24 March 2012

Rwanda: 60,000 Abortions Performed in the Country Annually - Study

Photo: Tiggy Ridley/IRIN
A pregnant woman is given a routine check-up at a clinic in Monrovia.

About 60,000 pregnancies are terminated in Rwanda every year, the majority of which are unsafe, with 40 per cent leading to complications that require treatment.

The study, the first of its kind, jointly conducted by the Ministry of Health, the National University of Rwanda's School of Public Health and the U.S.-based Guttmacher Institute, released, this week, shows that the national abortion rate is 25 abortions per 1,000 females aged between 15 and 44.

Almost all abortion cases are unwanted pregnancies, according to the study, and one-third of women who suffer complications do not receive necessary treatment.

It is estimated that about 19 per cent of married Rwandan women have an unmet need for contraception to delay getting pregnant or want no more children but are not using a any family planning method.

Most of these unsafe abortions are carried out by unqualified providers such as traditional healers, lay practitioners or pharmacists using dangerous methods, which are unhygienic and carry a high risk of complications, and may, at times, lead to death.

Unsafe abortions in Rwanda are largely attributed to the fact that it is illegal, and currently it is one of the clauses in the penal code that will soon be promulgated.

Most hospitals are equipped to surgically treat abortion complications, but most of them do not use Manual Vacuum Aspiration (MVA), the safe and easy technique recommended by the World Health Organisation (WHO).

"Nationally, seven women are hospitalised for treatment of abortion complications per every 1,000 women of reproductive age. This means that 21per cent of women will require treatment for abortion complications over their lifetimes," the study reads in part.

In 2009, 16,700 women received care at health facilities for complications resulting from unsafe abortions.

The number of deaths registered in Rwanda annually, as a result of performing unsafe abortions, is unknown. However, the World Health Organisation estimates that unsafe abortion accounts for one in six maternal deaths in Eastern Africa.

According to Chantal Umuhoza, the coordinator of Safe Abortion Action Fund (SAAF), the statistics "could even be less than cases of abortion carried out in Rwanda."

"The 60,000 cases of abortion annually aren't alarming as it's even likely to be way more than that. The report is based on cases recorded from health facilities, yet many abortions are carried out elsewhere," stated Umuhoza, during a telephone interview.

She observed that unsafe abortion cases are high basically due to its illegality in Rwanda, which prompts women to seek services from unqualified people, leading to health complications.

She noted that legalising abortion is the only way Rwanda can reduce maternal mortality rate since some of the deaths are caused by complications during unsafe abortions.

In South Africa, where the abortion law was liberalised in 1997, the annual number of abortion-related deaths fell by 91 per cent by 2001.

Umuhoza hopes abortion will be legalised in Rwanda, not only to address the issue of maternal mortality rate "but also since its a right for a woman to terminate a pregnancy they aren't ready for."

She believes unsafe abortions are life threatening but once abortion is safe; women's health will improve whilst avoiding harsh means of abortion.

Many women, Umuhoza added, abort because they conceived out of rape, defilement while others are unwanted pregnancies resulting from lack of contraceptives.

Dr Fidel Ngabo, the Coordinator of Maternal and Child Health, explained that abortion is allowed in Rwanda on only four grounds; when the pregnancy can endanger the life of the mother; when she conceived out of rape; when the unborn child's father is a family member or relative and the abnormality of the unborn child.

"These are the only reasons a woman is allowed to abort in Rwanda, and it has to be confirmed by at least three doctors," Ngabo said.

In a bid to combat the rate of abortions, which he also believes is high, Ngabo noted that the ministry has initiated programmes to prevent such acts, including holding reproductive health lectures in schools and extending family planning services to all health facilities and through community health workers.

"We want to install condom boxes in all public places like ministries, hospitals, the parliament, universities and also install condom vending machines in all hotels and restaurants before the end of this year, to avoid cases of unwanted pregnancies," said Ngabo.

About 47 per cent of pregnancies in Rwanda are said to be unintended.

Currently, only 30 condom vending machines are installed in various hospitals, and Ngabo said the ministry will acquire new ones, which will be bought by the hotel and restaurant owners.

"25 per cent of abortions are induced, which is dangerous. We now have post-abortion care in health facilities, which will be strengthened," Ngabo noted.

The overall abortion rate in Africa, where the vast majority of abortions are illegal and unsafe, showed no decline between 2003 and 2008, holding at 29 abortions per 1,000 women of childbearing age.

It increased by 14.3 per cent in Africa, up from 5.6 million in 2003 to 6.4 million in 2008, according to a study conducted by Guttmacher Institute.

Most abortions, carried out during the same period, occurred in Eastern Africa - 2.5 million - followed by the Western Africa - 1.8 million.

Southern Africa, with 200,000, has the least cases.

The increase, according to Guttmacher Institute data, is attributed to the increased number of women of reproductive age.

Out of the 6.4 million abortions, only three per cent were performed under safe conditions in Africa.

13 per cent of all maternal deaths (67,000 women), worldwide, are due to complications from untreated or poorly treated abortions.

About half of all abortions, worldwide, are unsafe, and almost all unsafe abortions (98 per cent) occur in developing countries.

The proportion of abortions that take place in developing countries also increased from 78 per cent in 2005, to 86 per cent in 2008, in part because the proportion of all women who live in the developing world increased during this period.

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