Kristin Palitza

CAPE TOWN, Oct 8 2009 (IPS) – One hundred African women and girls die unnecessarily from unsafe abortions every day because they have to rely on unqualified medical practitioners or self-induce abortion by ingesting poisonous substances or inserting tools into their uterus.
Africa has the highest percentage of maternal deaths due to unsafe abortion. 60 percent of abortion-related deaths occur in women and girls under the age of 25.

Abortions that have to be performed illegally translate directly to higher maternal mortality, warned Dr Anibal Faundes.

Faundes, who is professor of obstetrics at the State University of Campinas in Sao Paulo, Brasil, was speaking in Cape Town at the  World Congress of the Federation of Obstetricians and Gynecologists (FIGO), for which he chairs a working group for prevention of unsafe abortion.

International health experts argue that unsafe abortion is one of the causes of maternal mortality that could most easily be addressed, through improved access to family planning services, better post-abortion care and safe, legal abortion.

Non-surgical abortion in particular could be extremely effective says Mosotho Gabriel, Africa Alliance director of international women s health rights organisation Ipas. Few African women have access to non-surgical abortion which is done by administering a pill instead of a medical procedure because it is either illegal or not available as part of public health care.
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Because non-surgical abortion means that the patient doesn t have to be admitted to hospital, it is cheaper and makes abortion more accessible to poor and rural women, she explained.

More than five million African women have unsafe abortions each year, and more than half of the 67,000 global deaths from unsafe abortion occur on the continent, according to WHO data.

To advocate for more and better abortion services throughout the continent, Ipas is now collaborating with health ministries in 43 developing countries. In Zambia, Malawi, Kenya, Burkina Faso, Mali and Benin, Ipas helps health departments to roll out non-surgical abortion in selected health facilities to improve its acceptability, visibility and availability.

Cost remains a significant barrier to the safe provision of abortion. Left with no better option, women resort to life-threatening methods to terminate unwanted pregnancies.

Cost means poor women can t access (abortion services), and hence the women who die are the poor women, said Dorothy Shaw, FIGO president and senior associate dean of the Faculty of Medicine at the University of British Columbia in Canada.

What makes matters worse is that many women who suffer complications from unsafe abortion do not receive the care they need.

Many health care providers mistreat and discriminate these women. They don t see that society fails them in accessing safe abortion, said Faundes. We need better training for health providers, not only medically but also in terms of quality of care.

But without laws permitting abortion, health care providers hands are bound.

The laws governing access to safe abortion in African countries vary, ranging from very restrictive, such as in Kenya, where abortion is permitted only to save a woman s life, to liberal, such as in South Africa, where abortion is permitted until the 12th week of pregnancy or, in certain circumstances, even later.

Most governments lack the political will to ensure women can access safe abortion, despite regional policy development promoting more liberal abortion laws, lamented Dr Eunice Brookman-Amissah, Ipas vice president for Africa and former Ghanaian health minister.

In 2003, the African Union adopted the Protocol to the African Charter on Human and Peoples rights on the Rights of Women in Africa, which mandates countries to review abortion law. Three years later, African health ministers adopted the Maputo Plan of Action for Sexual and Reproductive Health and Rights, which identifies addressing unsafe abortion as a key area of action.

In addition, the Africa Health Strategy 2007-2015 recommends that safe abortion should be included in each country s law. But few African governments have implemented the recommendations.

The positive impact liberal abortion laws can have on women s health is shown in South Africa, where deaths from abortion were reduced by 91 percent after the country enacted the Choice on Termination of Pregnancy Act.

So why would other countries cling to laws that are detrimental to the health of women, asked Brookman-Amissah.

Still, legalisation alone does not increase the number of abortions performed. It s one thing to change the law but another to ensure the law is applied, said Faundes.

Slow implementation has been a stumbling block to the provision of abortions in South Africa.

Structural problems within the health care system mean that abortion is actually not accessible to people who need it most, observed Sa diyya Shaikh, researcher of the Department of Religious Studies at the University of Cape Town, with reference to the country s poor public health infrastructure.

Ultimately, health experts believe that educating women about family planning and making available different methods of contraception will lead to a reduction in abortion rates. Criminalisation is the wrong concept. The way to reduce abortion is to give women access to contraception, Faundes explained.

In most African countries, only between five percent and eight percent of women have access to contraception, with South Africa, with 15 percent, being the country where most women can access contraception, according to Ipas.

African countries have the highest unmet need for contraception in the world and therefore the highest rates of unwanted pregnancies, confirmed Kelly Culwell, senior advisor for abortion of the International Planned Parenthood Federation. Yet, family planning, contraception and reduction in abortion rates go hand in hand.