Early and late complications do occur with or after SA or IA, either
because abortions are managed by untrained persons or at unsafe places
or by unsafe modes or because of inherent problems like bleeding in
relation to abortion which can occur anytime, irrespective of person
performing or place of abortion. Even a woman with SA can have heavy
bleeding, long termsequlaeand recurrence too. Complications also
depended on the duration ofpregnancy which got aborted. The concept of
post/peri abortion care (PAC) has evolved in the recent past. It is a
global approach towards reducing the maternal mortality and morbidity
due to complications of SA and IA with various medical and social
interventions to ensure improvements in women’s sexual and reproductive
health4. The essential elements of PAC
include emergency treatment of incomplete abortion, bleeding, infection,
fever, pain as well as contraceptive counseling with desired services
and linkage to other emergency services. However, the mortality and
morbidity risks associated with safe or unsafe IA not only depended on
the availability and quality of abortion care, but also on woman’s
beliefs, willingness and ability to seek services. Ganatra et
al5 reported that around 25 million unsafe
abortions (45% of all abortions) occurred between 2010 and 2014 every
year worldwide. The majority of unsafe abortions (97%), were in
developing countries (Africa, Asia and Latin America). WHO also reported
that 19 of every 20 unsafe abortions took place in less developed
regions of the world6 and this was where 98%
of abortion-related deaths occurred7.So
women’s perceptions, beliefs and health seeking matter a lot.
Estimated 6.8 million abortions occurred every year in South Central
Asia, at a rate of 17 unsafe abortions per 1000
women8. Systematic analysis of 417 data sets
from 115 countries estimated the prevalence of maternal deaths from
abortive outcomes (ectopic pregnancy inclusive) as 8%. Overall,
sub‐SaharanAfrican countries had the highest contribution to maternal
deaths due toabortive outcomes9. Haddad et
al10 also reported that worldwide 47000 women
died due to complications of unsafe abortions, representing 13% of
pregnancy related deaths. Review of various studies by
Johnston11 revealed that nearly 18% of all
maternal deaths in India, were abortion related. Present community based
study of magnitude of SA or IA, related complications, care
sought by rural tribal women of two Districts of Maharashtra, India, was
carried out to know the community based burdeon of abortion
complications. There were access problems, lack of resources, lack of
awareness, scarce health services, and also quite a few things were not
obvious in Dharni Block of Melghat, hilly forestry region with extreme
poverty. However overall 3.3% women reported complications in relation
to SA in Sewagram region and0.3% women of Dharni Block,10 times less.
In Sewagram region care providers were family members, medical officers,
specialists, traditional birth attendants and ASHAs in 62%, 25%, 12%,
2% and 1% respectively. Overall 12.5% of the 24 women who had
complications were managed at home and 66.7%, 12.5%and 8.34% were
managed at Private hospitals, Medical colleges and District hospital
respectively. Care seeking seemed to be related to awareness, resources,
access to available facilities and beliefs also. Family members were
care providers for those who remained at home and the rest 22.5% were
managed by medical officers and only 3.75% by specialists at health
facilities. Abortion is usually kept secret and so private
servicesaresoughtmoreoften.Inthesevillagestribalwomensoughtprivate
services even with extreme poverty. It is essential for policy makers to
know this aspect of abortion care. In a study, at least 9% of
abortion-related hospital admissions had a near-miss event and around
1.5% ended in death10. Hemorrhage was the
most common complication reported. The pooled percentage of abortion-
related hospital admissions with severe hemorrhage was 23%, with around
9% having near-miss morbidity due to hemorrhage. Results suggested that
a substantial percentage of abortion related hospital admissions had
potentially life-threatening complications. Present study revealed that
in rural community, 1% women reported complications with IA in the form
of heavy vaginal bleeding and pain in abdomen in Sewagram region and
0.16% in Melghat region. Not very high numbers. These eventful IA in
Sewagram region were cases performed at private hospitals, either for
spacing (29%) or for health reasons (71%) and were conducted by
medical means in 71%, and surgical procedures in 28%. Whatever was
easily available was used was obvious. However there were no major
problems reported. No one seemed to have complications to cause near
miss or even severe illness. There was no abortion related death in
these villages during the whole duration. A lot of research is needed
about practices, specially because there were no major complications.
Further more women with pregnancy of 10-13 weeks had complications. It
is a grey zone. At this gestation medical methods are not used and
surgical procedures are likely to cause trauma. It is known that second
trimesterIAcarriedahigherriskofcomplicationsbuttheycontinuedinthisregion.
However dangerous complications did not occur even in these women. With
FGDs it was obvious that there was lack of awareness about possible
complications. In a study it was found that in seven of ten countries,
less than 10% of primary level facilities could provide basic PAC, and
in eight of ten countries less than 40% of referral-level facilities
could provide comprehensive PAC12. In the
present analysis, not many complications were reported and no services
were sought by many even for complications. Primary Health centre,
subcentre did not provide PAC. In a study 7.9% women experienced
complications13. Case fatality rate was worst
for abortion‐related infections (19.1%). In the present study most
common post-abortion complications reported were excessive vaginal
bleeding and lower abdominal pain but neither in many women,nor heavy.
They did not lead to severe illness or near miss morbidity. Other less
frequent complications were high grade fever, foul smelling discharge,
backache and weakness, probably infection related but still did not lead
to severe illness. A community-based study in Madhya Pradesh, revealed
that more than one out of two IA among rural women (57%) and more than
two of five IA among urban women (46%) resulted in at least one
complication14. It was not found in the
present study which was community based in villages with extreme
poverty. Whatever information was possible verbally was collected and
analyzed. There were no records. Because of linkage with maternal
services information about severe illness, near miss cases, maternal
deaths due to any reason was available. So it was obvious that in this
region there were not many problems in abortion cases.
Doorman et al15 reported thatindigenous
people and local communities (IPLCs) knowledge and practices rely on
holistic and integrative conceptualizations of nature and value systems
acknowledging interlinked human-nature relations. IPLCs hold a body of
knowledge that has been accumulated through generations within their
specific cultural and environment context. Using knowledge systems as
equal partners informing one another requires bridging them, rather than
synthesizing them. Knowledge co- production as a dialog and partnership
can harness the practical wisdom and cultural values of IPLCs towards
innovative solutions.Conclusion Awareness is needed about abortion complications. Also a lotof research
is needed about traditional medicine, reverse pharmacology and
sociobehavioural aspects too.