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Dealing with the complications of abortion

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At the 1994 International Conference on Population and Development (ICPD) in Cairo, unsafe abortion was identified as a major public health concern and governments agreed to work for its elimination. The plan of action included better access to modern contraceptive methods, to high-quality post-abortion care (needed for treating the complications of miscarriages as well as those of unsafely induced abortions), and to safe abortion services to the full extent permitted by local laws. The United Nations General Assembly’s special session in 1999 (ICPD+5) stated that "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" ( 101 ).

Safe and comprehensive post-abortion care for the complications of induced abortion, and the provision of abortion services to the extent permitted by law, remain severely restricted by the deficiencies of health systems and lack of access. Women, particularly adolescents, the poor and those living in rural areas, often do not know where to find services that are safe and legal. They may lack the resources, time or decision-making power to avail themselves of such services, or be deterred by lack of privacy and confidentiality and by the attitudes of health care providers ( 102 ). The result is that many women, particularly in developing countries, may then resort to unqualified providers or "quacks" and put their lives in danger. A particularly dramatic case is that of refugees, in a context where systematic rape is increasingly used as a weapon of war. Most countries permit abortion in such circumstances, yet women as well as health care providers are often unaware of this, and humanitarian assistance, for example in refugee camps, tends to neglect this issue ( 103 ).

Abortion is legal, on varying grounds, in many countries (see Figure 3.3), but even policy-makers and professionals are often only vaguely aware about what the law permits and what it does not. Where legislation is less restrictive, there are, in principle, more possibilities for women to terminate an unwanted pregnancy under safe conditions. Yet, services may be poorly equipped or health personnel inadequately trained, even though the training, equipment and policies needed to ensure that women eligible under law have access to safe care are neither complicated nor costly ( 84 ). In India, for example, where a liberal abortion law has been in place since 1974, unsafe abortions still outnumbered safe abortions by a factor of 7 in the early 1990s, as a result of administrative barriers and lack of information, with deaths from unsafe abortion accounting for 20% of all maternal deaths. But where, to the extent permitted by law, measures are taken to train and equip professionals and facilitate access to safe services and information, as recommended by the United Nations General Assembly, women are less likely to resort to unsafe abortion.

Every year, many millions of women experience the distressing event of an unwanted pregnancy. Continued investment in education, information, and public provision of contraceptive services can go a long way to keep this to a minimum – although no family planning policy will prevent all unwanted pregnancies. But it is possible to avoid all of the 68 000 deaths as well as the disabilities and suffering that go with unsafe abortions. This is not only a question of how a country defines what is legal and what is not, but also of guaranteeing women access, to the fullest extent permitted by law, to good quality and responsive abortion and post-abortion care.

Footnotes

84 Safe abortion: technical and policy guidance for health systems. Geneva, World Health Organization, 2003.

101 ICPD + 5: Key actions for the further implementation of the programme of action (http://www.un.org/esa/population/publications/POPaspects/ICPD+5%20Key%20Actions.pdf, accessed 13 January 2005).

102 Mundigo AI, Indriso C, eds. Abortion in the developing world. New Delhi, Vistaar Publications for the World Health Organization, 1999.

103 Vekemans M, Hurwitz M. Access to safe abortion services to the fullest extent permitted by law. IPPF Medical Bulletin, 2004, 38.

104 World abortion policies 1999. New York, NY, United Nations Populations Division, 1999.

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