Zero tolerance for unsafe abortion.

Abortion--A Worldwide Perspective

Colin Francome and Marcel Vekenams

(Middlesex University Press, 2007, 200pp) 978-1-90475-023-9, _19.99

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THIS BOOK IS BY TWO PEOPLE whose longstanding efforts to promote the importance of reproductive choice are well-recognized. Professor Colin Francome is a British sociologist who has written numerous books and articles about abortion politics and practice (as well as those about related subjects, including childbirth and men's health) and who has collaborated with the UK prochoice movement for many years. Marcel Vekemans also has long-term active involvement with prochoice politics in Europe, having worked for the decriminalization of abortion in Belgium. He is an obstetrician and gynecologist and has used this expertise to assist the work of a number of non-government organizations working to improve reproductive health (he is currently the senior medical officer for abortion in the London office of the International Planned Parenthood Federation).

These authors have a great deal of knowledge and experience to draw upon and are well-placed to write a volume about abortion worldwide. Nonetheless,

they took on a very ambitious project with this book. dbortion--A Worldwide Perspective has at its center a summary of abortion service provision in 82 countries, divided into sections about Europe,

Asia, Africa, Latin America and the Caribbean, Oceania and North America. The information tells something about the abortion laws and policies of every country with a population of more than 20 million people. The discussion also briefly covers the history of these regulations, and we are given some key statistics (for example, about population size and average age of mortality). The scope of the book is such that the context for abortion for 90 percent of the world's women is considered, albeit briefly. This information is prefaced by an introduction that sets out the authors' main conclusions that we might draw from such a worldwide perspective on abortion. Three short chapters at the end discuss the problem of illegal abortion, the merits of legal abortion, and the authors' recommendations for changes to service provision.

One use of the book is as a reference volume, since it provides readers with a handy summary of some important information. It does not seek, however, to be only a sort of short encyclopedia of abortion laws. Rather, the point of Abortion--A Worldwide Perspective is to draw attention to what Francome and Vekemans consider to be the pressing and scandalous problem of continuing inequality in reproductive health and choice worldwide. The mass of information they provide emphasizes the gap between the situation of women in different parts of the world, and their project is to provide an explanation for this gap and press the case for shrinking it.

The main message concerns the differences between countries and the implications of these differences. Attention is drawn to the disparity of experience within regions of the world where abortion is legal. For example, they highlight the difference in abortion rates within Europe. The issue is not simply the legality of abortion, since women's health suffers where legal abortion is relied upon because contraception remains relatively unavailable. The central difference preoccupying the authors is that between countries where there is safe, legal abortion and those where abortion remains unsafe, primarily because of its legal status.

This difference, the authors argue, reflects and reinforces the uneven distribution of wealth worldwide. Unsafe abortion is "largely a problem of poverty," they contend. Thus, while the past three to four decades has seen a systematic shift to the legalization of abortion and the provision of better abortion services, the poorer areas of the world have been excluded from this positive trend. Maternal mortality and morbidity rates in poorer countries where abortion is legally restricted are far, far worse than those in more wealthy countries. The point is strongly made, however, that abortion will not "go away" whatever the legal regime. The real alternatives are not the presence or absence of abortion but of legal abortion and vastly improved health status for women on the one hand, and the legal restriction of abortion and its costs on the other.

This point is re-emphasized in a different way in the chapters that end the book, as the authors review historically the effects of illegal abortion in developed countries (Britain and the US), and consider the ways in which the trend to legal abortion overall has improved matters for individuals and societies. The discussion about recent medical developments further affecting women's well-being--namely the advent of new abortion techniques that make abortion even safer--show the positive implications of the provision of abortion.

SOME IN THE PROCHOICE COMMUNITY may take issue with assertions about relationship between poverty and family size; for example, the claim that the correlation between poverty and family size should point toward contraception and abortion rather than increased economic development. Some of us robustly contest the idea that the primary explanation for poverty lies in family size and population growth. The rhetorical device used at the start of the book to draw attention to the need to raise awareness about unsafe abortion may also not find favor with all: "While terrorism dominates the media and billions are spent preventing terrorist attacks, unsafe abortion remains the silent killer." In Britain, the claim that unsafe abortion is a bigger problem than terrorism is only the most recent in a growing list of similar claims-others include obesity and global warming--to try to draw awareness to a particular problem. This does raise the question of the extent to which those who seek to draw attention to issues can do so successfully in a marketplace of claims in which "bigger than terrorism" seems to be the standard means to emphasis the scale of a problem.

While the overall message of this volume will be familiar to those in the prochoice movement, its strength is in compiling in one short volume such a compelling summary of facts and argument about abortion worldwide. The book is a valuable resource for the library of anyone concerned with reproductive health, and its main messages are ones that need to be promoted more widely.

ELLIE LEE is o lecturer in social policy at the University of Kent, the coordinator of the Pro-Choice Forum, and has written articles and has done extensive research and writing on topics such as abortion, teen pregnancy and motherhood.