1. 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

2. 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: Ipas_publications@ipas.org Web: www.ipas.org Email: pubs@familycareintl.org Web: www.familycareintl.org

3. Introduction This presentation includes modules on: Context and general information on unsafe abortion. International agreements Legal issues

4. Unsafe Abortion in Context Module 1

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. Abortion Restrictions and Maternal Mortality

12. 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

13. 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

14. International Agreements Module 2

15. 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

16. 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

17. 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

18. 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

19. 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.

20. Legal Context Module 3

21. 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

22. 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