Breaking the silence surrounding high maternal mortality from unsafe abortions. 

 

The World Health Organization estimates that around the world nearly 68,000 women die every year from complications of unsafe abortion. This translates to approximately 190 deaths per day; about the equivalent of a fatal jumbo jet crash with nearly 400 people on board every two days year round. How does death on such a massive daily scale not raise a global outcry? 

Here is a story I would like to share with you.

I was born 18 years ago. I couldn’t go beyond primary school since my parents died. I’m living with my grandmother. I got pregnant by accident. I was just earning my bread from sex. I decided on my own to abort. A traditional healer gave me some local herbs to drink but it was unsuccessful. I decided to go to hospital and talk to a doctor whom I believed was sympathetic and he carried out the abortion. I couldn’t change my mind since if I was to proceed with that pregnancy where I could get money to feed myself and take care of that child?
 

I went to school but couldn’t continue after I got pregnant. I fell in love with a soldier who impregnated me. I was 14 years old. I used to play sex with that soldier without protection. I didn’t like it and I decided to
have an abortion.Once my sister’s husband raped me. I felt so bad mentally and physically because this was a man I respected.I told him and he advised me to get an abortion. I knew I could not continue with this pregnancy. 

First, I didn’t want my sister to know that her husband had made me pregnant. Secondly, I would like to continue with my studies. I couldn’t explain to my parents. I couldn’t ever stand the shame and blame. I have moved out of my sister’s house to avoid further torture.

I am living with HIV. What I fear is that we might get a child who is HIV positive and I would die tomorrow and leave this child with all that difficulty. I don’t have a father, I don’t have any other person who would look after a child especially one with this kind of status. So I was not really comfortable having another child.
“

A true story  told,..

Guidelines for pregnancies up to 12 weeks:

Step 1: Insert four 200-mcg tablets (or their equivalent) deeply into the vagina or in the mouth under the tongue or in the cheek pouch.  If tablets are placed under the tongue or in the cheek pouch, hold in the mouth for 20-30 minutes to allow them to dissolve, and then swallow the remaining fragments.Bleeding and uterine contractions(cramping) may begin half an hour following this first step and will almost always start within the first 12 hours.  Bleeding itself does not mean that an abortion has occurred.  Close inspection of the sanitary pad or other receptacle may reveal whether the pregnancy has been terminated.This will be difficult to detect in very early stages of pregnancy, however, because the embryonic tissue is indistinguishable from the normal clotting of menstrual blood.

Step 2: If tablets were administered vaginally in Step 1, insert four more 200-mcg tablets of misoprostol deep into the vagina three to 12 hours after the first administration.If tablets were administered by mouth in Step 1, place four more 200-mcg tablets under the tongue or in the cheek pouch three hours after the first administration and hold them there for 20-30 minutes until they dissolve.  The shorter time interval between steps for tablets in the mouth is needed to achieve the same effectiveness  as vaginal administration at longer intervals but may cause more side effects. 

                       Step 3: If the pregnancy has not been terminated after using the second set of pills and bleeding, insert four more 200mcg tablets of misoprostol 3 to 12 hours after the second vagina administration or three hours after the second administration by mouth. The majority pregnancies up to 12 weeks duration are terminated within hours of the first administration of misoprostol.  Generally, more than three quarters of women experience abortion within the first 24 hours, although it sometimes takes longer.

MISOPROSTOL

Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug  induced astric ulcers, for early abortion, to treat missed miscarriage, and to induce labor.

Misoprostol is typically sold in pharmacies in tablets of 200 mcg. Four tablets are recommended to initiate an early abortion, and four (or, rarely, eight) more may be required for its completion.  It is best to use misoprostol within nine weeks since the last menstruation; that is, fewer than 63 days counting from the first day of the last regular period.  The earlier in the pregnancy it is administered the better, because it is safer, more effective and less painful.  Misoprostol can be used later in pregnancy but the risks of complications are higher (see below).  Women with an intrauterine contraceptive device (IUD) in place should have it removed before using misoprostol.

Intended effects and side effects of misoprostol

• Bleeding and uterine contractions (cramping) are the intended effects of using misoprostol for inducing an abortion.
• Cramping will be stronger than for an ordinary menstrual period and may be painful.  Non-steroid anti-inflammatory pain medication such as ibuprofen may be taken without interfering with the misoprostol. 
• Bleeding will be heavier and more prolonged than for a normal period: up to a week, in most cases, often with continued spotting until menstruation resumes in four to six weeks.  These effects will be more pronounced in pregnancies of longer duration.  
• Chills and fever are common side effects but are transient. High fever is less common but can occur and usually disappears within a few hours as do nausea, vomiting, and diarrhea. 

Women should seek medical attention if they experience any of the following side effects after taking misoprostol:

• Very heavy bleeding (soaking more than two large-sized thick sanitary pads each hour for more than two consecutive hours);
• Continuous bleeding for several days resulting in dizziness or light-headedness;
• Bleeding that stops but is followed two weeks or later by a sudden onset of extremely heavy bleeding, which may require manual vacuum aspiration or D&C;
• Scant bleeding or no bleeding at all in the first seven days after using misoprostol, which may suggest that no abortion has occurred and require a repeat round of misprostol or surgical termination; or
• Chills and fever lasting more than 24 hours, which suggest that an infection may be present requiring treatment with antibiotics.

                     

 

 Comprehensive school-based sex education is an effective and efficient way to educate adolescents


Addressing the sexual and reproductive health needs of adolescents in Sub-Saharan Africa is vital, given the devastating impact of AIDS, the high rates of unintended pregnancy and the risk that those pregnancies may lead to unsafe abortions. Protecting the health of adolescents is clearly important for the adolescents themselves. In addition, it is a critical public health priority. Increased investment in adolescent sexual and reproductive health can contribute to wider development goals, because it enables adolescents to become healthy, productive adults.

Comprehensive sex education is effective in improving knowledge and reducing sexual risk behaviors, and it does not increase sexual activity. At best, only about half of 15–19-year-olds across the four countries have received any sex education at school. Although strengthening sex education programs can be difficult in places where resources and infrastructure are limited, key aspects of effective programs have been identified and can be applied across different settings. Important recommendations include:

1. Adopt curricula that provide comprehensive, accurate sexual and reproductive health information. Programs should avoid using an exclusive “abstinence-until-marriage”approach, as recent evaluations show that this approach alone does not lead to protective behaviors.

2. Support teacher training. To effectively expand coverage of sex education, it is vital that teachers receive adequate training in sex education topics and in participatory learning methods.

3.Target very young adolescents. Many adolescents leave school before reaching the grade levels at which sex education begins. Programs that start before the end of primary school increase the opportunity to reach youth before they leave school and before they begin sexual activity.

4.Help adolescents stay in school. Even if they do not receive sex education, young people who stay in school are less likely than their peers to have sex.

 ZAWADI SMARTLOVE PAPER DOLL CAMPAIGN



In addition to that,WAYAN advocates for the affordability, accessibility of female condoms by sensitizing the community to reduce HIV prevalence among young women through an initiative that uses paper dolls.

This initiative use a paper doll called Zawadi Smartlove.

 Zawadi is a paper doll, and there are thousands more like her. She is the heart of the Female Condom Paper Doll campaign of the Universal Access to Female Condoms Joint Programme. The campaign aims to combine awareness-raising in different countries and advocacy efforts at national and United Nations level.

People from all over the world write down their message demanding female condoms on Zawadi paper dolls. These dolls are then collected and made into a long chain, representing the worldwide demand for female condoms. The strings of dolls send the powerful message that there is a great demand for female condoms, from people all over the world. Female condoms can help to solve two of the greatest challenges the world faces today: HIV/Aids and unintended pregnancy.





 The NGOs participating in the campaign use the paper dolls in their sensitization and awareness- raising meetings. The participants of such meetings can then have an active role by writing their message on a paper doll knowing that these messages will be presented to local as well as international leaders later on. The Paper Doll Campaign had 40 NGOs in 2011 participating in for instance Argentina, Cameroon, Costa Rica, Kenya, Liberia, Mexico, New Zealand, Nigeria, Rwanda, Tanzania, Thailand, United States of America, Venezuela and Zimbabwe. These organizations will continue to participate in 2012.

 WHY REACH OUT TO YOUNG VULNERABLE WOMEN?


Every 90 seconds one  young woman dies in pregnancy or childbirth, with rural women living in resource-poor countries particularly vulnerable.   Poor, rural women are the least likely to have access to family planning and the most likely to deliver without a skilled birth attendant.

In countries with high maternal mortality, access to quality and affordable  medical care is in short supply, thus leaving most of the women to rely on the help of existing community members such as traditional birth attendants (TBAs), health extension workers (HEWs), Community-based Reproductive Health Agents (CBRHAs), rural chemical sellers, and others. 

In poor countries, the direct causes of maternal mortality are concentrated in 3 major areas: postpartum hemorrhage, unsafe abortion, and eclampsia.  There are powerful examples of community-based interventions reaching rural woman and reducing their risk of maternal mortality by addressing these causes.

Mid this year 2012, WAYAN received a grant from PHI(Public Health Insitute) to educate the community at large on the correct, proper use of Misoprostol.This initiative will improve women’s health by enhancing the capacity of leaders from a range of diverse community-based organizations in Kenya  to provide the most up-to-date information about the correct uses of Misoprostol, and support them in developing concrete strategies and proposals to empower women to access safe and effective use of Misoprostol within their communities.

 PHI will improve sexual and reproductive health outcomes and reduce rates of maternal morbidity and mortality by increasing access to safer and more effective services and
building on existing efforts by other organizations.

We are glad to be part of this initiative to help reduce maternal mortality among young women. this is in line with MDG 5( Improve Maternal Health)  On 23rd June 2012, WAYAN held its fist sensitization meeting with 50 young people aged 18-28 in Huruma.

We will share the whole report.