Asia and the Middle East
While the rate of safe abortion has declined from 1995 to 2003, the rate of unsafe abortion has stayed almost static—which means a greater percentage of women who seek abortions are turning to unskilled practitioners than they were before. In 2003, nearly 26 million abortions were performed in the region—and about 10 million of those were performed by an unskilled practitioner or in unsafe conditions. IWHC partner group CommonHealth in India and other organizations across the region are working to give women in their countries better access.

Latin America and the Caribbean
Abortion for any reason is completely outlawed in only a few countries and territories in the world, and most of them are in Latin America and the Caribbean. Many other countries in the region impose heavy restrictions over legal access. Despite governmental and religious attempts to rid the region of abortion through law and stigma, 4.1 million abortions—virtually all of them unsafe—were  performed in 2003 across Latin American and the Caribbean. Still, there is hope: recent loosening of abortion laws in Colombia and Mexico City led to an immediate increase in safe, legal abortions in those places, and women’s health advocates like our partners at Catholics for the Right to Decide continue to fight for more liberal laws around the region.

Africa
The number of abortions performed in Africa rose dramatically from 1995 to 2003, yet about 92 percent of women of childbearing age there live in countries with restrictive abortion laws.  Of the 5.6 million abortions performed in 2003, only 100,000 were done under safe conditions. Many groups, including IWHC partner organization, the Campaign Against Unwanted Pregnancy in Nigeria, are bravely advocating for more liberal abortion laws and greater access to safe services across the region.

This week on Akimbo, we published a bunch of great resources about access to safe abortion around the world. Check them out!

• Welcome to International Access to Safe Abortion Week
• Promoting Women’s Access To Safe Abortion: Tools For Advocates
• Video: An Adolescent’s Fight for Safe Abortion
• Little-Known Medication Offers Safe and Accessible Alternative to Surgical Abortion
• Act Now for Global Sexual And Reproductive Health
• Video: Abortion in India: Legal, But Not Always Safe
• Ten Fact About Abortion

Our “Ten Fact About Abortion” manual serves as a quick reference guide for pro-choice advocates. The guide offers factual evidence debunking ten widely disseminated abortion myths, and provides supporting background information and resources. We hope this guide will help reproductive rights activists to confidently respond to challenges to our work and to continue advocating for abortion based on clear, scientific and unbiased data.

Here are the facts!

1. Postabortion syndrome is not a valid psychiatric diagnosis.
2. There is no causal relationship between abortion (spontaneous or induced) and an increase in women’s risk for developing breast cancer.
3. Emergency contraception prevents pregnancy, it does not cause abortion. If a woman is already pregnant, emergency contraception will have no effect on the pregnancy and will not cause an abortion.
4. Abortions performed by trained providers under hygienic conditions are much safer than pregnancy and childbirth.
5. When women have access to safe, legal and affordable abortion, maternal death and injuries due to unsafe abortion decrease dramatically.
6. The best way to reduce abortions is to reduce unintended pregnancies through comprehensive sexuality education, prevention of gender-based violence, and access to woman-centered and effective contraception.
7. Medical abortion is a safe and effective option for terminating a pregnancy in the first trimester.
8. Women who do not have information and access to reliable contraceptive methods face higher rates of unplanned pregnancy and may use abortion to terminate the pregnancy, regardless of the legality of abortion.
9. Since the beginning of recorded history, women throughout the world have terminated unwanted pregnancies. This practice is well documented
10. Abortion to save the life of a woman or girl is medically necessary under certain circumstances and is widely accepted by professionals and institutions like the World Health Organization.

The full version is a detailed, 60-page document that you can download as a PDF here.

Since 1971 abortion has been permitted in India for a broad variety of reasons. Throughout the country, women who can afford health care in private hospitals have fairly good access to sexual and reproductive health care services, including abortion. But in rural and poverty-stricken areas, where people rely on public health care facilities called Primary Health Centers, access is more limited, to devastating effect. In India, rates for maternal mortality are highest among poor rural women. India has the largest number of deaths from unsafe abortions in the world.

IWHC’s latest video features Rajesh Chaturvedi who works with the organization Gramin Punarnirman Sansthan (GPS) in Uttar Pradesh, the most populous state in India. GPS is a member of CommonHealth, one of our partners in India. Over the last few years, GPS has focused on advocacy around obtaining better reproductive health care services in the Azamgarh District of Uttar Pradesh. On a program visit to India, IWHC’s then-Program Officer Khushbu Srivastava met Rajesh. He was generous enough to tell her this very personal true story about the insufficiency of the health care system in India in dealing with abortion.

In the 21st century there is no reason for a woman to die or suffer the traumas of an unsafe abortion. Access to safe abortion is about more than policy – communities and those who provide them with health care must be committed to achieving true access.

For more information, check out the following resources:

• Abortion With Self-Administered Misoprostol: A Guide For Women
• Promoting Women’s Access to Safe Abortion: Tools For Advocates
• Access to Safe Abortion is a Human Right

A full transcript of the video is after the jump.

Text card: The International Women’s Health Coalition (IWHC) presents

Text card: Abortion in India: Legal, But Not Always Safe

Scrolling text: CommonHealth, an IWHC partner, is a network in India that advocates for maternal health, including access to safe abortion. CommonHealth introduced IWHC to Rajesh Chaturvedi,
who works to address the health of rural women and their families in the state of Uttar Pradesh, India.

Rajesh narration: She had three children before. All girls. Then she became pregnant for the 4th time.

Scrolling text: Abortion in India was legalized in 1971 but many people, especially in rural areas, do not know that abortion is legal. India has the largest number of deaths from unsafe abortions in the world.

Rajesh narration: So she took medication from a quack doctor in the village for abortion.

Scrolling text: Despite its legality, many health care providers don’t know how to do safe abortions or refuse to provide the service.

Rajesh narration: After taking medication she got some spotting but did not have complete abortion. Then after two, three days she told her husband to take her to a doctor as she needs to take medicine. She needed to complete the abortion. For the abortion she went to the clinic and she met the nurse. They paid 1000 rupees and the nurse put some medicine inside the uterus. She went home and on the first day she had mild bleeding, second day she had mild bleeding but on third day she had very heavy bleeding and it was a problem so she told her husband to take her to the doctor. Her husband again took her to the clinic doctor who had administered the medication.The doctor saw her from the distance and said she will not see her as she looks seriously ill and they should take her to the some other doctor. So they immediately drove from Nadiya Paar to Atraulia- where there is one private hospital.The doctor looked after her from 6 pm to 3 am.  The treatment did not help and at 3 am she was discharged. She went to another private hospital from 4 am to 10 am. There she was given a blood transfusion that cost 2000 rupees. But she still didn’t get better. Her condition became worse. At 10 am the doctor arrived and said to give her another transfusion. Her husband went to their village to arrange for borrowing money. He paid 2000 rupees, but she died before they could give her blood.

Scrolling text: Every year, nearly 70,000 women around the world die because they do not have access to safe abortion services or are refused care by health care providers.  Legal restrictions and cultural stigma on abortion access do not reduce the number of abortions, they increase the likelihood that women will have serious complications.

Rajesh narration: People think it is a sin. “This is sin and it is a woman’s issue, men are not responsible.” So in our society, women get abortions done secretly, that is the main reason of this difficulty. They get it done secretly because it is not accepted in the country.

Scrolling text: These deaths are preventable Women need reproductive health care services that are comprehensive, with policies that reinforce human rights, and clinics that grant safe access to vital services, especially in rural areas.

CREDITS

Featuring Rajesh Kumar Chaturvedi

This video is a collaborative production of the International Women’s Health Coalition, CommonHealth, and Gramin Punarnirman Sansthan.

Camera: Khushbu Srivastava

Editing: Audacia Ray and Lori Adelman

Script guidance and editing support: Melanie Abrahams and Kelly Castagnaro

Translation: Sunita Bhadauria and Khushbu Srivastava

Photos courtesy of CommonHealth and the International Women’s Health Coalition 

In April 2010, Rep. Yvette D. Clarke (NY-11) introduced the Global Sexual and Reproductive Health Act to ensure a more comprehensive U.S. approach to addressing the range of the sexual and reproductive health needs of individuals.  For example, this first-of-its-kind bill would modify U.S. foreign assistance to support the provision of a broad constellation of sexual and reproductive health services: family planning, testing and treatment for sexually transmitted infections, including HIV,   maternal health care, and access to safe abortion where permitted by local law.   It also would promote linkages between sexual and reproductive health services, child health, malaria, and neglected tropical diseases.

Currently, the United States is the top donor in sexual and reproductive health services. While the U.S. has achieved remarkable successes in this area, according to Rep. Clarke, the bill would ”  establish[ing] an integrated, progressive model for delivering more efficient and effective sexual and reproductive health services across the globe.”

Providing the full menu of services that women and young people need is not only the right thing to do, it’s the smart thing to do.  Please write your Representative TODAY – show your support for a comprehensive approach to women and young people’s health:

Dear [NAME],

In the 21st century, no woman or girl should die or suffer the traumas of an unsafe abortion, die while giving birth, or lack access to sexual and reproductive health information and services they need to make healthy and informed decisions about their own lives.

The Global Sexual and Reproductive Health Act (HR 5121), introduced by Rep. Clarke (D-NY) would take a major step forward in achieving these goals by, for example, combining family planning services with testing and treatment for sexually transmitted infections, including HIV, and with maternal health care.  It also would promote linkages between sexual and reproductive health services, child health, malaria, and neglected tropical diseases.   The bill would also seek to reduce unsafe abortions, which account for 13% of maternal deaths worldwide, by ensuring access to contraception and safe abortion services where permitted by local law.

I care deeply about ensuring that United States foreign assistance supports the rights of women and young people to access the tools, information, and services they need to live healthy, productive and just lives. I urge you to cosponsor and support efforts to move the Global Sexual and Reproductive Health Act forward. Your support is critical to ensuring the most effective use of U.S. foreign assistance dollars and that the health and rights of women and young people are realized.

Sincerely,

[NAME]

Millions of women worldwide have safely terminated their pregnancies with medication since mifepristone -or RU 486- was first introduced in the late 1980s. Research in the past two decades has identified a highly effective regimen for early medical abortion with a success rate of 95 to 98 percent, consisting of 200 milligrams of mifepristone followed by 400 or 800 micrograms of misoprostol. Whether taken in a health center or at home by women themselves, the regimen offers an option that many women prefer to surgical procedures such as manual vacuum aspiration or dilation and curettage (D&C).

Because mifepristone is a registered abortion drug, its sale and use are not permitted in most countries with restrictive abortion laws. In contrast, misoprostol is an anti-ulcer medication that is registered under various trade names in more than 85 countries. Research has found that misoprostol used alone is about 85 percent successful in inducing abortion when used as recommended, offering a safe and accessible alternative for women who have no other option.

Not enough women know about misoprostol as an option for safe abortion, so we’ve collaborated with Gynuity Health Projects to release “Abortion With Self-Administered Misoprostol: A Guide For Women,” available in English, Spanish, Portuguese, and French.

Gynuity has also done research about the registration of misoprostol around the world, and has produced the map below, which shows where misoprostol is registered and available for off-label use (solid purple), where it is also approved for medical abortion (stripes), and where it is not approved for any use (yellow). You can also download a PDF of the map, with English or Spanish text, here.

As with anything related to women’s health, access is more complex than the legal registration of a medication. The publication “What Women Want – Meeting Global Demand for Medical Abortion“ [link downloads a PDF], produced by Marie Stopes International (MSI), details the complexities of access to medical abortion. Both mifepristone and misoprostol are increasingly available in black markets in Africa and the Middle East, regions with the most restrictive laws around these drugs. Prices for the pills also vary widely from country to country; depending on legal status and local markets, pills can cost anywhere from $1 to $30 each. In 2007, the World Health Organization added misoprostol to their Essential Drugs List, and more recently it was “redefined as an essential medicine for incomplete abortion/miscarriage management,” according to MSI. However, the process of registration and approval for new medications can be lengthy. In the U.S., for example, the approval of new drugs can take eight to ten years.

While it is certainly important for health care practitioners to be trained on the administration of medical abortion so that they are capable of providing comprehensive information and services to the women they work with, it is also important for women themselves to have access to life saving information. MSI puts this really well in their “What Women Want” guide (pg 21):

Within the public health community there is increasing acknowledgement of the potential afforded by demedicalising the provision of some healthcare services. The increasing shift from surgical to medical abortion is an example of demedicalisation in practice: medical abortion requires less technology, can be carried out in non-clinical settings, does not necessarily need to be delivered by high-level providers such as physicians, and users can play a more active role in the process through self-administration of medication. Furthermore, some women and men prefer less clinical environments.

Medical abortion has the potential to transform traditional relationships between reproductive healthcare providers and their clients. In contrast to surgical abortion, medical abortion is not done to women but by them, with appropriate support provided by health professionals.

Wherever unwanted pregnancies happen –which is to say, all around the world– there will be women who choose to terminate their pregnancies. It’s essential that women get the information they need to make informed and safe choices about their bodies and reproductive health. The availability of misoprostol, and the distribution of multilingual information about how to use misoprostol, are both steps in that direction.

In this video by the Center for Reproductive Rights (CRR) we hear this story through to its devastating conclusion—directly from L.C., the girl who lived through it all.

Together with IWHC partner The Center for the Promotion and Defense of Sexual and Reproductive Rights (PROMSEX), CRR has represented L.C. in filing a petition for increased access to therapeutic abortion. Much more work remains to be done, but thanks to this work and other efforts by CRR and PROMSEX, therapeutic abortions have become more commonly granted to Peruvian women.

The video is hard to watch, but worth it. Afterall, it’s brave voices like L.C.’s that will finally help us secure a just and healthy life for all women and girls.

To that end, this new IWHC information brief highlights four messages about safe abortion and presents a selection of advocacy “tools”- resources with information, evidence and ideas for strategic action that can be accessed online. Advocates at every level-local communities, state and national levels, and international forums- are encouraged to use this brief to convince policy makers and health care providers that ensuring every woman’s access to safe services for preventing and terminating unwanted pregnancies is an urgent public health priority and a basic human right [link leads to PDF].

The four messages contained in the brief are crucial components of any advocates’ efforts to ensure greater access to safe abortion services for women:

• Access to safe abortion is a woman’s right;
• Restrictive laws do not reduce the number of abortions and have negative health, social and economic consequences;
• Policies and practices that impede access to safe abortion where legal terminations are available must be eliminated; and
• Where restrictive laws are in force, safe alternatives to legal abortion must be supported in recognition of the right of all women to make free and responsible decisions about their bodies and their lives.

Click here to download the brief in full, and learn more about how you can best advocate for increased global access to this important human right.

This week is International Access to Safe Abortion Week here on Akimbo, and we’ll be highlighting work being done to achieve greater access to safe abortion services for women around the world with blog posts, two new resources on safe abortion, and a new video about access to safe abortion in India.

In collaboration with our partners around the world, IWHC seeks to foster a better understanding of women’s experiences of unwanted pregnancy and subsequent abortion, and to dispel myths, stigma, and misinformation. Dictated by women’s realities and supported by the knowledge that restrictive abortion laws only serve to force the procedure underground and into the hands of unqualified practitioners, we seek to expand the availability and quality of safe abortion services as part of comprehensive reproductive health policies and programs around the world.

Here’s what you can look forward to this week:

• “Promoting Women’s Access to Safe Abortion: Tools For Advocates,” a brief that includes resources with information, evidence, and ideas for strategic action that can be accessed online. The resource is available in English, Spanish, French, and Portuguese.
• “Abortion with Self-Administered Misoprostol: A Guide for Women,” a brief with information on using misoprostol, co-authored with Gynuity Health Projects. The resource is available in English, Spanish, French, and Portuguese.
• A video about the impact of the lack of access to safe abortion in rural India.
• Blog posts featuring the work of our partners and colleagues and their work to secure the access to safe abortion for all women who choose it.

I hope you’ll join us, and spread the word about these resources.