With new restrictions on abortion in Supreme Court, many are wondering what it will mean for women if Roe vs. Wade is knocked down. We looked for answers in other countries.
Consider this: Every day around the world, some 96,000 women risk their lives for unsafe abortion, seeking to end an unwanted pregnancy. Millions of women face complications from unsafe abortion and at least 22,000 die each year. This last push to overthrow Roe vs. Wade aims to deny women autonomous control of their own bodies and portends a return to the days before Roe deer, in the United States, when the death rate from illegal abortion among women of color was 12 times that of white women.
MSI Reproductive Choices works in many countries where abortion is severely restricted and we are called upon daily to provide life-saving postabortion care to women and girls who have attempted to terminate an unwanted pregnancy on their own. Faith Pyentim, a midwife from Nigeria, described a teenage girl who sought help after a desperate attempt to terminate an unwanted pregnancy. “There was a bad smell, so we knew there was an infection. She was then 17 years old, single with a child already at home.
The young woman received treatment for her infection, remained on contraception to prevent future unwanted pregnancies and has since returned to school. But not everyone in this situation has access to life-saving postabortion care.
Restrictions increase unsafe abortions
No matter where they live, whatever the laws of their country, women terminate unintended pregnancies. Access to a safe abortion must therefore be included in essential health care. In fact, abortion-related deaths and disabilities are highest in countries where abortion is most severely restricted. The Guttmacher Institute analysis showed that in countries where abortion is severely restricted and in those where there are fewer restrictions, the incidence rate of abortion is similar, at around 40 percent unwanted pregnancies ending in abortion.
But while the abortion rate is similar, in countries where abortion is restricted and highly stigmatized, women resort to unsafe methods that dramatically increase complications and mortality. In sub-Saharan Africa, where laws are generally more restrictive, deaths from unsafe abortions have increased steadily since the 1990s. Adolescents in rural areas, such as the young woman served by Faith, are particularly at risk.
Bárbara Pérez, member of the MSI team in Mexico, described what she sees in rural areas where access to abortion services is limited: “Often women do things like stick threads to put on end of pregnancy. We have had cases of women taking a pesticide used in the fields when they found out they were pregnant.
Unsafe abortions are the cause of about 13 percent of pregnancy-related deaths in many developing countries, and due to underreporting, the true number is likely much higher. The consequences are far-reaching. Seven million women face complications each year, including serious health problems such as hemorrhages, infections, incomplete abortions and infertility. Public health facilities bear much of the burden of treating these injuries, and women bear the additional burden of stigma. Many women suffer from chronic illnesses associated with abortion without receiving the medical care they need.
Unsafe abortions are the cause of about 13 percent of pregnancy-related deaths in many developing countries, and due to underreporting, the true number is likely much higher.
Beyond the direct health costs of treating women who have undergone unsafe abortions, there are important indirect consequences: social stigma because a woman or girl has had to undergo an unsafe procedure; orphaned children when they lose their mother; women with disabilities and unable to work; families whose hopes are dashed by infertility. These are preventable tragedies, which can be easily remedied with access to safe, low-cost abortion services.
Fewer abortion restrictions save lives
At MSI, we know that laws alone don’t solve the problem. In Zambia, for example, abortion is legal for several reasons, including to protect a woman’s physical or mental health. But the law required three doctors to sign before a woman received treatment. In a country where there is one doctor for every 12,000 people, this requirement meant that it was often impossible to provide the services women need. What seemed harmless on paper was a major barrier to safe and timely care in practice, and deaths from unsafe abortions remained high, accounting for 30 percent of pregnancy-related deaths in the country.
MSI Zambia knew that change was needed for women who could not get the required signatures and were at risk of requesting an unsafe abortion. MSI Zambia began working with the Ministry of Health and other stakeholders to develop new guidelines to complement the law that would make safe abortion more accessible. In 2018, after four years of persistent advocacy, new guidelines were finally approved and now only one doctor’s signature is required in an “emergency”, defined broadly enough to include the risk of abortion at risk or threats to a woman’s health. Now we are working to change the law to bring it into line with practice.
Guarantee access through a policy
Other countries, like Nepal, are leading the way. Nepal legalized abortion in 2002, but when unsafe practices continued, the government included abortion care in the national universal health care plan in 2016. Progress towards universally safe services is still uneven, but there are some promising signs. The Nepal Demographic Health Surveys of 2011 and 2016 showed an increase in the proportion of women who know that a safe abortion is available in public facilities (71.4% to 79%). More and more people know that abortion is now legal (38% to 41%), and clinics have also seen an increase in the number of women seeking safe abortion care.
Shraddha Adhikari, a health care provider from MSI in Nepal, explained the impact of universal health care: “Sustainable and equitable access to abortion services can only be achieved when safe abortion care is not available. not separate from other components of health care. As a health care provider, I take great pride in serving to save women’s lives. If we are unable to provide services, many women face health care complications and even die. “
Restrictive laws don’t stop women who are determined to end an unplanned pregnancy from finding ways to do it – they never have and never will. MSI Reproductive Choices will continue to care for the women and girls who need us and to push for legal and policy changes to protect their right to choose.
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