Augustine Kumah

The Programme of Action of the 1994 International Conference on Population and Development (ICPD) broadly defined reproductive health to include all matters relating to the well-being of the reproductive system and its functions and processes. It envisioned that every sexual interaction should be free of coercion and infection, every pregnancy should be intended, and every delivery and childbirth should be healthy.

The Programme of Action emphasized the rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, the right to information and access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as the right of access to appropriate health-care services that ensured safe and healthy pregnancy and childbirth.  The Programme of Action underscored the importance of preventing and managing unsafe abortions and providing services for safe abortion where it is not against the law. It also urged Governments to prioritize the prevention of unwanted pregnancies, so as to eliminate the need for abortion. It called upon all Governments and relevant organizations to “deal with the health impact of unsafe abortion as a major public health concern” and stated that “in all cases, women should have access to quality services for the management of complications arising from abortion”. Since the ICPD, many Governments have modified legal provisions for abortion and strengthened programmes to provide safe abortion services and post-abortion care, as well as adopted a variety of policies and programmes to improve reproductive health services and outcomes.

Between 1996 and 2013, the percentage of Governments permitting abortion increased gradually for all legal grounds, except to save a woman’s life which remained at 97 per cent. Despite overall expansion in the legal grounds for abortion, policies remain restrictive in many countries. In about two thirds of countries in 2013, abortion was permitted when the physical or mental health of the mother was endangered, and only in half of the countries when the pregnancy resulted from rape or incest or in cases of fetal impairment. Only about one third of countries permitted abortion for economic or social reasons or on request.

Abortion laws determine both the availability of abortion services and their safety. Nearly all western democracies permit abortion under broad social and health grounds, enabling women to obtain a medically supervised and extremely safe abortion early in pregnancy. Access to abortion is further determined by the actual implementation of laws as well as by societal and cultural views on sexuality and reproductive. Evidence points to a strong correlation between less-restrictive abortion laws and policies, safer abortion and lower maternal mortality.

Abortion is a key aspect of fertility regulation and of reproductive health. Pregnancy is not always planned or welcomed, an awkward reality for public health practitioners and policy makers. Some women conceive when they do not want to, and pregnancy is not always trouble free. Programs must therefore, address such problems.

We must not forget the fact that abortion is invariably a response to unwanted pregnancy and reflects a decision that may be due to a range of circumstances. The incidence of abortion has much less to do with its legal status than with levels of unintended pregnancy, the root cause of most abortions. The best way to reduce rates of both unintended pregnancy and abortion is by giving women and couples the power to control their fertility through access to quality family planning information and services. If not so, abortion rates will be higher where desired family size and effective contraceptive use are low, regardless of the legal status of abortion. Also, unintended pregnancy prevention efforts need to be grounded in broader antipoverty and social justice efforts, because those most disadvantaged do not fully share in the benefits of contraceptive use.

Complications arising from unsafe abortion continue to pose a serious global threat to women’s health and lives. Their treatment cost impose a major economic burden on limited family and health system budgets, particularly in resource poor settings. Post abortion care (PAC) programs are being implemented in a growing number of countries and increasingly stress a continuum of care and recognize the need to build partnerships with communities. However, there remain many obstacles to making PAC services more accessible. Much more work is needed in this vital rea to prevent unsafe, incomplete, and repeat abortion, and improve the reproductive health and well-being of women and their families.

Let’s note that, almost all abortion-related deaths and injuries take place in countries with highly restricted abortion laws and policies, and which are almost entirely preventable. We must make laws and policies based on evidence that reflects health concerns, facilitating access to safe abortion services and decreasing obstacles to other reproductive health care.