By Marie-Evelyne Petrus-Barry, Regional Director, International Planned Parenthood Federation, Africa Region (IPPFAR).
Numbers don’t lie: Between 2015 and 2019, on average, 73.3 million induced (safe and unsafe) abortions occurred worldwide each year. Every year, between 4.7% – 13.2% of maternal deaths can be attributed to unsafe abortion.
The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both. Unsafe abortions result in the deaths of 47,000 women every year and leaves millions temporarily or permanently disabled.
In Africa, nearly half of all abortions happen in the least safe circumstances. Moreover, mortality from unsafe abortion disproportionately affects women in Africa. While the continent accounts for 29% of all unsafe abortions, it sees 62% of unsafe abortion-related deaths (WHO).
An estimated 93% of women of reproductive age in Africa live in countries with restrictive abortion laws. This means that the country’s laws only permit abortion in certain cases, often only if there is risk to the woman’s life, her health, the pregnancy is the result of rape, or there is evidence of foetal impairment.
The costs of treating medical complications from unsafe abortion constitute a significant financial burden for developing countries’ public health care systems. Further, the more restrictive the legal setting, the higher the proportion of unsafe abortions.
Statistics from unsafe abortions give us a glimpse into the suffering women must endure to end an unwanted pregnancy. We must challenge, re-evaluate different countries’ positions on the provision of life-saving safe-abortion care. We must advocate for changes in laws and policies and push-for the uptake of targeted and budgeted approaches that reach women and girls with safe abortion and contraception services wherever they are.
IPPF and other key stakeholders are working towards ensuring that in the next five years, more women and girls will access abortion services differently, as the solutions to terminate a pregnancy will be more easily understood and available through self-managed medical abortion. This new approach promises to radically transform how health care is perceived and accessed by firmly placing women and girls at the centre of the abortion process; shifting the power dynamic from a medicalized and provider-led/decided approach to one that is person-centred and guarantees bodily autonomy. Where women can take control of their bodies and decide when and if to have children; whilst being supported by the healthcare system if needed.
This approach has been endorsed by WHO and is detailed within the newly released self-care guidelines. Several studies have confirmed that self-managed abortion is safe, effective, and not inferior to those performed in clinical settings. A recent WHO review revealed that 94–96% of self-managed abortions had similar success rates to those conducted in clinic-based settings. In fact, 90% of clients confirmed they would recommend self-managed medical abortion.
As local and global actors working for women’s health, rights and bodily autonomy, we must champion and roll out such new models and approaches that uphold, protect and champion women’s health, sexual rights and reproductive justice.
Last July, IPPF joined global actors at the Generation Equality Forum to define and announce ambitious investments and policies for women and girls worldwide. Among our bold commitments, was a resolve to “expand and improve the provision of abortion care through 102 Member Associations, including quality medical and surgical abortion, person-centered abortion self-care support, and abortion care beyond 12 weeks of gestation through a simplified outpatient model using task-shifting to mid-level providers, including self-managed medical abortion.”
This is a bold pledge that cannot depend on IPPF alone. It is critical if we are to reach the target of making the self-management of abortion a reality by 2026. Among others, IPPF calls upon the global ecosystem; feminist movements and civil-society organisations to continue to counter the multiple barriers i.e., legal, cultural, social and religious, that impede women from accessing safe abortion freely.
IPPF also calls upon policy and decision-makers to uphold their sexual reproductive health and rights (SRHR) commitments and repeal laws and policies that prevent safe abortion. We ask donors to invest in commodities and essential supplies, service delivery partners and prioritize research that promotes this approach.
We also urge local and national stakeholders and service providers to embrace this new approach by encouraging, providing and supporting the integration of new models of abortion service delivery within existing clinic-based services.
Self-care is not a magic bullet, and neither will this radical change happen by chance. It takes all of us to make it happen. This is not just a question of access. It is a fundamental question of freedom, empowerment, and bodily autonomy.
Read more about The Global Comprehensive Abortion Care Initiative (GCACI).
Marie-Evelyne Petrus-Barry is the Regional Director of the International Planned Parenthood Federation, Africa Region (IPPFAR). The International Planned Parenthood Federation Africa Region (IPPFAR) is one of the leading providers of quality sexual and reproductive health (SRH) services in Africa and a leading sexual and reproductive health and rights (SRHR) advocacy voice in the region.