Access to Safe Abortion is a Human Right

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Safe abortion—the termination of a pregnancy by trained health care providers using correct, sanitary technique and proper equipment—is a simple, lifesaving health service. Nonetheless, of the 42 million induced abortions each year, an estimated 20 million are unsafe and 97% of those occur in developing countries.  Every year, nearly 70,000 women die unnecessarily from the complications of unsafe abortions, and countless more suffer infections, infertility, and debilitating injuries.

Abortion is legal in almost all countries to save a woman's life, and approximately 30% of the world's women may seek abortions either to preserve their physical or mental health or for socioeconomic reasons. Too often, though, safe abortion services are not provided by public health systems. The services that are available are not widely accessible or are of poor quality. This is true even where abortion laws are liberal as in India. Evidence from countries including the United States, Romania, and South Africa demonstrates that abortion-related deaths and injuries can be virtually eliminated with appropriate laws, policies, and services.

IT IS A WOMAN'S RIGHT TO DETERMINE WHETHER TO CARRY A PREGNANCY TO TERM

A woman's ability to exercise her rights to control her body, to self-determination, and to health depends, in part, on her right to determine whether to carry a pregnancy to term.

LEGAL RESTRICTIONS DO NOT REDUCE ABORTIONS

Women and girls who face punishment for having an abortion are not less likely to attempt abortion—they are less likely to have access to safe services. When abortion is restricted by law, trained providers may be reluctant to perform abortions, even when legally permissible, because they do not know the law, fear censure from the community, or hold personal beliefs against abortion. This can force women to seek unsafe abortions.

FUNDING LIMITATIONS JEOPARDIZE ACCESS

Restrictions on foreign assistance that limit the availability of safe abortions, such as the U.S. Global Gag Rule, have forced family planning clinics to cut back their services, and in some instances, close.

PREVENTING UNWANTED PREGNANCIES REDUCES ABORTION
Reduction in the incidence of induced abortion is directly related to contraceptive availability. Recent data from countries of the former Soviet Union, for example, show that when contraception is widely available, the incidence of unintended pregnancy and abortion both decrease dramatically. In the developing world, more than 200 million women have an unmet need for contraceptives, including emergency contraception.

AVAILABLITY AND ACCESSIBILITY ARE ESSENTIAL

Access to good quality contraceptive services is essential but not sufficient. Safe abortion services will always be necessary because contraceptives are not universally available or affordable and are not always used consistently to prevent pregnancy.

ABORTION SHOULD BE PART OF A COMPREHENSIVE APPROACH

Safe abortion care is part of comprehensive reproductive health services, which should be accessible to and affordable for all women, married or not. These services should also include:

• family planning counseling and contraceptive supplies, including female and male condoms;
• antenatal, delivery, and postpartum care;
• access to safe abortion services;
• counseling and care after all abortions, safe or unsafe, as well as miscarriages;
• prevention, care, and treatment for sexually transmitted infections (STIs), including HIV-prevention methods such as microbicides when they become available;
• programs that prevent violence against women and provide care and support.

Often, women and girls cannot exercise their rights to make sexual and reproductive health decisions. Comprehensive sexuality education for girls and boys promotes the rights of women to determine when and if they want to have children and their overall sexual health. Upholding women's rights also requires that women's access to education, income generation, and general health care is assured.

SUSTAINED AND ROBUST ADVOCACY IS CRUCIAL

• REFORM LAWS AND POLICIES. Support is needed for the many advocates working at local, national, and international levels to rescind or liberalize restrictive laws and to implement and protect laws that enable women to decide whether or not to end a pregnancy and to have access to safe abortion services. 

• DOCUMENT THE CONSEQUENCES OF LIMITING ACCESS TO SAFE ABORTION. Research undergirds policy changes that expand access to safe abortion services and protect women's rights, health, and lives.

• TRAIN AND EQUIP HEALTH CARE PROVIDERS. Governments, non-governmental organizations, and women's health and rights advocates can educate and encourage health care providers to perform abortions to the fullest extent permissible under current law, retrain them when laws change or new techniques become available, and support their care of women who have unsafe abortions. In areas where there are few doctors, mid-level health care providers can be trained to perform safe abortions and refer women to higher levels of care when needed.

• SUBSIDIZE SERVICES FOR POOR WOMEN. Unsafe abortion rates are highest among poor women and young women. Governments and international donors need to understand that investing in contraception and safe abortion services for poor women costs significantly less than paying for the complications of unsafe abortions. 

Acknowledgements
We are grateful to reviewers Akinrinola Bankole (Guttmacher Institute), Marianne Mollmann (Human Rights Watch), Maria Jose Rosado-Nunes (Catholics for the Right to Decide-Brazil), and Maria Isabel Plata (PROFAMILIA).

For more information:

LAW AND POLICY
The African Union Commission—2006 Maputo Call for Action
Developed by African Ministers of Health to advance sexual and reproductive health http://www.unfpa.org/africa/newdocs/maputo_eng.pdf

Center for Reproductive Rights' Abortion Worldwide: Twelve Years of Reform
http://www.reproductiverights.org/pdf/pub_bp_abortionlaws10.pdf

Guttmacher Institute—Nepal Reforms Abortion Law to Reduce Maternal Deaths, Promote Women's Status
http://www.guttmacher.org/pubs/tgr/05/2/gr050213.pdf

International Women's Health Coalition—Global Gag Rule
http://www.iwhc.org/global/uspolicy/ggr/index.cfm?language=1

International Women's Health Coalition—Eliminating unsafe abortion worldwide
http://iwhc.org/resources/lancet101307.cfm

International Women's Health Coalition—Expanding Access to Safe Abortion: Strategies for Action
http://www.iwhc.org/resources/expandingaccess.cfm?language=1

United Nations Population Fund—ICPD+5
Review of progress on International Conference on Population and Development goals http://www.unfpa.org/icpd/icpd5.htm

OVERVIEW
The economic impact of unsafe abortion
http://www.id21.org/focus/unsafe_abortion/art03.html

Ipas—Needless Death and Injury: Unsafe abortion as a critical
global health issue
http://www.ipas.org/Publications/asset_upload_file45_3213.pdf

International Planned Parenthood Federation—Death and Denial
http://www.ippf.org/en/Resources/Reports-reviews/Death+and+Denial.htm

HEALTH AND SAFETY
Guttmacher Institute—Abortion Care Services Provided by Registered Midwives in South Africa
http://www.guttmacher.org/pubs/journals/2814402.html

Guttmacher Institute—Get "In the Know": Safety of Abortion
http://www.guttmacher.org/in-the-know/safety.html

World Health Organization—Frequently asked clinical questions about medical abortion
http://www.who.int/reproductive-health/publications/medical_abortion/index.html

World Health Organization—Safe abortion: Technical and policy guidance for health systems
http://www.who.int/reproductive-health/publications/safe_abortion/

Page last updated 1/22/08.