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106-522: There are two main measures used when talking about the rates of maternal mortality in a community or country. These are the maternal mortality ratio and maternal mortality rate, both abbreviated as "MMR". By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) 2017 report, about every 2 minutes

212-571: A 2004 WHO publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage, endometritis , operative vaginal delivery , episiotomy , low birth weight , preterm delivery , and small-for-gestational-age infants, all of which can lead to maternal death. The leading cause of death for girls at

318-748: A 2012 study in Obstetrics & Gynecology , in the United States the risk of maternal mortality is 14 times lower after induced abortion than after childbirth. The CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births, while the US abortion mortality rate was 0.43 maternal deaths per 100,000 procedures. In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion

424-532: A child , domestic violence , lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest . When done legally in industrialized societies, induced abortion is one of the safest procedures in medicine . Unsafe abortions —those performed by people lacking the necessary skills, or in inadequately resourced settings—are responsible for between 5–13% of maternal deaths , especially in

530-471: A combined regimen of mifepristone and misoprostol or surgical abortion. Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office , abortion clinic , or hospital. Complications, which are rare, can include uterine perforation , pelvic infection , and retained products of conception requiring a second procedure to evacuate. Infections account for one-third of abortion-related deaths in

636-953: A delayed/suspended menstruation". Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide, though this varies by region. Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion. There are two commonly used methods of measuring

742-426: A heart problem. As women have gained access to family planning and skilled birth attendant with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015. Many countries halved their maternal death rates in the last 10 years. Although attempts have been made to reduce maternal mortality, there

848-497: A medical facility, lack of adequate medical facilities in the area, and lack in confidence in medicine. Delays in receiving adequate and appropriate care may result from an inadequate number of trained providers, lack of appropriate supplies, and the lack of urgency or understanding of an emergency. The three delays model illustrates that there are a multitude of complex factors, both socioeconomic and cultural, that can result in maternal death. The four measures of maternal death are

954-557: A midwife, doctor, or trained nurse), with back-up obstetric care for emergency situations that may occur during the process of labor. This can be examined further by looking at statistics in some areas of the world where inequities in access to health care services reflect an increased number of maternal deaths. The high maternal death rates also reflect disparate access to health services between resource communities and those that are high-resource or affluent. The disparities in maternal health outcomes are also present among racial groups. In

1060-510: A mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion ( vacuum aspiration ), especially when clinical practice does not include detailed inspection of aspirated tissue. Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%. If medical abortion fails, surgical abortion must be used to complete

1166-443: A pregnancy are termed accidental , incidental , or non-obstetrical maternal deaths. Indirect causes include malaria , anemia , HIV/AIDS , and cardiovascular disease , all of which may complicate pregnancy or be aggravated by it. Risk factors associated with increased maternal death include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and cesarean delivery . According to

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1272-548: A prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone, particularly in the second trimester. Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation. In very early abortions, up to 7 weeks gestation , medical abortion using

1378-422: A public health measure. Abortion laws and views of the procedure are different around the world. In some countries abortion is legal and women have the right to make the choice about abortion. In some areas, abortion is legal only in specific cases such as rape, incest, fetal defects , poverty, and risk to a woman's health. An induced abortion is a medical procedure to end a pregnancy. In present-day English,

1484-473: A senator, in 2019 Harris reintroduced the Maternal Care Access and Reducing Emergencies (CARE) Act which aimed to address the maternal mortality disparity faced by women of color by training providers on recognizing implicit racial bias and its impact on care. Harris stated: "We need to speak the uncomfortable truth that women—and especially Black women—are too often not listened to or taken seriously by

1590-577: A significantly increased chance of mortality or morbidity, and reducing the number of fetuses to lessen health risks associated with multiple pregnancy . An abortion is referred to as elective or voluntary when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term elective because " elective surgery " generally refers to all scheduled surgery, whether medically necessary or not. About one in five pregnancies worldwide ends with an induced abortion. Most abortions result from unintended pregnancies. In

1696-402: A specific abortion procedure. Abortions can be characterized as either therapeutic or elective. When an abortion is performed for medical reasons, the procedure is referred to as a therapeutic abortion. Medical reasons for therapeutic abortion include saving the life of the pregnant woman, preventing harm to the woman's physical or mental health , preventing the birth of a child who will have

1802-674: A wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow the easier accessibility of these medications. However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check ups and proper implementation of diets during pregnancy and lactation also contributes to its prevention. Indirect obstetric deaths are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy . Fatalities during but unrelated to

1908-445: A widespread trend towards greater legal access to abortion since 1973, but there remains debate with regard to moral, religious, ethical, and legal issues. Those who oppose abortion often argue that an embryo or fetus is a person with a right to life , and thus equate abortion with murder . Those who support abortion's legality often argue that it is a woman's reproductive right . Others favor legal and accessible abortion as

2014-763: A woman dies because of complications due to child birth or pregnancy. For every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication. UNFPA estimated that 303,000 women died of pregnancy or childbirth related causes in 2015. The WHO divides causes of maternal deaths into two categories: direct obstetric deaths and indirect obstetric deaths. Direct obstetric deaths are causes of death due to complications of pregnancy, birth or termination. For example, these could range from severe bleeding to obstructed labor , for which there are highly effective interventions. Indirect obstetric deaths are caused by pregnancy interfering or worsening an existing condition, like

2120-428: Is a key performance indicator (KPI) for efforts to improve the health and safety of mothers before, during, and after childbirth per country worldwide. Often referred to as MMR, it is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). It is not to be confused with the maternal mortality rate , which

2226-548: Is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during obstetric hemorrhage . It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage. Some maternal deaths can be prevented through medication use. Injectable oxytocin can be used to prevent death due to postpartum bleeding . Additionally, postpartum infections can be treated using antibiotics. In fact,

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2332-623: Is a procedure similar to a caesarean section and is performed under general anesthesia . It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion. First trimester procedures can generally be performed using local anesthesia , while second trimester methods may require deep sedation or general anesthesia . In places lacking

2438-461: Is a systematic tool that is used to collect information on the cause of death from laypeople and not medical professionals. Confidential enquires for maternal deaths do not occur very often on a national level in most countries. Registration systems are usually considered the "gold-standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all maternal deaths. Another concern for registration systems

2544-459: Is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion. Safely permitting women to self-administer abortion medication has the potential to improve access to abortion. The review also noted a research gap concerning methods to support women who take medication at home for a self-administered abortion. Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are

2650-439: Is as safe from 64 to 70 days' gestation as it before 63 days. There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation. Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using

2756-422: Is common since it is more likely to be legally restrictive and/or more highly stigmatizing. Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of maternal deaths related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in

2862-459: Is contrast to high income countries, for which the most common cause is thromboembolism . Between 1990 and 2015, the maternal mortality ratio has decreased from 385 deaths per 100,000 live births to 216 maternal deaths per 100,000 live births. Some factors that have been attributed to the decreased maternal deaths seen between this period are in part to the access that women have gained to family planning services and skilled birth attendance, meaning

2968-524: Is essential for the attainment of the highest possible level of sexual and reproductive health". Historically , abortions have been attempted using herbal medicines , sharp tools, forceful massage , or other traditional methods . Around 73 million abortions are performed each year in the world, with about 45% done unsafely. Abortion rates changed little between 2003 and 2008, before which they decreased for at least two decades as access to family planning and birth control increased. As of 2018 , 37% of

3074-541: Is generally safer than continuing a pregnancy to term." Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally." In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14–16 percent of maternal deaths resulted from abortion. In

3180-497: Is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion , or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons given for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health , an inability to afford

3286-515: Is legal and accessible, it is widely regarded as safer than carrying a pregnancy to term and delivery. In fact, a study published in the journal Obstetrics & Gynecology reported that in the United States, carrying a pregnancy to term and delivering a baby comes with 14 times increased risk of death as compared to a legal abortion. However, in many regions of the world, abortion is not legal and can be unsafe. Maternal deaths caused by improperly performed procedures are preventable and contribute 13% to

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3392-414: Is legal and available. The health risks of abortion depend principally on how, and under what conditions, the procedure is performed. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Legal abortions performed in the developed world are among the safest procedures in medicine. According to

3498-666: Is legally restricted. They may attempt self-induced abortion or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis , hemorrhage, and damage to internal organs. Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries . Unsafe abortions are believed to result in millions of injuries. Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in

3604-455: Is legally risky in the United States. Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine . Such herbs include tansy , pennyroyal , black cohosh , and the now-extinct silphium . In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil. Because

3710-456: Is much room for improvement, particularly in low-resource regions. Over 85% of maternal deaths are in low-resource communities in Africa and Asia. In higher resource regions, there are still significant areas with room for growth, particularly as they relate to racial and ethnic disparities and inequities in maternal mortality and morbidity rates. Overall, maternal mortality is an important marker of

3816-484: Is one of the interventions proposed to reduce maternal mortality where maternal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. Maternal and perinatal death reviews have been in practice for a long time worldwide, and the World Health Organization (WHO) introduced

3922-524: Is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and fetus . Second, skilled birth attendance with emergency backup such as doctors, nurses and midwives who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death which are hemorrhage , sepsis , unsafe abortion, hypertensive disorders and obstructed labor . Lastly, postnatal care which

4028-471: Is safe and does not contribute greatly to overall rates of maternal death. However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of maternal death. According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions. Unsafe abortion practices are defined by

4134-402: Is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many maternal deaths occurring during these pregnancies and deliveries may not be properly record through these methods. There are also issues with using verbal autopsies and other forms of survey in recording maternal death rates. For example, the family's willingness to participate after

4240-636: Is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to countries where abortion is legal and available. For example, the 1996 legalization of abortion in South Africa led to an immediate reduction in abortion-related complications, with abortion-related deaths dropping by more than 90%. Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal . A 2011 study concluded that in

4346-565: Is the number of maternal deaths (direct and indirect) in a given period per 100,000 women of reproductive age during the same time period. The statistics are gathered by WHO , UNICEF , UNFPA , World Bank Group , and the United Nations Population Division . The yearly report started in 1990 and is called Trends in Maternal Mortality . As of the 2015 data published in 2016, the countries that have seen an increase in

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4452-437: Is the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women. Lifetime risk of maternal death is a calculated prediction of a woman's risk of death after each consecutive pregnancy. The calculation pertains to women during their reproductive years. The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (MMR), or

4558-424: Is the six weeks following delivery. During this time, bleeding, sepsis and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended. Additionally, reliable access to information, compassionate counseling and quality services for

4664-407: Is uncontrollable bleeding from the uterus, cervix or vaginal wall after birth. This can happen when the uterus does not contract correctly after birth, there is left over placenta in the uterus, or there are cuts in the cervix or vagina from birth. Hypertensive disorders of pregnancy happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of

4770-577: Is usually termed " stillborn ". Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap. Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth. The vast majority of miscarriages occur before the woman is aware that she is pregnant , and many pregnancies spontaneously abort before medical practitioners can detect an embryo. Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon

4876-456: The Lancet which covered the period from 1990 to 2013, the most common causes of maternal death world-wide are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labor (6%). Other causes include blood clots (3%) and pre-existing conditions (28%). Postpartum bleeding happens when there

4982-563: The American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain. Some older reviews concluded that abortion was associated with an increased risk of psychological problems; however, later reviews of

5088-557: The bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld . Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion

5194-436: The cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons. Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion

5300-435: The developing world . However, medication abortions that are self-managed are highly effective and safe throughout the first trimester . Public health data show that making safe abortion legal and accessible reduces maternal deaths. Modern methods use medication or surgery for abortions. The drug mifepristone (aka RU-486) in combination with prostaglandin appears to be as safe and effective as surgery during

5406-748: The first and second trimesters of pregnancy. The most common surgical technique involves dilating the cervix and using a suction device . Birth control , such as the pill or intrauterine devices , can be used immediately following abortion. When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems. In contrast, unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause between 22,000 and 44,000 deaths and 6.9 million hospital admissions each year. The World Health Organization states that "access to legal, safe and comprehensive abortion care, including post-abortion care ,

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5512-441: The maternal mortality ratio (MMR), maternal mortality rate, lifetime risk of maternal death and proportion of maternal deaths among deaths of women of reproductive years (PM). Maternal mortality ratio (MMR) is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period. The MMR is used as a measure of the quality of a health care system. Maternal mortality rate (MMRate)

5618-548: The 2010 United Nations Population Fund report, low-resource nations account for ninety-nine percent of maternal deaths with the majority of those deaths occurring in Sub-Saharan Africa and Southern Asia. Globally, high and middle income countries experience lower maternal deaths than low income countries. The Human Development Index (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries. In most cases, high rates of maternal deaths occur in

5724-696: The Maternal and Perinatal Death Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities. It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth. The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions. An important factor that contributes to

5830-551: The U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record." According to Rickie Solinger , A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims. A 1940s American physician spoke of his pride in having performed 13,844 illegal abortions without any fatalities. In 1870s New York City,

5936-523: The US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery , lower or similar to running a marathon, and about equivalent to traveling 760 miles (1,220 km) in a passenger car. Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions. The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth. Outpatient abortion

6042-497: The United Kingdom, 1 to 2% of abortions are done because of genetic problems in the fetus. Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation . A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a " premature birth " or a "preterm birth". When a fetus dies in utero after viability , or during delivery , it

6148-452: The United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services prior to delivery. In 2023, a study reported that deaths among Native American women was three-and-a-half times that of white women. The report attributed

6254-403: The United States where 96% of second trimester abortions are performed surgically by dilation and evacuation . A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion. Further research is required to determine if self-administered medical abortion

6360-449: The United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old. Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. Additionally, lack of access to skilled medical care during childbirth ,

6466-540: The United States, black women are 3-4 times more likely to die from maternal mortality than white women. Unequal access to quality medical care, socioeconomic disparities, and systemic racism by health care providers are factors that have contributed to the high maternal mortality rates among black women. Discounting factors such as pre-existing conditions, do not impact the rate of this disparity. In 2019, Black maternal health advocate and Parents writer Christine Michel Carter interviewed Vice President Kamala Harris . As

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6572-726: The United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state. The analysis, however, did not take into account travel to other states without such laws to obtain an abortion. In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally. Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of

6678-565: The United States. The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office. Preventive antibiotics (such as doxycycline or metronidazole ) are typically given before abortion procedures, as they are believed to substantially reduce the risk of postoperative uterine infection; however, antibiotics are not routinely given with abortion pills. The rate of failed procedures does not appear to vary significantly depending on whether

6784-741: The WHO as procedures that are performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean. Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries. Complications include hemorrhage, infection, sepsis and genital trauma . There are four primary types of data sources that are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy

6890-669: The WHO as time- and cost-effective, is the sisterhood method . The United Nations Population Fund (UNFPA; formerly known as the United Nations Fund for Population Activities) have established programs that support efforts in reducing maternal death. These efforts include education and training for midwives, supporting access to emergency services in obstetric and newborn care networks, and providing essential drugs and family planning services to pregnant women or those planning to become pregnant. They also support efforts for review and response systems regarding maternal deaths. According to

6996-461: The abortion is performed by a doctor or a mid-level practitioner . Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen. The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from

7102-527: The abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming more safe or less safe with respect to the overall mortality of women. The prevention and reduction of maternity death is one of the United Nations ' Sustainable Development Goals , specifically Goal 3 , "Good health and well being". Promoting effective contraceptive use and information distributed to

7208-411: The abortionist/midwife Madame Restell (Anna Trow Lohman) is said to have lost very few women among her more than 100,000 patients —a lower mortality rate than the childbirth mortality rate at the time. In 1936, obstetrics and gynecology professor Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that With each decade of the past fifty years

7314-467: The actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus. Women seeking an abortion may use unsafe methods, especially when abortion

7420-435: The age and health of the pregnant woman. 80% of these spontaneous abortions happen in the first trimester. The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease (such as lupus ), diabetes , other hormonal problems , infection, and abnormalities of

7526-433: The age of 15 in developing countries is complication through pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births. However, in

7632-444: The availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s. The most common early first trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost ) up to 10 weeks (70 days) gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or

7738-431: The blood vessels, likely because of the placenta . This includes medical conditions like gestational hypertension and pre-eclampsia . Postpartum infections are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge. Obstructed labor happens when the baby does not properly move into

7844-481: The cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable. Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening

7950-598: The contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools ( Bakri Balloon ) can be placed if there is concern for excess bleeding. A public health approach to addressing maternal mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both prior to pregnancy and during pregnancy, to combat those causes and prevent maternal mortality. Maternal mortality ratio The maternal mortality ratio

8056-423: The decisions made by the women who are pregnant and/or other decision-making individuals. Decision-making individuals can include a spouse and family members. Examples of reasons for delays in seeking care include lack of knowledge about when to seek care, inability to afford health care, and women needing permission from family members. Delays in reaching care include factors such as limitations in transportation to

8162-466: The first trimester because of fetal abnormalities, more rigorous research would be needed to show this conclusively. Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called " post-abortion syndrome ", but this is not recognized by medical or psychological professionals in the United States. A 2020 long term-study among US women found that about 99% of women felt that they made

8268-674: The government of Texas created the Maternal Mortality and Morbidity Task Force in 2013. This KPI was used for the Millennium Development Goals from 2000 to 2015 and is part of the Sustainable Development Goals . The list of countries with a comparison of this KPI in 1990, 2000 and 2015 are: Abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus . An abortion that occurs without intervention

8374-832: The health care system, and therefore they are denied the dignity that they deserve. And we need to speak this truth because today, the United States is 1 of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. That risk is even higher for Black women, who are three to four times more likely than white women to die from pregnancy-related causes. These numbers are simply outrageous." The Covid-19 pandemic heightened maternal mortality rates, disproportionately impacting communities of color. Multiple factors contribute to this widening disparity, notably, social factors such as implicit bias, repeated racial discrimination, and limited access to healthcare. All issues are further exacerbated for people of color who face systemic barriers to adequate medical care. Overall,

8480-401: The health of the country and reflects on its health infrastructure. Lowering the amount of maternal death is an important goal of many health organizations world-wide. Direct obstetric deaths are due to complications of pregnancy, birth, termination or complications arising from their management. The causes of maternal death vary by region and level of access. According to a study published in

8586-718: The high rate in part to the fact that Native American women are cared for under a poorly funded Federal Health Care System that is so stretched that the average monthly visit lasts only from three to seven minutes. Such a short visit allows neither time for performing an adequate health assessment nor time for the patient to discuss any problems she may be experiencing. The decline in maternal deaths has been due largely to improved aseptic techniques , better fluid management and quicker access to blood transfusions , and better prenatal care . Technologies have been designed for resource poor settings that have been effective in reducing maternal deaths as well. The non-pneumatic anti-shock garment

8692-508: The incidence of abortion: In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable. For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error . The number of abortions performed worldwide was characterized as stable in the early 2000s, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide

8798-482: The indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure , such use is not recommended by physicians. Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage . In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of

8904-631: The last menstrual period). It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested. Current evidence finds no relationship between most induced abortions and mental health problems other than those expected for any unwanted pregnancy. A report by

9010-454: The loss of a loved one, misclassification of the cause of death, and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, a potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications to seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion

9116-408: The management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of maternal deaths. In regions where abortion is legal, abortion practices need to be safe in order to effectively reduce the number of maternal deaths related to abortion. Maternal Death Surveillance and Response is another strategy that has been used to prevent maternal death. This

9222-460: The maternal mortality rate (MMRate). Proportion of maternal deaths among deaths of women of reproductive age (PM) is the number of maternal deaths in a given time period divided by the total deaths among women aged 15–49 years. Approaches to measuring maternal mortality include civil registration system, household surveys, census , reproductive age mortality studies (RAMOS) and verbal autopsies. The most common household survey method, recommended by

9328-527: The maternal mortality rate increased from 23.8 deaths per 100,000 live births in 2020, to 32.9 deaths per 100,000 live births in 2021. An apparent spike in this rate can be noted in 2021. For non-hispanic black women the rate of maternal deaths per 100,00 live births increased from 44.0 in 2019 to 69.9 in 2021. According to UNFPA , there are four essential elements for prevention of maternal death. These include, prenatal care , assistance with birth, access to emergency obstetric care and adequate postnatal care. It

9434-399: The maternal mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in

9540-466: The maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of maternal death worldwide. Unsafe abortion is another major cause of maternal death worldwide. In regions where abortion is legal and accessible, abortion

9646-528: The maternal mortality ratio since 1990 are the Bahamas, Georgia, Guyana, Jamaica, Dem. People’s Rep. Korea, Serbia, South Africa, St. Lucia, Suriname, Tonga, United States , Venezuela, RB Zimbabwe. But according to Sustainable Development Goals report 2018, the overall maternal mortality ratio has declined by 37 percent since 2002. Nearly 303,000 women died due to complications during pregnancy. With an exceptionally high mortality ratio compared to other U.S. states,

9752-412: The medical literature found that previous reviews did not use an appropriate control group. When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes. However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial. Although some studies show negative mental-health outcomes in women who choose abortions after

9858-615: The most common surgical methods of induced abortion. Manual vacuum aspiration (MVA) consists of removing the fetus or embryo , placenta , and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. Both techniques can be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later. MVA, also known as "mini-suction" and " menstrual extraction ", or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening

9964-418: The necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary. This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout

10070-470: The past decade; deaths from unsafe abortion account for around 13% of all maternal deaths . The World Health Organization believes that mortality has fallen since the 1990s. To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services. A major factor in whether abortions are performed safely or not

10176-436: The pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled at a way that does not allow it to pass through the pelvis and birth canal. Blood clots can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lung, as well as travel to the heart or brain, leading to complications. When abortion

10282-558: The procedure. Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain , France , Switzerland , United States , and the Nordic countries . Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in Canada , most of Europe, China and India , in contrast to

10388-436: The question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute , American Cancer Society , Royal College of OBGYN and American Congress of OBGYN ) have concluded that abortion does not cause breast cancer. In the past even illegality has not automatically meant that the abortions were unsafe. Referring to

10494-557: The right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. The researchers also stated: "These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself." Some purported risks of abortion are promoted primarily by anti-abortion groups, but lack scientific support. For example,

10600-432: The same countries that have high rates of infant mortality . These trends are a reflection that higher income countries have stronger healthcare infrastructure, more doctors, use more advanced medical technologies and have fewer barriers to accessing care than low income countries. In low income countries, the most common cause of maternal death is obstetrical hemorrhage , followed by hypertensive disorders of pregnancy. This

10706-452: The second trimester are labor-induced abortions in Sweden and other nearby countries. Only limited data are available comparing labor-induced abortion with the dilation and extraction method. Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion

10812-416: The term abortion , when used without further qualification, generally refers to induced abortion. A pregnancy can be intentionally aborted in several ways. The abortion method depends upon the gestational age of the embryo or fetus, which gains mass as the pregnancy progresses. Abortion laws , regional availability, and the personal preference of the women and her doctor may inform the women's choice of

10918-954: The travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths. Pregnancy-related deaths between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions, and the following are some of the more common causes related to maternal death: cardiovascular diseases (15.2%.), non-cardiovascular diseases (14.7%), infection or sepsis (12.8%), hemorrhage (11.5%), cardiomyopathy (10.3%), pulmonary embolism (9.1%), cerebrovascular accidents (7.4%), hypertensive disorders of pregnancy (6.8%), amniotic fluid embolism (5.5%), and anesthesia complications (0.3%). The three delays model describes three critical factors that inhibit women from receiving appropriate maternal health care. These factors include: Delays in seeking care are due to

11024-409: The use of broad-spectrum antibiotics both for the prevention and treatment of maternal infection is common in low-income countries. Maternal death due to eclampsia can also be prevented through the use of medications such as magnesium sulfate. Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example,

11130-476: The uterus. Advancing maternal age and a woman's history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma ; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide . Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with

11236-425: The world's women had access to legal abortions without limits as to reason. Countries that permit abortions have different limits on how late in pregnancy abortion is allowed. Abortion rates are similar between countries that restrict abortion and countries that broadly allow it, though this is partly because countries which restrict abortion tend to have higher unintended pregnancy rates. Globally, there has been

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