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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
These 20 million unsafe abortions are estimated to have resulted in 70,000 deaths of women, of which 69,000 are in developing countries, one-third of them in Africa (World Health Organization, 1994:Table 3). Although some abortions result from pregnancies that were desired at the time of conception, the great majority are likely to have been unintended from the outset.
Abortion complications are not uniquely problems of the young and the unmarried, whose sexual activity may not be considered legitimate. For example, in low-income urban communities in Kenya, women who had recently had abortions were typically in their 20s and had previously given birth (Baker and Khasiani, 1991). ''While not denying that induced abortion is a growing problem among young, educated women [in Africa], evidence suggests that the problem is not limited to them" (Coeytaux, 1988:187).
CONSEQUENCES OF UNWANTED PREGNANCIES AND BIRTHS
Unwanted pregnancies and births can have a variety of negative consequences, for the children themselves, their siblings, their parents, and society as a whole. Unwanted births impose psychological and financial costs to the family, and high fertility, much of it unintended, imposes costs on society as well.
Unwanted pregnancies expose women, especially poor women, to health risks simply by increasing the number of pregnancies and deliveries in their lifetimes. The lifetime risk of complications is determined in great part by the number of pregnancies a woman has. The lifetime risk of maternal mortality is a function of the number of pregnancies and the quality and likelihood of utilization of available health care. For a given level of access and utilization of effective health care, a reduction in the number of pregnancies will bring about lower maternal mortality rates (Koenig et al., 1988).
In adequate medical settings, abortions are not dangerous procedures, yet most abortions in developing countries are carried out in inadequate settings, and the procedure can be dangerous (World Health Organization, 1994; Mashalaba, 1989). Incomplete and septic abortions are one of the four leading causes of pregnancy-related mortality and also account for a huge number of nonfatal injuries (see Chapter 5). Since most induced abortions result from unwanted pregnancies, and safe and effective methods of preventing pregnancies exist and are acceptable in most societies, the morbidity and mortality caused by unsafe abortion are preventable. Contraception can be regarded as primary prevention of complications