Various factors contribute to the extent and severity of post abortion complications:
a. Delay in seeking abortion
b. Negative attitudes of trained providers
c. Resorting to untrained providers
d. Use of dangerous methods
e. Laws relating to abortion
f. Service-delivery factors
g. Complications following spontaneous abortions
a. Delay in seeking abortion is the most important factor and the commonest
cause of complications and death among adolescents. Delay is again due
to ignorance (Not aware that pregnancy has occurred) or hoping to hide
pregnancy till it becomes too late or the costs involved.
b. The judgemental and unwelcoming attitudes of health providers can also lead to delay in reaching them or force them to seek abortion from untrained providers.
c. It is commoner among adolescents to go to untrained and unskilled providers especially when they are unmarried or the pregnancy is unintended and adolescent wants to get rid of it clandestinely (without informing the in-laws). The younger they are, it is more likely that they will be forced to opt for a potentially unsafe abortion conducted in an unhygienic condition by unskilled provider
d. Use of dangerous methods are also common in adolescents especially unmarried girls who are advised by mothers, untrained birth attendants, quacks, to insert foreign bodies into the cervix unhygienically or ingest certain potions or drugs.
e. There is general lack of awareness among adolescents about the ‘Medical Termination of Pregnancy’ Services that can be availed of in all District Womens’ hospital and some PHCs. These latter are however, inaccessible because of the family’s need for secrecy and confidentiality and bowing to societal and community demands.
f. At present, health facilities do not offer user-friendly abortion services and some are not themselves aware of the rights of clients to these. Most clinets feel that privacy and confidentiality is difficult do be maintained in public system.
g. Even after a spontaneous abortion, an adolescent may have post abortion complications, if the abortion is not complete or some infection has set in due to retained products of conceptions and unhygienic practices of perineal region.
The extent of problems related to unsafe abortion among adolescents
varies from state to state and within communities and depends on whether:
• Reproductive health information and services are available and accessible to adolescents;
• Early and safe abortion services are available and accessible;
• Health-care providers are sensitive and non-judgemental towards adolescents;
• Community and societal norms permit frank discussion about sexuality matters in adolescents;
• National law and policy makers ensure the dissemination of adequate knowledge related to reproductive health information services.