Running head: Deaths of UNSAFE ABORTIONS 1

Deaths of Unsafe Abortions: A Literature Review

Yamel V. De Leon

University of Texas at El Paso

Deaths of UNSAFE ABORTIONS 2

Abstract

Women take the decision of ending pregnancies, mostly unintended, since ancient times which

can be dangerous the abortion is not performed correctly. Unsafe abortions have taken the life of

millions of women that wanted to terminate their pregnancy but did not have access to a safe

abortion for many different reasons such as the law or social and cultural believes. Maternal

deaths have been decreasing with time but the rate is the same due to the growing populations of

women of reproductive age. The lack of access to a safe abortion leads them to perform the

abortion themselves by the insertion of objects through the uterus or the digestion of substances

or by a back alley abortionist lacking qualifications and skills to perform a safe abortion. The

purpose of this literary review is to inform how unsafe abortions are affecting women in different

locations around the world, and the techniques of abortion. Connect countries and their laws,

believes, and economy regarding abortion and how they compare on maternal deaths caused by

unsafe abortions.

Keywords: abortion, unsafe, unintended, pregnancy, back alley, abortionists, maternal,

deaths
Deaths of UNSAFE ABORTIONS 3

Deaths of Unsafe Abortions: A Literature Review

Abortion has been a controversial issue for many years in the world. It can be seen in

different ways making the community agree or disagree with it depending on their ideas and

believes. Some of the controversies against abortion involves it being murder, fetuses feel pain,

abortion causes psychological damage, among others. Other controversies for it are that women

should have control of their bodies, women who receive abortions are less likely to suffer mental

health problems that women denied abortion, access to legal, professionally-performed abortions

reduces maternal injury and death caused by unsafe, illegal abortions. The death of women

caused by illegal and unsafe abortions is an issue happening around the world, in some places

more than others depending on the religions, politics, education, and economy at their location.

The lack of access to a safe abortion will lead women to doing unsafe abortions that can be done

in many different ways, all of them very dangerous. It has been going on since ancient times and

to this day, now in this modern era and we question the how, why, and where by considering this

questions:

1. How does unsafe abortion affect maternal mortality?

2. How do unsafe abortions occur?
3. How accessible is safe abortion?

The answer to this questions will give a better understanding of the issue by providing

information on how it affects women deaths or how it can affect their lives if they survive an

unsafe abortion, they techniques used to terminate an abortion and where is more likely to

happen.

How does unsafe abortion affect maternal mortality?

WHOs definition of an unsafe abortion is a procedure for terminating an unwanted

pregnancy either by person slacking the necessary skills or in an environment lacking the
Deaths of UNSAFE ABORTIONS 4

minimal medical standards, or both (1992). Approximately 13% of all maternal deaths are due

to unsafe abortions in the world. Unsafe abortions continue to happen affecting womens lives

and their health although they are preventable. According to WHO, abortion related deaths have

been reducing from 69,000 in 1990 to 56,000 in 2003, and 47,000 deaths from 21.6 million

estimated abortions in 2008, most of them in developing countries. The unsafe abortion rate has

been the same at about 14 unsafe abortions per 1000 women ages 15 to 44 even though unsafe

abortions have increased from 19.7 million in 2003. This is due to the growing population of

women of reproductive age. From approximately 210 million women that become pregnant in

the world each year, 135 million of them give birth. 42 million of 75 million pregnancies that end

in stillbirth or spontaneous or induced abortion end voluntarily: 22 million safely and 20 million

unsafely (2011). 67,000 women, of the 20 million unsafe abortions, die from abortion

complications in countries where abortion is illegal (Rosenthal, 2007)

Figure 1. Estimated annual number of unsafe abortions, globally and by major regions, 2003 and

2008.
Deaths of UNSAFE ABORTIONS 5

Source: Ahman, E., Shah, I., (2011). Unsafe abortion: Global and regional estimates of

incidence of unsafe abortion and associated mortality in 2008, Sixth Edition. Retrieved from

World Health Organization Website: http://www.who.int

How do unsafe abortions occur?

In the 1950s, about 200,000 to 1.2 million unsafe abortions were performed per year.

When women do not have access to a safe abortion, they would have it unsafely doing self-

induced abortions in unhygienic conditions and dangerous intervention. Other ways of self-

inducted abortion are the insertion of an object in the uterus such as coat hangers, knitting

needles, bicycle spokes, ball-point pen, chicken bone, and rubber catheter, and the ingestion of

medication or hazardous substances such as turpentine, bleach, detergents and a range of herbal

and vegetable teas. Others, such as potassium permanganate would be placed in the vagina

causing chemical burns. They would squirt toxic solutions in to the uterus, such as soap and

turpentine, causing kidney failure and death.

Dr. Daniel Mishell, Jr. remembers conditions before Roe v. Wade:

Theyd try to insert chemicals drain cleaner, fertilizer, radiator-flush and miss the

cervix, corrode an artery and bleed to death. Mishell once put a catheter into a womans

bladder and got a tablespoon of motor oil. young, healthy women in their 20s die from

the consequences of an infected nonsterile abortion. (as cited in Grimes, 2015).

From 1940 to 1954, more than 7,000 cases of incomplete abortion were treated, and a third were

complicated by infection at Bellevue Hospital in New York. Causing external injury to end their

pregnancy some women threw themselves off of stairs and roofs or by violent abdominal

massage.
Deaths of UNSAFE ABORTIONS 6

They would also have unsafe abortions by unsafe providers also called back-alley

abortionists, lacking qualifications and skills to perform induced abortion, where the

environment does not conform to minimal medical standards, and where they endured danger

and abuse, sometimes sexual abuse. These providers improperly perform dilation and curettage

in unhygienic settings, causing uterine perforation and infections. These were the options women

had if they did not have enough money to travel somewhere where abortion is legal or did not

have enough money to offer to a doctor to perform a safe abortion even if it was illegally. I did

not propose to put my head in a noose for the $150 that she offered me said a doctor in an

account published by The Times in February 1882 of a young woman who died from an abortion

using carbolic acid (Morrison, P., 2014). Before Roe v Wade had legalized abortion in the United

States, in 1972, there were 39 maternal deaths from illegal abortions nationwide, and after Roe v

Wade, in 1976, there were only two maternal deaths from illegal abortions (Cates, Grimes, &

Schulz, 2004). The World Health Organization estimated 68,000 maternal deaths worldwide in

2004 mostly in developing countries.

Further hazardous features of unsafe abortions are:

The lack of immediate intervention if severe bleeding or other emergency

develops during the procedure;

Failure to provide post abortion check-up and care, including no contraceptive

counselling to prevent repeat abortion;

The reluctance of a woman to seek timely medical care in case of

complications because of legal restrictions and social and cultural beliefs

linked to inducted abortion. (WHO, 2011, p.2)

Women who survive unsafe abortions, according to Obstetrics & Gynecology, less than

one quarter of one percent of abortions lead to major health long-term complications. About 5
Deaths of UNSAFE ABORTIONS 7

million women end in the hospital due to unsafe abortion complications such as hemorrhage,

infection, sepsis, genital trauma, and necrotic bowel which are the main causes of death from

unsafe abortions. Long-term complications include poor wound healing, infertility, consequences

of internal organ injury, vowel resections, lack of productivity and psychological damage (2009).

According to WHO, a woman dies every 8 minutes due to these complications in a developing

country where 55% of abortions are unsafe. Most of them in Latin America, Africa, and South

East Asia (2011).

How accessible is safe abortion?

Each country in the world has different social and cultural ideas and beliefs regarding

abortion which affects its legal permission and the accessing services. In some of them the access

is highly restricted while in other countries is available on broad medical and social grounds or

on request (Ahman & Shah, 2011, p.3). Studies have found similar rates where abortion is legal

and where is not, meaning that the legal status of abortion will not influence womans decision to

terminate a pregnancy (Rosenthal, 2007). If theres an unplanned pregnancy, it does not matter

if the law is restrictive or liberal. Said Dr. Paul Van Look, director of W.H.O. Department of

Reproductive Health and Research, in a telephone interview (as cited in Rosenthal, 2007). The

law does influence the safety of the abortions. It will be safer where it is legal and unsafe where

it is not. Sharon Camp, chief executive of the Guttmacher Institute said that data has shown that

making contraception widely available decreases the rates of abortion, not making abortion

illegal.

According to WHO, Abortion is permitted to save a womans life in 98% of the countries

and only 28% allows it upon request. 53 countries only permit abortion to save a womans life

and half of them explicitly allows it under this one condition while in the other half is not
Deaths of UNSAFE ABORTIONS 8

explicit, causing the access to be restricted. The other 136 countries allow abortion to save a

womans life as well and under many more conditions, giving 80% of women, ages 15-44, in the

world to have the legal right to abortion for other reasons than only to save their lives. Some

abortion laws increase the limitation of an unsafe abortion even if it is legal by adding conditions

such as the requirement of a specialist to terminate the pregnancy where there is a scarce amount

of doctors and specialists. Other requirements include counselling for an abortion prolonging the

procedure which could past the legally permitted time period for induced abortion (2011).

Figure 2. Induced abortion rates in sub regions that have restrictive versus those that have less-

restrictive abortion laws, by contraceptive prevalence (CPR) ordered by declining total fertility

rate (TFR), 2003.

Source: Ahman, E., Shah, I., (2011). Unsafe abortion: Global and regional estimates of

incidence of unsafe abortion and associated mortality in 2008, Sixth Edition. Retrieved from

http://www.who.int
Deaths of UNSAFE ABORTIONS 9

In developing countries, 55% of women give birth in hospitals due to the low

availability of hospital services in rural areas and less than 95% in urban areas. 35% in rural

areas in Africa and Asia, 78% in urban areas in Africa and 68% in Asia. 60% in rural areas and

92% in urban areas in Latin America (Ahman & Shah, 2011, p.7). Unsafe abortions still happen

in countries in transition for less restrictive abortion laws since the provided services, such as

infrastructure and skills, have not the proper conditions for a safe abortion. Countries that

recently legalized abortion, still have many unsafe abortions as the ones provided safely for

many reasons such as lack of awareness of what the law permits among professionals in the

public, legal and health sectors; and women are not being informed of their right under the law

and may be unaware of the conditions under which they are entitled to access abortion services;

(Ahman & Shah, 2011, p.7).

Conclusion

The termination of a pregnancy is a decision women make and sometimes restricted by

the law and other barriers in their country or in their area leading them to have unsafe abortions.

Complications from unsafe abortions can affect womens health or it can cost them their life.

Abortions in the world have been increasing with time, but the abortion rate stays the same due

to the growing population of women of reproductive age. Maternal deaths have been decreasing

with time. Used techniques to terminate a pregnancy when there is no access to a safe abortion

includes the insertion of objects in the uterus or the ingestion of substances or going to back

alley abortionists. There are many barriers that force women to have an unsafe abortion such as

insufficient provision for abortion services due to social and cultural beliefs, lack of awareness,

abortion services are too costly, among others. The numbers of maternal deaths caused by unsafe
Deaths of UNSAFE ABORTIONS 10

abortions vary in every country depending on the barriers mentioned and the technique used to

terminate the abortion.

Deaths of UNSAFE ABORTIONS 11

References

Ahman, E., Shah, I., (2011). Unsafe abortion: Global and regional estimates of incidence of

unsafe abortion and associated mortality in 2008, Sixth Edition. Retrieved from World

Health Organization Website: http://www.who.int

Cates, W., Girmes D.A., Schulz, K. F.,(2004). The public health impact of legal abortion: 30

years later. Retrieved from https://www.guttmacher.org

Grimes, D. A., (2015). The bad old days: Abortion in America before Roe v. Wade. Retrieved

from www.huffingtonpost.com

Haddad, L. B., & Nour, N.M. (2009). Unsafe abortion: Unnecessary maternal mortality.

Obstetrics & Gynecology, 2(2), 122-126. Retrieved from https://www.ncbi.nlm.nih.gov

Morrison, P. (2014). The coat hanger, symbol of dangerous, pre-Roe abortions, is back. Los

Angeles Times, Retrieved from http://articles.latimes.com

Rosenthal, E., (2007, Oct 12). Legal or not, abortion rates compare. The New York Times,

Retrieved from http://www.nytimes.com/

Sedgh, G., Singh, S., Henshaw, S. K., Bankole, A., (2011). Legal abortion worldwide in 2008.

Perspectives on Sexual & Reproductive Health, 43(3), 188-198. doi: 10.1363/4318811

Upadhyay, U. D., Desai, S., Zlidar, V., Weitz, T. A., Grossman, D., Anderson, P., & Taylor, D.

(2015). Incidence of emergency department visits and complications after abortion.

Obstetrics & Gynecology, 125(1), 175-183. doi: 10.1097/AOG.0000000000000603

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