In a Catholic country such as the Philippines where abortion is illegal, it is disgraceful to know that our abortion rates are even higher than in countries where abortion is freely and legally available. In the US, the reported abortion rate is 16 abortions per 1,000 women whereas in our country, the rate is a whopping 20 to 30 per 1,000 women. Some 400,000 abortions are performed in our country every year. There is no question that backdoor abortions occur frequently such that 80,000 women per year are estimated to be treated in hospitals in the Philippines for complications of induced abortion.
Since the procedure is illegal in this country, you would think it would be very rare to find a doctor performing the procedure. However, a survey of health professionals in the Philippines suggests that about one-third of women seeking an abortion get it from a doctor or nurse, which has reduced the proportion of complications requiring hospitalization in the last two decades. The majority of women still consult traditional practitioners or attempt, through the use of prostaglandin medications, to induce the abortion themselves. Based on the health professionals survey done in 1996, it is believed that untrained abortion practitioners in our country have increased their use of hormones and modern drugs, aside from using traditional methods such as abdominal massage. Usually, midwives or
hilots do the procedure in a house or, sometimes, a clinic where they perform lower abdominal massage over the uterine area, prescribe some bitter herbs from quinine, or ask you to take some tablets orally or to insert some tablets vaginally to soften the cervix and allow it to dilate. If that effects the bleeding, they may tell you to go to an obstetrician to complete the abortion or wait for spontaneous expulsion. If that does not work, the more dangerous procedure is to insert a rubber catheter (normally used for draining urine from the bladder) inside the uterus and keep it there for several hours to induce bleeding. It can be a painful experience since the foreign body in the uterus is intended to cause uterine contractions, which feel like severe cramping or dysmenorrhea. Bleeding is always a desired result to effect expulsion of the product of conception.
Aside from the moral reasons attached to having an abortion, which involves tampering with life itself, there are solid scientific and medical reasons which document the dangers of undergoing an abortion.
Approximately 10 percent of women undergoing elective abortion will suffer immediate complications, of which approximately one-fifth (two percent) are considered life-threatening. The nine most common major complications which can occur at the time of an abortion are: infection, excessive bleeding, embolism, perforation of the uterus, anesthesia complications, convulsions, hemorrhage, injury to the cervix, and endotoxic shock. The most common "minor" complications include: infection, bleeding, fever, second-degree burns, chronic abdominal pain, vomiting, gastro-intestinal disturbances.
The women who undergo abortion were found by research to be linked to certain behaviors such as smoking, drug abuse, eating disorders, and promiscuity, which all increase their risk for health problems. Teenagers comprise one-third of those who undergo abortion and are even at a much higher risk of suffering both immediate and long-term abortion-related complications. It was found that if the partner was present but not supportive, the miscarriage rate is more than double and the abortion rate is four times greater than if he was present and supportive. Absence or abandonment by the partner increases the abortion rate to six times greater.
Excessive bleeding during or after abortion may happen in the presence of cervical lacerations, uterine perforation, uterine atony or disorders in blood coagulation. This is one of the most common complications after the procedure.
With the introduction of any foreign body into the uterus, the potential risk for infection increases. Post abortion, the patient may be at increased risk for infection of the uterus (endometritis), of the fallopian tubes (salpingitis) which may lead to ectopic pregnancies. The danger comes when a patient is not screened for sexually transmitted disease prior to the procedure. Studies have found that one-fourth to one-fifth of patients seeking abortion have a Chlamydia infection and one-fourth of them will develop Pelvic Inflammatory Disease (PID)within 4 weeks. In the absence of Chlamydia, there is still a 5 percent chance the woman may develop PID as a result of the abortion procedure.
Perforation
Between two and three percent of all abortion patients may suffer perforation of their uterus through the use of instruments. The chances even increase for those who were under general anesthesia during the abortion procedure (since they cannot scream with pain to alert the practitioner of the mishap) or for those who had multiple deliveries. Damage to the uterus may eventually evolve into problems requiring a hysterectomy, if not reproductive or pregnancy problems.
During an abortion, the cervix may be forced open by an inexperienced practitioner, causing cervical tears or permanent damage leading to cervical incompetence, which in turn may cause habitual abortion, premature delivery or labor complications.
Abortion is significantly related to an increased risk of subsequent ectopic pregnancies (condition when the embryo implants outside the uterus) because of the infection and damage that may arise in the fallopian tubes. Since fertilization occurs in the tubes, the embryo is unable to travel towards the uterus for implantation. Since the fallopian tube is not as distensible as the uterus, it will eventually rupture, causing internal bleeding and pain, which can be life-threatening and may jeopardize one’s chances of future fertility.
>Women with one abortion face a significant risk for cervical cancer, liver, and ovarian cancer. One reason for this may be the due to the disruption of the hormonal changes which accompany a pregnancy.
Abortion increases the risk of placenta previa in later pregnancies. Abnormal development of the placenta due to uterine damage increases the risk of fetal malformation, perinatal death, and excessive bleeding during labor.
Having an abortion can lead to many complications that can threaten the life of a woman and even ruin her chances of having a baby in the future. It is so easy to be swayed by passion and be unmindful of the consequences. But remember that preventing a pregnancy can be much safer than trying to get rid of one.
(Dr. Rebecca B. Singson is a fellow of both the Obstetrics and Gynecologic Society and Philippine Society of Cervical Pathology and Colposcopy. She holds clinics at Rm. 381, Makati Medical Cente with telephone number 892-7879 and Rm. 202-203. Asian Hospital and Medical Cente with telephone numbers 771-9204 and 771-9206 or e-mail at obmd@surfshop.net.ph.)
