Staunching Burkina's abortions

One-third of all pregnancies in Burkina Faso are unintended and a third of them end in abortion, according to a study published this month by the University of Ouagadougou and the reproductive health think tank Guttmacher Institute, which also found that more than 100,000 abortions were carried out in the country in 2012, most of them performed in unsafe conditions or by untrained health workers.

Abortion is illegal in most circumstances, but the practice continues in secrecy. In 2008, 25 out of 1,000 women between 15 and 49 years old terminated a pregnancy, the study says. The rate of abortion in rural Burkina Faso is 22 per 1,000 women, and 28 for 1,000 in urban areas. The rate in the capital, Ouagadougou, is 42 out of 1,000.

Almost four in 10 of women who have an unsafe abortion suffer complications and do not receive proper health care.

"It's alarming, and these are situations that could have been avoided by adopting preventive measures," said Angele Sourabie, programme director at Burkina Faso Association for Family Welfare (ABBEF).

"In the field we conduct sensitization campaigns for 18-to-24 year olds. Since we cannot prevent them from having sex, we make sure they have safer sex by using contraceptive methods to avoid pregnancies," Sourabie added.

The study, Unwanted Pregnancy and Abortion in Burkina Faso, recommends the expansion of family planning programmes throughout the country's primary health services and the provision of family planning counselling and methods, which should be made a routine part of post abortion care.

Georges Guiella, a researcher in demographics and health at the University of Ouagadougou, said that teenagers are the most affected by clandestine abortions because of their low access to family planning methods.

"It is very important to rethink the services of family planning so as to improve the access to contraceptives by this category of teenagers, who are the most vulnerable," Guiella explained.

Low access

According to the health ministry, 23.8 percent of women do not have access to contraceptives. "This means that these women come to the health centre and don't receive what they come for," Djénéba Sanou, director general of health services, told IRIN.

An effective family planning policy targeting teenagers and youths could reduce maternal mortality by 30 percent, says the health ministry. Maternal mortality in Burkina Faso stands at 341 for 100,000 live births, according to the 2010 Demographic Health Survey.

Poor health services, inadequate health worker training and medical costs are some of the barriers to contraceptive provision, said ABBEF'S Sourabie. The study recommends that more attention should be given to teenagers, the more neglected group in health service provision.

Revised health policies in 2009 abolished restrictions on providing family planning care to teenagers and girls. The move put focus on an individual's contraceptive health needs rather than providing the service based on age group. Still, one in five Burkina Faso women did not have access to contraceptive health, and a quarter of married women did not use contraceptives in 2010, according to the study.

More subsidies, changing attitudes

The government in 2013 agreed to halve the already subsidized contraceptive costs. For instance, a pack of pills will cost 50 francs (US$0.10) and a contraceptive implant 500 francs, effective April 2014.

"Despite subsidies of 90 to 97 per cent, the cost remains an obstacle," said health services director Sanou. "Behind each abortion, there is an unintended pregnancy, there is a lack of protection, and there is a risk to get infected by HIV/AIDS."

However, attitudes of some health workers are not helpful, said Guiella. "Because of the stigma by society against sex out of marriage, some health professionals reproach teenagers asking for family planning services and go as far as refusing to assist them," he said.

The government this year also introduced health education in schools and health training centres focusing on post-abortion care in a bid to change attitudes.

"In saving the lives of these victims, we should avoid moralistic discourse. We'd rather teach them how to avoid sexually related problems. If not, they won't come back even though they are faced with a life-threatening difficulty," said Sanou.

Sourabie said that positive attitudes by health workers towards those who opt for abortion will help save lives, pointing out that the number of women coming for post-abortion care at the ABBEF health centres set up in 1998 was increasing by 10 percent every year.

"At the beginning, the attendance was low, but after we pushed forward with sensitization and with adequate training for our staff, more women are coming for post-abortions care," said Sourabie "Whatever we do, abortion will always be performed. "

Lack of training

The report found that out that 13 percent of the abortions had been performed by midwives and trained male birth attendants and 12 percent by health assistants. However, none of them had received training in safe abortion techniques. Only three percent were believed to have been conducted by doctors. The rest were through other means.

About four in 10 of all women who had abortions used potions, high doses of drugs, or caustic products such as bleach or laundry soap, putting their lives at risk.

Poor women in rural areas face the greatest risk of unsafe abortions, with seven in 10 using traditional practitioners or ending their pregnancies themselves. Some 97 percent of abortions performed by rural women are unsafe.

Contraceptives can help prevent 116,000 women from having unwanted pregnancies in Burkina Faso, and can prevent 37,000 risky abortions and 400 maternal deaths, saving US$18 million on yearly spending on the health sector, the study said.

The law

Even though the report calls for easing the legal restrictions on abortion, the health ministry says no amendments are being considered at the moment. Under the law, abortion in permitted only when the woman's life is in danger, in cases of incest, rape and foetal impairment.

Many women's organizations and NGOs point out that requirements, such as certification by two doctors to prove a pregnancy resulted from incest or rape, are an obstacle. "Most of the time, the victims will hide and try to clean themselves up because of stigma behind rape or incest," said Sourabie.