Unsafe abortions: The Silent Pandemic
Unsafe abortion is a silent pandemic that warrants the global community’s attention as a public-health and a human-rights imperative. The WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and defines an unsafe abortion as a “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.” [i]
Women have always obtained abortions and presumably always will, regardless of prohibitive laws. Unmarried women, physically ill women, mentally ill women, women in poverty, elderly women, women with severe situational problems, women made pregnant with rape, women made pregnant as a result of incest, women who simply do not desire children and the list goes on. The WHO has identified six main grounds that generally apply in allowing abortion in member countries: 1) risk to life; 2) rape or sexual abuse; 3) serious foetal anomaly; 4) risk to physical or sometimes mental health; 5) social and economic reasons; 6) on request. [ii]
International legal support for a woman’s right to safe and legal abortion are found in numerous international human rights treaties as interpreted by their respective treaty bodies. In accordance with international human rights standards, sexual and reproductive health services must be available, accessible, acceptable and of good quality. To this end States have an affirmative duty to ensure access to lawful reproductive health services and to prevent legal, social and regulatory barriers infringing upon women’s ability to access contraception or abortions. The limited access to emergency contraception has resulted in high rates of clandestine abortions (Ex: Guatemala, Honduras, El Salvador, Nicaragua). Restrictive laws tend to affect especially women and girls in poverty, with low levels of education and living in rural areas.
Evidence shows that banning abortion does not stop women from undergoing terminations. Instead, it pushes women to find unsafe methods. Desperate women facing financial burdens and social stigma of unintended pregnancy continue to risk their lives by undergoing unsafe abortions. The primitive methods used for unsafe abortion show the desperation of women. Methods of unsafe abortion include drinking toxic fluids; inflicting direct injury to the vagina, cervix, or rectum; or inflicting external injury to the abdomen. Complications also arise from unskilled providers causing uterine perforation and infections.
Measurement of the worldwide prevalence of abortion related mortality and morbidity is difficult due to the clandestine and illegal nature of the procedure. Under-reporting is routine even in countries where abortion is legally available. However according to the WHO, worldwide an estimated 68,000 women die as a result of complications from unsafe induced abortions every year—about eight per hour. [iii] The primary methods for preventing unsafe abortions are less restrictive abortion laws and greater contraceptive use. Access to safe, effective contraception substantially reduces but never eliminates the need for abortion.
Increasingly, private foundations and donor governments, including the UK, the Netherlands, Sweden, Norway, Denmark, and Finland, have funded activities to advance access to safe abortion. By contrast, the US has since 1974, precluded use of developed assistance for abortion services. In 2001, the US government re-introduced the even more restrictive Mexico City Policy, known by opponents as the Global Gag Rule. According to this policy, private organisations outside the USA are eligible for family planning assistance only if they agree not to engage in most abortion-related activities, even with their own funds. This has compromised the sexual and reproductive health related services which were earlier provided to the needy in low-income countries.
The African Women's Protocol is the only legally binding human rights instrument that explicitly addresses abortion as a human right and affirms that women's reproductive rights are human rights.[iv] According to abortion proponent scholars, the right to voluntary motherhood and thus to decide the question of abortion is integral to a broad range of fundamental human rights, especially women’s rights to equality, life, health, security of person, private and family life, freedom of religion, conscience and opinion, and freedom from slavery, torture and cruel, inhuman or degrading treatment—all of which take precedence over claims to protection on behalf of the foetus. Given the dangers of illegal abortions, many argue for abortion as a human right, woman’s right, sexual and reproductive right to safeguard women’s lives who are compelled to undergo life-threatening unsafe abortions.
[i] See, https://www.who.int/reproductivehealth/topics/unsafe_abortion/hrpwork/en/ [ii] Berer, Marge (2017), “Abortion Law and Policy Around the World: In Search of Decriminalisation”, Health and Human Rights Journal, 19 (1): 13-27. [iii]See, https://www.who.int/reproductivehealth/topics/unsafe_abortion/article_unsafe_abortion.pdf [iv] Zampas, Christina and Gher, Jaime Todd (2014) “Abortion and the European Convention on Human Rights: A lens for abortion advocacy in Africa”, in Ngwena, Charles and Durojaye, Ebenezer (eds) Strengthening the protection of sexual and reproductive health and rights in the African region through human rights, Pretoria: Pretoria University Law Press.
About the author Ms. Aswin Grace is Research Scholar at Human Rights Studies Programme, School of International Studies, Jawaharlal Nehru University, New Delhi.