Unsafe Abortions Key Factor in Maternal Deaths

Unsafe abortions might account for up to a quarter of all maternal deaths in Cambodia, which continue to occur at a staggeringly high rate, according to a health official.

The most recent maternal mortality rate reported in the 2005 Cam­bodian Demographic Health Sur­vey was 472 deaths per 100,000 live births, which, according to Unicef’s Chief of Child Survival Viorica Ber­daga, translates to about five maternal deaths every day.

While Cambodia’s maternal mortality figures are better than many African countries, they are “among the worst in the region,” Berdaga said Wednesday.

“Now, why do women die having babies? The main reason is that they hemorrhage, and they deliver at home or someplace where they can’t get help. The other reason is unsafe abortion,” said John Napon­ick, team leader of the Reduction in Maternal Mortality Project at the National Maternal and Child Health Center.

Though health officials agree that the majority of maternal deaths result from hemorrhaging—something that is, in most cases, avoidable given the right care—Napon­ick said some people believe as many as 30 percent of maternal deaths in Cambodia result from un­safe abortions.

The World Health Orga­n­iz­ation uses a lower figure of be­tween 15 percent and 20 percent, he said, adding that he believes the true number is probably somewhere between the two estimates.

Officials at WHO would not comment on the country-specific situation of abortion in Cambodia, referring comments to the national manager for the Health Ministry’s national reproductive health program, Tung Rattavy, who declined comment for this article.

Due to the fact that abortion remains a largely clandestine practice in Cambodia, facts and figures are hard to come by.

The 2005 CDHS reported that 8 percent of Cambodian women of reproductive age have had at least one abortion in their lifetime.

Naponick said there is likely “massive underreporting” in this area, mainly due to the fact that most women seeking abortions utilize the formal health sector only as a last resort, if then.

Women will often try running long distances and jumping up and down in an effort to shake the fetus loose, turning to herbal remedies when that doesn’t work, Naponick said.

Sin Somuny, executive director of Medicam, an umbrella organization of health NGOs, said that the private sector, which goes largely unregulated in Cambodia, sees the most abortions.

“Most women still go outside the legal abortion institutions. The reason is because of social stigma,” he said.

He said that abortions can cost between $20 and $200 in the private sector “where you don’t know the quality of care…. It’s an issue. We don’t have enough data yet.”

Despite the fact that first trimester abortions have been legal in Cambodia since 1997, even within the formal health sector, abortion services are limited.

A 2007 survey conducted in conjunction with Ipas, a women’s health and reproductive rights NGO, reported that only 47 percent of hospitals, 10 percent of high-level health centers and 5 percent of low-level health centers have abortion services available.

Of the facilities that provide abortion services, nearly half refuse services to adolescents and 40 percent of hospital providers believe elective abortions aren’t permitted by the Health Ministry.

The Reduction in Maternal Mortality Program, which began in 2006 and is funded through 2010 by the United Kingdom’s aid arm DFID, began training medical professionals this year in an effort to reduce the number of women who die from unsafe abortions and the overall maternal mortality rate.

Since January, the program has offered one-week training courses in safe abortion procedure at the National Maternal and Child Health Center and has graduated to date 101 doctors and midwives from all over the country.

“It’s legal, it’s part of the government’s health package,” said DFID’s health adviser, Jean Marie Aitken. “We believe strong­ly that it should be of high quality.”

Aitken said that as far as she knew DFID was the first big donor to provide support to the sector in Cam­bodia when they committed more than $4 million to the RMMP program.

Ol Elina, a secondary midwife who works for UK NGO Marie Stopes, graduated from the course last week and said she learned a lot about sterile procedures that she plans to take back to her organization in Kompong Thom province.

She said that most of the seven or eight women who seek an abortion at her organization every month have sought abortions through informal means in the past.

“Some midwives have taken the wrong methods in performing abortion,” she said. “They use their elbows or two arms to press on a woman’s womb strongly from the top to the bottom of the stomach to kill the fetus.”

“The majority of women like having abortions in a secret place where they charge very little. [They] aren’t thinking of the quality or risks of getting such improper and unskillful abortion procedures,” she said.

Ol Elina said that her organization charges $15 for a first trimester abortion.

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