Low Socioeconomic Status Leading to Unsafe Abortion-related Complications: A Third-world Country Dilemma

Introduction An unsafe abortion is a persistent, preventable dilemma. It is a procedure where an unintended pregnancy is terminated either by untrained individuals, or in an environment not meeting medical standards, or both, as defined by the World Health Organization (WHO). It endangers women in developing countries, where abortion is restricted either by law and culture or legally permitted but not easily accessible. Induced abortions are usually performed by unqualified and untrained individuals or are self-induced. Such incidents take place in unhygienic conditions and involve inappropriate methods or administration of medications. Even if carried out by medical experts, a clandestine abortion carries an additional risk, medical coverage is not immediately available in an emergency and the woman may not receive appropriate post-abortion attention. Induced abortion-related complications happen and the woman may hesitate to seek medical care. Unsafe abortion-induced complications contribute a major burden, such as increased hospital stay, drug costs, and an unusual delay of other operations on gynecological services in developing countries. The purpose of this study was to seek an association between low socioeconomic status and complications related to unsafe abortion. Materials and methods A total of 296 female patients of child-bearing age presented between 2012 and 2015 in the emergency department (ED), Nishtar Hospital, Multan, after an unsafe abortion, were included. Spontaneous miscarriages and abortions cases carried out on legal or medical grounds were excluded. Patient or their attendants (who usually present the real picture of incidents leading towards unsafe abortion) were interviewed for determinants leading to unsafe abortion. A detailed clinical assessment of the patient was done and complications like hemorrhage, uterine perforation, and bowel perforation were recorded along with basic demographic information such as age, gestational age, parity, and weight. Results There were 296 female patients in the study with a mean age 28.391 ± 4.57 (Range: 13-40 years). In a majority of patients, gravida and parity were 5-6. The mean weight was 60.283 ± 9.31 kilograms and the mean gestational age was 7.733 ± 2.45 weeks. The determinant in the shape of poor economic status was 71.6%. Hemorrhage was seen in 30.1% of the patients followed by uterine perforation (49.3%) and bowel perforation (45.6%). Conclusion Our results indicate that unsafe abortion is a major cause of maternal morbidity, mostly because the service is being sought from untrained healthcare providers in unhygienic conditions secondary to poor socioeconomic status. Since maternal morbidity due to unsafe abortion is a violation of a woman's basic human right: the right to life, there is a dire need to prevent these unwanted complications by improving the quality of the family planning program and providing safe abortion services.