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RUNNING HEAD: UNSAFE ABORTION

Interview-Based Report writing (Community Health Nursing-II)

Topic: Unsafe Abortion

Course: CHN-II

Faculty: Farah Naeem

Due Date: 14th-Nov-2023

Group Members: Farhana Amir (0629)

Farhad Ali Akram (0628)

Bassam Nasir (0627)

Ayesha Sana (0626)

Yusra Zafar (0669)

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Shifa College of Nursing, Islamabad

Introduction

Abortion is a highly sensitive and complex topic that has been a subject of debate and controversy for many

years. It encompasses a range of medical procedures intended to terminate a pregnancy, and the ethical, legal, and

social dimensions surrounding it have sparked intense discussions worldwide. According to the World Health

Organization (WHO) around 73 million induced abortions take place worldwide. 6 out of 10 (61%) are unintended

pregnancies (WHO, 2020). This report seeks to provide a comprehensive and balanced exploration of abortion,

covering the level of knowledge in women regarding its cause, treatment and management and the level of trust on

Nurses. This report also explains the legal status in Pakistan, the ethical dilemmas it raises, and the impact on

women's health and reproductive rights. A survey was conducted all over Pakistan according to which 8.9 million

induced abortion take place annually in Pakistan ,One out of 7 pregnancy is terminated (37%), which is due to

unwanted pregnancy. 6.4 women per 1000 are hospitalized due to unsafe abortion. Only 1.9 million women are

educated in hospitals (Zeba et al., 2007). It is evident from the literature that education about abortion is critically low

and this number has increased hundred times by this year. Our aim is to present a clear and objective overview of this

multifaceted issue, shedding light on more informed and empathetic discussion.

Selection of the topic

Our faculty has assigned us a report writing task focused on the topic of unsafe abortion. We

distribute the tasks among all group members and each team member conducts the interview sessions to gather

valuable insights and information. After reviewing many research articles we found that unsafe abortions lead to

increased maternal mortality. In Pakistan, it is estimated that 10,000-12,000 women die annually because of unsafe

abortions or abortion-related complications (Population Council, 2016). Unsafe abortions often occur due to limited
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access to safe and legal abortion services, pushing individuals to seek clandestine procedures that lack medical

supervision, leading to health risks and complications of haemorrhage, infection, uterine perforation, and long-term

reproductive health issues, all of which pose significant risks to individuals’ well-being. Stigmatization and restrictive

laws can also deter individuals from obtaining safe abortions, increasing the incidence of unsafe practices. The choice

to focus on the topic of unsafe abortion is often driven by the urgent need to raise awareness about the significant

public health and human rights issues associated with it, ultimately aiming to promote safer and more accessible

reproductive healthcare and promote awareness for individuals at risk.

Significance in Terms of Country

The exact number of abortions taking place in Pakistan is unknown because of ignorance and

budget constraints. A report about abortion in Pakistan holds significant importance due to several reasons, as it sheds

light on critical issues affecting the country's healthcare system, women's rights, and social dynamics. Pakistan has a

high maternal mortality rate, and unsafe abortions contribute significantly to this problem. 230 abortion cases observed

during a 68.0% of the women were married, while 32.0% were unmarried. Furthermore, 76% of the patients had no

formal education, and only 24.4% had completed primary education, which was the highest level of education achieved

among them. (Sathar at el, 2007). Abortion often carries a social stigma in Pakistan. These attitudes make it difficult for

women to seek reproductive health care Abortion laws in Pakistan are highly restrictive and anti-choice. According to

1996 the criminal will pay blood money in the foetus is matured but in 1997 it was amended to protect the mother’s

life. There is no personal choice unless there is a serious complication. It is crucial to address the public health, legal,

social, and ethical issues, opportunity to seek reproductive health and women empowerment. It can serve as a positive

change in the society.

Application in the field of Nursing

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In the field of nursing, factors related to unsafe abortions include limited access to comprehensive reproductive

healthcare, stigma and judgement surrounding abortion, the lack of access to comprehensive reproductive healthcare is

a critical issue. When individuals don’t have easy access to family planning services, including contraception and safe

abortion options, they are more likely to face unplanned pregnancies, increasing the risk of resorting to unsafe

abortion methods. The ethical dilemmas in regions with restrictive laws, inadequate patient education, challenges in

providing post-abortion care, and the crucial role of nurses in advocacy and education efforts to promote safe and legal

abortion services and reduce the incidence of unsafe practices. Nursing professionals have a multifaceted role in

addressing unsafe abortions. They must navigate various challenges to ensure that individuals receive the support and

services they need while promoting safe and legal practices. Nurses can participate in community education programs

to raise awareness about safe abortion options, contraception, and reproductive health.

Total Clients Surveyed

A total of 25 clients were surveyed through the distribution of 25 questionnaires at three distinct locations: the

Rotary Centre at Bari Imam, the Falahi Clinic at Shifa International Hospital, and the G1-W4 Gynaecology Ward. The

questionnaires were employed to evaluate the clients' understanding, treatment, and social issues. The survey

encompassed married women aged between 20 and 50 years. It's important to note that data collection commenced

prior to obtaining client consent, with strict confidentiality measures in place.

A study using questionnaire approach

The report was prepared by questioning from a diverse number of people .To observe the understanding of

people about unsafe abortion we prepared Questionnaire which consists of 25 Closed ended Questions (Yes/No) from

different study materials. For the data we visited Shifa International Hospital Islamabad Gynaecology ward, Falahi

ward and rotary centre .People of urban and rural areas have not much gone through unsafe abortion but mostly they
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acquainted with this and the data validated it .The Questionnaire developed from 25 Questions collected from 25

people. The faculty under whom we were assigned approved the questionnaire.

Literature Review

Unsafe abortion is defined as a termination of an unintended pregnancy by persons lacking the necessary skills,

or in an environment lacking the minimum medical standards, or both. Globally, unsafe abortions account for 13% of

all maternal deaths and contribute to significant morbidity among women, especially in under-resourced settings

(Rasch, 2010).Maternal mortality and morbidity are the leading causes of death and illness among women of

reproductive age in many countries throughout the world of all maternal deaths, those related to unsafe abortion are the

most severely underestimated and yet at the same time they are those which are the most preventable ( Rasch, 2010).

The major causes of unsafe abortion are : 1:Poor knowledge of abortion law and safe abortion services is a

contributing factor to unsafe abortion .2:Many women engaged in unsafe abortion practices due to poor knowledge of

abortion law and safe abortion services.3:Low-income countries account for 97% of all global abortions between 2010

and 2014, with higher percentages of unsafe abortions in countries with highly restrictive abortion laws.4:15% of

women in the reproductive age group have practised unsafe abortions due to various factors such as lack of knowledge

on safe abortion services, poor socio-economic conditions, cultural and religious beliefs, stigma of unplanned

pregnancy, a desire to bear children only after marriage, and a desire to pursue education (Faundas A et al., 2019).

A study was carried to see the clinical presentation of the women after unsafe abortion in 2017 by the Department of

the obstetrics and Gynaecology, Pak Emirates Military Hospital ,Rawalpindi. Total 30 patients were included in this

study and the symptoms were abdominal pain, constipation with abdominal distension, vaginal bleeding and shock

(Khanum F et al., 2017). The role of the nurses is to provide abortion care in hospitals and clinically and support the

abortion care through sexual health education and family planning care in sexual health clinics, schools and family

practice. Nurses improve access to abortion not only as prescriber of medication abortion but also as primary care
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providers of counselling, resources about pregnancy options and abortion follow-up care in their communities. Nurses

can provide abortion care follow-up in their communities. As a leader they should provide assessable, inclusive

abortion service and discuss barriers and gap in their role and knowledge. Nurses should be included in abortion

medication practice in their communities and this practice contributes in the equitable access , optimization and

evolution of nurse role in abortion care and family planning (Carson et al , 2019).

Unsafe abortions are a significant global health concern, with over two million abortions performed annually in

Pakistan, mainly due to unwanted pregnancies, poverty, and lack of awareness (Khan, 2023).For prevention of unsafe

abortion we should Train health workers, particularly LHWs, to improve their knowledge of preventing abortion and its

risk factors can help reduce abortion-related morbidity and mortality, contributing to the Sustainable Development

Goals (SDGs) related to maternal health. Community health workers (CHWs) have been introduced as a solution, but

they often lack effective training and support. The Lady Health Worker Program in Pakistan was established to

improve family planning services and primary healthcare through trained Lady Health Workers (LHWs) in their own

communities (Khan, 2023).

Graphical representation

1. Do you know what abortion is?

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16%

84%

yes No

 84 % of the interviewed population has been known to the term abortion.

2. Do you know what miscarriage is?

20%

80%

yes No

 80% of the interviewed population is aware of the term miscarriage.

3. Do you know about safe abortion?

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44%

56%

yes no

 56 % of the interviewed population doesn’t know about safe abortion.

4. Do you know the difference between abortion and miscarriage?

20%

80%

YES NO

 80 % of the interviewed population don’t know the difference between

miscarriage and abortion

5. Have you been through abortion?

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40%

60%

yes No

 40 % people have been done with abortion from which the interview was taken.

6. Do you have any other medical condition (HTN, diabetes or any)?

48%
52%

YES NO

 52 % of the interviewed population has other medical conditions in which mostly women were suffered with

hypertension.

7. Do you have any of the following symptoms (abdominal pain, fever, abdominal distension,

vaginal bleeding)?
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Chart Title
5

40% 3

2
60%
1

0
Abdominal pain Fever abdominal distension vaginal bleeding

yes no

 40 % of the interviewed population suffered from the symptom’s abdominal

pain (4 women), fever (6 women), abdominal distension (3 women) and vaginal

bleeding (2 women).

8. Do you know what causes abortion?

48%
52%

yes No

 48 % of the interviewed population doesn’t know the causes of the abortion.

9. Have you ever been educated about the risk factors for abortion?
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20%

80%
yes no

 80 % of the population don’t know the risk factors of the abortion.

10. Have you ever been educated about the prevention of unsafe abortion?

32%

68%

yes no

 68 % of the interviewed population has not been educated about prevention of

the unsafe abortion.

11. Have you ever been educated about the potential risk of unsafe abortion?
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32%

68%

yes No

 68 % of the interviewed populations have not been educated about potential

risks of the unsafe abortion.

12. Are you aware of the organizations or clinics that provide safe abortion services in your area?

44%

56%

yes No

44 % of the interviewed population don’t even know the services where safer abortion is provide.

13. Have you been informed about emergency medical care in case of unsafe abortion?
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20%

80%

Yes No

 80 % of the interviewed population was not informed about emergency medical

care in case of unsafe abortion.

14. Have you ever encountered stigma or judgment when seeking information or assistance related to abortion?

20%

80%

yes no

 80 % of the interviewed population doesn’t encounter such situation.

15. Do you know about the importance of seeking medical care if you experience any post abortion

complication?

12%

88%
yes No
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 88 % of the interviewed population knows the importance of seeking medical

care.

16. Do you think there should be gap should be between two abortions? If yes specify the number.

8.5
7.5
6.5

Number of persons
5.5
4.5
48%
3.5
52%
2.5
1.5
0.5
6 months 4 months 3-5 months
Series1 8 3 2

Yes No

 52 % of the population told the time period in which 8 women (6 months ) ,3

women ( 4 months )and 2 women told ( 3-5 months ) of the gap period .

17. Have you ever been educated about post abortion care?

20%

80%

yes no

 80 % of the interviewed population was not aware of the post abortion care .

18. Do you think nurses can provide emotional support and comfort during abortion?
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8%

92%

Yes No

 92 % of the interviewed population think nurse can give emotional support and

comfort during abortion.

19. Have you ever been provided with clear and comprehensive information by nurses related to

abortion and its complications?

44%

56%

Yes No

 44 % of the interviewed population don’t get such type of information.

20. Do you think nurses can maintain privacy and confidentiality during abortion?
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16%

84%

Yes No

 84 % of the interviewed population feels that nurses can maintain confidentiality

during abortion.

21. Do you feel well informed about pain management and follow-ups?

40%

60%

Yes No

 60 % of the interviewed populations have not been informed about pain management and follow-ups.

22.Do you think nurses are emphatic and non-judgmental?

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28%

72%

Yes No

 72 % of the interviewed populations think so that nurses are emphatic and non-judgemental.

23.Do you think nurses are competent enough to carry out the procedure of abortion?

28%

72%

Yes No

 72 % of the interviewed population don’t think nurses can carry out the

procedure of the abortion .

RECOMMENDATIONS

Following are essential recommendations regarding unsafe abortion.

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 To avoid unintended pregnancies, it’s important to use contraception consistently and correctly.

 It’s also crucial to understand reproductive health and the different methods of contraception available in order to

make informed decisions.

 Attempting a self-induced abortion using unsafe methods can be extremely dangerous, so it’s important to seek

support from friends, family, or counselling services if needed.

 In case of complications, it’s important to be aware of emergency medical services in your area and not delay

seeking help.

 After an abortion, it’s important to follow the post-abortion care instructions provided by healthcare providers and

attend follow-up appointments to monitor recovery.

CONCLUSION

We conducted the survey in different areas Rotary Center Bari-Imam, Shifa Falahi Clinic, G-1 Wing-4, (Gyne ward).

We mainly interviewed women mostly between 20-50years of age. It was observed that people are mostly not aware of

the risk factors.people are not aware of the sign and symptoms and Prevention's. They don’t know about the health care

facilities. People are educated about to seek Medical advice from qualified healthcare providers for safe and legal

options.
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References

 Abortion Laws in Pakistan and around the world a case study of Roe vs. Wade, Urooj Lasari Sindh Mehran Institute

of Law Association at Jilani, 2022

 CA Atakro, SB Addo, JS Aboagye, A Menlah, I Garti, KG Amoa-Gyarteng, BMC women's health 19 (1), 1-17, 2019

 Khan RS. Educational training of Lady Health Workers and prevention of abortion related morbidity and mortality

Pak Postgrad Med J 2023;34(1): 1-2

 Khanum F, Tariq A, Waseem SM, Mahmood T. The Patterns of Clinical Presentation in Patients with Unsafe

Miscarriage. Pak Armed Forces Med J 2022; 72(5): 1535-1539

 Optimizing the Nursing Role in Abortion Care: Considerations for Health Equity Sheila Dunn, MD, MSc, CCFP

(EM), FCFP, Research Director, Family PSheila Dunn, MD, MSc, CCFP (EM), FCFP, Research Director, Family

Practice Health Centre, Women’s College Hospital Associate Professor, Dalla Lana School of Public Health

University of Toronto, Toronto, ONractice Health CentreWomen’s College Hospital ,Associate ProfessorDalla Lana

School of Public Health University of Toronto 2019