LITERATURE REVIEW
This chapter deals with the review of related literature on abortion as a causative factor to the increase in mortality rate among adolescents.
This study will be treated under the following headings:
Type of abortion
Reasons why adolescent engage in abortion.
Consequences of induced abortion.
Ways of preventing abortion among adolescents in Nigeria.
Types of Abortion
Abortion, the loss of pregnancy before it has reached viability, can either be spontaneous or induced, Okonofua (2001). Spontaneous abortion occurring in the first trimester of pregnancy is often due to a chromosomal abortion conceptus, while in the second trimester, it is frequently due to uterine abnormalities such as cervical incompetence and uterine fibroids. Induced abortion is the process of rupturing the membranes through the cervix.
According to Okonofua (2001), induced abortion is an age long method of fertility control that continues to be practiced in all countries and by all people. Induced abortion frequently invokes sensitive social, medical, political, religions, legal, ethical and public health concerns. Therefore, many countries have formulated laws and policies to regulate its practice.
In a study carried out by Okojie (1985) in Benin City, found out that a higher percentage of students (post-primary) engaged in induced illegal abortion compared to other groups within the society. The age distribution showed that the highest number of induced abortion were recorded by those between the ages of fourteen to nineteen (50%) while between ages fourteen or less than eighteen and twenty one age group accounted for 86.4% of the total number of patients. He also stated that 18.6% of these abortions were done by doctors, 62.2% were done by quacks, chemists and nurses, while untrained hands and self induced abortion accounted for 11.8% and 6.8% respectively. The survey showed that quacks, chemists and nurses and people that mostly performed illegal abortions.
The induced abortion can occur in two main methods or ways, that is, therapeutic and criminal abortion Okonofua (2001).
Therapeutic abortion: This consists in the evacuation of the uterus carried out by a qualified medical practitioner as treatment in the interest of the mother’s life or of her well being.
Criminal abortion: This is the type of abortion performed when the conditions set out in the abortion law in Nigeria are not fulfilled. As the name implies, it is illegal and punishable by law. Simply put, criminal abortion is the evacuation of contents of the uterus by unauthorized persons. According to Okonofua (2001), criminal abortion is carried out for various political, social, economic and religious reasons unlike the therapeutic abortion where the health of the women is the reason behind the abortion. Criminal abortion is not carried out in accordance with the Abortion Act of 1968, which stated that abortion remedial offence, but a registered medical practitioner will not be guilty of an offence when a pregnancy is terminated in certain defined place, provided two medical registered practitioners have certified in writing their opinion in good faith that:
The continuance of the pregnancy would involved risk to the life of the pregnant woman greater than if the pregnancies were terminated or
It would involved risk of injury to the physical or mental health of any existing children of the pregnant woman greater than if the pregnancies were terminated or
It could involved risk of injury to the physical or mental health of the pregnant woman greater than if pregnancies were terminated.
There is substantial risk that if the child were born, it would suffer from such physical or emotional abnormalities as to be seriously handicapped and it must be carried out in a national health service hospital or a place approved by Act by the appropriate ministries.
Criminal abortions, which we are concerned with in this study occur when the above conditions are not fulfilled.
Abortion has resulted in the loss of several lives. Many of the teenage girls who indulge in abortion has a little opportunity of survival. Most of them die as a result of the complications they encounter during such act.
According to Okonofua (2001) unsafe abortion is a leading cause of maternal mortality in developing countries. Nearly seventy thousand women die from complications of abortion annually throughout the world. Abortion is estimated to account for 40% of maternal deaths in Nigeria.
Abortion is carried out strictly by abortionist. These abortionists go against the law and perform abortions.
The issue to be addressed here is that, those abortionists who are aware of the legal status of abortion in the country still perform abortion and this plays a major role in increasing the death rate due to illegal abortions, because most of the deaths and complications cases arising from abortion are those that were illegal induced.
Reasons why Adolescents Engage in Abortion
Pregnancy is a thing of joy to every mother, most women yearn for the day which they would hold their child in their arms. It is seen as “a blessing from God” and everyone awaits eagerly for the coming for a new born baby. In the case of teenage girls, the opposite is the case they see babies as that which would ruin their lives, and in this case it may seem like “a curse rather than a blessing to them”.
An unwanted pregnancy creates a very complex situation for the young single girl, she is distressed regarding the disclosure of a sexual relationship. Once these young girls discover that they are pregnant, they became afraid, ashamed and frightened because at their age they are not expected to have involved in any sexual relationship. Unwanted pregnancy is a serious stigma especially for unmarried girls who would go to any length to procure an induced abortion, Myles (1985).
A young girl would rather have an abortion than have a baby because of a number of reasons which influence her decision and because of these reasons she is forced to terminate the pregnancy rather than carry it to full term.
The major reasons why adolescents procure abortion include:
POVERTY: Most of these young girls are still financially dependent and as such are not able to met up with the financial demands of caring for a new born baby and for this reason abortion is thought to be a safeguard against the burden of an unwanted baby. If she carried it to full term, there would be no money to care for a child as she is not yet financially independent (Shereider, 1993).
DISHONOUR FROM ILLEGITIMACY: Young girls may decide to have an abortion or order to save her family from shame. They believed that an illegitimate child could bring dishonour to the family, therefore these young girls would rather have abortion than a child outside marriage.
EDUCATION: Most of these young girls, when pregnant finds themselves in a very difficult situation. She is concerned about her education, her career and her future. Most schools expel girls that are found to be pregnant.
A young girl would have an abortion rather than give birth in a baby so that she can continue schooling. Also when they realized that they would be driven out of school when they continue with the pregnancy, making them to face bleak future often drives adolescents to seek induced abortion.
SHAME: Most of these young girls are ashamed when they discover that they are pregnant.
They are unable to bear the laughter and other remarks from members of the society and so they would decide to have an abortion instead of bring a laughing stock in the society.
When would her parents, peer and other members of the society think of her? They are likely to disapprove of her (Shereider, 1993).
PROSTITUTION: These young girls usually engaged in prostitution. They have sex with different men and when they get pregnant, they are not able to identify the father of their baby and this could lead a young girl to make the decision to have an abortion.
STRICT PARENTS: Some parents are very strict and unapproachable, these young girls who have such parents may not have enough courage to seek the advice of their parents, and their parents would never condole such ills as unwanted pregnancy and so they may decide to have an abortion rather than face the wrath of their parents.
RAPE: Rape is another reason why young girls engage in abortion. A young girl who gets pregnant as a result of rape will not be able to face the psychological trauma associated with it and the only solution for her is to procure an abortion in order not to have a child who may never known him/her father.
PEER PRESSURE: Peer influence is also a contributory factor to the increased mortality rate caused by abortion among adolescents. Perceptions about what their peers are doing and what their peer group accepts may be more strongly related to their motivation to engage in abortion. According to African Journal of Reproductive Health (1999) levels of sexual activity among adolescent may be affected by peer pressure in the school.
Most adolescents get pregnant because they are ignorant or unaware of the use of contraceptives or prevention measures. According to Okonofua (2001), the failure of adolescents to use contraceptives is the major cause of unwanted pregnancies and induced abortion in Africa.
Despite the psychological trauma, these young girls go through trying to make a decision, they still end up having abortion. Abortion is seen by these young girls as the only solution to the problem of unwanted pregnancy.
CONSEQUENCES OF INDUCED ABORTION
According to Okonofua (2001), as a result of restrictive abortion laws, most abortions cannot be carried out in public health institutions in many parts of African. Doctors working in private setting perform more than 80% of induced abortions in Nigeria. The rest are either self induced or done by other Health professionals. When self-induced women have been known to use a variety of dangerous instruments including coat hangers, needles, bottles and harmful drugs such as lime potash, and heavy alcohol. Most self induced abortion as well as those carried out by other health professional and alternative providers are unsafe, and often result in serious complication.
Unsafe abortions are major cause of serious maternal mortality. These young girls may not go to the hospital after complications begins to develop, by the time a doctor is called, it would be too late to combat the infection and prevent the young girls from dying.
Sudden death can occur due to the introduction into the uterus soap solutions and paste (Myles, 1985).
These young girls can also develop renal failure, which may cause death. Acute renal failure has been known to destroy the tabillar epphelium of the kidney as a result of the use of forcible douching with soap solutions.
According to Osula (1994), a young girl undergoes an abortion is exposed to so many dangers and complications. These young girls may develop hemorrhage, acute bacteria, shock, and infertility. They may also be infected by the instrument used to induced abortion.
Osula (1994) also explained the dangerous effect of abortion on the womb of these young girls. The womb of these girls could also be damaged. There could be incompetence of the neck of the womb and occasional rupture of the womb in subsequent pregnancies.
The fallopian tubes of these young girls could get blocked as a result of infection and they may never be able to get pregnant again.
Induced abortion make the young girl to develop chronic pelvic inflammatory diseases, chronic vaginal discharge, infertility as a result of unsterilized instrument that was used during the act (Okonofua, 1997). Induced abortion is often characterized by Amenorrhoea (absence of menstruation) during pregnancy termination. The degradation of abortion and apparent loss of integrity creates negative psychological impart on abortion complication (Osula, 1994).
Abortion also destroys their sense of moral, well being, body and their future career. According to Aware (2000), babies of teen mothers tend to have lower birth weight, more childhood illnesses, more infant mortality, poorer medical care, suffer more from hunger and malnourishment.
If a girl becomes pregnant she must eventually make a number of far-reaching decisions. For herself and her unborn child, many of them do consider abortion. Abortion especially when its unsafe that is, done by an unqualified person may lead to complications. The World Health Organization estimates that 3 to 7 million abortions are performed each year in Africa, where the risk of mortality from unsafe abortions is greatest.
According to Salter (1997) abortion contribute to infection, infertility and mortality among young women.
Also, the society of gynecology and Obstetrics of Nigeria (2000) reported that unsafe abortion can cause complications such as hemorrhage, septicerdia of the items, secondary sterility and in many cases death.
WAYS OF PREVENTING ABORTION AMONG ADOLESCENTS IN NIGERIA
Abortion is a major cause of maternal mortality. Therefore, a programme should be designed to prevent complication (Okonofua, 2001). Strategies should be put in place to prevent unwanted pregnancies that could lead to unsafe abortion.
There should be provision of reproductive health information and service for adolescents to help them make informed choices and prevent unplanned and unwanted pregnancy.
There should be provision of quality sexuality education to all age groups, promotion of all forms of family planning methods, (including abstinence) and the establishment of sustainable contraceptive delivery services that is accessible to all ages (Okonofua, 2001).
Adolescent should be taught ways of preventing unwanted pregnancies such as use of contraceptives. Parents should be friends with their adolescent children. This will make them free and enable them to open up and have confidence in their parents, so that they will be able to tell their parents their problems. This can stop a child from performing an abortion.
Parents should prevent their children from watching pornographic films that will stimulate and arouse them and also prevent them from keeping bad friends. Television programmes should be free from pornographic films in order to stop adolescents from being aroused.
The adolescents should be taught about the grave dangers associated with induced abortion. The mass media should help to disseminates information to the public on the effects of induced abortion especially on adolescents. There should be seminars, workshop on the dangers associated with induced abortions among adolescents.
When these young girls go to the doctors for an abortion, the doctors should take time to counsel them to seek for an alternative means to abortion or rather increase the fee so as to discourage them.
In addition to the above, parents should monitor their children and the type of friend they associate themselves with that is, they should know where they are at any particular time. And also stop them from keeping late night in order not to fall a victim of rape.
SUMMARY OF REVIEW OF LITERATURE
The review of literature revealed that abortion is a major cause of adolescent death. Other discussions were the reasons why adolescents engage in abortion, which were discussed extensively such as shame, poverty, prostitution, etc.
The review also revealed that induced abortion has various consequences on the person who engages in it, such as infertility and complication.
The literature review is built on the various ways of controlling abortion among adolescents in Edo State such as organizing seminars and workshop on the effects of abortion. Also by banning pornographic films from being shown on the screen, also by teaching adolescents the various contraceptives that are available.
The literature also revealed that peer influence induce adolescents to engage in abortion.