• pregnancy
• abortion
• death

• especially to adolescent girls in Africa

• 51 percent of maternal deaths due to abortion complications

• Addis Ababa, Ethiopia
• Lusaka, Zambia

• shockingly high
• even though usually based only on hosptal-based samples

• women under 20 who went to hospital for delivery of a second pregnancy
• 25 percent had had their first pregnancy terminated by an illegal induced abortion

• abortion was the preferred course of action in 90 percent of pregnancies
• among unmarried working women

• of 1800 never-married females, age 14-25
• 50 percent of students
• 66 percent of the others had been pregnant AND terminated the pregnancy by induced abortion

• 18 percent of all adolescent pregnancies lead to abortion

• 72 percent of women who presented for induced abortion
• were aged 13-19, most unmarried

• only 9 permitted abortion for reasons other than health of mother
• of these 9, only Togo allowed abortion on request
• of these 9, only Cameroon did not require approval from husband or a committee
• Zambia was legal, but required written consent from 3 physicians

• paternal recognition is a problem
• single adolescents who are unemployed or underemployed
• single adolescents who are desperate to stay in school

• illegal abortions have much higher rates of complication than legal ones

• 15,000 operations performed to follow an incomplete abortion

• 25 percent of all women admitted with abortion complications had tried to induce abortions by
• one: inserting plants or twigs in cervix
• two: drinking detergents or gasoline
• three: taking large doses of aspirin, chloroquine, and other toxic substances

• private physicians induce abortion illegally by inserting a device in the woman’s uterus
• then instruct the woman to go to the hospital to complete the procedure

• More likely to resort to illegal ones: CONFIDENTIALITY
• Less likely to have access to ready CASH; more likely to go to semiskilled practitioners or attempt self-induced abortion.
• Tend to postpone abortion longer: DENIAL

• MEDICAL TRADITIONS
• A TRADITION includes SECTORS
• "Patients" RESORT to SECTORS in PATTERNS

• perhaps, but internalizing too
• long history of self-induced (female-induced) abortions WHY???
• HOW??? Enemas; cassava stem up os through cervix; herbal drinks

• Skilled gynecologists who perform complete abortions underground. BIG CASH
• Physicans who assist in producing abortion complications, access to hospital.
• Unskilled practitioners
• "Self"-induced

• decline of postpartum abstinence taboo
• intro of idea of companionate, monogamous marriage
• camouflaged polygamy: "outside wives"

• 1960, "middles" become "big men" ("sugar daddies")
• 1973, oil crisis, economies/optimism collapse
• 1989, end of Cold War, arrival of AIDS

• procure illegal abortion
• bring to term and get expelled from school

Vulnerable "school girls" vs. "gold-diggers"

by 1970-72, crisis of school girls/sugar daddies in Tanzania

by 1971, "perils of abortion"

1971, no maternity pay for unwed mothers

1975, "dumped babies" crisis

• don’t want to get married
• fashionable, sophisticated, modern
• "English-speaking vaginas"
• most terminated at least one pregnancy guiltlessly (32 in all)
• many local "folk" abortafacients
• some saline injections, followed by D and C (dilation and curettage) operation by qualified doctors in hospital or private clinic
• less cash: crude instrument abortions without anesthesia

• "backstreet" abortionists
• qualified gynecologists

• high mortality from tetanus and other septic causes
• A WHOLE WARD in Korle Bu, the largest teaching hospital in Accra, catered to these casualties.