Publication:

Maternal morbidity due to unsafe medical abortion in rural practice is just the tip of the iceberg: is it really preventable?

Background In India around 6.4 million abortions are performed annually, of which 3.6 million (56%) were unsafe abortions, account for 8-20% of all maternal deaths. Medical methods of abortion have been proven to be effective and safe option to save women’s lives when practiced under medical supervision. This study was carried out to determine the frequency of unsafe medical abortion, demographic profile of patients, reasons for seeking abortion, abortion providers, evaluation of significant adverse outcome and management.

Methods A 5 year retrospective observational study included 400 patients with history of unsafe medical abortion who were admitted with complications between June 2009 and May 2014, in the department of obstetrics and gynecology, government medical college (Chhattisgarh institute of medical sciences) and tertiary care hospital Bilaspur Chhattisgarh.

Results Unintended pregnancy was the main reason for the unsafe medical abortion in 378 (94.5%) women. Most frequent complains observed for admission were heavy bleeding and retained products (incomplete abortion). Major complications seen in 177 (44.25%) cases only, of which moderate to severe anaemia in 141 (35.25%), shock in 23 (5.75%), septicaemia in 11 (2.75%) and acute renal failure in 2 (0.5%) cases. Majority 206 (51.50%) required surgical intervention. However 5 (1.25%) patients could not survive despite of all resuscitative measures. Post-abortion family planning adopted by 27 (6.75%) cases only.

Conclusions Mostly unsafe abortions take place behind the scene, always remain unnoticed and never listed in government data. In Chhattisgarh state where majority of rural population are tribal, illiterate, living in difficult to reach areas, unaware of safe abortion and abortion rights and dependent on herbs, quacks or paramedics, due to unavailability of clinicians or lady medical officers in government facilities. Thus the best way remain to prevent unsafe abortion is the prevention of unwanted pregnancy.