Doctors say survey underestimates number of women dying from botched abortions
WOMEN denied the right to an abortion are injuring and killing themselves in an attempt to end their pregnancies, doctors and specialists say. In Yangon’s Central Women’s Hospital, it is estimated that from one-third to half of pregnancy deaths occur because of botched abortions, often carried out by the women themselves.
The two main causes of maternal mortality are heavy blood loss after birth, known as menorrhagia, and related infections. Many of the women brought to hospital arrive too late to be saved, said obstetrics and gynaecology specialist Dr Soe Lwin, an associate professor at the hospital.
“Of every 10 pregnant women who die in our hospital, six have had unsafe abortions,” he said. “A patient suffering from menorrhagia can die within the hour. A woman who becomes infected after an unsafe abortion can suffer for a long time. And, if she is not brought to hospital in time, she will die.”
“The death rate from unsafe abortions is not precisely known, but is expected to be high,” Dr Soe Lwin added.
Every day, about eight women in Myanmar die from preventable causes related to pregnancy, with one in five deaths among young women due to maternal health complications. About 10 percent of female deaths among women of reproductive age - defined as 15-49 years old - are related to maternal health, according to the “Thematic Report on Maternal Mortality” report compiled by the Ministry of Labour, Immigration and Population on September 27, based on data from the 2014 census.
Abortion is illegal in Myanmar. Since a doctor performing the operation can lose his or her licence, be fined and be sent to prison for up to five years, data on abortions is hard to obtain. Some experts believe more than half of maternal deaths may be due to botched abortions.
Data on the situation outside Yangon is even more unreliable. The government says abortion is responsible for 10pc of all maternal mortality, but that figures is considered to be low because of the wide range of infections that can occur following a terminated pregnancy, says Dr Sid Naing, country director of Marie Stopes Myanmar.
“When a woman dies after an abortion, her family and friends don’t tell anyone. People don’t talk to health experts because they’re afraid of the law. Because so many women are brought to hospital too late, it’s hard for doctors to identify the cause of the infection. It could be that more than half the maternal mortality rate is due to abortions, but there are so many possible causes of infection it’s hard to be sure.”
“The survey data is incomplete. The government figure of 10pc is certainly on the low side. The true rate of death caused by abortion-related infections could be about 35pc,” said Dr Sid Naing.
The September report on maternal mortality found that such a fate befalls an average of 2800 expectant mothers each year, amounting to 282 women per 100,000 live births at the Union level, the second-highest in ASEAN.
In addition to women with high childbirth frequencies, other demographics at particular risk are very young women, whose bodies are not ready for childbirth, and women over 40. Women over 45 are four times more likely to die in childbirth, but age itself is not the only factor. According to the report, maternal mortality rates are highest in Chin State and Ayeyarwady and Magwe regions, and lowest in Tanintharyi Region, Nay Pyi Taw and Yangon Region.
Abortions are mostly carried out by midwives or even the pregnant women themselves. As the practice is illegal, the tools are necessarily improvised – and therefore radically unsafe. The most common technique to end a pregnancy is by breaking open the amniotic sac. Materials range from bamboo to steel or iron; implements range from branches broken off trees to the ends of umbrellas. Sometimes, as an alternative, acid is used.
Health experts said greater public knowledge about reproductive health, including the importance of birth spacing, is needed to reduce Myanmar’s maternal mortality rate.
‘When a woman dies after an abortion, her family and friends don’t tell anyone.’
Dr Sid Naing Marie Stopes Myanmar