Family planning is education, comprehensive medical and social practice of controlling the number of children one has, interval between births particularly using various contraception methods such as abstinence, condoms, pills, intrauterine device, implants, and spermicide, among others. An additional benefit to preventing unwanted pregnancies by using contraception methods is preventing sexual transmitted diseases.
The WHO report shows that between 2010-2014, there were 56 million abortions (safe and unsafe) each year. Unsafe abortion refers to a procedure of terminating an unintended pregnancy either by a person lacking necessary skills or terminating it in an environmental lacking the minimal medical standards. Worldwide, 25 million unsafe abortion cases occur, most of which are found in developing countries. In Africa, 75% of abortion cases are unsafe and most of them result in maternal death. Each year, maternal deaths attributed to unsafe abortion is 4.7 to 13.2 % worldwide “preventing unsafe abortion, WHO 2018”
Administering unsafe abortions and ensuing complications is expensive. Almost every death and disability due to abortion can be prevented through sexual education, effective family planning, counseling and legal abortion. In this article, I am going to discuss the cause of unsafe abortions, complications which result from abortion, and ways to overcome unmet need for family planning in Africa.
Family planning is of paramount importance in preventing unwanted pregnancies, which can in turn lead to unsafe abortions. To date, many factors lead to unsuccessful family planning programs in sub-Saharan Africa. They include, but are not limited to, little to no knowledge about programs meant to raise awareness and provide accurate information about family planning; false believes that contraceptive methods can cause infertility and cancer. Religion is a great challenge to this program as well.
Although these factors are stumbling blocks to the success of family planning, some governments do not also prioritize family planning. At least 1 in 10 married or in-union women in developing countries have an unmet need for family planning. According to WHO, in Africa, 39,261,000 women currently have unmet need for family planning which will project to 43,788,000 in 2030. In sub-Saharan Africa 45% of pregnancies are unintended. Globally, 220 million women have unmet need for family planning. Of these 220 million women, 80 million have unintended pregnancies, particularly in developing countries.
The high numbers of unintended pregnancies lead to abortions, which tend to be predominantly unsafe, especially in developing countries. 75% of abortions in Africa are unsafe and lead to maternal death. Unsafe abortions are usually conducted by inserting sharp instruments into the uterus, using high dose medicine such as birth control pills or flushing the vagina with liquids such as bleach. Such practices are associated with various complications, which are highly dangerous and lethal. Some of the complications related to unsafe abortion include incomplete abortion in which part of pregnancy material remain in uterus, heavy bleeding, infections, infertility, uterine perforation which may end up destroying the uterus and result in no more chance to bear children.
Prevention of unwanted pregnancies is the key to preventing unsafe abortions resulting in maternal deaths. Governments need to intervene and mobilize communities to raise awareness and stimulate individual involvement. Government and health policy makers should build strong programs and revise strategies towards unwanted pregnancy prevention. Unintended births affect all sectors of the country’s health, economy, and society. They also affect the education system and cause a rise in number of street kids, unemployment, maternal deaths, and infant mortality.
It is possible to end this but it requires everyone’s intervention and willingness. Health professionals should focus on preventing unintended pregnancies rather than managing complications. They can do this by offering information, education, and counseling to men and women about family planning. Governments can legalize abortion, as fit, and make available contraceptive methods to the communities as much as possible.
The number of women who need family planning increases every year. It is important that they are empowered to satisfy their needs not only by increasing the availability of contraceptive methods but also by providing information, education, and counselling about proper use of contraceptives. Strong family planning programs reduce unmet needs by making modern contraceptive methods more widely available and by removing obstacles to using them. Information, education and counselling programs are particularly relevant for sub-Saharan Africa, where the countries with low contraceptive usage and high-unmet need for family planning are concentrated and where the demand for family planning is expected to increase in the coming decades.
1. WHO, family planning highlight 2017. Preventing unsafe abortion, http://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf
2. unmet need for family planning: Recent Trends and Their Implications for Programs by Lori Ashford, https://assets.prb.org/pdf/UnmetNeedFamPlan-Eng.pdf
3. Family planning in sub-Saharan Africa: progress or stagnation? (2010), http://www.who.int/bulletin/volumes/89/2/10-077925/en/
Written by Philemon NISINGIZWE , a medical student at University of Rwanda.