Non-specialized abortion is deadly dangerous

Handwritten books at a hospital recounted a heartless story. In January, 17 of the 31 minor surgical procedures here were performed to address the consequences of 'abortion and incomplete abortion'. Some of them are due to miscarriage, but most are abortion abortions carried out by clumsy amateur hands.

Mortality rate at birth - Reckless measures

More than half a million women die each year during pregnancy and childbirth, largely due to treatable or preventable causes. This is the second in a total of three articles attempting to reduce mortality in an African-Tanzanian country.

Abortion is illegal in Tanzania (unless it is to save the life of the mother), so when girls or mothers go to amateur doctors they will have to take measures like taking medicine Other herbs or preparations, even suffer from being punched in the stomach or placing vaginal objects. Inflammation, bleeding and perforation of the womb or intestines are often consequences and can be fatal. Doctors who treat women after this negligent effort have no choice but to remove their uterus.

Pregnancy and childbirth are the biggest dangers faced by African women, where the world's largest mother mortality rate - at least 100 times more than in developed countries. Abortion accounts for a significant part of that mortality rate.

Maternal mortality rates are very high in Tanzania, with an average of 950 deaths per 100,000 births. In the United States, this number is 11, it is even lower than in other developed countries. But the rate in Tanzania is not the lowest or the highest in Africa. Many other African countries also have similar statistics, some have lower rates and many have more serious proportions.

80% of the Tanzanian population lives in rural areas, the Berega hospital - miles away from paved roads and poles - is characterized by a rural hospital, also struggling to cope with the same problems. deals that other hospitals across the country face. Abortion is always a constant worry.

Worldwide there are 19 million unsafe abortions every year, and 70,000 women are killed (accounting for about 13% of the mother's mortality rate), mostly in poor countries like Tanzania where the abolition is done. Pregnancy is illegal, according to the World Health Organization. More than 2 million women experience serious complications each year. According to Unicef, unsafe abortions cause 4% of deaths in pregnant women in Africa, 6% in Asia, and 12% in Latin American and Caribbean countries.

The figures for abortion in Tanzania are hard to believe, but the World Health Organization has announced that the East African region has the second highest rate of unsafe abortions in the world (second only to South America). Africa generally has the highest rates of youth - 25% - among unsafe abortions.

The 120-bed hospital in Berega has to rely on solar energy, but the generator runs only a few hours a day. Without human resources, supplies and even water shortages, the hospital spends most of its scarce resources cleaning up after abortions fail.

Dr. Paschal Mdoe, 30, said many patients who underwent unsafe abortions were between the ages of 16 and 20 and were about 4 months pregnant. He said the trend of these cases is stable, as well as in other hospitals throughout the country. He said: 'This situation is the same everywhere'.

On a January 6, 6 out of 20 patients in the area for women recovered from an abortion. One of them was a 25-year-old teacher who groaned and writhed. She was treated in the hospital a week ago due to an incomplete abortion and now returned with severe pain and bleeding. She was taken to the operating room again to be anesthetized. Emmanuel Makanza who treated her for the first time found that he did not remove all the membranes formed during pregnancy. Again, he had to scrape the woman's uterus with a metal tool. It is a painful process, losing a lot of blood. This time finally succeeded.

A woman in Berega, Tanzania needs to be cared for after a abortion.In Tanzania, abortion is considered illegal.The rate of maternal death is very high partly due to abortion abortion.(Photo: Béatrice de Gé / The New York Times)

Mr. Makanza is a medical support worker, not a fully trained doctor. Medical support staff are also trained in the same way as physician assistants in the United States but receive additional training in surgery. They are the solution in Tanzania to make up for the serious shortage of doctors, they perform simple surgeries such as caesarean section and surgery of appendix. The hospital in Beraga has two people like that.

Berega abortions are also seasonal, mainly in March, April, August and September, at the same time as the harvest and harvest season when social integration takes place, according to Dr. Mdoe. According to him, it was rumored that many abortions were carried out by a man living in Gairo - a town west of Berega. In some cases, this person has just begun the process to let the doctor finish the job.

Dr. Mdoe suspects that some people conducting other illegal abortions are illusionary workers at the hospital that they have surgical skills.

He said: 'They just poked the patient's abdomen. Then the miserable women have to come here. ' Sometimes doctors also find that there are pieces of sticks on the inside of the uterus - the cause of infection.

In the past, some hospitals threatened to refuse care until the patient identified their abortion ( abortion may be sentenced to 14 years in prison ) but that rule was removed to brings after-abortion treatment to women. But women still don't want to talk about what happened or even acknowledge anything but abortion, because in principle they can be prosecuted for abortion. The law stipulates 7 years of imprisonment for women. So often doctors do not ask the question to force them to answer.

Dr. Mdoe said: 'They can be arrested, our doctor's job is to help them and they will certainly recover'.

He continued: 'As health workers, we think abortion should be accepted by law so that a qualified person can perform surgery and have a safe abortion'. But Tanzania has no plans to change the law.

High number of abortions reflects the indifference of the majority of people on contraceptive methods. Young people who don't know or don't care about contraception or safe sex, Dr. Mdoe said.

In most countries, the rate of abortion whether legal or illegal and the rate of abortion due to abortion tend to decrease as more contraceptive methods are applied. Only about a quarter of Tanzania's population use contraception. In South America, the contraceptive prevalence rate is 60%, in Kenya is 39%. Both countries have a lower proportion of mothers than Tanzania. South Africa also allows abortion on demand.

But in other African countries like Sierra Leone or Nigeria, abortion is not conducted on demand, the number of contraceptive use is even lower than Tanzania's, and the mortality rate of mothers Higher than this country. Non-profit groups are cooperating with the Tanzanian government to provide planning measures, but because Tanzania is very large, the rural population is widely distributed, making it difficult to reach them.

Geography is not the only obstacle. Telesphory Kaneno, a medical support worker, said: 'Talking about sexual activity or reproductive organs is still a taboo in our community. For women, if people know she uses birth control pills, she will face the fear of being considered spoiled. '

In interviews, some young women who give birth at an adolescent age say they do not use contraception because they do not know them or they think they are not safe. They say condoms are not hygienic, and birth control pills and contraceptive methods by other hormones can cause cancer.

Mr. Kaneno said that doctors always try to eliminate those taboos and persuade women that there is a good chance that they should be pregnant and the time of pregnancy.

However, 'there's still a long way to go to get there,' he said.