Introduction

It is now widely accepted that restrictive abortion laws seem to be causing more harm than than good as experienced by the high incidence of unsafe abortions and maternal mortality in countries where it is being practiced. This can also be evident by what happened in Romanian in the 19th century. According to Manuela, prior to 1966, women in Romania and other Eastern Europeans countries had access to legal and safe abortion with records of very low maternal mortality rate. But in 1966, the then head of the ruling party (Nikolai Ceauşescu) through decree 770/1966 placed a ban on abortion and the use of modern contraceptives as a strategy to inverse a decline in the Romanian population. As a way of enforcing the law, women of reproductive age were subjected to compulsory pelvic examinations at places of work and doctors were also indicted for performing unauthorized abortions. About a year after, women developed many clandestine methods of performing abortions most of which usually cause to server hemorrhage, pelvic infections leading high maternal mortality [1]. This pronatalist policies of Ceaucescu resulted to a 10 times increase in the incidence of unsafe abortion and maternal mortality in Romania (about 150 maternal deaths per 100,000 live births) [1]. Following the execution of Ceauşescu in 1989, the new government immediately abolished the abortion law and provided safe abortion services and modern contraceptives method to women. This led to an immediate and dramatic decrease in the rate of unsafe abortion and complications with the corresponding plummet in abortion-related maternal mortality from 150/100,000 to 58/100,000 live births [2]. These number of maternal deaths continued to experience geometric decline yearly suggesting that the high maternal mortality experienced was probably as a result of unsafe abortion methods that were being practiced in the background because of the restrictive abortion laws. However, the promotion of modern contraceptive methods and improvement in the standard of living and health care system could have also contributed.

Abortion and complications remain one of the commonest causes of maternal mortality in most developing countries. It is a truism that the primary method of controlling unwanted pregnancies and to reduce septic abortion is by using modern contraceptives methods. This primary prevention method (use of contraceptives) however remains an unmet need in most developing countries. Therefore, secondary prevention through the provision of safe abortion and post-abortion care cannot be swept under the carpet. For abortion to be safe, it has to be performed legally, by trained health personnel who have the knowledge, skills and or experience in using appropriate instruments and methods in an environment that meets the minimum medical standard. But, the debate on whether abortion should be legal seems to be clouded by a complex interplay between religion, culture, society, and ethics while neglecting the public health consequences and the universal declaration of women right to access comprehensive reproductive health. Restrictive abortion laws seem not to be reducing the rate of unsafe abortions but instead push it to the background and increase unnecessary maternal morbidity and mortality. Maternal death here refers to the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy and from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. The burden of maternal mortality is traditionally measured in terms of the Maternal Mortality Ratio (MMR), which is defined as the number of maternal deaths per 100,000 live births [3]