By Jag Jivan
On the International Safe Abortion Day, 28 September, the global advocacy group SHE & Rights Media Initiative held a session on decriminalising abortion and making safe abortion accessible to all-in-need globally, with speakers insisting that it is critical to deliver on promises enshrined in SDGs. It was celebrated as the Global Day of Action to demand access to safe and legal abortions everywhere and for all women, girls, and gender-diverse individuals.
“All people, including women and girls and gender diverse peoples, have a right to bodily autonomy- that is the right to make free and informed decisions about one’s own body, without coercion or violence. We see violations of bodily autonomy when a lack of choice and decision-making leads to unplanned pregnancy, or to unsafe abortion that is a leading yet totally preventable cause of maternal mortality and morbidity. Six out of 10 unplanned pregnancies end in induced abortion, and around 45% of these abortions are unsafe,” said Shobha Shukla, Coordinator of SHE & Rights (Sexual Health with Equity and Rights) Media Initiative.
“The next year 2025 marks 30 years since Beijing Declaration and Platform for Action was signed in 1995 – it highlighted the impact of unsafe abortion on women's lives and health, and the need to reduce recourse to abortion through expanded family planning services. Governments need to walk the talk on the promises for gender equality and human rights – with equity and justice,” she added.
“Induced abortion is in fact very common – it is estimated that 73 million induced abortions occur worldwide annually. Around 61% (or 1 in 6) unintended pregnancies end in induced abortion – so these are pregnancies that were not planned – and 29% (or 3 in 10) of all pregnancies end in abortion globally. So, quite a significant number of both- unintended and intended pregnancies- end in abortion around the world,” said Melissa Cockroft, Global lead for abortion at the International Planned Parenthood Federation (IPPF).
“More than half of all unsafe abortions occur in Asia, most of them in south and central Asia. In Latin America and Africa, the majority (approximately 3 out of 4) of all abortions are unsafe. In Africa, nearly half of all abortions occurred under the least safe circumstances. But what is perhaps most devastating is that deaths due to unsafe abortion are entirely preventable. It is lack of access to safe, timely, affordable and respectful abortion care that leads to these preventable maternal deaths,” said Melissa Cockroft.
The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating a pregnancy performed by persons lacking the necessary information or skills or in an environment not in conformity with minimal medical standards, or both. The persons, skills and medical standards considered safe in the provision of abortion are different for medical and surgical abortion and by pregnancy duration.
“Abortion can be provided safely even if it is provided or occurs in a country where abortion is legally restricted. Similarly, an unsafe abortion can be provided in a country context where abortion is legally permitted. So legal status of abortion does not always predict that an abortion will be safe or unsafe – however restrictions are known to be more likely to lead to unsafe abortions. And legal restrictions do not prevent abortion from occurring. When women, girls and pregnant people want an abortion they will find a means to obtain it, even if it is unsafe,” said Melissa Cockroft.
“Abortion is safe! Did you know that medical abortion (misprostol and mifepristone) is in fact safer than common medicines like penicillin, Tylenol, and Viagra! Abortion is one of the safest medical and surgical procedures –particularly when managed by a trained person, including nurses and midwives, as WHO data have shown. Self-managed medical abortion has also been found to be safe when the right information, support and referral network are in place,” added Melissa Cockroft of IPPF.
“Restricting abortion does not prevent or reduce abortions but keeps them unsafe: Abortion rates in countries which legally restrict abortion are actually higher than those where abortion is available on request, not least because women, girls and pregnant people also do not have good access to contraception either. When people with unintended pregnancies face barriers to attaining safe, timely, affordable, geographically reachable, respectful and non-discriminatory abortion care, they often resort to unsafe abortion. Laws and policies imposing gestational limits and other barriers such as waiting periods or the need for permission by 2 doctors only act as barriers to safe abortion care,” explains Melissa Cockroft.
Post-abortion care is the treatment of complications due to unsafe or incomplete abortion, is never illegal. Majority of severe restrictions on abortion are concentred in the global majority (Latin America and South America, Africa and Asia) – which is also consistent with where we see the highest rates or maternal death due to unsafe abortion.
“No woman should be forced to continue a pregnancy against her will, or face life, health, or legal risks as a result of having an abortion. While it is encouraging that a number of countries have moved toward liberalization of abortion laws and policies since the 1995 Beijing Declaration and its Platform for Action called for review of punitive abortion laws, still too many countries have yet to do so. Restrictive laws discriminate against women by penalizing them for a health procedure only women, girls and pregnant people need. Women who cannot access safe abortion services instead have clandestine, risky procedures and then avoid seeking treatment for complications due to stigma and fear of punishment in places where abortion is legally restricted,” said Melissa.
“UN Sustainable Development Goals (SDGs) advocate for removing barriers to unsafe abortion as key objectives for achieving universal access to sexual and reproductive health, reducing maternal mortality and promotion of gender equality.”
SAIGE initiative made a difference towards realising safe abortion as a human right
“Safe abortion advocacy initiative in the Global South (SAIGE) was led by a network of Global South advocates, activists, academics and service providers committed to realizing safe abortion as a human right. This initiative drove the abortion rights movement forward by calling for increased access to safe abortion services demanding governments to decriminalize abortion and mobilize communities to end stigma on abortion,” said Anjali Shenoi, Programme Manager (Monitoring and Evidence Generation for Change), ARROW (Asian-Pacific Resource & Research Centre for Women).
Pacific region has one of the highest unmet needs for contraception globally
“Women are being left behind and unable to exercise their sexual and reproductive health and rights in the Pacific region. The Pacific region has one of the highest unmet needs for modern contraception: one in three women of the reproductive age have an unmet need for modern contraception,” said Jessica Work, Youth Networker for the Pacific at the International Planned Parenthood Federation (IPPF) East and South-East Asia and Oceania Region – Fiji.
“One in six young women in the Pacific have commenced childbearing by the age of 18. Up to 68% of Pacific women have reported experiencing physical or sexual violence by a partner in their lifetime and one in two young women and girls (aged 15 to 25) in the Pacific have experienced physical and or sexual intimate partner violence,” added Jessica.
Abortion laws in the Pacific are very restricted in most cases across the island nations. “Abortion is only permitted to save the mother's life. Some countries like Fiji also allow abortion for cases of rape or sexual violence. Cultural and social stigma makes it more difficult for those in need to access safe abortion services. There is very limited data on abortion in the Pacific. Some estimates show that approximately 34 abortions occur for every 1,000 women of reproductive age in the Pacific with about one-third of them being unsafe,” said Jessica.
She further added: “Climate crisis is also very acute in the Pacific. Climate change influences sexual and productive health and rights adversely. When climate-related disasters happen, it exacerbates access of women and girls to contraception (which already is limited during stable times) and puts them at a heightened risk of sexual and other forms of gender-based violence -- which could lead to unintended pregnancies. We need to engage young people in decision-making about policies that impact their lives. We have peer young educators who go into communities to teach young people about contraception access, bodily autonomy and consent. Safe abortion is healthcare and a human right. I want the choice -- I want the future generations to have a choice envisioning a Pacific region where we break the shackles of stigma around abortion through unity, through intersectionality and through intergenerational mentoring ensuring safe abortion rights for all.”
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