A Study on unsafe abortion presented for medicolegal examination: medicolegal evidence and limitations in opinion

Abstract

INTRODUCTION: Unsafe abortion is a major health problem causing women's health at risk. It is the third leading cause of maternal mortality in Sri Lanka during the last decade. Strong evidence for administration of justice and thereby to improve the health care and policies regarding such victims is the expected aim of medicolegal examination. OBJECTIVE: The aims of the study were to determine the pattern of unsafe abortions in medicolegally referred cases and to assess the strengths and the limitations of medicolegal opinion in such cases. STUDY DESIGN: Retrospective descriptive study was done based on the notes of the medicolegal examinations performed by the authors, on women who underwent illegal abortions during past 5 years. RESULTS: Of 51 cases reviewed, mechanical interference was the method used in 45% of cases. Sixty-eight percent of the women were admitted to hospital with heavy bleeding. The condition on admission was critical requiring medical interventions to save the life in 53% of cases. Referral for medicolegal examination had been performed after 3 days of admission in the majority (59%) of cases, whereas in 47% of cases, there was a therapeutic interference within 3 days of medicolegal examination. At the time of medicolegal examination, evidence of initial interference could not be identified in majority (84%). CONCLUSION: Provision of strong evidence to give expected legal outcome in cases of illegal abortion is limited. Judiciary and law enforcement authorities should be aware of these limitations and look for strong corroborative evidence to implement the penalty.