Inas Alhamdani

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    In Iraq “illegal termination of pregnancy” still happens!

    Inas Alhamdani, Taghreed Alhaidari (Iraq)

    Al Elwyia Maternity Teaching Hospital and College of Medicine, Baghdad University, Baghdad, Iraq

    Background. 55.000 unsafe abortions take place all over the world, with 95% in developing countries and with more than 200 maternal deaths per day. In the Arab World 5% of all maternal deaths are due to unintended abortion related complications. The 2003, the UNFPA reports showed that Iraq has an increase in spontaneous and unsafe abortions but with no data on the exact number of illegal terminations.

    Aim. To assess how wide the problem is, throughout a survey performed in 2007 at one of the big maternity centers in Baghdad; that is Al Elwyia Maternity Teaching Hospital.

    Methodology. The current work presents an observational longitudinal study, including 322 women who present cases of illegal termination of pregnancy from a total of 3100 women who terminated their pregnancy before 24 weeks of gestation for any indication during the year 2007. All those women had a direct interview with special questionnaire, clinical examination was conducted thereafter.

    Results. Out of the total 3100 women admitted for termination of pregnancy, 322 were confirmed to have illegal termination. That represents 10. 4% of the total. Most of the patients (62%) were between 20-30 years old, with 69.9 % already having children. The most common mode of termination was the combined medical and surgical method, which has been performed by medical or paramedical staff (86,9 %). In 93.7 % of cases, pregnancy was confirmed by ultrasound. Failed contraception due to improper pills intake represents 53% of the cases. Decision for termination was taken by the wife herself in 64% of cases; mainly due to financial reasons. The most common presentation was septic abortion (86%), with 89.4% requiring 1 to 3 units of blood transfusion.

    Conclusion and Recommendations. Illegal termination of pregnancy is still an ethical, religious and medical problem all over the world, including our country. The main determining factor for termination of pregnancy amongst those women seemed to be the fact that it was unwanted and/or unplanned; either due of inappropriate timing, problems in the relationship itself, or due to social and economic implications, which are important issues in Iraq. The main problems encountered were improper contraceptive use in spite of very good awareness and/or the desire to use, as well as the abuse of misoprostol (which is not yet  approved in our country) by pregnant women and paramedical staff . There is a real need for thorough attention to update our national family planning and access to contraception policy, in order to meet the emerging social demands.There is also an urgent need to integrate abortion care related services into the overall reproductive health care, as part of a broader and safer motherhood plans.