Abortion In Mauritius Health And Social Care Essay

Abortion In Mauritius Health And Social Care Essay When does human life begin? In one sense this is a philosophical or religious issue, outside the realm of science. From a purely biological point of view the life of an individual begins when there is fertilisation. The birth of a child, no doubt, is a wonderful occasion. However women do abortion to limit births. Definition of abortion According to World Health Organisation, abortion is defined as an induced termination of pregnancy by use of medications or surgical interventions after implantation of the embryo and before the foetus is able to survive outside the maternal organism (before 22nd week of pregnancy). Types of abortion The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages. Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring safely and 20 million unsafely. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. One of the main determinants of the availability of safe abortions is the legality of the procedure. Forty percent of the worlds women are able to access therapeutic and elective abortions within gestational limits. The frequency of abortions is, however, similar whether or not access is restricted. Abortion has a long history and has been induced by various methods including herbal abortifacients, the use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing pro-life and pro-choice worldwide social movements (both self-named). Incidence of abortion has declined worldwide, as access to family planning education and contraceptive services has increased. Abortion in Mauritius Abortion is generally illegal in Mauritius under the Penal Code. Any person procuring an abortion or supplying the means to procure an abortion is subject to imprisonment for up to 10 years. Abortion in Mauritius is one of the taboo subjects even in 2010. Why abortion still taboo is can maybe be explained by the fear of open talks and some constraint that some cultures and religions put upon such talks. Since abortion is illegal in Mauritius and in this globalized world it is still considered as a taboo, there is very few empirical evidence on this issue in Mauritius. Women fear or sometimes are ashamed of talking on this issue. Sometimes after having an abortion done illegally that they make use of the contraceptives method. The study will provide an insight of the perceptions of young women on the issue of abortion. Rational of the study The purpose of this study is to provide an insight of the perception of the issue of abortion among young women in Mauritius since the rate of abortion is increasing and many women are having post abortion complications. Aims and objectives To evaluate the perception of the issue of abortion among young Mauritian women. To assess their understanding on the causes and consequences of abortion among young women. Chapter outline Chapter 1 is the introduction. It will give an introduction of abortion and will give and overview of what will the dissertation consist of. Chapter 2 is the literature review and it will give an overview of the situation. Chapter 3 is the methodology. It will give an overview of the methodology used to carry out the study. The study will be a qualitative study using in depth interviews as the perceptions of women are to be assessed. Chapter 4 is the report finding and analysis. In this chapter the findings will be presented and analysed by using graphs, charts. Chapter 5 is the conclusion and recommendation. Man, through the ages from primitive, non-literate societies to advanced, industrialized and sophisticated societies, has attempted to control conception by a variety of largely crude and rule-of-thumb methods. When he failed to prevent conception he tried to interrupt pregnancy. As a means of fertility, abortion is as old as humanity and probably occurs in all cultures. Throughout recorded history women have resorted to abortion to terminate unwanted pregnancies, regardless of moral or legal sanctions and often at considerable physical or psychological risk and cost. Definition of abortion Abortion means ending a pregnancy. There are different definitions of abortion and they are as follows: Medical and pro-choice communities definition The definition used by the medical and pro-choice communities is: the end of a pregnancy before validity of the fetus. i.e. the termination of the process of gestation after the time when the zygote attaches itself to the uterine wall (about 14 days after conception), but before the fetus is possibly capable of surviving on its own (currently 23 to 28 weeks from conception). The American College of Obstetricians and Gynecologists definition According to the Encyclopedia Britannica, the American College of Obstetricians and Gynecologists has defined abortion as occurring before the 20th week (134th day) of gestation. There are two types of abortion: Accidental abortion: a termination of pregnancy before viability that occurs naturally, without medical intervention. This is commonly called a miscarriage by the public. Therapeutic abortion: a termination of pregnancy via the intervention of a physician through surgery or the use of RU-486 or some other medications. Pro-lifers definition Pro-lifers sometimes define abortion as an intentional interruption of the development process, at any time from conception to birth. Definition from Wikipedia An abortion is the termination of a pregnancy by the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. An abortion can occur spontaneously due to complications during pregnancy or can be induced. Statistics on abortion According to World Health Organisation, every year in the world an estimated 40-50 million women faced with an unplanned pregnancy decide to have an abortion. 20 million of them resort to unsafe abortion, often self induced or obtain clandestinely. These unsafe abortions are carried out by untrained person under poor unhygiene conditions. This corresponds to approximately 125,000 abortions per day. Worldwide in 1995, there were approximately 45.5 million abortions. Of these 19.9 million were unsafe or clandestine abortions and about 25.6 million abortions took place in countries where the procedure is legal under a broad range of conditions. Why seek an abortion? An unwanted or unplanned pregnancy is at the start of the abortion decision making process. Some of the most commonly declared reasons for having an abortion are the following: (Alan Guttmacher Institute. Aborto clandestine: una realidad Latinoamericana. New York, The Alan Guttmacher Institute, 1994 (in Spanish)) A woman is unable to raise a child because she and her partner receive a low salary, have unstable jobs or are unemployed or are students The relationship between the women and her partner is unsufficiently stable for the couple to be sure of raising children together or because the man stopped providing emotional and economic support to the women when the pregnancy was discovered. The women or the couple have all the children they want or they want another child but not at this time The pregnant adolescent or unmarried woman fears rejection by her family and society Some young single women wish to attain a certain level of personal satisfaction before becoming mothers In certain cases, the pregnancy is the result of rape or incest or the fetus is abnormal. Other reasons why women decide to terminate their pregnancy are as follows: They do not want more children or want them later on They are not married Their contraceptive method failed A child would disrupt their education or ability to work They cannot afford to raise a child Their relationship with their partner is bad They are too young Their parents objects They do not want their parent to know Methods of doing an abortion Many women are confronted with an unwanted pregnancy resort to a variety of techniques to induce an abortion. Many of these procedures begin in the womans home and end in the hospital emergency room. They may include self-administered abortifacients taken orally or administered vaginally. When women turn to others for help, the uterus may be manipulated by an unqualified person who may introduce a probe, catheter or sharp object to cause an abortion. Private physicians and other medical, paramedical and pharmaceutical facilities may also provide abortion services for a fee, using high-dose oral or injected hormone treatments such as misoprostol, aralen, quinine or oxytocins illegally. Millions of women through the centuries have followed old wives tales about drugs that produce abortion. Many have been the primitive, painful and dangerous methods used for abortion. Historically both tribal and urbanized societies have employed a variety of methods to end unwanted pregnancies. German Greer in her book Sex and Destiny described some of the abortion methods used throughout the world. They include the application of pressure outside the womb using logs and rocks, jumping on the womens abdomen as well as internal methods such as the ingestion of highly toxic chemicals and the use of various implements inside the uterus. In todays more industrialized societies technology has simplified the abortion procedure to a few basic, safe methods. For example medical and surgical abortion methods. Medical abortions use medications to end the pregnancy. This can be accomplished with a variety of medications given either as a single pill or a series of pills. It is commonly known as the Abortion Pill RU486 (brand name Mifeprex). Medical abortion causes an early abortion through the combination of the two medications, mifepristone and misoprostol. In Mauritius, it is commonly known as Cytotec. Some examples of surgical abortion methods are: Vacuum Aspiration and Dilation and Curettage: This abortion procedure, also known as DA or suction aspiration, uses gentle suction to remove all of the pregnancy tissue. Additionally, dilation and curettage or DC, may be necessary after a vacuum aspiration. In this procedure, a separate curette (a spoon-shaped instrument) may be used to help remove any remaining tissue that may be lining the uterus. Dilation and Evacuation (DE): This method uses the same procedures as DC procedure while also using additional surgical instruments (such as forceps). A DE abortion is usually performed during the second trimester of a pregnancy (roughly 13 to 24 weeks since conception). Induction Abortion This procedure is used to end a second or third trimester pregnancy through the use of medications that trigger the start of contractions. This, in turn, expels the fetus from the uterus. Induction abortions must be done in a hospital, so that the woman can be monitored during the entire procedure. During this procedure, a woman will undergo all the steps of delivery and childbirth. Induction abortions are usually only performed if there is a medical problem or illness present in the fetus or the pregnant woman. Intact Dilation and Extraction This method is performed after 21 weeks of pregnancy and is also referred to as DX, Intact DX, Intrauterine Cranial Decompression and Partial Birth Abortion. This abortion procedure takes about 2 to 3 days and results in the extraction of an intact fetus. Risks associated with abortion Abortion may impair a womens health through a variety of early and late somatic complications, which may occur at the time of the abortion or soon thereafter or which may be discovered much later, perhaps in connection with another pregnancy or with efforts to become pregnant again. Studies in Hungary and in Japan have shown that premature births tend to occur more frequently among women who have had induced abortions than among women who have not had them. Death According to the best record based study of deaths following pregnancy and abortion, a 1997 government funded study in Finland, women who abort are approximately four times more likely to die in the following year than women who carry their pregnancies to term. In addition, women who carry to term are only half as likely to die as women who were not pregnant. The leading causes of abortion related maternal deaths within a week of the surgery are hemorrhage, infection, embolism, anesthesia, and undiagnosed ectopic pregnancies Breast cancer The risk of breast cancer almost doubles after one abortion, and rises even further with two or more abortions.   Cervical, ovarian, and liver cancer   Women have had an abortion done face the risk of cervical cancer, compared to non-aborted women. Ovarian and liver cancers have also been linked to single and multiple abortions. These increased cancer rates for post-aborted women are apparently linked to the unnatural disruption of the hormonal changes which accompany pregnancy and untreated cervical damage.   Uterine perforation The risk of uterine perforation is increased for women who have previously given birth and for those who receive general anesthesia at the time of the abortion. Uterine damage may result in complications in later pregnancies and may eventually evolve into problems which require a hysterectomy, which itself may result in a number of additional complications and injuries including osteoporosis.   Cervical lacerations:   The risk of cervical damage is greater for teenagers, for second trimester abortions, and when practitioners fail to use laminaria for dilation of the cervix.   Placenta previa Abortion increases the risk of placenta previa in later pregnancies (a life threatening condition for both the mother and her wanted pregnancy) by seven to fifteen fold. Abnormal development of the placenta due to uterine damage increases the risk of fetal malformation, perinatal death, and excessive bleeding during labor.   Complications of labour Induced abortion not only increased the risk of premature delivery, it also increased the risk of delayed delivery. Women who had one, two, or more induced abortions are, respectively, are more likely to have a post-term delivery (over 42 weeks). Pre-term delivery increases the risk of neo-natal death and handicaps. Handicapped newborns in later pregnancies Abortion is associated with cervical and uterine damage which may increase the risk of premature delivery, complications of labor and abnormal development of the placenta in later pregnancies. These reproductive complications are the leading causes of handicaps among newborns.   Ectopic pregnancy Abortion is significantly related to an increased risk of subsequent ectopic pregnancies. Ectopic pregnancies, in turn, are life threatening and may result in reduced fertility. Endometritis Endometritis is a post-abortion risk for all women, but especially teenagers are more likely to acquire endometritis following abortion.   Immediate complications   The nine most common major complications which can occur at the time of an abortion are: infection, excessive bleeding, embolism, ripping or perforation of the uterus, anesthesia complications, convulsions, hemorrhage, cervical injury, and endotoxic shock. The most common minor complications include: infection, bleeding, fever, second degree burns, chronic abdominal pain, vomiting, gastro-intestinal disturbances, and Rh sensitization. Clients and abortion provider Clients are usually referred to a provider by a family member or friends who have used the service before. Sometimes the help of intermediaries such as person from the community, a chemist or a lay health provider may be sought. This informal information network is the main source of accessing services in illegal contexts. Women do not always obtain satisfactory services from the first provider they visit and sometimes refuse a service because the cost is prohibitive. In contexts of illegality or poor availability of services the choice of provider is limited but where options exists, women demonstrate a concern for quality of care and safety. Frequently mentioned reasons for choosing a particular provider include the fact that he or she is known to be experienced in performing abortions. A variety of techniques to induce abortion are used depending on the type of provider. Traditional methods vary widely and range from abdominal massage to insertion of roots, twigs, catheter, holy water, bitter concoctions etc. Many service providers ignore the psychological needs of women undergoing abortion or post abortion care and focus only on the physical aspect of the abortion. Motives and attitudes of providers tend to vary considerably and are not always focused on providing appropriate abortion-centered care. In a study in a public hospital in Mexico in 1998 where women were admitted with incomplete abortions were interviewed, it was reported that these women often felt considerable worry, fear, and /or guilt in addition to physical pain, that the staff were short of skills and time, and in many cases showed little interest in providing a minimally dignified encounter. Cost and abortion Unwanted pregnancy is a social problem of major urgency to society and of central important to individual women who must accept the consequences or seek alternative solutions. The cost of a legal abortion varies from country to country. For example, in Romania, the price of an abortion is less than US$3 public clinics but may be as much as US$15 in private clinics. In Armenia, abortion was provided free of charge until August 1997; since then, the charge has increased gradually form about US$7.50 in 1997 to approximately US$9 in 1999 and general anesthesia raises the charge to approximately US$13.50. In Lithuania, abortions under 6 weeks gestation cost approximately US$15; those beyond 6 weeks gestation cost approximately US$22. Private practices also offer abortion services ranging from US$100 for vaccum aspiration to US$200 for dilation and curettage. In the Russian Federation although abortion is theoretically free of charge, prices may reach US$50 in some clinics. A study was carried out on induced abortion in Mauritius (Study on induced abortion in Mauritius: Alternative to fertility regulation or emergency procedure? July 1993. A total number of 475 women who had undergone an abortion were interviewed. 7.1% of the women obtained abortion by aspiration. Aspiration is done mainly by private doctors and is accessible only to those who could afford to pay for the procedure. The cost varied from Rs 1000 and Rs 4000 depending on the expertise and qualifications of the doctor. Historical evolvement of abortion The practice of abortion dates back to ancient times. Pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. The first recorded evidence of induced abortion is from the Egyptian Ebers Papyrus in 1550 BC. A Chinese record documents the number of royal concubines who had abortions in China between the years 500 and 515 BC. According to Chinese folklore, the legendary Emperor Shennong prescribed the use of mercury to induce abortions nearly 5000 years ago. Many of the methods employed in early and primitive cultures were non-surgical. Physical activities like strenuous labor, climbing, paddling, weightlifting, or diving were a common technique. Others included the use of irritant leaves, fasting, bloodletting, pouring hot water onto the abdomen, and lying on a heated coconut shell. Evolution of abortion related laws in some countries Historically laws on abortion have been influenced by religious attitudes that consider abortions a sin. Women seeking and obtaining abortion were considered perpetrators of a wrong. The extent to which a woman has a legal right to determine the fate of her pregnancy is differently interpreted in the different countries. Societies attempted to restrict the practice of abortion, partly on religious and moral grounds but undoubtedly largely because the primitive methods available until relatively recently resulted in the death or maiming of large numbers of women. Despite often severe penalties on abortionist and aborted women alike and the high risk of illness and death, abortion continued to be employed. With the evolution of medical science, safer methods of abortion emerged, thus removing one of the principal bases for restricting abortion. Changing religious and moral views, coupled with the realization in many societies that illegal abortion using primitive and dangerous methods is wide spread, lead some countries to liberalize their abortion laws. Termination of pregnancy at the request of the women was first legalized in the Soviet Union on November 8 in 1920. Historically abortion was legalized in most Eastern European countries following the 1920 Soviet Union. In 1920 Lenin legalized all abortions in the Soviet Union. In 1931 Mexico was the first country in the world to legalize abortion in case of rape. 1932 Poland was the first country in Europe outside Soviet Union to legalize abortion in cases of rape and threat to maternal health. In 1935, Iceland became the first Western country to legalize therapeutic abortion under limited circumstances. In 1935, Nazi Germany amended its eugenics law, to promote abortion for women who have hereditary disorders. The law allowed abortion if a woman gave her permission, and if the fetus was not yet viable, and for purposes of so-called racial hygiene. In 1969, Canada passed the Criminal Law Amendment Act, 1968-69, which began to allow abortion for selective reasons. In 1971, the Indian Parliament under the Prime Ministership of a lady Prime Minister Indira Gandhi, passes Medical Termination of Pregnancy Act 1971 (more commonly referred to as simply MTP Act 1971). India thus becomes one of the earliest nations to pass this Act. The Act gains importance, as c India had traditionally been a very conservative country in these matters. In 2007 the government of Mexico City legalizes abortion during the first 12 weeks of pregnancy, and offers free abortions. On August 28, 2008, the Mexican Supreme Court upholds the law. In 2008, the Australian state of Victoria passes a bill which decriminalizes abortion, making it legally accessible to women in the first 24 weeks of the pregnancy. In 2009, in Spain a bill was passed to decriminalize abortion, so as to make it legally accessible to women in the first 14 weeks of the pregnancy. The evolution of religious views on abortion Mans attitude towards abortion have ranged over a wide spectrum, from approval, bordering on encouragement to total prohibition and condemnation; all the way from the early civilizations Assyrian, Babylonian, Hindu, Greek and Roman to the present day. History is strewn with evidence that abortion has always been a subject of interest, if not of controversy. Provisions for abortion in almost all contemporary societies and the rituals prescribed in these societies, lead one to suspect that attitudes towards abortion are a part of a universal cultural process in the same manner as attitudes towards puberty or mating. Eastman has demonstrated the lack of historical correlation between the attitudes of societies towards abortion and their ethical conduct or intellectual sophistication. Our own attitudes towards abortion are thought to be derived from the commandment Though shalt not kill, and its Judeo-Christian interpretation. A major factor in the evolution of present-day attitudes towards abortion has its origin in the gradual breakdown of the repressive sexual mores of the Victorian Age. An important cause of this change and one which has received little attention, is the devastating effect of the First World War which left in its wake disillusionment and loss of hope in a social system whose values, buttressed by a Victorian moral code, had brought on the slaughter. Weisner (7, p.24) notes that the concept of the phase in which the fetus is imbued with life varies according to culture. The degree of approval or disapproval of induced abortion will depend in part on this concept. For 70% of weisners Chilean study population, life does not begin at the moment of conception but is generally defined as beginning somewhere between the first and third month of the pregnancy; the state prior to this is considered a blood clot formation. The early Christians views The attitude of early Christians is that anything that interrupted human life, be it contraceptive potion or poison or abortion was disapproved of and denounced as murder. The Catholic views The Catholic Church believes that life begins at conception and therefore the removal of a zygote, embryo or foetus is considered as murder and is hence forbidden. The Hindu views The Hindu scriptures from the vedic age down to the Smritis (100 BC-AC100) called it bhruna-hatya (foetus murder) or garbha-hatya (pregnancy destruction) and condemned it as a serious sin. The Jewish views The popular Jewish wisdom of the Sentences of Pseudo-Phocylides (written between 50 B.C and A.D 50) says that a woman should not destroy the unbirth babe in her belly nor after his birth throw it before the dogs and vultures as a prey. Similarly the first century Jewish historian and apologist Josephus wrote The law orders all the offspring to be brought up, and forbids women either to cause abortion or to make away with the foetus. A woman convicted of this was regarded as having committed an infanticide, because she destroyed a soul and diminished the race. Abortion law in Mauritius The legal provisions governing abortion in Mauritius are a result of the intermingling of elements of French and English law. The French ruled Mauritius from 1721 to 1810, while the British ruled from 1810 until independence was attained in 1968. The provisions of the Penal Code dealing with abortion are derived directly from the French Napoleonic Penal Code of 1810 and from the British Offences against the Person Act of 1861. They were not modified by the 1938 revision of the Penal Code of Mauritius. Abortion is generally illegal in Mauritius under the Penal Code. Any person procuring an abortion or supplying the means to procure an abortion is subject to imprisonment for up to 10 years. A similar punishment is prescribed for a woman who induces her own abortion or consents to its being induced. Physicians, surgeons and pharmacists who facilitate or perform an abortion are also subject to imprisonment. Nonetheless, under general criminal law principles of necessity, an abortion may be performed to save the life of the pregnant woman. Abortion in Mauritius Abortion is the dread secret of our society. It has been relegated for so long to the darkest corners of fear and mythology that an unwritten compact virtually requires that it remains untouched and undiscussed so writes Lader in the introductory remarks of his 1966 work on abortion. Abortion, unlike many countries, is illegal in Mauritius is not permitted under any circumstance. Despite these strict legal parameters, clandestine illegal abortions are being performed in all corners of the island, by untrained doctors, nurses, midwives and wise women, and mostly under unsafe conditions. There are no reliable statistical data available on the number of abortions performed in Mauritius. More than 2,800 post abortion complication cases have been registered in Government hospitals in 2000. The number of abortion is estimated to range between 15,000 to 20,000 and almost equal to the number of live births annually (Mauritius Research Council Biomedical Research, September 2001 pg 33). Any form of abortion which is defined as the termination of pregnancy is illegal in Mauritius yet a large number of cases are admitted at hospitals and clinics following complications of abortions. A Mauritius family planning official has estimated that there is one abortion for every live birth. Among 2008 official cases of post abortion complication registered in 1997, 798 occurred among youth below the age of 24 years old. Mauritius has a high incidence of unsafe abortions because of unprotected intercourse experienced by many young women in a rapidly industrializing environment. The Mauritius Family Planning Association (MFPA) tackled the issue of unsafe abortion in 1993. The MFPA organized an advocacy symposium in 1993 on unsafe abortion. The advocacy campaign of the MFPA consists of having abortion legalized on health grounds and improving family planning services, especially for young unmarried women and men. The full support of the media was secured on the abortion issue: articles appeared, meetings were attended by the press, and public relations support was also received from them. The MFPA worked closely with parliamentarians. A motion was tabled in 1994 in the National Assembly which called for legalization of abortion on health grounds, but the Church squelched its debate. In March 1994 MFPA a conference on Unsafe Abortion in Mauritius with the participation of over 100 representatives from 2 0 countries. Studies on abortion in Mauritius It is estimated that each year there are some 20,000 cases of induced abortion, which is illegal in the country. Since abortion services are illegal, post abortion services addressing complications are often a womans only point of contact with the public health sector. A study was carried out on induced abortion in Mauritius (Study on induced abortion in Mauritius: Alternative to fertility regulation or emergency procedure? July 1993. A study based on a sample of 475 women admitted to three hospitals with complications due to induced abortion revealed considerable use of unreliable methods (e.g., withdrawal and natural methods), frequent method switching, and inconsistent use of modern methods. The study also found that women seeking abortion were usually under 30 years of age, and 20% of women with abortion complications were not using any method, and some 50% were using an unreliable method at the time they become pregnant. It emerged that with increasing numbers of women employed, their work schedules hindered their going to a family planning clinic and resulted in abortion being used as a