1) Unsafe abortions are a major reproductive health challenge, accounting for 24 million procedures and over 360,000 deaths annually. 2) Lack of access to contraception and family planning services, as well as social factors like poverty, early marriage, and gender inequality contribute to high rates of unwanted pregnancy and unsafe abortion. 3) Improving access to contraception, comprehensive sexuality education, and safe abortion and post-abortion care services can help reduce maternal mortality from unsafe abortion and advance progress on Millennium Development Goal 5 of improving maternal health.

1. GRAZ ’II

2. GRAZ ’II
web. innoevent.dk
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MMD ODENSE facebook. innoevent
Nanna Maaløe, MD

3. THIS YEAR
720 JUMBO JETS CRASHED

4. 500 PEOPLE WERE
ABOARD EACH FLIGHT

5. ALL PASSENGERS DIED
ALL PASSENGERS WERE PREGNANT WOMEN

6. Reproductive
Health
Challenges
Agenda
Reproductive Health Challenges and MDG 5
• An introduction
Unsafe abortions
• A reproductive health challenge
The World Summit
Youth Award Festival 2011
Graz, Austria
Nanna Maaløe, MD

7. Each year
there are…
200.000.000 pregnancies
80.000.000 unwanted
pregnancies
50.000.000 induced abortions
24.000.000 unsafe abortions
360.000 deaths of women
during pregnancy
and child birth
7.000.000 still births and early
neonatal deaths

8. Pregnancy and birth related mortality
Risk of dying during Life expectancy:
pregnancy or child 82 years
birth:
1:17.000
Risk of dying during Life expectancy:
pregnancy or child 39 years
birth:
1:35

9. MDG 5: Improve
Maternal Health
a. Reduce maternal mortality with 75%
between 1990 and 2015
b. Achieve, by 2015, universal access to
reproductive health
• Contraceptive prevalence
• Antenatal care coverage
• Unmet need for family planning
• Adolescent birth rate

10. Maternal mortality ratio, by country, 2005

11. Causes of maternal deaths
Causes of maternal deaths:
Background causes:
Childhood malnutrition
Too early marriage
Poverty and illiteracy
Harmful practices
Denied equal rights
Denied access to family
planning / maternal health
services

12. Reproductive health
challenges
Abortions
Sexual Traditional
transmitted harmful
infections practices
Maternal
and
HIV/AIDS
Reproductive perinatal
health
Health
Cervical Family
cancer planning
Violence
Childlessness against
women
- And women’s empowerment

13. Unsafe abortions…The most easily preventable cause to maternal deaths?

14. Unsafe abortions
A procedure for terminating an unwanted pregnancy
• either by persons lacking the necessary skills
• or in an environment lacking the minimal medical standards
• or both
Grounds on which abortion is permitted around the world:

15. The example of Romania:
Effects of the introduction in Romania in November 1966 of an anti-abortion
law, and legalization of abortion in December 1989:
Maternal
deaths
per
100
000
live
births
Abor4on
deaths
per
100
000
live
births

16. Abortion laws:
Denmark Tanzania
Every woman aged 18 and over has a Illegal abortion carries sentences:
right to pregnancy interruption in a
public hospital at no cost to her
• up to 14 years for the abortionist
without stating any reasons, providing
she is resident in Denmark and the
interruption is performed before the • up to 7 years for the woman herself
end of the 12th week of gestation.
• up to 3 years for any person
supplying drugs or instruments

18. Characteristics of women
having unsafe abortion
362 women with illegal abortion
in Tanzania:
88% were aged 15-24 years
93% were single
56% were still attending school
79% had never used a contraceptive method
51% had, in relation to their first pregnancy,
had an induced abortion
• The girls were involved in unstable relationships
• Their partners were often twice their age and
already married
• Many had unprotected sex with multiple
partners
• 14% had previously been affected by a sexually
transmitted infection
Rasch V., Muhammad H., Urassa I., Bergström S.
Am J Public Health 2000

19. Contraception
Many couples in the world have no
access to contraceptives
• especially in Sub-Saharan Africa
A study from Malawi found…
• Only 50% of young people knew that
abstinence, faithfulness and condoms
prevent infections
• 40% of the women believed that if
having sex in a standing position, there
was no risk of getting pregnant

20. ! This is 1. Emergency treatment
accepted by 2. Contraceptive counseling, STI evaluation and treatment
all countries 3. Community involvement
In Tanzania, more than half of the patients admitted at gynecolological
wards attend because of complications to unsafe abortion.

21. Post-abortion care
Manual Vacuum Aspiration (MVA)
! A life saving intervention

22. Post-abortion care
If pregnant and signs of infection,
excessive bleeding, or in a critical
condition:
Clinical management imedeately!!
Yet, several studies report:
• Severe delays in life saving urgent
management
• Missing awareness and utility of
evidence-based guidelines of best and
achievable clinical management
• Missing use of simple and low cost life
saving clinical interventions

23.
Thank you for
helping to…
1. Develop new ways to achieve the
fifth Millennium Development Goal
2. Improve sexuality education and
family planning
3. Avoid unsafe abortions
4. Improve post-abortion care services
at health centers
! Sexual and reproductive health
and rights is one key to development!