Unsafe abortions among leading causes of maternal death: Economic Survey

Unsafe abortions are among the top five causes of maternal death among women aged 15-49 in Karnataka, data from the recently released Economic Survey shows.

Hypertensive disorders, postpartum haemorrhage, obstructed labour and sepsis are the other chief causes.

Deaths caused by obstructed labour, abortion and sepsis rose in 2020 when compared to 2019, the survey reveals.

Obstetrician Dr Anitha G S, an assistant professor at the Bangalore Medical College and Research Institute (BMCRI), says doctors at Vani Vilas Hospital handle at least one or two daily cases of women with incomplete abortion. Vani Vilas is a tertiary care government hospital for pregnant women.

“Stigma and judgement over abortion force women to access over-the-counter pills or approach quacks,” she said. “When abortion is performed without determining if it’s ectopic or not, and in an unhygienic way, women bleed torrentially and we find ‘retained’ products of conception.”

To address this, all government hospitals have Comprehensive Abortion Care (CAC) programmes, where MBBS doctors and nurses from primary health centres on the peripheries are trained.

Dr Shashikala N, head of gynaecology department at KC General Hospital, said they started the CAC programme in January 2015 in which 100 doctors, including medical officers and obstetricians, besides 100 nursing officers have been trained.

“We teach them reproductive rights of women, the Medical Termination of Pregnancy Act, manual vacuum aspiration, and teach them how to counsel women on unwanted pregnancies and family planning. A timely referral is key to saving the woman’s life in that condition. Health facilities on the periphery should also be equipped on how to handle such situations,” she said.

Dr Hema Divakar, former president of the Federation of Obstetric and Gynaecological Societies of India, said maternal deaths due to postpartum haemorrhage and pre-eclampsia have reduced because of focus on prevention, early detection and timely action. “Access to care is crucial. Sepsis is directly proportional to lack of infection control practices,” she said.

“We need a lot of aggressive workaround capacity building for supervised deliveries so that obstructed labour can be recognised,” Dr Hema added. “Similarly, robust prevention of unwanted conceptions by use of contraceptives so that abortions and septic abortions are on the decline is required,” she added.

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