What Causes Eight Maternal Deaths per Hour?
What Causes Eight Maternal Deaths per Hour?
Abstract & Commentary
By Alison Edelman, MD, MPH, Assistant Professor, Assistant Director of the Family Planning Fellowship, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, is Associate Editor for OB/GYN Clinical Alert.
Dr. Edelman is a consultant to Schering-Plough and receives grant/research support from the Society for Family Planning.
Synopsis: Updated statistics on the worldwide abortion rate reveal a decline in the incidence of safe abortion, but no change in the incidence of unsafe abortion and its associated morbidity and mortality.
Source: Singh S, et al. Abortion worldwide: A decade of uneven progress. New York, NY: Guttmacher Institute; 2009. Available at: www.guttmacher.org/pubs/AWWfullreport.pdf. Accessed Oct. 27, 2009.
The Guttmacher Institute, in collaboration with the World Health Organization, recently published an updated account of abortion rates worldwide. They found a decline in the incidence of abortion from 1995 to 2003 (46 million to 42 million); most likely due to an increase in contraceptive use. Unfortunately, the decline in abortion was not universal across both developed and undeveloped countries and there was no decline in the number of unsafe abortions. Incidence of abortion in developing countries remains high (35 million) with more than half being performed unsafely. The estimated morbidity and mortality associated with these unsafe abortions include 8 million abortion-related complications and 70,000 maternal deaths. These complications appear to affect women of poverty more than women who are economically better off.
What causes eight maternal deaths per hour?1 Unsafe abortion. While it is exciting to see the rates of abortion decline concomitantly with an increase in contraceptive use, it is sobering to find no change in the rates of unsafe abortion.2 What is the solution to preventing unsafe abortion? Unfortunately, there is no one solution — the situation is complex and gets mired in the sociopolitical cloud surrounding abortion.
An urgent multifaceted effort, including legal, social, economic, and health reform, needs to take place to save lives. Outlawing abortion does not make the problem go away and appears only to compound it. Countries with the most restrictive laws have the highest rates of unsafe abortion.2,3 Legal reform, however, is not the panacea if safe and accessible services are not available.2 Preventing and planning pregnancies through contraceptive use appears to have decreased the rate of safe abortion and has the potential to decrease the rates of unsafe abortion.2 This requires that low- or no-cost-options are available and accessible, women and their partners are educated regarding their choices, and women are allowed to play an active role in planning when to reproduce. Provision of contraception has been shown to save health systems money. In the United States, every dollar spent on contraception saves approximately $4 for prenatal and neonatal care.4 Improvements also need to be made in the care of women who chose to carry their pregnancies to term — this currently is a very dangerous choice to make (with a maternal mortality rate of 450/100,000 live births in developing countries in 2005).5
To end on a more personal note, I was recently at a meeting with several OB/GYN physicians from Central America. One of the physicians had come to the meeting directly from covering a septic abortion service. He was worried about one of his patients and checked in with the hospital; she had died. Visibly upset, he turned to me and asked what my preferred regimen was for treating septic abortions. Although I have been trained in the treatment of septic abortion, I have yet to treat a woman for septic abortion in my U.S.-based practice. I told him that I didn't have a preferred regimen. I look forward to the day when he can say the same thing.
- Unsafe abortions: Eight maternal deaths per hour. Lancet 2009;374:1301.
- Abortion worldwide: A decade of uneven progress. New York, NY: Guttmacher Institute; 2009. Available at: www.guttmacher.org/pubs/AWWfullreport.pdf. Accessed Oct. 27, 2009.
- Moloney A. Abortion ban leads to more abortion deaths in Nicaragua. Lancet 2009;374:677.
- Frost JJ, et al. Estimating the impact of serving new clients by expanding funding for Title X. Guttmacher Institute Occasional Report No 33. November 2006. Available at: www.guttmacher.org/sections/index.php?page=reports. Accessed May 30, 2007.
- World Health Organization. Maternal Mortality in 2005. Available at: http://whqlibdoc.who.int/publications/2007/9789241596213_eng.pdf. Accessed Oct. 27, 2009.
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