Mosotho Gabriel: Program Director Ipas Africa Alliance for Women’s Reproductive Health and Right ICMA Meeting: 11 March 2008, Johannesburg, South Africa 1

Overview Unsafe abortion and women in Africa Why the problem persist Africa Abortion Laws International, Regional and National responses Policies and Practice Regional agenda for action Conclusion 2

Unsafe abortion and women in Africa According to WHO estimates, 4.2 million unsafe abortions occur annually in Africa Of the 70,000 unsafe abortion deaths globally, 44% are due to unsafe abortion in Africa 90 African women die every day 20 to 50% of all maternal deaths in African countries are abortion-related Tens of millions of African women will experience an unsafe abortion

Lack of access to contraception; Africa has the lowest contraceptive prevalence rates Gender issues- Violence / Poverty / Youth Africa has the world’s most restrictive abortion laws Religious dogma and ignorance Health system issues—lack of policies and services Lack of Political Will to save women's lives Social attitudes and stigma attached to abortion Organized opposition to safe abortion Why the problem persist?

Africa Abortion Policies and Laws Africa Abortion Policies and Laws Only 5 out 53 African countries allow abortion to be performed on request Majority of laws are limited to saving the life of pregnant women During the last decade a number of countries; Benin, Burkina Faso, Chad, Guinea, Mali, Swaziland, and Togo, have reviewed their laws The majority of African countries have retained colonial laws on abortion. 5

Abortion Laws in Africa 2005

1980: The safe motherhood initiative 1994: ICPD called for safe abortion, with preventive focus on family planning and post abortion care 1999: ICPD+5 called for training and equipping providers to make safe abortion accessible 2003: WHO guidance to health ministries on safe abortion Global response

Millennium Developments Goals Goal 5 Calls for: Reduction of the maternal mortality ratio by 75% by 2015 Achieve, by 2015, universal access to reproductive health In some settings reducing unsafe abortion may be technically the easiest way to reduce maternal deaths as mandated by MDG 5 Unsafe abortion can be reduced through comprehensive sexual and reproductive health education, quality contraceptive services, and safe abortion services The Millennium Development Goals were approved by UN member states following the Millennium Assembly, held in 2000.

The regional response 2005: African Union Protocol defining abortion as a human right 2006: Maputo Plan of Action strategy to increase access to safe abortion

Protocol on the Rights of Women in Africa Adopted July 2003 by the African Union in Maputo Governments undertook to take appropriate measures to: “authorize … medical abortions in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus.”

Progress in national policies Liberal abortions laws in: Tunisia, South Africa, Cape Verde, Zambia and Ethiopia ; Countries with at least 3 indications include: in Benin, Burkina Faso, Chad, Guinea, Mali, Swaziland, and Togo; under consideration in Mozambique Majority of countries still have 1 indication i.e. to safe a woman’s live includes: Senegal, Uganda, Malawi, Niger, Nigeria; to name a few

INCIDENCE OF UNSAFE ABORTION POLICY Compile and disseminate data e.g. magnitude and consequences of unsafe abortion Enact policies and legal frameworks to reduce incidence of unsafe abortion Implement regional instruments to reduce unsafe abortions Practice Advocate for provision of safe abortions services to the fullest extend of the law Create a favorable societal context though education on SRH & Rs and use of values clarification Train health care providers in prevention and management of unsafe abortion

A regional agenda for action Support additional legal and policy reforms Train and equip providers and strengthen the role of midlevel providers in abortion care Strengthen health systems capacity; in particular PHC Increase options for women who seek services by increase the availability of technologies (MVA & MA)

A regional agenda for action Reduce stigma associated with abortion Monitor & counter the opposition Educate women, including young women about their SRH & Rs Advocate for use of Misoprostol as it is available in all African countries; registered in some Established and strengthen existing regional networks

Definition of Medical Abortion Early pregnancy termination, generally before 9 weeks’ gestation, resulting from abortion-inducing medications and without primary surgical intervention

Why Women Choose Medical Abortion Avoids surgery, noninvasive Perceived by some women as: “Better” or “easier” than surgical abortion More natural, like a miscarriage

Conclusion Maternal Mortality from unsafe abortion is a social injustice Denying women control of their bodies, denies them their full citizenship and limits their self- determination We shall have won the fight against unsafe abortion when no deaths occur; and when no woman suffer the negative circumstances of unsafe abortion There is an urgent need to advocate for protection of women’s health and rights to choose 18

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