Maternal Mortality and Morbidity Post Unsupervised Consumption of Abortion Pills to a Secondary Hospital Setting: A Case Series

Unsafe abortions contribute to approximately 8-11% of global maternal fatalities and predominantly occur in low- and middle-income nations. The Medical Termination of Pregnancy (MTP) Act enacted by the Indian Parliament in 1971, aimed at regulating and ensuring the accessibility of safe abortion services. Following the enactment of this legislation, a legal framework was established for abortion in India. This act delineates the circumstances under which abortion may be performed, the locations suitable for such procedures, and the qualified personnel authorized to carry them out. The World Health Organization (WHO) and the Federation of Obstetric and Gynecological Societies of India (FOGSI) have developed comprehensive guidelines for pre-abortion assessments, including the confirmation of pregnancy, accurate determination of gestational age, and validation of the intra-uterine location of the pregnancy. In spite of the relatively progressive abortion care services available in India, a significant number of women resort to self-medication with unsupervised over-the-counter (OTC) abortion pills for MTP. This practice results in a considerable incidence of unsupervised abortions and potentially life-threatening complications. We present herein a series of case reports documenting instances of OTC abortion pill consumption that led to morbidity and perilous situations, including near-miss cases that necessitated urgent medical and surgical interventions. Furthermore, we illustrate how our support and care have played a pivotal role in fostering resilience and faith in these women.