Introduction
Abortion has remained a legally regulated health procedure in most countries over the years given the growing concern of deaths resulting from it. Despite efforts by countries to increase the liberal abortion policies, the growing dangers of unsafe abortion have prompted greater regulation some of which are based on religious ideology. Globally, about 35 to 1000 women between 15 to 44 years have access to abortion services annually (Makleff, Wilkins, Wachsmann, Gupta, Wachira, Bunde & Baum 2019). There are approximately 59% of women of reproductive age living in countries that permit abortion while the remaining 41% live under restrictive laws (Singh, Remez, Sedgh, Kwok & Onda 2018). Most of the countries (93%) with highly restrictive laws are in developing regions while nations in Europe and North America have broadly liberal laws (Singh et al., 2018). Nonetheless, some of the countries with broadly liberal laws show appreciation for abortion restrictions to promote women’s health and safety. Despite efforts by countries to legalize abortion due to the physical and psychological effects of unsafe abortion, there are many social, religious, and cultural barriers to safe abortion.
Physical Effects of Abortion
There has been an increasing concern about the impact of abortion legalization on physical health. About 8% of the global maternal deaths are abortion-related with 99.5% of these deaths being experienced in developing countries (Latt, Milner & Kavanagh 2019). Unsafe abortion is a strong predictor of increased mortality and maternal morbidity. According to the WHO, annually 13.2% of abortion-related maternal deaths result from illegal and unsafe abortions. World Health Organization (2021) indicates that unsafe abortion is the leading cause of maternal deaths and morbidities. Countries with restrictive abortion laws are the most affected with the proportion of unsafe abortions increasing despite the overall decline in the abortion rate. There have been debates that the improvement of abortion law reforms in such countries would reduce maternal mortality. A study conducted in Nepal showed that the reformation of abortion laws led to a significant decline in abortion related-related morbidities including systematic complications and serious infections (Latt et al., 2019). There is adequate evidence that to lower maternal mortality, countries should consider abortion legalization. Flexible abortion laws promote accessibility of abortion services within the health system and reduce the incidences of unsafe abortions.
Clinicians attending to patients seeking abortion services should inform them of the long-term physical health consequences they are likely to experience to enable them to make informed decisions. In Lin, Hsieh, Hou, Hsueh, Chang & Tseng’s (2018) study, abortion exposes women to pelvic inflammatory diseases, infertility, urinary tract infection, and other pregnancy-related complications such as ectopic pregnancy. Other physical health risks resulting from unsafe abortion include incomplete abortion, hemorrhage, uterine perforation, and damage to the internal organs and genital tract. The list of essential health care services 2020 advocates for comprehensive abortion care to lower the detrimental health effects of unsafe abortions worldwide (WHO 2021). However, this has not been achieved in most developing countries because of the restrictive laws which deny women safe, timely, respective, and non-discriminatory abortion with the burden of unsafe abortion rising to 97% (WHO 2021). The legalization of abortion provides women with access to accurate information and support from well-trained health workers. Contrary, failure to legalize abortion exposes women to abortions performed by untrained persons under the least safe conditions. The legalization of abortion makes the procedure a safe health care intervention that promotes mothers’ health.
Psychological Effects of Abortion
Restrictive abortion regulation has been linked with distress, stigma among other psychological health problems. Failure to legalize abortion forces imposes financial burdens and other logistical barriers on women and girls with unwanted pregnancies (Biggs, Neilands, Kaller, Wingo & Ralph 2020) Laws reducing the availability of safe abortion make it less accessible and affordable impacting people’s mental health. Most of these women are forced to seek unsafe abortions which result in costly and distressful post-abortion treatments. Others have to cover long distances and incur huge costs to access abortion care. The logistical constraints have a significant mental health impact on women seeking abortion services. Abortion legalization reduces the burden of accessing it and lowers the levels of psychological stress among people seeking an abortion.
Women in most countries with restrictive abortion laws suffer internalized and perceived stigma after undergoing an abortion. A study by Zia, Mugo, Ngure, Odoyo, Casmir, Ayiera & Heffron (2021) about the psychological impacts of abortion among adolescent girls and women in Sub-Saharan countries showed that most of them faced psychological distress following their parents’ and partners’ anti-abortion attitudes. The criminalization of abortion leads to some women experiencing sadness and grief because of pregnancy termination. The difficulty around the decision and the feelings of loss lead to clinically significant disorders. The psychological outcomes experienced by women after undergoing unsafe abortion show the need for the legalization of abortion to make it an aspect of safe health intervention.
Frowning upon Abortion Legalization
Limited access to safe abortion services and increased stigma are some of the main reasons why people disapprove of abortion legalization in most developing countries. People are concerned about the family’s, friends’, and partners’ reactions after an abortion. Societal norms are a major reason why people would not openly support abortion under several circumstances. People are afraid of the stigma and shame experienced after abortion as a result disapprove of it. For instance, despite Zambia’s legalization of abortion, stigma remains a health concern in the country with most people seeking abortion services choosing to remain secret about it to avoid social inclusion (Zia et al., 2021). The need to maintain cultural and social traditions remains key in frowning upon the legalization of abortion in most countries specifically those in developing regions.
A few women seeking abortion services both in restrictive and broadly liberal legal contexts have demonstrated some sense of empowerment in the prioritization of their healthcare needs. However, the religious stigma around abortion denies a significant percentage of them the autonomy of choice. A survey conducted in America in 2019 exhibited a great deal of complexity and contradiction among participants about abortion legalization (Montanaro 2019). About 75% of people in the poll registered significant dissatisfaction with abortion legalization suggesting increased restrictions. The results of the survey provide adequate evidence of the frowning upon legalization of abortion.
Conclusion
Though abortion legalization is among WHO’s significant interventions towards curbing the abortion-related psychological and physical health-ill outcomes, people continue to frown upon the promotion of broadly liberal legal abortion laws. The social stigma surrounding abortion has a negative impact on people’s mental health and their willingness to seek safe abortion services despite the legal laws. The cultural and religious stereotypes of terminating life are a major reason why people discourage abortions. Fear of exclusion and abandonment by family and friends explain why people in countries with abortion legalization opt for secrecy and keep abortion an autonomous decision.
References
Biggs, M. A., Neilands, T. B., Kaller, S., Wingo, E., & Ralph, L. J. (2020). Developing and validating the psychosocial burden among people seeking abortion scale (PB-SAS). PloS one, 15(12),1-10.
Latt, S. M., Milner, A., & Kavanagh, A. (2019). Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries. BMC women’s health, 19(1), 1-9.
Lin, T. B., Hsieh, M. F., Hou, Y. C., Hsueh, Y. L., Chang, H. P., & Tseng, Y. T. (2018). Long-Term physical health consequences of abortion in Taiwan, 2000 to 2013: a nationwide retrospective cohort study. Medicine, 97(31),1-9. doi: 10.1097/MD.0000000000011785
Makleff, S., Wilkins, R., Wachsmann, H., Gupta, D., Wachira, M., Bunde, W.,… & Baum, S. E. (2019). Exploring stigma and social norms in women’s abortion experiences and their expectations of care. Sexual and reproductive health matters, 27(3), 50-64.
Montanaro, D. (2019). Poll: Majority want to keep abortion legal, but they also want restrictions. Politics.
Singh, S., Remez, L., Sedgh, G., Kwok, L., & Onda, T. (2018). Abortion worldwide 2017: uneven progress and unequal access. Guttmacher Institute.
World Health Organization. (2021). Abortion.
Zia, Y., Mugo, N., Ngure, K., Odoyo, J., Casmir, E., Ayiera, E.,… & Heffron, R. (2021). Psychosocial experiences of adolescent girls and young women subsequent to an abortion in sub-Saharan Africa and globally: A systematic review. Frontiers in Reproductive Health, 3(13), 1-13.