Gulya Nazarovna Alimbayeva1
Gulzhan Narimbayevna Chimbayeva2
The World Health Organization's (WHO) definition of health, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" was adopted on 7 April 1948 and has not been amended.1 But what is an unwanted pregnancy and abortion? Is it health or illness?
In recent decades, adolescent (< 20 years of age) pregnancyhas become an important health issue in a number of developed and developing countries. However, pregnancy during adolescence is by no means a new phenomenon. In many countries, large numbers of adolescent pregnancies and births are reported. Two decisive aspects of the adolescent period have strongly influenced this increase. The first is the decreasing age at menarche and the second is the increasing age of marriage. This widening gap is the basis of unwanted pregnancies during young ages.
Why is the issue of adolescent pregnancy so difficult to solve? If we investigate the definitions that cover this specific life period, we can determine that:
Pregnancy is a great burden for adolescents. A female in this age range may be simultaneously treated as a child, an adolescent, and a reproductive female. We can determine the causes of the increase in adolescent pregnancies if we consider their social backgrounds and that pregnancies may happen in children with reproductive potential.
To gain an understanding of the issue of adolescent pregnancies in Kazakhstan during the period of 2007-2011, we have investigated the official statistics database of the National Ministry of the Health (MoH) and their # 13 Statutory Form (SF). We first investigatedabortion. The # 13 (SF) has long been in use in Kazakhstan.5 There are some limitations in the assessment levels and dynamical changes of the abortions among adolescents because databases are divided into several columns (e.g. less than 15 years of age, ages 15-18 and 19 and above).
There was a 28 % reduction in the number of abortions between 2007 and 2011 in Kazakhstan. On the other hand, the total number of adolescent (up to 15 plus 15-18 years old) abortions decreased by 52.7%. This happened as the result of prevention activities of medical specialists and social programs.
Figure 1 shows the dynamics of reduction for the specific weight of adolescent abortions among the total number of abortions. This figure illustrates a decreasing trend from 4.5 % to 3.0%. Contrary to the specific weight of adolescent abortions, the figure also indicates that abortions in adolescents under age 15 remains constant, with slight increase from 1.4%-1.6%.
Figure 2 illustrates a decreasing trend in the specific number of first pregnancy abortions among adolescents ages 15-18, from 51.3 % to 35.8%. This fact clearly reflects the effectiveness of prevention activities among adolescents who have already had abortion or labor.
Against the background of a decrease in the total number of adolescent abortions, specific weight of spontaneous abortions has increased from 23.2 % to 45.0%. This is difficult to explain and warrants further investigation. Figure 3 illustrates this trend.
During the analyzed period, there were two lethal outcomes from spontaneous abortions among females ages 15-18 (1 in 2008 and 1 in 2010). Abortion lethality in adolescents reached 0.02 % in 2008 and 0.03 % in 2010. At the same time, the rate of total abortion lethality in Kazakhstan has never exceeded 0.01%. This statistically confirmed database underlines the particular danger of unwanted pregnancy among adolescents. Data on regional specifics of adolescent abortions were not available.
This paper provides an overview of statistics on adolescent abortions, which is a serious public health concern in Kazakhstan. Despite modest improvements, adolescent abortions in Kazakhstan remain burdensome for medical specialists and teachers, calling for the need to establish more effective public health programs to reduce the number of abortions in young and vulnerable population groups. Adolescents who have had a previous abortion are at a higher risk of subsequent procedures as compared to those who have never had an abortion. Considering that there were two deaths associated with abortions in 2008 and 2010, adolescents must be better educated about reproductive health. Our paper demonstrates wide disparities in younger vs. older adolescent groups, with lesser success achieved in adolescents under the age of 15. Methods that are currently used for reduction of the total number of adolescent abortions in Kazakhstan need improvements.
1. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. (http://www.who.int/about/definition/en/print.html)
2. Convention on the Rights of the Child. London: Child Rights International Network, 1989. (http://www.crin.org/resources/treaties/CRC.asp)
3. Adolescent Growth and Development. Hong Kong: Hong Kong Polytechnic University, World Health Organization Collaborative Centre for Community Health Services. (http://www.youthnet.org.hk/jobaid/Module %201.pdf)
4. Women's Health Fact Sheet. Geneva: World Health Organization, 2009. (http://www.who.int/mediacentre/factsheets/fs334/en/)
5. Medinform. Medical Statistics.Almaty, KZ. http://www.medinfo.kz/medstat.jsp