As part of the main drivers of the BAM Group of Companies, this being the umbrella company within which Informative Newspaper operates, alongside sister brands Finite Magazine, Finite Lifestyle Club, Bam Promotions and Twin Talk, Informative Newspaper takes particular interest in social issues and causes created to advance the development of young girls and women and their participation in the global space.
To advance and cement the organization’s support for women and young girls, the Sexual and Reproductive Health and Rights is today, through this issue introduced. Its purpose is to advance knowledge and create further awareness on developments surrounding the said community sector and to help audiences stay updated on such, further guiding means of both action and reaction to these developments.
This week we discuss Access to safe abortion,
This is a key component of SRH and countries have clear human rights obligations to ensure that women can access safe abortions in accordance with their rights to health and non-discrimination and equality. Very few countries in Africa have laws that promote access to safe and legal abortion; a 2015 study estimated that 93% of African women live in countries with restrictive abortion laws that either prohibit abortion completely or only allow it in very limited circumstances.61 A 2012 Guttmacher study showed that abortions are increasingly concentrated in developing countries and correlate with poor access to contraception.62 Improving access to contraception would therefore significantly reduce the number of unintended pregnancies and therefore abortions.
Unsafe abortion can have catastrophic health consequences for women and girls: WHO estimates that approximately 47 000 women die each year as a result of unsafe abortions, largely in countries with highly restrictive laws. Another eight million women suffer serious and sometimes permanent injury as a result of complications from unsafe abortion.
Women living with HIV have the same right to choose to terminate a pregnancy, but they need additional information and services to make informed decisions, including information about the risks to their health of continuing a pregnancy and the availability of ART to prevent mother to child transmission.
Decriminalising abortion and removing legal barriers to abortion and post-abortion care is not only a critical part of realising SRHR, but a public health necessity. The CEDAW does not explicitly mention abortion, but the CEDAW Committee has consistently criticised restrictive abortion laws on the basis that these laws, particularly those that criminalise abortion in all circumstances, violate women’s right to health. The Committee has encouraged states to review punitive abortion laws. The UN Human Rights Committee has made similar criticisms.
In 2011, the Special Rapporteur on the Right to Health issued a report that condemned both forced abortions and forced pregnancies as violations of the right to health. The ground-breaking report states the “criminal prohibition of abortion is a very clear expression of state interference with a woman’s sexual and reproductive health because it restricts a woman’s control over her body”.63 The report encourages States to take measures to ensure that safe and legal abortion services are available, accessible and of good quality.
The majority of women and girls in SADC countries do not have access to safe and legal abortions and the only SADC country to fully decriminalise abortion is South Africa. Evidence shows that the criminalisation does not reduce demand, but rather forces women and girls to seek out illegal and unsafe abortions. Criminalisation also deters women who have had illegal abortions from seeking post-abortion care, including when they experience complications, because they fear arrest and prosecution.
Lack of access to safe abortion-related information
Even where abortion is available under limited circumstances, women and girls struggle to access information about where and how to access safe and legal abortions, leading to delays and often a failure to access abortion timeously. Vulnerable women such as sex workers, women with disabilities and women living with HIV may experience additional barriers to accessing reliable and accurate information about the availability of abortion. For example, women living with HIV may lack information about the impact of pregnancy on their health, while women with disabilities may not be able to access accessible information to allows them to make informed decisions about their reproductive health.
Abortion-related stigma
The criminalisation of abortion and social and religious resistance to abortion contributes to high levels of stigma and fear, which have a chilling effect on women’s willingness to ask for information about abortion, access legal abortion and seek post abortion care, including where abortion is legal
Continental campaign to decriminalise safe abortion
In 2016, the African Commission on Human and Peoples’ Rights and the Special Rapporteur of the Rights of Women in Africa launched a campaign to decriminalise abortion in Africa. The campaign aims to reduce the number of deaths related to unsafe abortions and to prevent women and girls from being criminally charged for having abortions. At the launch of the campaign, the Special Rapporteur called on all states to honour their commitments in terms of the Maputo Protocol and the African Charter on Human and People’s Rights. She emphasised that “criminalising abortion violates many basic human rights, including the right to: life, liberty, security, health, and freedom from torture. Criminal abortion laws discriminate on the basis of sex – they penalise a health service only women need.”
HIV and safe abortion
Women living with HIV who get pregnant often face judgemental and stigmatising attitudes from health care workers and cannot access information about their full range of options, including abortion. Information about abortion should form part of a comprehensive package of reproductive health care and information offered to pregnant women with HIV. Some women living with HIV may feel pressurised to terminate their pregnancies by health care workers, partners and family, and may resort to unsafe abortions in countries where abortion is criminalised. Conversely, women living with HIV who want to end their pregnancies, are frequently unable to do so because abortion is criminalised or because they cannot access information about their reproductive options.
Consequences of lack of access to safe abortion and post-abortion care
Unsafe abortion is one of the leading causes of maternal mortality and injury. The improvements in maternal health care have led to a global reduction in the number of women and girls who die in childbirth, but the proportion of deaths attributable to unsafe abortion remains steady at 13%. In 2014, in Africa, 9% of maternal deaths (16 000) were caused by unsafe abortion.
South Africa and safe abortion
The South African Parliament adopted the Choice on Termination of Pregnancy Act in 1996. The ruling African National Congress (ANC) ruled that all its parliamentarians had to vote in favour of the Act, even though some had requested to be allowed to vote in accordance with their personal beliefs, and the act was passed by 209 votes to 87. The Act came into force in 1997.
Although there are significant challenges with the implementation of the Act, it does demonstrate how decriminalising abortion has significant benefits for women’s health: abortion-related deaths have decreased by up to 90% in some places in the years following the enactment of the Choice Act.
The preventable deaths caused by unsafe abortions levy enormous financial, social and emotional costs on families, communities and society.
Economic costs of unsafe abortion
An Ethiopian study presents one of the first comprehensive looks at the true cost to the national health system of providing post abortion care. It found that the direct cost of treating post abortion complications in 2008 was $7.6 million, or $36 per woman treated. This in a country where the average person lives on less than one dollar a day. Ethiopia expanded access to legal abortion in 2005. Previously, abortion was only legal to save the life of the woman or to protect her physical health. Following a change in the law, women can now terminate pregnancies that are the result of sexual violence and incest and in cases of foetal impairment. Women can also terminate pregnancies if they cannot raise the child as a result of their age (i.e. if they are minors) or because of mental or physical disability. Despite the partial decriminalisation of abortion, many women continue to struggle to get access to safe and legal abortions.
Next we discuss what parliamentarians can do to advance access to family planning and contraception?
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