Guardian: Unsafe abortions kill 70,000 a year

The Guardian, Wednesday 14 October 2009

by Sarah Boseley, Health Editor

About 70,000 women die every year and many more suffer harm as a result of unsafe abortions in countries with restrictive laws on ending a pregnancy, according to a report.

The total number of abortions across the globe has fallen, the influential Guttmacher Institute says, but that drop relates only to legal abortions and is mostly the result of changes in eastern Europe.

There were 41.6m terminations worldwide in 2003, compared with 45.5m in 1995. But in 2003, says the report, 19.7m of these were unsafe, clandestine abortions. The numbers of those have hardly changed from 1995, when there were 19.9m.

Almost all the unsafe abortions were in less developed countries with restrictive abortion laws.

"Virtually all abortions in Africa and in Latin America and the Caribbean were unsafe," says the report. In Asia, safe procedures outnumbered unsafe because of the large number of legal abortions in China. Most of those in Europe and almost all in North America were safe.

The figures are hard to obtain in countries with restrictive laws from hospitals dealing with women damaged by backstreet or self-induced abortion. But the institute, which has been monitoring the numbers for many years, is confident of the picture it paints and hopes it will influence policy makers.

"Our hope is that the new report will help inform a public debate in which all too often emotion trumps science," said the institute president, Dr Sharon Camp.

Fundamental to turning the tide is preventing unwanted pregnancy, but in many countries there is little advice on family planning and contraceptive products are in short supply. "Women will continue to seek abortion whether it is legal or not as long as the unmet need for contraception remains high," Camp said. "With sufficient political will we can ensure that no woman has to die in order to end a pregnancy she neither wanted nor planned for."

The US has always been the biggest funder of family planning in developing countries, but a significant amount of it stopped under the presidency of George Bush, who reinstated a policy known as the "global gag rule" on arrival in office in January 2001.

It removed funding from any family planning organisation overseas that had anything to do with abortion, including counselling. Although European governments, including the UK, stepped up contributions, funds were short at a time when more couples were becoming interested in smaller families. "It really was a lost decade," said Camp.

President Barack Obama has rescinded the policy and more US funds are expected, but the process of ordering increased contraceptive supplies from manufacturers and getting them to where they are needed will take time.

Where contraceptive use has risen, such as in the former Soviet bloc countries, abortion rates have invariably fallen. Worldwide, the unintended pregnancy rate has dropped from 69 for every 1,000 women aged 15-44 in 1995 to 55 for every 1,000 in 2008. The proportion of married women using contraception increased from 54% in 1990 to 63% in 2003.

However, only 28% of married African women use contraceptives. Lack of availability is the biggest issue.

The report points to a global trend towards the liberalisation of abortion laws, which has allowed women with an unwanted pregnancy to end it safely. Nineteen countries have relaxed their restrictions since 1997. But in three countries, Poland, El Salvador and Nicaragua, tougher legislation has been introduced, the latter two prohibiting abortion even when the woman's life is at risk.

"We have seen an increase in women's deaths and teenage suicides in Nicaragua," said Dr Kelly Culwell, of the International Planned Parenthood Federation at the report's launch.

Camp deplored the exit of the pharmaceutical companies from research and development work on contraceptive products. "There used to be 13 major pharmaceutical companies with full-blown programmes of contraceptive R&D. Now there are none," she said.

Yet there was a real need for products women could use if they were having occasional rather than regular sex apart from the condom, which requires the consent of the man.

(IMAGE CAPTION: A woman in a maternity ward at Makeni hospital in Sierra Leone. A report found only 28% of married African women use contraceptives. Photograph: Issouf Sanogo)

guardian.co.uk © Guardian News and Media Limited 2009

BBC News: Bans 'do not cut abortion rate'

Restricting the availability of legal abortion does not appear to reduce the number of women trying to end unwanted pregnancies, a major report suggests.

The Guttmacher Institute's survey found abortion occurs at roughly equal rates in regions where it is legal and regions where it is highly restricted.

It did note that improved access to contraception had cut the overall abortion rate over the last decade.

But unsafe abortions, primarily illegal, have remained almost static.

The survey of 197 countries carried out by the Guttmacher Institute - a pro-choice reproductive think tank - found there were 41.6m abortions in 2003, compared with 45.5 in 1995 - a drop which occurred despite population increases.

Nineteen countries had liberalised their abortion laws over the 10 years studied, compared with tighter restrictions in just three.

But despite the general trend towards liberalisation, some 40% of the world's women live amid tight restrictions.

On some continents this is particularly pronounced: well over 90% of women in South America and Africa live in areas with strict abortion laws, proportions which have barely shifted in a decade.

Researchers also noted that while liberalisation was a key element in improving women's access to safer terminations, it was far from the only factor.

Even in countries where abortion is legal, lack of availability and cost may prove major obstacles. In India for example, where terminations are legally allowed for a variety of reasons, some 6m take place outside the health service.

The costs of unsafe abortions, which can include inserting pouches containing arsenic to back street surgery, can be high: the healthcare bill to deal with conditions from sepsis to organ failure can be four times what it costs to provide family planning services.

COUNTRIES WHERE ABORTION HAS BEEN RESTRICTED
# 1997: Poland re-instated law outlawing abortion except when mother's life at risk or she had been raped
# 1998: El Salvador outlaws all abortions even when mother's life at risk
# 2006: Nicaragua similarly eliminates all grounds for legal abortion

Every year, an estimated 70,000 women die as a result of unsafe abortions - leaving nearly a quarter of a million children without a mother - and 5m develop complications.

In the developed world, legal restrictions did not stop abortion but just meant it was "exported", with Irish women for instance simply travelling to other parts of Europe, according to Guttmacher's director, Dr Sharon Camp. In the developing world, it meant lives were put at risk.

"Too many women are maimed or killed each year because they lack legal abortion access," she said.

"The gains we've seen are modest in relation to what we can achieve. Investing in family planning is essential - far too many women lack access to contraception, putting them at risk."

Double Dutch

Western Europe is held up as an example of what access to contraceptive services can achieve, and the Netherlands - with just 10 abortions per 1,000 women compared to the world's 29 per 1,000 - is held up as the gold standard.

“ Ensuring women have the means to end their pregnancies is not liberating them ”
Josephine Quintavalle Comment on Reproductive Ethics

Here, young people report using two forms of contraception as standard.

Even the UK, which has a relatively high rate, fares well in comparison to the US, where the number of abortions is among the highest in the developed world. The institute says this rate is in part explained by inconsistencies in insurance coverage of contraceptive supplies.

In much of eastern Europe, where abortion was treated as a form of birth control, abortion rates have dropped by 50% in the past decade as contraceptives have become more widely available.

And globally, the number of married women of childbearing age with access to contraception has increased from 54% in 1990 to 63% in 2003, with gains also seen among single, sexually active women.

But there were still significant unmet contraception needs, and a lack of interest among pharmaceutical companies in developing new forms of birth control that provide top protection on demand, the institute said.

Josephine Quintavalle of the anti-abortion Comment on Reproductive Ethics said stopping women falling pregnant in the first place was an area where minds could meet.

"Abortion - back street or front street - is not the answer. Ensuring women have the means to end their pregnancies is not liberating them - they should be able to make real choices before they fall pregnant in the first place," she said.

"But that shouldn't necessarily mean taking pills every day. There will always be problems with access and cost, particularly in countries where people struggle just to buy food.

"What we need is to better understand our fertility - if there are just 24 fertile hours in a month, we need to work out a cheap, effective way for women to know when they can fall pregnant. That would be freedom, and that's what we should aim for."

Story from BBC NEWS


Published: 2009/10/13 17:28:22 GMT

Documentary Film Screening and Performance

WHERE: River Room, Glucksman Art Gallery, UCC
WHEN: Sunday 18th October 2009, 2:00 PM – 5:30 PM

FILMS:
Abortion Democracy: Poland/South Africa (www.abortion-democracy.de), a film about why illegal
abortions are easier to access in Poland than legal ones in South Africa, by Sarah Diehl (Germany); and The Coat Hanger Project (www.thecoathangerproject.com), about abortion rights activism in the US from 1973-present, by Angie Young (USA). Young's film was an Official Selection at the 2009 Rosebud Film Festival.

PERFORMANCE BY:
Ann Rossiter, feminist activist and academic, whose book on the work of the London-Irish women's underground support network for Irish women travelling for abortions was published this year, will perform a 15-20 minute one woman show at the beginning of the event.

Both filmmakers and performer Ann Rossiter will be present at the event. It is a unique and exciting opportunity to view and discuss their work.

This free film event is organised by UCC Women's Studies Programme.
Info on it is brought to you by Cork Women's Right to Choose Group.
Donations to CWRCG are welcome.
For more info on the films see our Facebook event page.