The Reality of Unsafe Abortion Among Adolescent and Young Women
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Asian-Pacific Resource & Research Centre for Women (ARROW) Asian-Pacific Resource & Research Centre for Women (ARROW) www.arrow.org.my Vol. 12 No. 3 2006www.arrow.org.my n ISSN 1394-4444 Published by the Asian-Pacific Resource & Research Centre for Women (ARROW) Young and Vulnerable: The Reality of Unsafe Abortion among Adolescent and Young Women The Asia-Pacific is home to over a point to young women self-inducing billion people between the ages of abortion and going to hospitals for 10-24 but data on the incidence of treatment of complications, or travelling induced abortion among this group are overseas for services (e.g., to Australia).3,4 sparse, unrepresentative and incomplete, Micro studies and hospital data especially with respect to unmarried consistently show that deaths from women. Estimates in Asia using abortion-related complications are national/subnational data range from higher among adolescents, particularly 1-15% of all abortions1; micro studies if unmarried.1,7 This is primarily because indicate much higher proportions.1,2 (1) they are more likely to have second On the other hand, except for Australia trimester abortions which even in the and New Zealand, Pacific data are safest of settings carry greater risk than Photo Illustration by: Likhaan Illustration by: Photo unavailable.3,4 earlier abortions; (2) they are more likely In most parts of the Asia-Pacific, to access services of an unskilled provider the majority of young abortion seekers or self induce; and (3) they are less likely are unmarried. In South Asia, where 32% of 15-19 year to seek early care for complications. What then causes young olds are married and almost all women are married by age women to face these additional risks? 24,5 however, most unwanted pregnancies occur within Legal Barriers. Unsafe abortion is almost unknown marriage in the context of delaying a first birth or spacing a where laws are liberal and access widespread, as in East subsequent one. However, even in this subregion, incidence Asia. Where access is limited despite less restrictive laws of pregnancies among unmarried teenagers is on the rise, as in India or where abortion is severely restricted, young, especially in urban areas.1 unmarried, poor women are impacted disproportionately.1 Contraceptive use among sexually active unmarried Even liberal laws may contain ambiguity around the rights girls is negligible and even among married 15-19 year of unmarried women,8 impose age restrictions or require olds, use is lower than amongst older women.5 Lack of parental/guardian authorisation. Even where not mandated accurate knowledge of contraception, difficulties in access by law, hospitals may insist on the presence of the parent (especially for unmarried girls), gender inequalities, family at the time of the procedure.9 The signature of the husband planning programmes ignoring the needs of newly weds and may be required for married girls as either part of law (e.g. unmarried girls and the commonality of non-consensual sex South Korea) or practice.1 are all factors to this low use. Social Stigma, Lack of Support, Lack of Information. Unsafe Abortion among Young People. Shah and Premarital sex is stigmatised in most parts of Asia-Pacific. Ahman6 estimate that 9% of all unsafe abortions in Asia are In parts of South Asia, any pregnancy in an unmarried among girls aged 15-19 and a further 23% among young girl is referred to as ‘illegal’ and women often believe that women aged 20-24. These proportions are lower than in abortion in these circumstances is illegal even when it Africa or Latin America; nevertheless, the sheer size of may not be.1 Stigma imposes a need for confidentiality, Asia’s population means that the region accounts for just which coupled with lack of partner and/or family support under half (45.7%) of the 7.2 million unsafe abortions and economic vulnerability, may make it hard for some among women aged 15-24 that occur each year in the young women to access medically safe services1 and even developing world. In the Pacific, there is little information clandestine safe services may charge a high financial and official records on any aspect of induced abortion. premium. Unskilled providers may be the only option Interviews with key persons and micro studies, however, even in settings where safer, legal alternatives exist.1 Self- Vol. 12 No.3 2006 1 Asian-Pacific Resource & Research Centre for Women (ARROW) Asian-Pacific Resource & Research Centre for Women (ARROW) www.arrow.org.my www.arrow.org.my induction using misoprostol is also becoming increasingly may help providers to interact with these young women in common in some parts (e.g., China and India).1 In certain non-judgemental ways. contexts (e.g. the Philippines), religious prohibitions and Family planning programmes—whether of the state, cultural taboos against abortion are also very strong. Women the private sector, or of non-government organisations— still have abortions despite these barriers, but these limit must have policies that not just provide comprehensive even further options that are already limited by restrictive sexuality education and information but also make laws. Poor knowledge of reproductive physiology may contraceptives accessible to young women. Post-abortion delay recognition of the pregnancy; fear and psychological care must include contraceptive counselling and links to denial may also add to the delay. Safe second trimester effective contraception even for unmarried young women. services even in liberal legal environments are fewer, The potential for medical abortion—such as misoprostol urban-based, may have additional legal requirements (e.g. and mifepristone—in making access to safe abortion a a second physician opinion), the abortion takes longer and reality is immense. Yet much more information and work is may involve a hospital stay—all these factors also increase needed to understand how medical abortion can best meet the delay in seeking care or drive women to more easily adolescent needs in diverse settings in the Asia-Pacific available but less safe options. 1, 9 Moreover many unmarried without compromising safety. girls face judgemental attitudes and rude behaviour from Youth is a time of promise and hope. No young woman providers. Even compassionate providers may be reluctant should have to lose her life, health, future and dignity to to acknowledge the realities of premarital sex and focus the hopelessness, desperation, stigma and the judgement post-abortion counselling efforts on the need to avoid sex of societies unwilling to recognise her choices, rights and rather than these women’s contraceptive needs. 10 humanity. Barriers Faced by Married Adolescents. Married adolescents do not face the same social stigma that their Endnotes IAL unmarried counterparts do. Nevertheless, their status in the family, decisionmaking powers, financial independence and 1 Ganatra, Bela. 2006. “Unsafe abortion in South and South-East Asia: A review of evidence,” in mobility may be more limited than older women, 1 leading Warriner, I.K. & Shah, I.H. (eds.). Preventing Unsafe Abortion and Its Consequences: Priorities for 1, 11 Research and Action. New York & Washington: Guttmacher Institute. pp. 151-186. TOR to delays or the use of less skilled providers. I Ultimately, the barriers can be so strong that accessing 2 Warakamin S.; Boonthai, N.; Tangcharoensathien, V. 2004. “Induced abortion in Thailand: Current any form of abortion care becomes impossible. Young situation in public hospitals and legal perspectives.” Reproductive Health Matters (RHM). Vol. 12, No. 24 ED women may carry on with such pregnancies, may abandon (supplement). pp. 147-56. or sell their babies or resort to infanticide. The pregnant 3 UNFPA Office for the Pacific. 2005. Before It’s Too Late: Pacific Experiences Addressing Adolescent adolescent may be killed in order to preserve the family Reproductive Health. Suva, Fiji: UNFPA Office for the Pacific. 48p. Available at <pacific.unfpa. honour or be driven to suicide. 1, 12 org/pubs/pub_asrh.htm>. How Can Access Be Increased? While abortion data 4 UNFPA Office for the Pacific. 2006. Situation Analysis in Adolescent Sexual Reproductive Health are always difficult to obtain, governments and researchers in the Pacific Series. Suva, Fiji: UNFPA Office for the Pacific. Available at <pacific.unfpa.org/pubs/ should make every effort to obtain and make accessible ASRH%20Kiribati.pdf>. age-disaggregated information about the incidence of, 5 Population Reference Bureau (PRB). 2006. “The world’s youth: 2006 data sheet.” Washington, DC: PRB. morbidity and mortality from unsafe abortion. This is key pp. 9-11. to having appropriate information for advocacy. We need 6 Shah, I.; Ahman, E. 2004. “Age patterns of unsafe abortion in developing country regions.” RHM. Vol. to learn more about young unmarried women’s pathways to 12, No. 24 (supplement). pp. 9-17. abortion care-seeking and their informal information and 7 Olukoya, A. [et al.]. 2001. “Unsafe abortion in adolescents.” International Journal of Obstetrics and support networks, and academics and researchers should Gynecology. Vol. 75, No. 2. pp. 137-147. make this a research priority. Understanding these is a key 8 Hirve, Siddhivinayak S. 2004. “Abortion law, policies and services in India: A critical review.” RHM. step to finding appropriate community-based resources to Vol. 12, No. 24 (supplement). pp. 114-121. making information accessible to women, whatever the legal 9 Gallo, M.; Nghia, N.C. “Real life is different: a qualitative study of why women delay abortion until the circumstances. Where possible, policies that have blanket second trimester in Vietnam.” Social Science & Medicine. Available online 13 March 2007. age of consent requirements need to be modified to include 10 Klingberg-Allvin, M. [et al.]. 2006. “Perspectives of midwives and doctors on adolescent sexuality and the concept of the evolving capacity of the adolescent abortion care in Vietnam.” Scand J Public Health.