Sexual and Reproductive Rights
Abortion
Ameyo Bonventure Masakhwe - GFMER Coordinator for Kenya and Marloes Schoonheim, GFMER, Switzerland
Incidence and trends
According to the World Health Organization between 1995 and 2003 the estimated abortion rate, measured as the number of abortions per 1000 women aged 15 to 44, dropped from 35 to 29. Between 2003 and 2008 it remained stable at 28 abortions per 1000 women of childbearing age. It’s been estimated that nearly half of all abortions are unsafe, and the overall majority of unsafe abortions occur in developing countries. Unsafe abortions, performed by providers (including the pregnant woman herself) lacking qualifications and skills and/or in an environment that does not conform minimal medical standards, are a particular concern of WHO as an estimated 67000 women die every year due to complications of unsafe abortion. Maternal mortality resulting from complications of unsafe abortion is highest in Eastern Africa (an estimated 160 per 100 000 live births).
Abortion policies
In most countries, induced abortion is permitted on certain grounds. The United Nations has collected abortion policies around the world and, for each country, lists the grounds on which abortion is permitted:
- To save the life of a woman
- To preserve a woman’s physical health
- To preserve a woman’s mental health
- In case of rape or incest
- Because of fetal impairment
- For economic or social reasons
- On request
Advocacy
The decision by a woman or couple whether or not to seek abortion services is influenced by the existing legislative environment, by socio-economic, cultural and religious values, but also whether a health provider will provide abortion. Whether or not an induced abortion is performed safely is largely determined by the country’s jurisprudence, as well as the adequacy of healthcare services. Where the law on abortion is restrictive, even though qualified personnel may conduct the procedure, it is likely to be in unauthorized facilities and post-abortion care may not be a menu item. The propensity for this to occur in a ‘black market-like’ manner may therefore naturally impart prohibitive financial implications on accessing services from qualified personnel, especially for poor women.
Organizations like International Planned Parenthood therefore advocate that it is a woman’s right to choose whether or not to end a pregnancy, and promote safe and legal abortion services. WHO underlines that highly restrictive abortion laws are not associated with lower abortion rates. WHO also notices a relation between broad legal grounds for abortion and safe abortion, versus countries with restricted abortion law where abortion is typically unsafe. WHO provides guidance on technical and policy aspects of safe abortion.
International treaties and abortion rights
Treaties on reproductive health with a bearing on abortion include the following:
- The International Covenant on Economic, Social and Cultural Rights (1966): Article 10(2) outlines the need to protect mothers before and after birth, acknowledging the threat to preservation of mother’s physical and psychological wellbeing pregnancy may impose.
- The International Conference on Population and Development (1994) states in their Program of Action article 7.6 that “Reproductive health care in the context of primary health should, inter alia, include abortion” and in article 8.25 that “In no case should abortion be promoted as a method of family planning.”
- The Beijing Declaration and Platform for Action (1995) in article 106k calls upon states to “consider reviewing laws containing punitive measures against women who have undergone illegal abortions” and in article 115 includes forced abortion among acts of violence against women.
- The Plan of Action on Sexual and Reproductive Health and Rights (Maputo Plan of Action, 2011) in article 5 lists abortion as a sexual and reproductive health right, including “prevention of abortion, management of the consequences of abortion and safe abortion, where abortion is not against the law”.
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