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Severity of complications is another important measure of effects on health. A standardised measure of the severity of complications was used in South Africa before and after legalisation of abortion on request in 1996. The proportion of women classified with severe complications (fever of 38°C or more, organ or system failure, generalised peritonitis, pulse 120 per min or more, shock, evidence of a foreign body, or mechanical injury) in South Africa fell substantially from 16·5% before legalisation to 9·7% after. Applying similar methods, a study in Kenya found that 28% of hospitalised women had severe complications. Gestational age at abortion. | World Health Organization Sexual and Reproductive Health 4 D D Unsafe abortion the preventable pandemic David A Grimes Janie Benson Susheela Singh Mariana Romero Bela Ganatra Friday E Okonofua Iqbal H Shah Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues this scourge threatens women throughout the developing world. Every year about 19-20 million abortions are done by individuals without the requisite skills or in environments below minimum medical standards or both. Nearly all unsafe abortions 97 are in developing countries. An estimated 68 000 women die as a result and millions more have complications many permanent. Important causes of death include haemorrhage infection and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women s health in some countries such as India where abortion has been legal for decades access to competent care remains restricted because of other barriers. Access to safe abortion improves women s health and vice versa as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus and the use of misoprostol an oxytocic agent have improved the care of women. Access to safe legal abortion is a fundamental right of women irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but rather apathy and disdain toward women. Introduction Unsafe abortion is a persistent preventable pandemic. WHO defines unsafe abortion as a procedure for terminating an unintended pregnancy either by individuals without the .
