Here's What An Unsafe Abortion Environment Does To Women's Health

In case you, or Texas, needed a reminder.
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Every year, 7 million women in the developing world are treated for complications from unsafe pregnancy termination. These complications can include heavy bleeding, infection and sepsis, as well as more severe conditions, such as lacerations or uterine perforation, that can put a woman’s life at risk. 

Unsafe abortions account for between 8 and 15 percent of maternal deaths in developing countries, making them one of the leading causes of maternal mortality, according to a new report.

“It’s a big health issue for women in most countries in the developing world,” said Susheela Singh, vice president for research at the Guttmacher Institute and the lead author of the report, which was just published in BJOG: An International Journal of Obstetrics & Gynecology.

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Tom Williams

A group from Texas display their flags during a rally on the Mall for the March for Life anti-abortion demonstration.

Singh and her fellow researchers hope the United Nations will consider their study, and the issue of unsafe abortion, when it meets to agree on global public health goals. Because unsafe abortion is a sensitive and often stigmatized public health topic, it's often sidelined at global meetings where countries have to come to an agreement on health -- and where countries frequently opt in favor of recognizing easier aspects of women's health, such as maternal care.

But anti-abortion activists in the United States (we're looking at you, Texas) could stand to take a few pointers from the new study, too. As the BJOG report shows, lack of access to abortion clinics doesn't result in fewer abortions -- it results in unsafe abortions. This is what an unsafe abortion looks like in 2015:

There are several types of unsafe abortions

According to Singh, unsafe pregnancy terminations are either performed by individuals without formal training or are procedures that take place in unhygienic facilities. Some women try to perform self-abortions by taking strong substances or drugs, or by inserting foreign objects into their bodies in an effort to terminate their pregnancy. Such unsafe practices can have grave health consequences.   

"Even what we would normally think of as a safe procedure, like a manual vacuum aspiration or a D&C, depending on if the person has training, it could be it's not done safely," she said.

The availability of medical abortion, or using medication to terminate an early pregnancy, is one important improvement of the last decade over the kinds of methods women were using in the past. Still, women aren't getting the correct information on how to use the medication. This is in part because pharmacists don't always know the correct protocols for the drugs themselves, according to a small study of pharmacy workers in Bangladesh, published in the International Journal of Gynecology & Obstetrics in 2014. 

“The rate of unsafe abortions in the developing world is likely two or three times higher than the rate of treatment.”

Unsafe abortion rates vary greatly 

The study used health data and previous research from 26 countries to calculate the number of women who sought health care treatment from unsafe abortions in 2012. Since the data doesn’t include women who didn’t have complications from their unsafe abortions, 7 million should be considered a minimum estimate of unsafe abortions occurring in the developing world.

Among the 26 developing countries in the study, Pakistan had the highest rate of treatments for unsafe abortions (14.6 per 1,000 women ages 25 to 44) and Brazil had the lowest rate (2.4).

In reality, the rate of unsafe abortions in the developing world is likely two or three times higher than the rate of treatment, according to Singh. 

What Texas can learn from Pakistan 

Abortion clinics have been closing rapidly in Texas, according to the New York Times. In 2015 the state had only 17 abortion clinics, down from 41 in 2012, meaning the average Texas county is now 111 miles from the closest clinic. Meanwhile, legislation in Mississippi and North Dakota, among other U.S. states, is also aim reducing abortion access.  

If the BJOG study, and Pakistan in particular, is any evidence, the belief of some lawmakers that limiting women’s access to abortion clinics will decrease the number of abortions is unfounded. 

“When women want to end a pregnancy they find a way,” Singh said. “One lesson from this study is that even in countries with very restrictive laws, women are still seeking abortions. The problem is, it’s more likely to be unsafe.”

CORRECTION: A previous version of this article stated that unsafe abortions are the leading cause of maternal mortality in developing countries. In reality, hemorrhage is the leading cause. 

Also on HuffPost: 

Myths About Abortion That Need To Be Busted
MYTH: Abortion is dangerous.(01 of08)
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REALITY: Over 99.75 percent of abortions do not cause major medical problems.Less than one-quarter of 1 percent of abortions performed in the United States lead to major health complications, according to a 2014 study from the University of California, San Francisco, that tracked 55,000 women for six weeks after their abortions. The researchers note that this makes an abortion statistically about as risky as a colonoscopy.If that fact seems surprising, consider how American pop culture misrepresents the risks of abortion: Nine percent of film and television characters who have abortions die as a direct result of the procedure, according to another 2014 study from UCSF. (credit:Getty Images)
2. MYTH: Medical abortions -- those performed using pills -- are still fringe.(02 of08)
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REALITY: About one in five abortions are medical abortions.The Centers for Disease Control and Prevention found that 19 percent of abortions in 2011 were medical abortions and that 28.5 percent of those took place in the first nine weeks of pregnancy. The Guttmacher Institute also found that medical abortions increased substantially from 2008 to 2011, meaning more women have ended their pregnancies with this alternative to surgery.

3. MYTH: Women who get abortions will regret it, and are more likely to suffer mental health issues.
(03 of08)
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REALITY: Most women will not regret their decision, and are no more likely to experience mental health problems than women who carry an unplanned pregnancy to term.While many women experience mixed emotions after an abortion, 95 percent of women who have abortions ultimately feel they have made the right decision, according to an August 2013 study from UCSF. "Experiencing negative emotions postabortion is different from believing that abortion was not the right decision," the researchers explained. Furthermore, while unplanned pregnancies often cause emotional stress, there is no evidence to suggest that women who choose to terminate their pregnancies will be more likely to suffer from mental health issues, according to a 2008 report from the American Psychological Association that investigated all relevant medical studies published since 1989.The APA found that past studies claiming abortion causes depression and other mental health problems consistently failed to account for other risk factors, particularly a woman's medical history. The APA accounted for these factors and found that, among women who have an unplanned pregnancy, those who have abortions are no more likely to experience mental health problems than those who carry the pregnancy to term.
4. MYTH: Fetuses experience pain during abortions.(04 of08)
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REALITY: Fetuses cannot feel pain until at least the 24th week of pregnancy. Experts ranging from Britain’s Royal College of Obstetricians and Gynaecologists to the American Congress of Obstetricians and Gynecologists agree with that timeline. In fact, research from UCSF found that fetuses can't perceive pain before 29 or 30 weeks of development.Then why have so many states banned abortions after 20 weeks of pregnancy? Perhaps misrepresentation of research is partly to blame: Many of the researchers most frequently cited by pro-life politicians told The New York Times that their research does not prove anything about fetal pain.
5. MYTH: The majority of Americans don't think abortion should be legal.(05 of08)
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REALITY: Most Americans support a woman's right to choose.According to a Gallup poll from 2014, 78 percent of Americans think abortion should be legal in some or all circumstances. (Fifty percent said "some circumstances," while 28 percent said all.) What's more, in 2012, Gallup found that 61 percent of Americans think abortions that take place during the first trimester of pregnancy should be legal. (Nine out of 10 abortions in the U.S. do take place during that time period, according to Guttmacher.) (credit:Getty )
7. MYTH: Most American women have easy access to abortions.(06 of08)
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REALITY: Women face a growing number of barriers to accessing abortions.More than 57 percent of American women live in states that are hostile or extremely hostile to abortion rights, according to the Guttmacher Institute. That represents a marked increase from 2000, when 31 percent of American women lived in such states. In 2011, 89 percent of counties in America had no abortion clinics. This is no accident: Across the U.S., lawmakers have enacted 231 new abortion restrictions over the past four years, according to a Guttmacher analysis from January 2015. As a result, many women have to travel great distances to reach an abortion clinic, where they may face 24-hour wait periods. These barriers particularly affect women living in rural areas and low-income women, who often can't afford to take time off work and pay for gas and a hotel room. Other laws force women to go through potentially distressing procedures, such as viewing their own ultrasound photos, in order to move forward with an abortion.
9. MYTH: Women would never have abortions if they knew what it was like to have a child.(07 of08)
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REALITY: Most women who have abortions are already mothers.Sixty-one percent of women who had abortions in 2008 were mothers, and 34 percent had two or more children, according to the Guttmacher Institute. That number only increased after the 2009 financial downturn. The National Abortion Federation told Slate that between 2008 and 2011, 72 percent of women seeking abortions were already mothers. A study from Guttmacher found that mothers typically have abortions to protect the children they already have; they simply cannot afford to raise another child. (credit:Getty Images)
10. MYTH: It is dangerous to perform abortions in clinics that do not meet the same standards as ambulatory surgical clinics. (08 of08)
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REALITY: Requiring abortion clinics to meet these standards does little to improve patient safety and forces many to shut down.Currently, 22 states require abortion clinics to meet a set of restrictive and often arbitrary standards, dictating that they be close to hospitals and that their hallways and closets meet certain measurements. Clinics often need to undergo expensive renovations in order to comply, and leading doctors' groups say the laws do little to improve patient safety.What's more, 11 states now require that doctors at abortion clinics obtain admitting privileges at a nearby hospital, but many hospitals flat-out refuse to grant these privileges. As a result, hospitals essentially have the power to shut down nearby clinics. (credit:Getty Images)

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