Overview of Unsafe Abortion: Focus on Africa

Transcription

1 Overview of Unsafe Abortion: Focus on Africa Amb. Dr Eunice Brookman-Amissah MB. ChB, FWACP. FRCOG Ipas Vice President, Africa ESCRH Conference, Copenhagen, May Oldest known visual representation of abortion, at the Angkor Wat site in Cambodia, dated around 1150,. This poster from the Soviet Union around 1925 warned: about unsafe abortions: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death." Maternal mortality and morbidity remain a critical global problem Risk of Death from Unsafe Abortion Abortion Related deaths by Region per 100,000 abortions 2010 estimates --287,000 maternal deaths-- down from 543,000 in Translates to nearly 800 women dying of pregnancy related conditions every day This is still much too high Sub Saharan Africa and South Asia contribute to 86% of these deaths Vast majority are due to preventable causes including unsafe abortion that need minimal cost to address Lifetime risk in poor countries 1:20 vs 1:7300 in rich Major causes of unsafe abortion in Africa Low access to FP ---Average CPR about 20% High rates of unintended pregnancy unsafe abortions deaths and disabilities Poverty and lack of knowledge and access to safe legal abortion services Stigma and silence Cultural, Religious / Patriarchal issues Personal beliefs of policymakers and providers Lack of political will to address problem Inherited antiquated laws dating back to 1861 (1801) Global abortion laws Without Restric-on as to Reason - 56 Countries, 39.3% of World's Popula-on Socioeconomic Grounds (also life, physical health and mental health)- 14 Countries, 21.3% To Preserve Mental Health (also life and physical health) 23 Countries, 4.2% To Preserve Physical Health (also life) 34 Countries, 9.4% Could be PermiMed to Save a Woman's Life - 66 Countries, 24.8% Data Source: Center for Reproduc-ve Rights, 2007 Explicitly prohibited even to Save a Woman s Life 4 Countries, 1.1% 1

2 The PH crisis of unsafe abortion in Africa Restrictive laws and lack of access to safe services 22 million unsafe abortions globally in million in Africa 47,000 deaths globally from unsafe abortion 29,000 in Sub-Saharan Africa aloneafrica has 10% of Global population and 48% of maternal deaths Where safe abortion is unavailable women seek unsafe abortions. Alligator pepper, chalk, alum. Bleach Cassava plant Unsafe abortions 25-30% of MMR in Africa Quinine and other noxious substances WHO 2008 Bahaman grass Cost of post-abortion care (2006) Economic and Development issue (Vlassoff et al. 2008, 2009) IPPF WEBSITE International Human Rights Treaties & other Consensus Agreements African Union Commitments ICPD Cairo CEDAW 1979 Vienna Human Rights Conference Beijing Platform for Action MDGs

3 African Regional Policy Frameworks Progress in Africa since ICPD Continental Policy Framework on SRHR ( ) Protocol on the Rights of Women in Africa Abuja Declaration Maputo Plan of Action ( ) Barcelona Declaration CARMMA ECOWAS Communiqué South Africa CTOP -followed by S&Gs and training for services delivery. Abortion related MM 90% (2007) Ethiopia expanded its abortion law. Implementing safe abortion services. Incidence of unsafe abortion Ghana--Zambia- MOH with support from NGOs launched S&Gs to implement their very liberal abortion laws Several Francophone countries--increased legal indications for elective abortion; some have S&Gs Progress in Africa-creating the evidence base for advocacy Malawi, Mozambique, Senegal, Sierra Leone- Magnitude Studies, Strategic Assessments (WHO) Cost studies recommenda2ons for legal reform (Ghana, Zambia) Medical Abortion offers new opportunities Pilot studies in many countries to guide services set up Miso and Mife registered in several countries. BUT---STILL A LOT MORE TO BE DONE (29,900 deaths many more disabilities annually) STILL A Recent troubling Developments- Threat of regressive language in Constitutions Clause life begins at conception -threat to women s right to safe abortion Anti-choice imposition. Empirical- No legal, scientific or religious basis Kenya after might fight by women s rights advocates to mitigate language new Constitution has slightly increased grounds for legal abortion Zambia, Tanzania, Ghana reviewing their Constitutions-danger of regressive language 16 So how do we confront the challenge of unsafe abortion HIV - no known treatment, the world came together Unsafe Abortion -ALL the knowledge and technologies are known for prevention and management and treatment the world is sitting on the fence Recognize the gender dimensions of unsafe abortion Understand that unsafe abortions should not happen! Work at all levels- international, regional and country Support by international and donor community. Need for increased advocacy by health professionals / associations. -Credible advocates and natural champions Decisions on women s RH should not be left to diplomats in NY or Addis with no clue about issues Role of UN agencies UN Mechanisms CSW CPD should rely on evidence and not fundamentalist dogma UNFPA- still uncomfortable/reluctant about even working to implement existing laws. -Collaborate on access to safe abortion within national laws using WHO Guidance -Commit to support Country implementation -Emphasis on MLP training and empowerment -Sustainable supplies of RH Commodities WHO New opportunity to disseminate and support implementation of revised Guidance on Safe Abortion (2012) 3

4 African Commission on Human and People s Rights African Health Ministers Regional /national workshops for Parliamentarians African Women Rights MovementSafe abortion and FP on agenda Build Legal Literacy Lawyers -Understand laws, draft barrier free laws and interpret laws broadly. Also to support S&G development Judges Build capacity of judges and develop national/ regional jurisprudence Human rights institutions- Build capacity to protect and promote women s Reproductive rights and hold Govts. accountable to implement laws 4

5 Work with Health Professional Orgs EA Regional Champions workshop Credible advocates as witnesses to the carnage Midwives- critical for reaching women with services. Ipas supported formation of CONAMA to galvanize support for women s RH and Rights ObGyns-ESACOGS- keep abortion on agenda update information Also through FIGO Safe Abortion Initiative Work with the Media Regional and country level sensitizations and trainings. Train to do feature articles/investigative journalism Avoid sensationalism--harmful Link them up with advocates and champions and sources of information. Learning Exchanges and Best Practices: Medical Abortion training Tunisia 2009 Build network regional and national Catch them young! FAMSA-Federation of African Medical Students Associations Some persistent challenges ignorance about unsafe abortion Still marked ignorance about abortion Increasing organized opposition- by powerful countries and institutions Chill on African Governments and institutions Dwindling funds for RH- new FP funds sadly excludes unsafe abortion Persistent outmoded restrictive colonial abortion laws Lack of Political will and Politicization of abortion-e.g Kenya 30 5

6 What countries should do Resolve that unsafe abortions and deaths should not happen. Prevent unwanted pregnancies Improved access to FP, Emergency Contraception Translate many agreements into reality Discard restrictive colonial abortion laws according to international and regional human rights standards- Maputo Protocol minimum standard African Countries that have ratified the Maputo Protocol should harmonize all national laws to be in line with this Improve access to safe legal abortions Time to Deliver! ---It keeps startling me that at the beginning of the 21 st century, at a time when we can.. explore the depths of the seas and build an international space station, we have not been able to make pregnancy and childbirth safe for all women around the world.. This is one of the greatest social deficiencies of our time. -it is unethical not to take action to rectify this Human Rights Issue-- Dr. Thoraya Obaid Former Executive Director UNFPA Women are coun-ng on us! 6