Download Prepared by Ipas and Family Care International (FCI) to promote

Improving Access
to Safe Abortion
Guidance on
Making High-Quality
Services Accessible
Based on Safe Abortion: Technical and Policy Guidance
for Health Systems, World Health Organization, 2003
Prepared by Ipas and Family Care International (FCI) to
promote greater understanding of the challenge of
unsafe abortion and measures to make abortion services
safe and accessible to the full extent of the law, based
on international guidance from the World Health
Organization (WHO)*. Ipas and FCI are solely
responsible for the contents of this presentation, which
may be used or abstracted without prior permission.
September 2005
*World Health Organization. Safe Abortion: Technical and Policy Guidance
for Health Systems. Geneva: WHO, 2003.
Contact:
Email: [email protected]
Web: www.ipas.org
Email: [email protected]
Web: www.familycareintl.org
Introduction
• This presentation includes modules on:
• Context and general information on
unsafe abortion.
• International agreements
• Legal issues
Unsafe Abortion in Context
Module 1
Unsafe Abortion Worldwide
• There is a wide range of laws and
practices regarding abortion
• Almost 68,000 women die every year
due to complications from unsafe
abortion
• Globally, unsafe abortion accounts for
13% of maternal deaths
Unsafe Abortion in Context
• Abortions occur in all countries
• Unsafe abortions are concentrated in
developing countries (around 95%)
• Abortions occur in all age groups
• Married and unmarried women, with
and without children, seek abortions
The Context: Wanted Pregnancy
• A woman may want to have a child, but:
– Pregnancy may not be supported by
woman’s partner, family or community
– Pregnancy may threaten the woman’s
health or survival
– Foetus may have an abnormality
The Context: Unwanted Pregnancy
Many women do not want to become
pregnant because of:
•Personal reasons
•Health reasons
•Socioeconomic reasons
•Cultural reasons
•Relationships
•Desire to stop childbearing/space birth
The Context: Unwanted Pregnancy
(continued)
Yet, 80 million unplanned pregnancies
occur each year because of:
•Lack of access to contraception
•Contraceptive Failure
•Rape/Coerced Sex
Legal Status and
Demand for Abortion
• Legally restricting abortion does not
necessarily reduce the number of
abortions that occur in a country
• The legal status and availability does
affect the safety of abortion; where
abortion is legal and safe services are
available, deaths and disability from
abortion are greatly reduced
Definition: Unsafe abortion is the termination of a pregnancy carried out by someone without the
skills or training to perform the procedure safely, or in a place that does not meet minimal medical
standards, or both. (According to WHO, and endorsed by the UN)
Abortion Restrictions and
Maternal Mortality
Impact of Unsafe Abortion
• The deaths caused by unsafe abortion
are preventable
• Abortion performed in sanitary
conditions by a skilled provider is an
extremely safe procedure
• Safe abortion is much safer than
childbirth
Impact of Unsafe Abortion
• In addition to death, unsafe abortion can
also lead to:
– Significant short- and long-term illness
and injury to women
– High costs for treating complications
– Negative impacts on women, families,
children, and communities
– Increased likelihood of death among
children whose mother has died
International Agreements
Module 2
International Obligations
International agreements recognise that:
• Unsafe abortion is a major public health
concern
• Abortion should be safe and available to
the full extent of the law
• Health systems have a responsibility to
provide these services
International Obligations
ICPD
… In circumstances where abortion is not
against the law, such abortion should be
safe. In all cases, women should have
access to quality services for the
management of complications arising
from abortion.
Paragraph 8.25
Programme of Action, International Conference of Population and Development, Cairo, 1994
International Obligations
ICPD +5
…In circumstances where abortion is not
against the law, health systems should
train and equip health-service providers
and should take other measures to
ensure that such abortion is safe and
accessible. Additional measures should
be taken to safeguard women’s health.
Paragraph 63(iii)
Key Actions for the Further Implementation of the ICPD Programme of Action, 21st United Nations General Assembly
Special Session, New York, 1999
Millennium Development Goals
MDG 5
Reduce by three-quarters, between 1990
and 2015, the maternal mortality ratio
• In some settings reducing unsafe
abortion may be technically the easiest
way to reduce maternal deaths as
mandated by MDG 5
Millennium Development Goals
MDG 5 (continued)
• Unsafe abortion can be reduced through
comprehensive sexual and reproductive
health education, high quality
contraceptive services, and safe abortion
services
The MDGs were approved by U.N. member states following the Millennium Assembly, held in 2000.
Legal Context
Module 3
Legal Status and
Availability of Abortion
Around the world, there is a wide range of
scenarios:
•Abortion is legally allowed and safe
services are available
•Abortion is legally allowed but safe
services are difficult to access
•Abortion is legally restricted and safe
services are difficult to access
Legal Status of Abortion
Abortion is legal in some situations in
almost all countries:
• To save the woman’s life:
98% of countries
• To preserve physical and mental health:
62% of countries
• In cases of rape or incest:
43% of countries
Countries should offer safe abortion services in all
circumstances permitted by law