Introduction
Although effective contraceptive methods are widely available nowadays, contraceptive omissions or failures do occur at times because of various reasons, resulting in unplanned pregnancies.
With unplanned pregnancies, women may choose to terminate the pregnancies. Even when pregnancies are planned and wanted, there may be situations such as fetal abnormalities or maternal medical conditions when termination of the pregnancy is indicated. Nonetheless, in many parts of the world, legal restrictions and administrative b arriers may deny access to safe abortions. As a result, women with unwanted pregnancies may have to resort to unsafe illegal abortion procedures which can result in significant morbidity or even mortality.According to the World Health Organization (WHO) definition, unsafe abortion refers to a procedure for terminating an unintended pregnancy carried out by persons lacking the necessary skills and/or in an environment that does not conform to minimal medical standards. It has been estimated that about 43.8 million induced abortions took place worldwide in 2008, out of which 21.5 million were unsafe, and about 13% of all maternal deaths were the result of unsafe abortions. The majority of unsafe abortions happened in developing countries (1, 2). Unsafe abortion is actually an avoidable tragedy. Removal of the various barriers to accessing proper facilities for safe abortion for the women in need, as well as adherence to established evidence-based guidelines, is important to minimize complications.
While the regulations on legal abortions are diverse among different countries, it is unusual, even in countries with restrictive laws on abortions, to prohibit abortions under all circumstances. Most countries would allow abortions to save mothers' lives or when there is a significant fetal abnormality. Physicians should be familiar with the local laws, and make full use of the legal indications to help women obtain legal abortions.
It is of paramount importance that every physician should be able to provide the appropriate preliminary counselling in a non-judgemental manner to women who are requesting termination of pregnancy, and to help the women make their informed decision within the provisions of the legal constraints. If a doctor has conscientious objection on ethical or religious grounds to provide counselling or treatment for induced abortions, such a doctor should be obliged to refer the woman to another colleague who, in one's good faith, will be able to provide unbiased counselling.About two-thirds of major complications from induced abortions are attributable to those performed in the second trimester. As the risk of complications increases with gestation when an abortion is carried out, healthcare facilities should facilitate early assessment of women referred for termination of pregnancy and avoid unnecessary delays as far as possible. Due to the higher risk of serious complications, second-t rimester abortions should be carried out in a healthcare facility with access to blood transfusion and emergency laparotomy.