For safe and legal abortion.

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Because motherhood should be chosen and not imposed by cultural, political or religious dictates or repressive laws.

Because women have the right to choose if they wish to bear children and when to do so.

Because all children have the right to be wanted and welcomed, and because this knowledge endows their life with a sense of humanity.

Because criminalizing abortion only leads to more deaths resulting from clandestine procedures, while governments, legislators, religious hierarchies and society at large ignore the situation.

Because women must be able to make decisions over their own bodies freely and autonomously without being the object of violence, coercion or force.

In recent decades, human sexual behavior and reproductive activity has changed tremendously throughout the world, especially women's reproductive behavior. These changes are reflected in smaller family size. While some couples still have four or five children, especially in poorer countries and in rural areas, the gradual transformation of the traditional roles of women and men and the increasing incorporation of women into the workforce have had an impact on lower fertility rates.

Nonetheless, despite the increased access to contraceptive methods worldwide, over 120 million couples still have unmet needs with regard to fertility regulation and eventually have more children than their ideal family size. As a result, nearly 80 million women must deal with unwanted or unplanned pregnancies, which often end in abortions. When these procedures are performed in clandestine and unhygienic conditions, they can lead to serious health consequences and even result in the woman's death.

Complications related to pregnancy, childbirth, postpartum and abortion result in death for over 500,000 women every year, while another 10 million women endure consequences ranging from mild to very serious, including obstetric fistula and infertility. Over 80% of all maternal deaths are related to five causes: hemorrhage, sepsis, unsafe abortion, obstructed labor and pregnancy-related hypertension (preeclampsia and eclampsia). The other maternal deaths are the result of indirect causes including illnesses that can become aggravated if untreated during pregnancy. Nonetheless, one in three maternal deaths could be prevented with timely access to modern and efficient contraceptives.

In Latin America and the Caribbean, nearly 22,000 women die each year due to causes related to pregnancy, childbirth and the postpartum period. Most of these women are poor, indigenous, black and/or residents of marginalized or rural areas where they often lack access to comprehensive sexual and reproductive health services, pre- and post-natal care and contraceptive methods.

Adolescent and young adult women (aged 15 to 20) are twice as likely to die in childbirth as women over 20 years of age, and 15-year-old women are five-times as likely to die. Complications of pregnancy and childbirth are the leading cause of death among women aged 15 to 19 in developing countries. One in four of all unsafe abortions are performed on adolescent women age 15 to 19, approximately 5 million a year.

In 2003, some 42 million abortions were performed throughout the world, or 31 per 100,000 live births. This is a decrease from the 1995 rate when 46 abortions per 100,000 live births were reported. The worldwide abortion rate in 2003 was 29 per 1,000 women aged 15-44, compared to 35 in 1995.

Among all the abortions performed worldwide, 48% are illegal or unsafe abortions, a total of 20 million, resulting in the deaths of 74,000 women each year. Over 97% of these clandestine procedures are performed in developing countries.

While abortion rates are comparable for developed and developing countries, unsafe abortions are concentrated in the latter. Clearly, there is an urgent need to ensure access to a range of safe, modern contraception methods and to advance towards the decriminalization of abortion to ensure that women do not continue to die from this preventable cause.

Over 4 million abortions are performed every year in Latin America and the Caribbean. Most of them are illegal and therefore inherently unsafe. While estimates show these clandestine procedures to be one of the leading causes of maternal death, this reality has seemingly no impact on policy- and lawmakers in our region who are reluctant to liberalize the restrictive laws still on the books. Fundamentalist politicians and organized religion, primarily the Catholic Church, have unleashed their resources in our region to sway the media and political negotiations to prevent any legislative changes in favor of women's right to freedom of choice.

Global Call to Action

In this complex political, social and public health context, the groundbreaking Marie Stopes International Global Safe Abortion Conference took place in London on October 23-24 2007, providing new impetus and renewed commitment to achieving the fundamental right to access safe abortion services for women all over the world. Such action is particularly relevant for our region, given the recent announcement by the Vatican that the Catholic Church will take up a worldwide campaign against abortion to be spearheaded in Latin America and the Caribbean this year.

Over 800 health-care professionals, government representatives and activists attended the meeting in representation of some 60 countries. Also sponsored by Ipas and Abortion Rights, the conference drew attention to the deaths, injuries and illnesses that women endure as the result of unsafe abortion but stressed the recent improvement in women's access to safe abortion services as the result of the liberalization of laws in several countries around the world. The harshest criticism was reserved for countries like Nicaragua, which recently made therapeutic abortion illegal with the concurrent cost in both public health and social welfare, and for the Bush administration's support for the Global Gag Rule as well as other abortion-related measures that have been detrimental to sexual and reproductive health.

At the conference's conclusion, the participants developed the Global Call to Action for Women's Access to Safe Abortion, which can be signed at the conference website at http://www. globalsafeabortion.org/calltoaction. html. The Call to Action states:

We are women and men, young and old, professionals, elected officials, civil servants, researchers, students and advocates committed to the health and human rights of women.

We sign this Global Call to Action to demand that women everywhere facing unwanted pregnancies be treated with respect and compassion and have full access to legal, voluntary, safe and affordable abortions as part of comprehensive sexual and reproductive health care.

It is intolerable that:

* Millions of women continue to suffer severe injuries and trauma, and more than 66,000 die needlessly each year from abortions that are procured unsafely from unskilled providers or self-induced, almost all in developing countries. Others are criminalized or imprisoned.

* Women throughout the developing world are often denied the information and means to prevent unwanted pregnancy; many also face sexual violence, often resulting in pregnancy, without adequate protection or treatment.

* The contraceptive and abortion technologies to save women's lives have been well known for decades, yet these technologies are often not used because of politically and ideologically-motivated interference; restrictive laws; inappropriate, inaccessible and poor-quality services; lack of resources; or other barriers.

* With few exceptions, donor and government programmes aimed at the Millennium Development Goal to improve maternal health neglect the 13 per cent of maternal deaths caused by unsafe abortion globally and fail to support the full range of preventive actions required. We call for a global safe abortion movement promoting the following goals:

* Women's rights to contraception and safe abortion are protected and supported through reformed laws and policies at all levels.

* Governmental authorities and donors commit increased resources to ensure that comprehensive sexual and reproductive health care, including contraception and safe abortion services, is widely available through skilled providers in both public and private health systems.

* Medical training institutions routinely provide training in abortion-related care for physicians, nurses, midwives and other healthcare workers. * Women and healthcare providers are informed about women's legal rights and reproductive options and know where contraception, safe abortions and other reproductive health care can be obtained.

* Women in vulnerable circumstances have access to comprehensive sexual and reproductive health care that responds to their special needs--including young women and women who are poor, are refugees or displaced, or are survivors of sexual violence.

We will form new alliances with all who support these goals and the need for urgent action. We will hold accountable all those who by their words or actions stand in the way. The lives and health of millions of women are at stake. We will be heard, and we will act now.

Marie Stopes International will present the collected signatures to world leaders at the 60th anniversary of the Universal Declaration of Human Rights on International Human Rights Day, December 10, 2008, calling for women's access to legal, safe abortion to be recognized as a fundamental human right.

This initiative is of special importance to Latin America and the Caribbean because most of the countries in our region still have very restrictive laws or other barriers established by conservative sectors and the Catholic hierarchy with very serious results, including the outlawing of therapeutic abortion in Nicaragua, the refusal of Brazil's National Health Conference to support a proposal for the decriminalization of abortions, the barriers to the Law to Defend Reproductive Health in Uruguay and the ruling that Chile's National Regulations on Fertility Regulation were unconstitutional.

To contribute to the debate on this transcendental issue, we are pleased to include the following article sharing the experiences of civil actions to promote the decriminalization of abortion in Uruguay, written by Lilian Abrascinskas and Alejandra Lopez, coordinators of Mujer y Salud en Uruguay (MYSU, Women and Health in Uruguay).

Sources: The Lancet (http://www. thelancet. com/); the International Conference Women Deliver (http://www.womendeliver.org); the United Nations Population Fund (http://www.unfpa.org/); the Pan-American Health Organization (http://www.paho.org/); and the Global Safe Abortion Conference (http://www.globalsafeabortion.org).