The Politics of Women's Health
Unintended, mistimed, and unwanted pregnancies are realities faced by women in all countries and all cultures. In contrast to the similarity of the underlying issues that touch all women, the options women have to act on the decision not to continue a pregnancy vary widely from country to country.
An estimated 46 million abortions occur globally each year and about half of these are unsafe abortions, defined as a procedure performed by a person who lacks the necessary skills or in an environment that is unhygienic. Complications of unsafe abortion contribute 13% of maternal mortality worldwide with wide regional variation. In some areas, complications of abortion are the leading killer of women of reproductive age.
The toll of lack of access to abortion, counted in loss of women’s lives, is borne disproportionately by women who are poor, who live in the developing world, and who live in countries where women’s right to determine the number and spacing of children is not fully recognized and upheld. In countries where abortion is legal on request and where health systems take measures to ensure that safe services are available and accessible, abortion is a very safe procedure. In stark contrast, where there are few legal grounds for abortion, and where health systems have not taken measures to ensure that abortion is safe and accessible, maternal mortality from abortion tends to be very high.
The law of almost every country on earth permits abortion in at least some circumstances. Some of the most common grounds on which abortion is legally permitted include: to save a woman’s life, to preserve her health (physical or mental), in situations of rape or incest, for economic or social reasons, when there is fetal impairment, or on request. Wherever there are legal grounds for abortion, all women have a right to use abortion services to the full extent of the law. Further, the country has an obligation to make abortions that are permissible by law available and to ensure that the process to obtain an abortion is not unduly burdensome. In too many circumstances where a safe abortion is a legal right, women risk their lives and many die because the obligation has not been met. Even where women may not die, tremendous injustices are done to women in withholding care. For example, there are many reports of young girls who were raped and who had a legal right to abortion, yet suffered demeaning, humiliating treatment in seeking an abortion, and were still denied the legal abortion.
Women who can afford to may find safe services despite restrictive laws, burdensome processes, and lack of local services even if it requires travel to another country. Other women may use whatever local means are available. These may include: insertion of catheters, sticks, or other items through the cervix; ingesting medicines, herbs, chemicals or poisons; undergoing vigorous uterine massage, physical trauma or injury; or finding someone who is willing to perform a medical procedure. In many areas, unsupervised use of misoprostol is used by some women who cannot access services. Because the exact way misoprostol is used varies, it may result in accomplishing abortion for some women and to serious medical problems for others.
Basic steps to reduce the tragic loss of women’s lives include offering manual vacuum aspiration and medical abortion, either with mifepristone/misoprostol or with misoprostol alone, where women seek care, informing women about their right to legal abortion, and revising legal codes that do not recognize women’s human right to reproductive and sexual health, including abortion, or that are punitive toward women who have abortions or providers who perform them. It is clear that there will always be a need for abortion. The challenge is to make abortion services safe and accessible with effective contraceptive methods, including emergency contraception, available as a first line option for birth control.
For more information on global reproductive rights, see the website of Ipas.
Written by: Judith Winkler
Last revised: February 2005
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