Doc­tors say sur­vey un­der­es­ti­mates num­ber of women dy­ing from botched abor­tions

The Myanmar Times - - News - HTIKE NANDA WIN news­room@mm­

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

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