Adolescents with unwanted pregnancies continue to resort to abortions, whether or not it is safe, putting their lives at great risk. Prevention of such pregnancies must therefore be one of the key objectives in any reproductive health programme.
All stakeholders like family elders and decision makers, communities, health-care providers, governments, etc., should make all efforts to:
• Improve access to reproductive health information and
The need to improve adolescents’ access to reproductive health information and services in of prime importance to give sexually active adolescents the right to a range of options. The contribution that emergency contraception could make in preventing unsafe abortion needs to be clearly spelt out and adolescents need to know that this method is available, and where it could be obtained when needed.
• Address laws and policies on access to safe abortion
Even in our country where abortion is legally available on demand, women (especially adolescents) experiences difficulties in exercising their right to obtain these services. The reasons for this include an insensitive environment that cannot ensure confidentiality and not-judgmental behaviour, complicated administrative requirements, etc.
• Train health-care providers in comprehensive abortion
Health-care providers, both modern and traditions, need to be trained in comprehensive post-abortion care so that they can recognize the signs and symptoms of abortion-related complications and how to manage them effectively. They also need to be introduced to the concept of post abortion counseling including contraception. To be able to learn the latter, they need to examine their attitudes and beliefs, in order to prevent their own biases from hindering the provisions of care. Clear guidelines need to be issued for the management of post-abortion complications due to unsafe abortion.
Healthcare providers have a very important role to play in the communities
they serve in providing safe abortion services to adolescent. First,
however, they must overcome the barriers in their own minds about supporting
and counseling (even the unmarried and girls from marginalized section
of society) and providing the best technical care they can offer. They
must work as ‘Change-agents’ and involve communities in
discussions on unwanted pregnancy, unsafe abortion and its consequences,
and the contribution they could make by protecting and safeguarding
Factors that could help reduce unsafe abortion in adolescents
• Availability and accessibility of contraceptive information and services including Emergency Contraceptives (now going to be available even without prescription)
• Availability and accessibility of safe abortion services
• Helpful, friendly and non-judgmental health care providers
• Community norms that permit open and frank discussion with parents and gate keepers about sexuality in adolescents.
• Adolescent pregnancy is common in India.
• Adolescents have higher risk of poor pregnancy outcomes in the form of illness and death of themselves and their babies, especially in unmarried adolescents.
• Many complications of pregnancy and childbirth have worse outcomes than adults.
• Preventive health services should be directed towards:
- Increasing awareness in the community regarding risks and consequences of adolescent pregnancy and childbirth and unsafe abortions.
- Making family planning counseling and services easily available to adolescents.
- Involve other departments to help increase social and nutritional status of girls and increase their access to education / vocational training and job opportunities.
• Curative Health Services include:
- Providing ANC and promoting institutional delivery and post partum care.
- Counseling, providing or referring for safe MTP services.
• Unsafe abortions are those which are conducted in an unapproved facility for the purpose and / or by an untrained provider.
• Despite abortions being legalized in India 4 million women per year still resort to illegal abortions.
• Unsafe abortions are more common in unmarried girls.
• 50% of all maternal deaths in 15-19 year age group are due to illegal abortions.
• Complications due to unsafe abortions are medical and psychological.
• Management of post-abortion complications:
- Emergency resuscitation and referral to District Women’s hospital or appropriate facility with effective treatment even in private sector.
- Evacuation of uterus in early pregnancy by simple techniques as per Government of India guidelines for MOs at PHCs. Referral to CHC or District Women’s hospital if pregnancy 8 weeks or more upto 20 weeks.
- Management of further complications such as infection and injury.
- Arrangement of post-abortion care including contraceptive counseling and services.
• Prevention of unsafe abortions:
- Improve access to reproductive health information and services especially simple and safe MTP services even at the PHC level.
- Address laws and policies on access to safe abortion services by providing an adolescents sensitive environment.
- Train health care providers in comprehensive abortion care, and / or counseling for referral to a safe and appropriate facility.
- Involve inter-sectorial departments and gatekeepers to increase community awareness and reduce stigma associated with pregnancy in unmarried girls.
• Unsafe abortion implies interference of pregnancy by persons without the necessary knowledge and skills, or in conditions that are not conducive to good health. It can be within or outside of the law.
• Adolescents opt for abortions because of socio-cultural and / or socio-economic reasons.
• Adolescents undergoing unsafe abortions tend to be single, pregnant for the first time and usually obtain their abortions later in their pregnancies than adult women.
• They are more likely to have resorted to illegal providers and to have used dangerous methods for including abortion.
• They tend to present later, and with more entrenched complications.
• They tend to face more barriers than adults, in accessing and using the health services they need.
• They are less likely to come for post treatment follow-up.
• The management of post-abortion client should include management of complications, post-abortion counseling, addressing contraception and other issues.