According to the World Health Organisation, unsafe abortions are defined as procedures for terminating a pregnancy performed by people who lack the requisite skills, or, performed in an environment that is not in conformity with minimal medical standards or both. This definition is a product of the core concepts that were first outlined in a WHO Technical Consultation held in 1992.
The definition of unsafe abortions was conceptualised within the scope and ambit of the emerging guidelines concerning the management of the complications of induced abortion. Therefore, the interpretative scope of the definition remains confined to that context – and this link is absolutely important for the correct interpretation.
One might want to say that the definition should also predetermine what a safe abortion is – but that would not allow the dynamic evolution of what makes for a safe abortion given the advamces in science and technology. The WHO makes a clear mention of this as follows:
“Although unsafe abortions are, by definition, risky, safety cannot be dichotomized because risk runs along a continuum. Risk is lowest if an evidence-based method is used to terminate an early pregnancy in a health facility; it is highest if a dangerous method, such as the use of caustic substances orally or vaginally or the insertion of sticks into the uterus, is employed clandestinely to terminate an advanced pregnancy. There is a spectrum of risk between these two extremes. Along that spectrum, for example, lie cases of self-administration of misoprostol or the use of outdated procedures, such as sharp curettage, by skilled health-care providers.”
What does this really mean ? This statement is saying that risks are to be determined by taking into account a multitude of factors that include the legal context, the availability of and ease of access to safe abortion services, the level of stigma surrounding abortions, the degree of women’s access to information on abortion, the woman’s age and socioeconomic status.
So a woman who self- administers a medical abortion pill regimen correctly in the first trimester is getting a much safer abortion than a gynaecologist who is using sharp curettage !
Given the rate of underreporting and misclassification in surveys, the rates of induced abortion are difficult to measure. Keeping this in mind, the WHO has begun using a clear interpretation mechanism to measure safety in terms of legality of abortions in building its regional and global estimates of rates of unsafe abortion. But the recent trends of declining deaths due to the advent of safer methods, the focus should include the evaluation of mortality and morbidity as well.
While the report is indeed credit worthy, it is only the beginning for many more developments that are needed. It is not enough to assess the safety of induced abortions, while it is a good step to start with. In the longer term, a global consensus will be needed to develop and determine the kind of indicators that are to be used to assess the provision of safe abortions in keeping with WHO guidance.
This article is an adaptation from the original article appearing on the World Health Organisation concerning Unsafe Abortions.