Public health consequences of abortion in Myanmar

Taking a glance at abortion situation

High unmet need

↑Unwanted pregnancy

↑Unsafe abortion

17.7% (2007)

CPR in 2007: 41%

66/1,000 (2007)

MMR in 2007: 316/100,000LB

1, 2 (FRHS – 2007)

11% of pregnancies in married adolescent (15-19) end in abortion1

25% of hospital admission due to abortion – unsafe2

Country’s legal and sociocultural context

Law: abortion is illegal except when necessary to save women’s life

Population policy: Pronatalist

Religious based belief: abortion as killing a human being

Social factor: pregnancy of an unmarried woman as taboo

How women end their pregnancies?(Pummeling, Sticks and Kathy Pan)

TBAs- 44%

Bamboo sticks

Bicycle spoke

Cotton buds

Bird feather quill

Twig from tree

Fertility and pregnancy loss, Dr. Cynthia Maung and Suzanne Belton

Self-30%

Thway Say

“Hot” medicine

Where and who did abortion?

TBAs’ home

Private clinic

Home

% interviewed youth indicated1

78%

40%

36%

1 Family and Youth survey, 2004 country report, Department of population

Unsafe abortion

Incomplete abortionBleedingInfection

What are the consequences of abortion?

Bleeding

Infection

Trauma

Hospitalization

Mortality

↑Cost

Unsterilized and unskilled acts ensue in incomplete and septic abortion:

How to manage the consequences and prevention of such an event?

Consequences: B I T Emergency treatment

Management

Unwanted pregnancy Family planning

Barriers and concerns Counseling

Post

Abortion

Care

Where PAC services are available?

Emergency treatment

Services available

in some hospitals

Difficult to reach the facility

Consequences of abortion

Maternal deaths due to abortion related condition:

15 – 24% in rural area (2005 NCSMM)

Maternal deaths due to abortion related condition:

60% in hospital setting (hospital based data1)

1Integration of PAC: roles of TMO and midwives in Myanmar, Thein Thein Htay et al, 2003

If emergency treatment services are available in primary level, which will be the most suitable?

D & C

MVA

Misoprostol

Severe Complication EfficacyEase of use

2 – 4%

1 – 2%

Physician

Trained Health worker

>95%

>95%

RareTrained Health worker

>90%

How does Misoprostol work?

Bleeding after delivery

Bleeding after abortion

Use of the drug

Cheap, easy to store, transport and use

Thanks