http://www.salon.com/2012/12/13/how_many_savitas_have_there_been/

Thursday, Dec 13, 2012 6:36 PM UTC

It was worldwide news when a woman died in Ireland after being denied an abortion. She was hardly the only tragedy

By Irin Carmon

By now, many have heard the name of Savita Halappanavar, whose death in a Galway hospital this fall was a chilling reminder of how abortion bans can be deadly.

That case had the benefit of a vocal and angry person to speak on the dead woman’s behalf — her husband, Praveen. He has said she requested a termination that may have saved her life — but was told, “This is a Catholic country.” (An official inquiry by the hospital has yet to be released, and Praveen Halapannavar isappealing to the European Court of Human Rights.) But for every Savita, there are thousands of women whose names we don’t know, women who aren’t even counted.

The most commonly cited statistic suggests that complications from unsafe abortions led to approximately 13 percent of maternal deaths worldwide. That’s a World Health Organization figure first arrived at in 2000, which hasn’t been re-evaluated. Every year, when WHO says how many women have died from unsafe abortions, they’re simply taking the same percentage of the global maternal mortality figure — 56,000 in 2003, or 47,000 in 2008. But one epidemiologist, Caitlin Gerdts, wondered if that number wasn’t a potentially vast understatement.

A few years ago, Gerdts was planning to write her dissertation about maternal mortality at a hospital in Zanzibar, Tanzania. “From the data we were able to gather I was sure that we had missed a number of women who had died likely from unsafe abortion,” she told Salon. Even in the original WHO report, she said, the authors “talk about how unsure they are about that estimate, and how they have the aggregate data, and how the data that they did have from countries where abortion-related mortality is the highest were of the poorest quality. They say directly, this is the best number we can come up with –  but we think it’s an under estimate.”

And a lot has changed since 2000, in both directions: Some countries, including in sub-Saharan Africa, have liberalized their laws; others, notably in Central America, have toughened their bans. Meanwhile, misoprostol, a pill which can induce a miscarriage identical to a spontaneous one, has become more widely distributed across the developing world. “There has been so much happening in the last decade,” said Gerdts, who is now affiliated with Advancing New Standards in Reproductive Health at University of California, San Francisco. “It’s impossible that the number has stayed the same.”

She eventually proposed a statistical model that would take into account what the researchers were getting at but not naming: Stigma. Specifically, women who were coming into hospitals seeking post-abortion care and would be reluctant to attribute the bleeding to a self-induced abortion because they feared social and criminal consequences. And, said Gerdts, “Doctors aren’t going to record it because they’re afraid of repercussions. Or maybe the woman hasn’t even told her family she was pregnant or that she had induced abortion.”

Gerdts and her colleagues canvassed 300 women treated for post-abortion or miscarriage care in that Tanzanian hospital, and found that only seven of them admitted they had induced abortion. But over 85 percent of these women said they were “unsure or unhappy” about their pregnancies, suggesting that not all of them had spontaneous miscarriages. And that’s not even counting women like Halappanavar, who may have been eligible for what life-saving exceptions sometimes do exist on the books but who died out of physician reluctance to test the boundaries of the law.

If these women hemorrhaged to death or died of sepsis because they couldn’t access a safe termination, few, if anyone, would have known that it was no ordinary miscarriage — or that it could have been prevented.

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From Rafael Romo, Senior Latin American Affairs Editor

updated 11:11 AM EDT, Sat August 18, 2012
Watch this video

Mom blames doctors for daughter’s death

STORY HIGHLIGHTS
  • The pregnant teen dies after doctors delay her chemotherapy
  • Doctors say the treatment would violate the country’s abortion ban
  • She finally started treatment after a 20-day delay
  • “They have killed me, I’m dead, dead. I’m nothing,” her mother says

(CNN) — The mother of a pregnant leukemia patient who died after her chemotherapy was delayed over anti- abortion laws is accusing doctors of not putting her daughter’s health first.

The 16-year-old’s plight attracted worldwide attention after she had to wait for chemotherapy because of an abortion ban in the Dominican Republic.

Doctors were hesitant to give her chemotherapy because such treatment could terminate the pregnancy — a violation of the Dominican Constitution, which bans abortion. Some 20 days after she was admitted to the hospital, she finally started receiving treatment.

She died Friday, a hospital official said.

Fights over abortion rights

At the time the treatment started, Rosa Hernandez, the girl’s mother, said she tried to convince doctors and the Dominican government to make an exception so that her daughter’s life could be saved.

“My daughter’s life is first. I know that (abortion) is a sin and that it goes against the law … but my daughter’s health is first,” Hernandez said.

The teen died from complications of the disease, said Dr. Antonio Cabrera, the legal representative for the hospital.

“They have killed me, I’m dead, dead. I’m nothing,” her mother said. ” She was the reason for my existence. I no longer live. Rosa has died. Let the world know that Rosa is dead.”

The patient was 13 weeks pregnant.

Her body rejected a blood transfusion and did not respond to the chemotherapy, and her condition worsened overnight, Cabrera said.

She then suffered a miscarriage early Friday, followed by cardiac arrest, and doctors were unable to revive her.

Representatives from the Dominican Ministry of Health, the Dominican Medical College, the hospital and the girl’s family had talked for several days before deciding to go forward with the chemotherapy.

The case sparked renewed debate over abortion in the Dominican Republic, with some lawmakers calling on officials to reconsider the abortion ban.

According to Article 37 of the Dominican Constitution, “the right to life is inviolable from the moment of conception and until death.” Dominican courts have interpreted this as a strict mandate against abortion. Article 37, passed in 2009, also abolished the death penalty.


A hotline that gives women practical information about sexual and reproductive health in general and the use of a medicine called misoprostol to prevent heavy bleeding of women after giving birth and for inducing safe miscarriage at home, will be launched on Saturday the 25th June. Misoprostol is registered as an essential medicine on the list of the World Health Organization and registered in Pakistan under the brand names Arthrotec, Cytotec, Cytopan, and ST Mom®.

Where: press conference at Hotel Ambassador, 7 Davis Road, Lahore, Pakistan
When: 13:00 hrs, Saturday, 26th June, 2010.

The launch is being carried out by the coalition of Pakistani Organization who support women’s rights  – Aware Girls from Khyber Pukhtoonkhwa, Peace Foundation from Sindh and Wake Up Call International from Lahore, The hotline is supported by Asia Safe Abortion Partnership, Women on Waves and Women on Web.

Press inquiries:

0315-947 33 66 (Sindh)
0307-494 08 08  (Punjab)
0315-917 04 09 (Khyber Pukhtoonkhwa)
+31-6-52052561 (Women on Waves)

Women needing information in Pakistan/ hotline numbers:

0307 – 494 07 07 – (Urdu, Punjabi)
0315 – 917 04 08 – (Urdu, Pastho)
0315 – 947 33 99 – (Urdu, Sindhi)


Further information:

Pakistan has one of the highest rates of maternal deaths in Asia. Each
year 30 000 women die due to pregnancy related reasons. Nearly 90% of
women deliver at home in the absence of skilled birth attendants. Only
1 in 20 women reaches the emergency obstetric care. Heavy bleeding
after giving birth (PPH, postpartum hemorrhage) is the main cause of
maternal deaths. 80% of maternal deaths happen during home birth.
The abortion rate in Pakistan is 14 in every 100 live births,
approximately 890.000 are performed each year.

An estimated 11-15% of maternal mortality in Pakistan is caused by
unsafe abortions. (more…)