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Prevalence and factors associated with unsafe abortion among females below 25 years in Fort Portal regional referral hospital, Fort Portal City, Western Uganda.

Polly Nabbosa

Department of Medicine and Surgery, Kampala International University, Uganda.

ABSTRACT

Unsafe abortion is defined by the World Health Organization as a method of terminating an unplanned pregnancy that is either performed by someone who doesn’t have the necessary skills or in a setting that does not meet the bare minimum of medical requirements, or both. While the concept appears to be related to the procedure, the criteria of an unsafe abortion refer to unsuitable conditions that may exist prior to, during, or following an abortion. An unsafe abortion often has the following characteristics, however occasionally only a few or even all of them apply: Abortion is self-induced by ingesting traditional medications or dangerous substances, abortion is provoked by insertion of an object into the uterus by the woman herself or by a traditional practitioner, or by a violent abdominal massage, abortion is induced by an unskilled provider, frequently in unhygienic conditions, or by a health practitioner outside official/adequate health facilities, no pre-abortion counseling and advice, the wrong drug is provided for a medical abortion, or a pharmacist gives out the wrong medication with no instructions and no follow-up. A cross-sectional study design was deployed to generate the data for this study. Quantitative and qualitative methods of data collection were utilized and the study population was women aged below 25years attending post abortion care services in Fort portal Regional Referral Hospital. According to this study, the prevalence of Unsafe Abortion was 15.7% and the socio demographic factors that was commonly associated with unsafe abortions were; age 17-20 years (52.0%), single marital status (55.2%), unemployment (58.6%), No formal education (53.6%), Residing in the rural area (55.2%), age of first sexual intercourse at 17-20 years (48.5%), Having at least one child (61.2%) and having a monthly income lesser than 100,000/=(56.7%). Unsafe abortion continues to be a major public health problem. The risk factors associated with unsafe abortion were; age, marital status, unemployment, Level of education, Place of residence, age of first sexual intercourse, Number of children and financial status. The recommendation of this study is to encourage the people who provide information about Unsafe abortion to package a right full information to the young women. And to add on these young women should obtain extensive knowledge about contraception methods and safe methods of abortion. Parents are recommended to practice family planning methods as it would increase the care of parents to their girl child and this will decrease on the number of unwanted pregnancies thus prevention of un safe abortion.

Keywords: Unsafe abortion, WHO and pregnancy.

INTRODUCTION

Unsafe abortion is defined by the World Health Organization as a method of terminating an unplanned pregnancy that is either performed by someone who doesn’t have the necessary skills or in a setting that does not meet the bare minimum of medical requirements, or both [1]. While the concept appears to be related to the procedure, the criteria of an unsafe abortion refer to unsuitable conditions that may exist prior to, during, or following an abortion. An unsafe abortion often has the following characteristics, however occasionally only a few or even all of them apply: Abortion is self-induced by ingesting traditional medications or dangerous substances, abortion is provoked by insertion of an object into the uterus by the woman herself or by a traditional practitioner, or by a violent abdominal massage, abortion is induced by an unskilled provider, frequently in unhygienic conditions, or by a health practitioner outside official/adequate health facilities, no pre-abortion counseling and advice, the wrong drug is provided for a medical abortion, or a pharmacist gives out the wrong medication with no instructions and no follow-up. Unintended pregnancies happen when women desire to stop having children or space out their childbearing but do not use contraception, use it ineffectively, or engage in nonconsensual sex. Some of these pregnancies are terminated by induced abortions, but others result in unwanted births. Women may try to self-induce an abortion or turn to unqualified practitioners in areas where abortion laws are restricted, safe abortion facilities are scarce or of poor quality, running the risk of major negative effects on their health and wellbeing.

Up until the middle of the 19th century, abortion in the United States was treated in much the same way as it has been frequently everywhere in history as a quiet reality that was lawful until quickening [2]. Unlike today, the original anti-abortion campaign in America wasn’t primarily motivated by moral or religious considerations. Instead, doctors who wanted to regulate medicine were the first significant adversary of abortion in the United States. With a letter-writing campaign aimed at state legislators, the AMA pushed for the outlawing of abortion in 1857. They argued that life begins at conception rather than quickening because this is the general agreement among doctors. The campaign was a success. Between 1860 and 1880, at least 40 anti-abortion legislation were passed and put into effect. With the revelation of Associate Justice Samuel Alito’s proposed majority opinion for the U.S. Supreme Court, which would reverse the 1973 Roe v. Wade ruling upholding abortion rights nationally, the heated abortion debate has flared up once more. Based on the research of some historians, Alito came to the conclusion in his draft opinion that the right to abortion was not a part of the nation’s history or tradition [3].

Abortion is a frequent medical procedure. When done by a qualified individual, according to a procedure specified by the WHO, and with consideration for the length of the pregnancy, it is safe. Maternal fatalities and morbidities are primarily caused by unsafe abortion, which is also a preventable cause [4]. It may result in issues with women’s physical and mental health as well as social and financial pressures on communities and health systems. A serious problem for both public health and human rights is the lack of access to abortion treatment that is quick, safe, inexpensive, and respectful. Each year, there are about 73 million induced abortions performed worldwide. Three out of ten pregnancies (29% of all pregnancies) and six out of ten (61%) of all unplanned pregnancies result in an induced abortion [5]. The effects of unsafe abortion vary depending on the situation and surroundings, reflecting the availability, security, and legality of abortion at the time. Women who are financially better off are frequently able to access safe, covert procedures because they can afford the services of a trained provider, whereas poorer women and other disadvantaged groups (such as adolescents and women in rural areas) will frequently turn to providers who lack training in countries where abortion is severely restricted legally or where access to safe services is poor despite the law permitting abortion under broad criteria [6].Every year, there are reportedly 73 million abortions worldwide 45% of them are considered unsafe [4].Unsafe abortion is an overlooked issue in underdeveloped nations’ healthcare [7].One of the main factors contributing to maternal morbidity and mortality is unsafe abortion. Abortion is more frequent and frequently unsafe in Sub-Saharan Africa (SSA), which significantly increases maternal mortality [8]. In Sub-Saharan Africa, unsafe abortion has not yet been greatly decreased, and the rate of maternal deaths as a result of unsafe abortion is still high [9]. According to a study in Ethiopia, Induced abortions were common, at 18.8% [10]. Unsafe abortion, which increases the risk of maternal death, is a significant issue in Nigeria [11]. According to respondent reporting, the yearly incidence of abortions in Nigeria in 2017 was 29.0 per 1,000 women aged 15 to 49, or more than 1.2 million abortions [12]. Combined with data from respondents’ closest confidantes, there were nearly 2.0 million abortions performed in Nigeria. More than six out of ten abortions were regarded as most unsafe, and 11% of women sought treatment at a hospital after sensing problems. In East Africa, there is limited evidence on the prevalence and factors associated with abortion. The combined prevalence of abortion among women of reproductive age in East African nations was 5.96% with ranging from 3.10 percent in Malawi to 11.1 percent in Uganda [13].

The high rate of maternal deaths continues to be a public health challenge despite significant decreases in pregnancy-related deaths in Uganda over the past 20 years (the maternal mortality ratio declined from 684 per 100,000 live births in 1995 to 343 per 100,000 in 2015) [14]. This public health issue is still strongly impacted by unsafe abortion: According to a 2010 report from the Ugandan Ministry of Health, unsafe abortions were thought to be the cause of 8% of maternal fatalities [15]. Abortion is expressly permitted under Ugandan law to save a woman’s life. The National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights from 2006, however, go even farther by allowing abortion in additional situations, such as in cases of fetal abnormalities, rape, incest, or if the woman is HIV-positive [16].Obstetric violence against women who require abortion care still remains a serious issue if discursive technologies that exclude abortion care from national responses are not addressed [17].In Uganda, unintended pregnancies are frequently experienced, which increases the likelihood of unplanned deliveries, unsafe abortions, and harm to or death of mothers [18]. According to the 2016 Uganda Demographic Health Survey (UDHS) data, 18.1%, had ever had a pregnancies ended [19]. The findings showed that the likelihood of pregnancy termination was positively significantly correlated with the woman’s age, marital status, exposure to mass media, working status, and having visited a health facility.

Despite the fact that unsafe abortion is one of the preventable causes of maternal mortality, an estimated 25.1 million (45.1%) of the 55.7 million abortions performed globally annually between 2010 and 2014 were unsafe [20]. Every year, there are reportedly 73 million abortions worldwide 45% of them are considered unsafe [4]. Unsafe abortion is an overlooked issue in underdeveloped nations’ healthcare [7]. Abortion is more frequent and frequently unsafe in Sub-Saharan Africa (SSA), which significantly increases maternal mortality [8]. In Sub-Saharan Africa, unsafe abortion has not yet been greatly decreased, and the rate of maternal deaths as a result of unsafe abortion is still high [9]. In East Africa, there is limited evidence on the prevalence and factors associated with abortion. The combined prevalence of abortion among women of reproductive age in East African nations was 5.96% [13]. The high rate of maternal deaths continues to be a public health challenge despite significant decreases in pregnancy-related deaths in Uganda over the past 20 years (the maternal mortality ratio declined from 684 per 100,000 live births in 1995 to 343 per 100,000 in 2015) [14]. This public health issue is still strongly impacted by unsafe abortion: According to a 2010 report from the Ugandan Ministry of Health, unsafe abortions were thought to be the cause of 8% of maternal fatalities [15]. Approximately 50 patients attend Fort portal Regional Referral Hospital for post abortion care each month. Thus, this study will determine the prevalence and factors associated with unsafe abortion among females below 25 years in Fort portal Regional Referral Hospital.

CONCLUSION

Unsafe abortion continues to be a major public health problem. The risk factors associated with unsafe abortion were; age, marital status, unemployment, Level of education, Place of residence, age of first sexual intercourse, Number of children and financial status.

Recommendation

The recommendation of this study is to encourage the people who provide information about Unsafe abortion to package a right full information to the young women. And to add on these young women should obtain extensive knowledge about contraception methods and safe methods of abortion. Parents are recommended to practice family planning methods as it would increase the care of parents to their girl child and this will decrease on the number of unwanted pregnancies thus prevention of un safe abortion.

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Polly Nabbosa (2023). Prevalence and factors associated with unsafe abortion among females below 25 years in Fort Portal regional referral hospital, Fort Portal City, Western Uganda. IDOSR JOURNAL OF APPLIED SCIENCES 8(3) 101-110. https://doi.org/10.59298/IDOSR/2023/10.2.1417

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