy occurred when no children or no more children were desired. Or the pregnancy is mistimed, such as the pregnancy occurred earlier than desired. The concept of unintended pregnancy helps in understanding the fertility of populations and the unmet need for contraception, also known as birth control, and family planning. Most unintended pregnancies result from not using contraception or from not using it consistently or correctly.
In VCAT interventions, trained facilitators lead diverse stakeholders through a process conducted in an emotionally safe environment in which
-They examine their personal values, attitudes and actions related to abortion;
-Engage in honest, open-minded and critical reflection and evaluation of personally-relevant abortion information and situations
-Fully comprehend the harmful consequences of stigmatizing abortion and restricting service delivery and access to care.
In abortion VCAT workshops, participants
Participants
who effectively engage in the abortion VCAT process: gain
new knowledge, deepen their understanding of existing or
new knowledge, experience empathy for people who seek,
provide or are affected by abortion, clarify current values
on abortion, explore alternative values, recognize barriers
to change, and remain open to change
