• Physical fitness and related conditions.
• Mental status.
• Availability of time for the baby.
• Plans for the future.
• Knowledge on sexual and reproductive health.

are some of the issues that need to be considered. Thus with proper planning, a couple can have a healthy happy baby and maintain a good relationship within the family.

When a woman gets pregnant without proper planning she may face various unpleasant consequences including abortion.

• Lack of knowledge on Sexual and Reproductive Health (SRH). During a relationship or when planning for marriage, it is very important to be knowledgeable about the functions of the sexual and reproductive health systems. This will give an understanding of what will happen during sexual activity, how pregnancy occurs or how to avoid a pregnancy.
• Not using a contraceptive method. An unwanted pregnancy can occur unless a reliable contraceptive method is used.
• Contraceptive failure. An unexpected pregnancy can occur due to failure of a contraceptive method.
  Most of the modern methods are safe and reliable. Failure usually occurs due to incorrect and inconsistent use of the contraceptive method and also with natural family planning methods.
• Sexual abuse or rape.

Risk of an unwanted pregnancy needs to be kept in mind.

• Unplanned pregnancy becoming a wanted pregnancy
  Although initially a pregnancy is unplanned / unwanted, with time it can become a wanted pregnancy. Often this happens after discussion with spouse, family members, family doctor etc.
• Unplanned pregnancy continues as a unwanted pregnancy
  Mother’s state of mind and probably neglect of herself will affect the child and the mother physically and emotionally.
• Unplanned pregnancy leading to an abortion
  Abortion is illegal in Sri Lanka unless it is to save the life of the mother.
• Infanticide. Killing of the baby by the mother
  The mother may not take proper care of her self, go for regular checkups pay attention to food and vitamins.
  She may even try to conceal the pregnancy or try to deliver the baby by herself or even try to suffocate the baby.
  In all above situations there is danger to the life of the baby.
• Parental neglect
  Child may be subject to – malnutrition, stress and abuse. The abuse could be physical, psychological or sexual abuse.
  The end result would be that many children will have psychological issues.
• Effects on the mother
  Frequent pregnancies could affect the, Physical health – malnutrition, anaemia, other nutritional deficiencies, aggravate other conditions as heart problems, diabetes, high blood pressure etc. Psychological health – many issues if the mother is not prepared for pregnancy. These issues continue even after childbirth. If the woman resorts to an abortion often she thinks about it for many years. Such situations can affect the woman’s & the family’s physical & mental wellbeing.
• Given for adoption
  Due to financial instability, social reasons (Eg: large family, rejection by one partner) & reasons this decision is taken at times. However most women & the partners think about it throughout their life.
• Given for sale
  Mainly due to financial problems
• Abandonment (Leave the baby somewhere)
  - The baby may -  die of hypothermia or dehydration or get attacked by animals
  - Taken by others- at times the child is well looked after or may be subjected to various type of abuse
• Commit suicide due to
  - Depression- Pressure from society or family
  - Inability to support the family

It is always better to be safe in order to avoid facing any of the above mentioned situations. 

• Improve knowledge on sexual & reproductive health.
• Discuss with spouse & plan the family according to your needs.
• Improve knowledge on contraception & about the available methods.
• By using reliable contraceptives properly & regularly.
• Use an emergency contraceptive method after an unplanned  sexual encounter(if you are not on a regular method of contraception).

What is an abortion?
An abortion is the expulsion or removal of a fetus (small baby in the womb) before it is viable, which in developed countries is considered to be 20 weeks (5 months).

In Sri Lanka, viability is considered as 28 weeks – legally.
This can occur either spontaneously (occurring on its own) or artificially (terminated on purpose). A spontaneous abortion can be due to a known cause or without a cause. The products of conception can be expelled completely or incompletely.

As abortions are illegal in Sri Lanka most induced abortions are done in unsafe conditions by unskilled providers.

Incidence in Sri Lanka

• Due to the legal situation accurate data collection on abortion is difficult.
• It is estimated that around 550 – 750 abortions are performed in the country daily.
• Annually about 125,000 – 175,000 abortions occur.
• The press reported that around 240,170 abortions occur per year compared to 370,424 live births.
• This would mean that for every 3 babies born, 2 babies are aborted in Sri Lanka.

An abortion is only within the law of the country if it is performed to save the mother’s life   (if carrying the baby to term and delivery is a threat to the mother’s life).

Confirmation by two Consultant Obstetricians & Gynecologists is needed stating that there is a threat to the mother’s life before a legal abortion can be permitted. (Chapter 343, Penal Code Section 303 of the Criminal Law of 1833)

While it is illegal, it is also a criminal offense under the Penal Code of Sri Lanka.Violation of which can result in both the woman and the abortionist being tried in the courts and sent to prison if found guilty.

The effects of the abortion could be physical, psychological or social.

Physical:
Immediate complications:

• Bleeding and death.
• Infection and sepsis (severe infection that has spread via the blood stream).
• Damage to the womb & cervix.
• Incomplete evacuation.
• Abnormal connection between the vagina & the  bladder (fistula).
• Damage to other internal organs.

Late complications:

• Subfertility – Difficulty in getting pregnant
• Chronic lower abdominal/internal pain.
• Chronic infections in the internal organs.
• In the subsequent pregnancies increased risk of premature delivery.
• Ectopic pregnancy.
• Spontaneous abortions.

Pychological effects  on mother & family
Post Abortion Care:

Is the physical and psychological care and support given after an abortion to the woman and the family irrespective of whether the abortion was spontaneous or induced.

It is estimated that 1 in 8 pregnancy related deaths occur due to complications following an abortion. These deaths could have been prevented if basic care is given at the right time & right place at an affordable price.

Immediate complications:

• Bleeding and death.
• Infection and sepsis (severe infection that has spread via the blood stream).
• Damage to the womb & cervix.
• Incomplete evacuation.
• Abnormal connection between the vagina & the  bladder (fistula).
• Damage to other internal organs.

Late complications:

• Subfertility – Difficulty in getting pregnant.
• Chronic lower abdominal/internal pain.
• Chronic infections in the internal organs.
• In the subsequent pregnancies increased risk of premature delivery.
• Ectopic pregnancy.
• Spontaneous abortions.

Pychological effects on mother & family
Post Abortion Care:

Is the physical and psychological care and support given after an abortion to the woman and the family irrespective of whether the abortion was spontaneous or induced.

It is estimated that 1 in 8 pregnancy related deaths occur due to complications following an abortion. These deaths could have been prevented if basic care is given at the right time & right place at an affordable price.

• Emergency medical treatment.
• Medical assessment, pain management when needed.
• Post abortion Family Planning counseling and services to prevent repeated abortions, couple should be given a suitable contraceptive method after comprehensive counseling.
• Post abortion referrals to other reproductive healthcare service.
• Providing treatment for STI’s.
• Cervical cancer screening.
• Infertility services.
• Antenatal care.
• Counseling for.
• Emotional support.
• Physical wellbeing – pain, infection, aftercare, etc.
• Abortion.
• Planning the family.
• Resumption of fertility.

When to seek medical help?
If you have any of the following go to a hospital;

• Lower abdominal pain.
• Prolonged bleeding.
• Unwellness and lethargy.
• Fever.
• Vaginal discharge – profuse, foul smelling, purulent.
• Abdominal distention.
• Nausea and vomiting.

What the couple can do;

• Reasonable knowledge on sexual & reproductive health.
• Plan the family.
• Proper knowledge on all the methods of contraception.
• Persistent  & correct use of a reliable methods of contraception.
• Knowledge about emergency contraception methods.

What the health care provider/ system can do;

• Provide Sexual and Reproductive Health education.
• Increase access to contraception services.
• Give access to all the contraceptive methods available.
• Increase the number of methods available.
• Family planning programs to be more personalized and demand driven.
• Social protection of pregnant mothers and mother’s of small children.
• Provision of facilities for pregnant mothers & young children –living, day care etc.
• Reach out to the vulnerable groups.
• Take measures to increase the proportion of women taking modern contraceptive methods.
• Strengthen the existing system of delivering information on contraception to pregnant mothers.
• Awareness that emergency contraception can prevent an unwanted pregnancy.
• Measures to improve male attitudes towards contraception.
• Improve the capacity of healthcare providers to provide accurate information regarding contraceptive methods.
• Greater sensitization of parents and school children regarding SRH education.