Safe abortion services: a reproductive health imperative

Year 2012, Volume: 10 Issue: Özel Sayı, 10 - 23, 01.11.2012

Iqbal H. Shah

Abstract

Objective: This paper considers the reproductive health rationale for safe abortion by reviewing the evidence on the levels and trends in the incidence of abortion worldwide and by region, explores the linkages of contraceptive prevalence, switching and discontinuation, unmet need for family planning and abortion, as well as examines the consequences when safe abortion is legally restricted. Methods: A search of published material was conducted on PubMed database and of key journals in reproductive health and public health. In addition, the database maintained by the World Health Organization on unsafe abortion incidence and mortality due to unsafe abortion and the database on contraceptive prevalence and unmet need for family planning maintained by the United Population Division were used. The relevant information was extracted, collated and analyzed by themes covered in this paper. Results: Each year an estimated 43.8 million abortions take place worldwide, 21.6 million of these under unsafe conditions or by unskilled providers. Approximately, 47,000 maternal deaths each year globally are due to complications of unsafe abortion. Nearly, all unsafe abortions (98%) and deaths due to unsafe abortion (all, except 90 deaths) take place in developing countries and in countries where legal access to safe abortion is restricted. While safe abortion rates have declined, unsafe abortion rates continue to be high and largely unchanged since 2000. Conclusion: Deaths due to unsafe abortion are entirely preventable by improving access to modern methods of contraception and to safe abortion services. There is a strong public health, reproductive health and human rights rationale for making safe abortion services accessible to all women.

Keywords

Induced abortion, global and regional levels, contraceptive prevalence, unmet need, legal grounds.

Güvenli düşük hizmetleri: Bir üreme sağlığı zorunluluğu

Abstract

Amaç: Bu yazı üreme sağlığı bağlamında güvenli düşük konusunu inceliyor. Yazıda dünyada ve bölge bazında düşük oranları ve eğilimi konusundaki veriler inceleniyor, kontraseptif yaygınlığı, yöntem değiştirme ve bırakma, aile planlamasında karşılanmamış ihtiyaç ile düşük arasındaki ilişki araştırılıyor; güvenli düşük yasal olarak sınırlandığında ortaya çıkan sonuçlar gözden geçiriliyor. Yöntem: Bilgiler PubMed veritabanında ve temel üreme sağlığı ve halk sağlığı dergilerinde basılan kaynakların incelenmesi ile oluşturulmuştur. Bunun yanında, Dünya Sağlık Örgütü (DSÖ) tarafından düzenlenen güvensiz düşük sıklığı ve bundan kaynaklanan mortaliteyi izleyen veritabanı ve United Population Division tarafından düzenlenen kontraseptif yaygınlığı ve aile planlamasında karşılanmamış ihtiyacın izlendiği veritabanı da kullanılmıştır. Elde edilen bilgiler bu yazının planına göre gruplanarak yeniden biraraya getirilmiş ve analiz edilmiştir. Bulgular: Her yıl dünyada 43.8 milyon düşük olduğu tahmin edilmektedir. Bunların 21.6 milyonu güvensiz koşullarda ya da bu konuda becerisi olmayanlar tarafından gerçekleştiriliyor. Dünyada her yıl yaklaşık olarak 47,000 anne ölümü güvensiz düşüğün yol açtığı komplikasyonlardan kaynaklanıyor. Neredeyse bütün (%98) güvensiz düşükler ve onlardan kaynaklanan ölümler gelişmekte olan ve güvenli düşüğün yasal olarak sınırlandığı ülkelerde meydana geliyor. Güvenli düşük oranları azalırken güvensiz düşük oranı yüksek olmaya devam etmekte, bu durum 2000 yılından beri de pek değişmemektedir. Sonuç: Güvensiz düşükten kaynaklanan ölümler genelde önlenebilir. Bunun için çağdaş gebelikten korunma yöntemlerine ve güvenli düşük seçeneğine ulaşımı kolaylaştırmak gerekir. Güvenli düşük hizmetlerini bütün kadınların erişebileceği şekilde sağlamak için halk sağlığı, üreme sağlığı ve insan hakları ile ilgili çok güçlü gerekçeler vardır.

Keywords

İsteyerek düşük, küresel ve bölgesel düzeyler, kontraseptif prevalansı, karşılanmamış gereksinim, yasal çerçeve

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