Unsafe Abortions and Qualitative Data Analysis

The themes identified in this topic are education, abortion and facilities. Abortion refers to the termination of a pregnancy by explosion or removal of an embryo before it can be able to survive outside the uterus. It can also occur without interventions- miscarriage. Each year, around 210 million females become pregnant while about a fifth of the total number results in abortion (Sumner, 2014). The burden of illegal abortion is mostly experienced in developing countries with the highest number being in Africa and Latin America. Globally, unsafe abortions are some of the main causes of maternal mortality and morbidity. The basic reason for unsafe abortion is the lack of safe abortion services and even when legal system support abortion, they are frequently not available. Post-abortion complications are increasing yearly with an estimated seven million females admitted to hospitals every year. Some develop permanent disabilities while others are unable to carry pregnancy during the remaining part of life. This paper discusses some themes that arise in the context of abortions.

The performance of abortions is generally illegal under the Malawi Penal Code of 1930. People who procure abortions in ways that are not lawful and with intent are subject to up to 14 years in prison. A pregnant woman who unlawfully permits or uses any means with the intent of procuring her own abortion is subject to imprisonment of up to seven years. People who unlawfully procure or supply anything whatever, knowing too well that its intentions are to unlawfully procure an abortion is subject to an imprisonment of up to three years.

However, it is also legal to perform abortions in Malawi if only the said abortions are procured with the intent of saving lives. According to section 243 of the Penal Code, people usually are not responsible criminally for performing these abortions in good faith and with reasonable skill and care in surgical operations upon unborn children with the intention of preserving the mothers life if such operations are reasonable.

Most health care professionals working with post-abortion complications are nurses. Post-abortion care and contraception are some of the oldest reproductive and sexual health care services. In the 21st century, post-abortion services focus on the counseling needs of a woman who has undergone an abortion. To become a post-abortion care nurse in Malawi, one has to train in nursing and midwifery. These professionals have a variety of roles such as managing personal care, treatment, work with communities and families and play role in public health activities. In Malawi, these professionals are under the nurses and midwives council of Malawi (NMCM) whose role is to provide training, practice, education and professional conduct of the personnel in the sector. To become a nurse or a midwife technician in most countries, one has to have a diploma, degree, etc. training in the field (Levandowski et al., 2013). For instance, as per the interview extract, the two persons interviewed had the training to be midwives from recognized institutions. Based on world health organization (WHO), by 2020, the world should work in achieving universal health coverage and this will be achieved by ensuring education, motivated, and competent nursing and midwifery workforce among other strategic goals. The experience of a person in the profession is also important while dealing with cases of abortion. Based on the NMCM, age is not a considerate factor when employing nurses through their competence and experience is vital.

In the context of this interview, the theme of health facilities is present. Health facilities are those place where health care is provided. These include hospitals, care centers among others. To help prevent abortions and assist victims of unsafe abortions, health facilities should be put in place for women to receive immediate life-saving medical care. Health organization are created to meet the needs of a population and are based on the world health organization. A functioning health system should have well trained and adequate workforce, facilities such as electricity and water. Lack of these facilities can result in interference in the process of offering medical care to patients. In the context of abortion, medical procedures such as examining the individual possibility of abortion such as in ultrasonography and water can affect the hygiene of the patient.

Medical abortions play an important role in the provision of access to effective and safe abortion care. A number of studies have given timing, dosage interval and medication route for safe abortion (Sumner, 2014). In most cases, medical abortion is carried out within 70 days of gestation. Some of the medication involved in this process involve methotrexate which is often used and approved by the US food and drug administration. It is not used for a gestation period of greater than forty-nine days. It is injected into a woman muscle and almost 81% of pregnancy is terminated within two weeks and this percentage increase to 91% by the third week (Kulier et al., 2011). It is also used in the treatment of ectopic pregnancies though woman’s pregnancy hormone level must be monitored. Another drug used in the termination of pregnancy is mifepristone. This drug is taken orally as a pill. The medication affects the effects of progesterone which is necessary for pregnancy. Some of the side effects of this drug include vomiting, vaginal bleeding as well as pelvic pain. This drug is more effective than most of the drugs in the market and its effect is realized within 24 to fourth eight hours. It causes uterus contraction most of the women who receive this medication complete abortion within two weeks. As per the interview, the most known medication in the setup is known as stiba which is a form of a capsule.

Following a medication abortion, some of the risk involved include bleeding, infection and incomplete abortion which indicate some pregnancy elements remains. This problem can be treated in a health facility. Infection, on the other hand, can be treated with antibiotics. In a risk bleeding, a blood transfusion can be undertaken especially where bleeding is unusually heavy. Nevertheless, surgical procedure can be done to remove pregnancy elements. Lastly, some women become infertile though these cases may be rare with early interventions.

Instances of unsafe abortions in Malawi and around the world has been on the rise in the 21st century. This occurs regardless of improved medical facilities and well-trained workforce. In this paper, some of the themes that have come up include; education of the health care practitioners, health facilities that deal with abortion victims, some sexually transmitted diseases that can result to abortion, abortion and its medications where several medical procedures are undertaken to induce abortion.

Abortions may be as a result of certain viruses such as herpes virus. Some of the risk factors in the context of abortion include age, smoking cigarettes, use of drugs and poorly controlled chronic infections and disorders such as diabetes and hypertension. Some signs that can be associated with miscarriage include cramps, mild back pain, and heavy spotting. On the other hand, induced abortion refers to the elective or therapeutic and it is done using medication or medical procedure. Induced abortions are always performed during the early stages of pregnancy. Some procedures that can induce abortions include; aspiration, manual vacuum aspiration, dilation and curettage among other procedures. Abortion is a process that takes time and takes one to three weeks of bleeding and clotting. Some victims of abortions especially girl tent to hide cases of prolonged bleeding after abortion. Some people after abortion experience prolonged bleeding, fever, abnormal vaginal discharge among other complications which force them to see a doctor or medical practitioner.

To conclude that a woman had an abortion, as in "B, 4", the patient is examined for an informed conclusion. In this case, confirmation is done by observing the removals of the uterus content through ultrasonography. Additionally, quantitative serum beta human chorionic gonadotropin level diagnosis is undertaken. In many counties, many teenage perform an abortion without the consent of parents and guardians. Based on the United Kingdom legislation, girls young than 18 years need the consent of a parent or guardian for certain medical procedures. This ensures that the person has a full understanding of the effect of the decision of undertaking abortion. This means that a nurse can enquire from the parent about abortion.

Sexually transmitted diseases (STD) are known to cause abortions to many women. Globally, there are more than 30 variety of bacteria and viruses which are transmitted sexually. Some of the infections include gonorrhea, syphilis, and human papillomavirus, among others. STD are spread by sexual conduct including vaginal, oral and anal sex. They can also be transmitted via non-sexual means such as blood products. More than one million STD are acquired daily. These infections have serious impacts beyond the immediate impact of infection. Some of the infection such as syphilis affect the placenta and can affect the baby. Controlling such infection can be a good chance of controlling spontaneous abortions.

From this analysis, I learned that people in Malawi still continue to practice unsafe abortions. The government needs to tighten the noose so as to be able to bring into law such people who still practice unsafe abortions. More research needs to be conducted on the appropriate measures the government can put in place to entirely curb the practice.

Extract 1 from interview conducted by Bregje de Kok, with a nurse-midwife A in Blantyre, Malawi, in 2013

I: To begin with I would just like to ask your function you are a nurse midwife technician is this that right?

R: Yes

I: Ok, yah and what kind of training have you had exactly?

R: I was trained in general nursing and midwifery[WU1]

I: Where did you get the training?

R: I was trained in a mission nursing school that was Nkhoma School of nursing[WU2]

I: For how long have you been working?

R: I have been working for 16 years[WU3]

I: Ok, yeah that’s quite some time…may I ask you how old are you?

R: I am 40 years old[J4]

I: Ok, yah I see…and you have worked in others places than this one?

R: Yes I have worked in different health centres [WU5] and different districts

I: Yah, are health centres also like district hospitals?

R: I have never worked at district hospital, but I have been working at rural hospitals and community hospitals… community hospitals are hospitals whereby there should be a theatre at least for caesarian sections and minor procedures...there are some other areas and some other minor procedures that can be done at district hospital they can also take part in community hospital so it’s like it’s the taking major and some other activities that can happen at district level and they are taken to community and the community can benefit more as if they are at district hospital it’s not different from the rural hospital, they are all one but the community hospital is a l[J6] ittle bit bigger than rural hospital

I: Ok, yah that’s interesting. Ehm, I would like to ask you about your experiences with these complications of ehm abortions, stillbirths, early neonatal deaths, have you encountered them in your work[WU7] ?

R: Yes, many of them

I: Aha…and and which ones are more common the early neonatal deaths, or stillbirths or the abortions?

R: Most of the times it depends according to the season, you know most of the times the main problem when it comes to abortion is at times the season, when it is cultivating season. During the rainy season the people a lot of women are busy in their gardens cultivating and what I have seen that it is overworking that makes those people come with abortions. That can be the major problem. Yah, overworking. Secondly, is the poor nutrition intake. In rainy season most of the people they run short of food in their houses so they are not taking enough nutrition to cater with their pregnancies, with the demands of their pregnancies and these other things. So these are the main problems that I have discovered that they are maybe causing a lot of abortions but nowadays with the HIV/AIDS because of infections as well, we cannot count at which period of the year people are having a lot of complications and abortions [WU8] R This is just because of this of the infection HIV/AIDS, but in a rural setting, just because I have worked in the rural and also urban, but when it’s in the rural, most of the times during cultivating period and hunger as well…These two things can contribute to abortions.[J9]

I: Yah and do they play a role in the urban setting as well or not really?

R: In the urban setting, we cannot say that most of the times that they have got eh its not overworking itself per say but also the times nutritional problems are major problems as well here in Malawi just because like where I am staying here this is not urban site. Its semi urban site so we have different people with different cultural practices and different life styles so another: main problem can be nutrition itself. And nutrition and infections. Yah, in semi urban places, people are rushing for better things so that they should also compete with those people staying in urban so if they don’t have resources, enough resources they undergo other (...) sexual behaviours and they can get those viruses and infections. Just because it’s not their intention of getting those things but they just want support, financial support … to support their families[WU10] . Yah. So they indulge themselves in promiscuous behaviors to find money that’s why there comes the issue of infections like HIV/AIDS.

I: Ok, and then they can lead to sexually transmitted diseases that may cause abortions?

R: Yah abortions[WU11]

I: …and stillbirths as well or?

R: Yeah stillbirths are there as well just because sexually transmitted diseases they can also contribute much to stillbirth just because those infections do cross the placenta and they can also affect the baby. So had it been that we have enough resources like testing kits that we can test syphilis in the early stages of pregnancy that can be another good chance that we can control some of these unexpected abortions[J12] …just because most of the times we have hiccups of these testing kits, sometimes we have them, sometimes no. So it’s very difficult for a woman who is presented with an early problem to concerning sexually transmitted infection that we can treat it earlier unless she says am having of these a lot of discharges and what and what, those make symptoms and signs and maybe we can assume that it’s such a thing then we treat but they are some people who just suffering in silent, so such people are the ones who suffer such diseases and these infections.

References

• Kulier, R., Kapp, N., Gülmezoglu, A.M., Hofmeyr, G.J., Cheng, L. and Campana, A., 2011. Medical methods for first-trimester abortion. Cochrane database of systematic reviews, (11).
• Levandowski, B.A., Mhango, C., Kuchingale, E., Lunguzi, J., Katengeza, H., Gebreselassie, H. and Singh, S., 2013. The incidence of induced abortion in Malawi. International Perspectives on Sexual and Reproductive Health, pp.88-96.
• Sumner, L.W., 2014. Abortion and moral theory (Vol. 285). Princeton University Press.