Emergency contraception: A way to reduce abortion

A girl worried about her unwanted pregnancy (left). Emergency
Contraceptive Pill (right).

A 30 year old woman Rupa Akhter (not a real name) is married for 10 years living in a village. She planned to complete the family with her existing 4 children. But all on a sudden, she became pregnant unintentionally and mistakenly that made her very upset. Like many women, it was a matter of embarrassment for her talking intervention in a hospital after consulting a physician. Six months latter, she went to a traditional birth attendant (locally known as Dai) who induced her abortion through inappropriate way. The result was very dreadful. She delivered a dead baby with retained placenta (which covers and protect the baby in womb). She died after few hours of reaching a Subdistrict (Thana) Health Complex due to server bleeding and many others complications.
This is a very common scenario in Bangladesh where mothers are unnecessarily die as a result of unsafe abortion and suffer from various complications due to the lack of knowledge and dependency on traditional birth attendants. Emergency contraceptive pills (ECP) can play a major role in preventing unwanted pregnancy and thus reducing the risk of medical interventions like Menstrual Regulation (MR) and abortion.
According to the World Health Organisation (WHO), 14 percent maternal mortality is due to unsafe abortion out of total maternal mortality in Bangladesh. Reports of National Plan Parenthood Federation reveals that yearly more than 4 million women are pregnant in Bangladesh, but out of them 1.3 million are unwanted. More than 0.8 million of this pregnancies are terminated by unsafe abortion.
Each year, one-third of births in Bangladesh can be considered as unplanned, 19 percent are mistimed and 14 percent are unwanted. Lack of emergency contraceptive use, low contraceptive continuation rates, method failure, high unmet need for contraceptives are some leading causes of unwanted pregnancies and abortions. Emergency contraception (EC) may occupy a unique position in the range of family planning methods currently available to women.
EC enables women to prevent pregnancies after they have an unprotected sexual intercourse. Thus, it averts unplanned and unintentional pregnancies, which in turn, reduces unsafe abortions. Emergency contraception therefore, is an element of reproductive health care services which contraceptive reproductive choice for women in a situation where they may have little control over their sexual lives.
In the national family planning programme, EC is now incorporated as one of the important family planning methods. However, many women cannot access the EC due to extreme low coverage, lack of awareness of both health workers and target population. Only one brand of ECP named "Postinor-2" is available as emergency contraceptive pill in the government and NGO sector, but little is known about its acceptability, utilisation pattern. Providers' perception regarding the method is very limited.
In a study conducted by Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT), 45 percent service providers opined that they have lack of awareness providing ECP in the country. Another study of the same organisation revealed extreme low level of awareness (only 8 percent) among the newly married couples.
WHO publication indicates that the use of ECP could reduce the induced abortion rate as much as 50 percent, which could directly reduce the maternal deaths. EC can be a valuable reproductive health care option for tumbling tragic deaths and other severe complications from unsafe abortion.
The writer is a researcher.