What is it?
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Abortion or induced abortion is the termination of pregnancy intentionally by using drugs or surgery before the embryo or fetus has fully developed. This procedure is safer and more manageable during the early stages of pregnancy. During the late first or early second trimester, pregnancy is terminated by surgical means such as dilation & evacuation (D&E) or vacuum aspiration. Late-term abortions are rare and performed (D&E procedure) if the mother is in danger.
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The abortion procedure is usually not complicated if done correctly. There are safe and unsafe abortions. Safe abortion is performed by a trained healthcare professional with proper equipment & technique and hygienic environment standards. Unsafe abortion is performed by someone who doesn’t have the required skills in an environment without the standard medical requirement. It can cause maternal death.
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Suppose abortions aren’t performed by a professional. In that case, the complications that arise include incomplete abortion, hemorrhage (heavy bleeding), infection, holes in the uterine (caused when a sharp object pierces the uterus), and genital tract & internal organs damage, as a result of the insertion of dangerous objects into the vagina or anus.
Types of Abortion
There are two types of abortion: spontaneous or missed abortion (called miscarriage) and induced abortion (medical or surgical means).
Medical Abortion
Abortion can be induced during the first trimester through menstrual regulation, injecting prostaglandins (hormones that contract the uterus to remove the fetus), or a combination of abortion medications. The abortion pill needs to be taken within nine weeks of the first day of your last period. The first pill, called Mifepristone, stops the pregnancy from developing and is taken at a medical office. The second called Misoprostol, causes the uterus to empty and is taken at home. These pills thin the uterus to stop the embryo from staying attached or growing and remove it. You will have a follow-up visit to ensure you’re healing, evaluate the uterine size, or check for any signs of infection.
Risks:
- Incomplete abortion that may require you to get a surgical abortion
- The procedure might work, and you will still be pregnant
- Heavy bleeding for an extended period
- Infection
- Fever
- Discomfort in the digestive system
Surgical Abortion
Surgical abortion is a quick and minor operation (with sedation) that enlarges the opening to the uterus and inserts a small suction tube to remove the fetus. A urine test and an ultrasound test will be performed to determine how many weeks pregnant you are.
Risks:
- Heavy bleeding for 2 hours (going through 2 or more pads every hour)
- Vaginal discharge that smells awful
- Fever
- Cramping that worsens after two days
- Dispelling blood clots (gel-like clumps of blood) that are bigger than a lemon for over 2 hours
- Damage to the uterus
There are two types called vacuum aspiration and Dilate and Evacuate (D&E).
- Vacuum aspiration: is usually performed during the first trimester and involves removing the fetus by inserting a suction device after dilating your cervix. The suction device could be manual or mechanical. There are three main steps. First, the cervix is numbed by injection. Second, a soft, flexible tube is inserted through the cervix into the uterus. Lastly, suction is used to remove the pregnancy from the uterus. It usually takes less than 5 minutes for the procedure to be complete.
- Dilate and Evaluate (D&E): usually performed during the second trimester. It requires 2-3 consecutive days. For the first day, an ultrasound is needed to check the size and position of the fetus. Then, the cervix is numbed by injection, and dilators inserted into it expand overnight. The cervix is numbed again for the second day, and the doctor will remove the dilator. Then, the doctor will use special instruments to terminate the pregnancy. The last step is using the suction, the same as the Vacuum aspiration. More dilators are placed on the second day for more advanced pregnancies, and the removal procedure will be on the third day. The actual procedure usually lasts from 10-15 minutes.
Most abortion procedures do not influence future fertility. Menstrual cycles resume about 2 or 3 weeks after a first-trimester abortion and about three months after a second or third-trimester abortion.
Complications
After surgery, it will take a few hours to recover since you’ll still be sleepy from the medicines. You need to arrange for someone to pick you up. Depending on the stage of pregnancy, it will take a few days for physical recovery. You will have a follow-up appointment to make sure you’re recovering properly. A woman with several surgical abortions will have difficulty getting pregnant because the inner lining of her uterus might be scarred. You must refrain from sex and use tampons for two weeks to prevent infection.
Late-term Abortion
This method is rare, but it is for women in their third trimester and is only performed if the mother’s life is in danger. This can be done with the D&E procedure.
Risks:
- Cramping after three days
- Nausea for two days
- Sore breasts
- 2-4 weeks of light to heavy bleeding for two or more hours (going through 2 or more pads every hour)
- Dispelling blood clots (gel-like clumps of blood) that are bigger than a lemon
- Fever
- Vaginal discharge that smells awful
Postabortion Care (PAC)
It is a care service that treats women with complications of abortion following spontaneous abortion and unsafe abortion. PAC reduces maternal mortality & morbidity and includes both medical and preventive care. Essential elements of PAC include emergency treatment of incomplete abortion & potentially life-threatening complications and post-abortion family planning counseling & services.
After your abortion, your doctor will provide you with specific after-care instructions, but sometimes it isn’t enough to reduce undesirable side effects. Some methods to increase comfort after an abortion include:
- Use heating pads to relieve cramps
- Stay hydrated, particularly if you’re vomiting or diarrhea
- Have a support system to help with emotional changes due to the hormone shift
- Rest for a day or two to recover at home
- Take medication to decrease cramps and pain
- Massage the area where you have cramps
- Wear a tight-fitting bra to reduce breast soreness
Women who receive PAC without the necessary tools or information needed to prevent subsequent unwanted pregnancies and abortions may find themselves returning to health centers for similar services in the future. Lack of family planning information and tools leaves women trapped in a negative cycle of unwanted pregnancy and unsafe abortion. Research shows that reaching women at this critical stage helps increase contraceptive use significantly, leading to fewer repeat and possibly unsafe abortions.
Every woman seeking PAC care should receive physical and emotional support. The woman must be aware of precisely what will happen before, during, and after the procedure, including pain relief, immediate & future side effects, and possible complications. If the patient is an adolescent, additional care and attention are required to prepare her for the whole process.
A diagnosis for complications must be performed in any woman who missed her period and has bleeding, cramping, partial expulsion of POC, dilated cervix, smaller uterus than expected, or a combination of these. The diagnosis should assess injury or permanent damage to internal and external organs, permanent damage to the bladder or bowel that cause chronic problems, permanent infertility, possible death due to complications like infection and hemorrhage.
Ethiopian Law for Abortion
In Ethiopia, abortion is a sensitive topic where religious outlooks spread the controversy regarding criminalizing and decriminalizing abortion. Most religions believe that abortion is ending a life. Therefore, it is not accepted under any circumstance. However, advocates of women’s rights claim that the woman’s decision is the one that should count in the end.
Unsafe abortions cause over 10,000 yearly maternal deaths in Ethiopia. Safe abortion services in Ethiopia weren’t available until recent times. Many women still do not have access to medical care and abortion that can be performed in health facilities that can perform the procedure effectively. However, a woman can’t legally abort her baby unless it is due to the reasons listed by Ethiopian Law.
The Ministry of Health issued “Technical and Procedural Guidelines for Safe Abortion in Ethiopia” in June 2006. The guidelines state that abortion is the termination of pregnancy before fetal viability of fewer than 28 weeks from the last menstrual period or a birth weight of less than 1000 gm. After counseling, the woman can have it within three working days. In addition, minors and mentally disabled women should not be required to sign a consent form to obtain the procedure.
The grounds on which abortion is permitted in Ethiopia are:
- The pregnancy is the result of rape or incest
- Pregnancy endangers the mother’s or fetus’ life
- Fetal Deformity
- Women with physical and mental disability
- Unable to raise a child due to being a minor and aren’t physically or psychologically prepared
Abortion services are available in Marie Stopes Ethiopia (MSIE), private maternal and child care hospitals, public health facilities, IPAS Ethiopia, Engender Health, and Family Guidance Association. The cost of an abortion at clinics ranges from ETB 500 for medical and 2000 for surgical.
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