Complications due to unsafe abortions are high for all women, the adolescent group is especially at risk. Within this group, those who are very young, who are primigravida, unmarried and the very poor are even worse off. These can be categorized as medical, psychological and socio economic.
A. Major short-term medical complications
• Tetanus can result form the insertion of foreign bodies like sticks, rods or using unsterilized surgical instruments.
• Haemorrhage is seen very commonly and is mostly the presenting complaint. It is due to retained products of conception and injuries in the birth canal. It can be fetal. This complication can also result from spontaneous and / or legally induced incomplete abortions.
• Localized or generalized infection.
• Injuries range from genital lacerations to fistulae to perforation of uterus.
B. Major long-term medical complications are those that happen after a month or more and may leave the girl permanently unable to bear children and carry physical scars for the rest of her life.
• Chronic pelvic infection
• Secondary infertility
• Subsequent spontaneous abortion
• Increased likelihood of ectopic pregnancy
• Increased likelihood of premature labour in subsequent pregnancy
C. Psychosocial complications
Consequences of unsafe abortions in adolescents
A. Medical consequences: infections may lead to secondary infertility and reproductive tract injuries:
Medical consequences of unsafe abortion are especially high and more serious for adolescents because of the ways in which abortion is induced an also delay in care-seeing.
Major emergency surgical interventions are often required and these are either not available or not accessible to the disadvantaged sections of society. Thus, in many cases, the unfortunate adolescents who are forced to resort to unsafe abortions, end up dying at a very young age or live with severely damaged reproductive tracts.
The major long-term medical complications (more than a moth after the procedure) include secondary infertility (Akin to a life sentence in a society that equates a woman’s worth with her ability ot bear children), spontaneous abortion in subsequent pregnancy, and an increased likelihood of both ectopic pregnancy and pre-term labour.
B. Psychological consequences: though not commonly identified or reported do occur frequently and include depression and withdrawal.
Within the confines of an unforgiving and rigid society, there is no psychological support for the adolescent recently traumatized by an unsafe abortion. In fact, even health providers do not see the need for this kind of a support. The girl is left alone in her misery, confusion and ignorance and guilt can set in compelling her to resort to risky behaviour and even suicide.
C. Socio-economic consequences: are very severe when the girl is unmarried and she can be shunned by both her family and the community in general.
Girls who survive unsafe abortions face a range of social problems,
from disapproval, refection, even ostracism, from their families and
communities. They can be thrown out by their families and forced into
early marriage or prostitution. Their options become very limited.
The family faces grave economic burden of managing complications of unsafe abortion and is at times, reduced to bankruptcy and ruin.
Medical care costs will severely strain family resources an in the long run, investments made in the girl’s education and development are lost.
Highlight about provision of MTP act expanding for adolescent. Stress that the consent of guardian in case of minor <18 years girl is required. The MOs should involve community level functionaries and gatekeepers to create awareness in the community regarding awareness in the community regarding facility for Emergency Contraception (EC) and MTP and contraceptive services at PHC level. Stress that these complications and consequences are more in unsafe abortions.