abortion kk public.pptx
- 2. By the end of the lecture the students will be able to: Understand the magnitude of abortion Identify reasons behind unplanned pregnancy Define Unsafe abortion and know contributing factors Understand different components of post abortion care Learning Objectives
- 3. • Abortion is the termination or initiation of termination of pregnancy before reaching viability (before 20weeks or <500grams according to WHO or before 28 weeks of gestation or less than 1kg fetal weight in UK). • It can be spontaneous where termination is not provoked deliberately or induced when there is a deliberate interference with the pregnancy for the sake of terminating it. Meaning of Abortion
- 4. • Clinical stages: of spontaneous abortion are: threatened, inevitable, incomplete, complete or. If any of the stages mentioned get infected it is called septic abortion. • About fifteen percent of all clinically recognizable pregnancies end in spontaneous abortions. It is estimated that 30 to 50 million induced abortions are performed annually in the world and about half of these are performed illegally. Stages of Abortion
- 5. Incomplete abortion involves vaginal bleeding, cramping (contractions), cervical dilatation, and incomplete passage of the products of conception. A woman experiencing incomplete abortion frequently describes passage of clots or pieces of tissue, and reports vaginal bleeding. The cramping may be rhythmic or labor-like, although less intense than a full-term labor. At this point, the baby has already died and has either been passed or is part of the retained tissue. Treatment focuses on helping the woman to complete the miscarriage process by expelling any retained tissue, and emotional and physical healing.
- 6. Complete abortion is a completed miscarriage. Typically, a history of vaginal bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault; a closed cervical ; and no tenderness of the cervix, uterus, adnexa, or abdomen. The ultrasound demonstrates an empty uterus.
- 7. Threatened abortion Threatened abortion is vaginal bleeding that occurs in the first 20 weeks of pregnancy. The bleeding is sometimes accompanied by abdominal cramps. These symptoms indicate that a miscarriage is possible, which is why the condition is known as a threatened abortion or threatened miscarriage.
- 8. Inevitable abortion is an early pregnancy with vaginal bleeding and dilatation of the cervix. Typically, the vaginal bleeding is worse than with a threatened abortion, and more cramping is present. No tissue has passed yet. On ultrasound, the products of conception are located in the lower uterine segment or the cervical canal.
- 9. A missed abortion is a miscarriage in which fetus didn’t form or has died, but the placenta and embryonic tissues are still in the uterus. It’s known more commonly as a missed miscarriage. It’s also sometimes called a silent miscarriage. A missed abortion is not an elective abortion. Medical practitioners use the term “spontaneous abortion” to refer to miscarriage. A missed abortion gets its name because this type of miscarriage doesn’t cause symptoms of bleeding and cramps that occur in other types of miscarriages. This can make it difficult for you to know that the loss has occurred.
- 10. • WHO characterizes unsafe abortion by the lack of skilled providers, safe techniques, and/or sanitary facilities. Unsafe abortion is a common cause of maternal mortality. • 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. Unsafe Abortion
- 11. 1. 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. Globally, one unsafe abortion takes place for every seven births. Public Health Importance of Abortion
- 12. 1. Abortion-related morbidities and mortalities- Cont’d • 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. In some settings a quarter or more of all maternal deaths are abortion-related. Public Health Importance of Abortion
- 13. 1. Abortion-related morbidities and mortalities- Cont’d • Many women fail to seek treatment for abortion- related complications, leading to countless-and uncounted- deaths outside of health care systems. • Unsafe abortion is, however, one of the most easily preventable and treatable causes of maternal death and disability. Public Health Importance of Abortion
- 14. 1. Abortion-related morbidities and mortalities- Cont’d Between 20 and 50 % of all women who undergo unsafe abortions need hospitalization for complications. Public Health Importance of Abortion
- 15. 1. Abortion-related morbidities and mortalities- Cont’d Acute Complications • Incomplete abortion • Sepsis • Hemorrhage • Uterine Perforation • Bowel injury Public Health Importance of Abortion
- 16. 1. Abortion-related morbidities and mortalities- Cont’d Long-term Complications • Chronic pelvic pain • Pelvic inflammatory disease • Tubal blockage and secondary infertility • Ectopic pregnancy • Increased riskof spontaneous abortion or premature delivery in subsequent pregnancies. Public Health Importance of Abortion
- 17. 1. Abortion-related morbidities and mortalities- Cont’d These complications can limit women’s productivity inside and outside the home, constrain their ability to care for children and adversely affect sexual life. • . Public Health Importance of Abortion
- 18. Impact on the public health system 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. • . Public Health Importance of Abortion
- 19. Why Women Find Themselves with Unwanted Pregnancy? 1. Non-use of contraception • The majority of unwanted pregnancies occur in Non- users of contraceptive methods. • Despite the fact that family planning services are more effective and available than ever before, estimates suggest that ,worldwide: • 350 million couples lack access to information about contraceptives and a full range of modern family planning methods • 105 million married women have unmet need for family planning
- 20. Why Women Find Themselves with Unwanted Pregnancy? 1. Non-use of contraception • estimates suggest that ,worldwide:-cont’d • 12 to 15 million women may also lack access to services that will enable them to achieve their reproductive intentions. • Even after treatment for complications of unsafe abortion, many women leave hospitals without any counseling on how to prevent future pregnancies, and without a contraceptive method.
- 21. Why Women Find Themselves with Unwanted Pregnancy? 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. 3. Sexual coercion or rape • Twenty to fifty percent 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.
- 22. Why Women Find Themselves with Unwanted Pregnancy? 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.
- 23. Why does induced Abortion Occur? • 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.
- 24. Why does induced Abortion Occur? Unsafe abortion is a public health problem, particularly among young women since: • Poor access to family planning information and services →unplanned pregnancy • 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.
- 25. Legislation and policies • 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. • Only in a few countries- Chile, the Holy See, El Salvador, Nicaragua, and Malta-is abortion illegal in all circumstances.
- 26. Legislation and policies 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. Evidence shows that restrictive legislation is associated with higher rates of unsafe abortion and correspondingly high mortality.
- 27. Legislation and policies • Once abortion is legalized, a supportive relationship can be established and the decrease in external stress will be accompanied by a similar decrease in negative feelings. • 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
- 28. Legislation and policies Inadequate services • In many developing countries, safe abortion services are not available to the full extent permitted by law. • Many health workers lack vital information about the legal status of abortion, and do not know how to perform abortions.
- 29. Legislation and policies Inadequate services • When women experience complications due to unsafe abortion, appropriate medical care is often unavailable or inaccessible. • Lack of protocols for post-abortion care, misdiagnosis, negative attitudes on the part of health care providers and case overload result in life-threatening. These factors are also costly, and they delay services for women seeking treatment from the health system.
- 30. What can be done about unwanted pregnancies and unsafe abortions? • 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.
- 31. What can be done about unwanted pregnancies and unsafe abortions? I. Contraceptive services and information Prevent unwanted pregnancies through comprehensive, client-oriented reproductive health services especially family planning. During service provision one must be non- judgmental in attitudes, Confidential counseling and quality family planning information and services, including emergency contraception, should be universally accessible to all women,
- 32. What can be done about unwanted pregnancies and unsafe abortions? I. Contraceptive services and information- Cont’d Special attention should be given to the needs of young people, marginalized women, women living in situations of conflict, and women at risk of sexual abuse, rape and violence.
- 33. What can be done about unwanted pregnancies and unsafe abortions? II. Providing high quality appropriate services In more than 131 developing countries, induced abortion is permitted in certain circumstances. In countries where abortion is legal: • Services should be safe and available • Service providers must be carefully trained to offer high quality services and compassionate counseling.
- 34. What can be done about unwanted pregnancies and unsafe abortions? II. Providing high quality appropriate services • Providers must be well-informed about the legal status of abortion and protocols for providing services, so that women who are eligible can access services quickly and without unnecessary delays or bureaucratic procedures.
- 35. What can be done about unwanted pregnancies and unsafe abortions? II. Providing high quality appropriate services • Available services should also be publicized within the community and links should be strengthened with women’s groups, health centers and related organizations to ensure that women who need services are informed about where and when to seek care. • Appropriate technologies such as vacuum aspiration should be available. New technologies, such as non- surgical abortion, should be made available, where appropriate and feasible.
- 36. What can be done about unwanted pregnancies and unsafe abortions? III. Offering post-abortion care • Whatever the legal status of abortion, high quality services for treating and managing complications of abortions should be accessible to all women to reduce related maternal death. • The recently promoted abortion care approach is women- centered approach of provision of the services. In the woman –centered approach, the provider asks for and focuses on woman’s concerns and interests and takes a comprehensive approach to meeting every woman’s medical and psychological needs at the time of treatment.
- 37. What can be done about unwanted pregnancies and unsafe abortions? III. Offering post-abortion care Key elements of post abortion care include: 1.Treatment of incomplete and unsafe abortion; 2.Counseling; 3.Family planning services; 4.Links to comprehensive reproductive health services; and 5.Community and service provider partnerships.
- 38. What can be done about unwanted pregnancies and unsafe abortions? IV.Educating communities • Education is critical for reducing the public health problem of unsafe abortion. Health education messages should be based on the incidence and impact of unsafe abortion within communities, and be sensitive to people’s beliefs, attitudes and practices. • They should offer information on: the legal status of abortion; preventing unwanted pregnancy; avoiding unsafe abortion; and recognizing and seeking appropriate treatment for abortion complications.
- 39. What can be done about unwanted pregnancies and unsafe abortions? V.Supportive laws and policies When laws are modified to allow greater access to abortion- related services, such as legal changes, must be accompanied by changes in the health service structure. • Development of appropriate service delivery standards; protocols, guidelines and administrative procedures; • Restructuring of the health system to ensure that high quality, safe services are available at the lowest levels compatible with good quality care. • Staff must be trained and willing to provide services; and • Supplies of necessary equipment and drugs must be available • Requisite funds must be allocated for all these activities.
- 40. What can be done about unwanted pregnancies and unsafe abortions? V.Supportive laws and policies Policies and laws can contribute to unsafe abortion by impeding women’s ability to protect their sexual and reproductive health. Examples – Prohibitions on contraceptive delivery to unmarried women and adolescents - Requirements for spousal consent for the use of family planning services Such policies and laws should be reviewed and revised, taking into account the cultural, religious and moral values of the communities concerned.