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Advocacy to bring down alarming rates of unsafe abortion.

In Asia, unsafe abortion accounts for 12 per cent of all maternal deaths, higher than in any other region of the world with an estimated 38,000 women dying each year from medical complications alone. (1) Half of the world's unsafe abortions (10.5 million) took place in Asia in 2000. (2)

About 14 unsafe abortions occur for every 100 live births in Asia, excluding East Asia where safe abortion is widely accessible. (2) There has been a continuous struggle to maintain the status quo with regard to safe abortion where it is available and to reverse the situation where it is not available, in spite of the relative successes of implementing key recommendations of the ICPD Programme of Action (POA). The present US government's policy on abortion has a disproportionately negative influence, making other governments and NGOs nervous about cutbacks in financial resources for their sexual and reproductive health programmes. The US government directly and indirectly goes to extraordinary lengths to exert their double-standard point of view on others, as recently witnessed at the ESCAP conference in Bangkok and other UN organised conferences. Abortion is legal in the US, but its government will not fund abortion outside the US.

Countries in Southeast Asia have relatively low rates of unsafe abortion. Not learning from this experience is a missed opportunity for other countries in Asia. In many Southeast Asian countries, such as the Philippines, there are indications of growing religious influence that deters open support of safe abortion, if not exerting outright opposition.

It is clearly stated in the ICPD POA that abortion should not be promoted as a method for family planning. However, humane treatment and counselling must be given to women who have had recourse to abortion (POA, Para 8.25). Other critical key language from the ICPD POA and Beijing Platform for Action (PFA) that can be used in an advocacy strategy include: "All governments are urged to strengthen their commitment to women's health, to deal with the health impact of unsafe abortions as a major public health concern and to reduce the recourse to abortion through expanded and improved family planning services. In all cases, women should have access to quality services for the management of complications arising from abortion" (PFA, para 106). Another key declaration advocates can use in lobbying to improve access to safe abortion is the Millennium Development Goals that cite improved maternal health as one of the targets. This can be interpreted to include access to safe abortion.

Advocacy Strategies

To fulfil the needs of women and expand access, successful advocacy strategies should target all or some of the following issues:

* Broad participation--a concerted advocacy effort that includes working with community women, service providers, the legal profession, activist groups, sympathetic people in government, media, NGOs and private sector;

* Improving abortion laws without jeopardising existing availability, as in Bangladesh where menstrual regulation is relatively accessible;

* Work towards enactment of laws that protect both women and providers;

* Take on legal cases to encourage both service users and providers;

* Advocate for increased, adequate and better use of human and financial resources and logistics/supplies for safe abortion services;

* Campaign for improved policy and practice of government, private sector and NGOs for safe abortion;

* Engage in policy dialogue with key decision makers in government and donor institutions;

* Take into consideration new medical methods of abortion, such as Mifepristone, to expand choices available to women;

* Ensure that the method, timing and message of advocacy is appropriate to the environment and circumstances--inappropriateness can result in much damage;

* Raise the awareness of younger women who do not appreciate the absence of laws and safe services. It must be ensured that the existing positive situation is not eroded (particular reference to Southeast Asia);

* Promote training of service providers to ensure good technical, planning and management skills;

* Undertake 'quiet' awareness raising among stakeholders on an on-going basis;

* Campaign for collaborative design, implementation and use of research and documentation for sharing and learning about safe abortion laws, policy, practices and services; and

* Once positive laws are enacted, advocate for supportive funding, policy, practices, services, training, logistics, supplies, research, etc, which are crucial processes for implementation.

Activists have already designed frameworks and manuals to assist NGOs in advocating to improve access to safe abortion in the region. A framework analysing the political, economic, administrative, social, cultural, national and international contexts can assist advocates to devise an effective strategy. Training required to undertake a successful abortion advocacy strategy should include: understanding of advocacy, problem identification, problem analysis, research, policy papers,, situation analysis, stakeholder analysis, negotiation and lobbying, audience targeting, communication materials, interventions and organisational capacity. White's framework consisting of mapping the policy arena, defining major issues and designing policies and implementation strategies can be a useful guide, as it looks at macro and sectoral policies, institutional analysis, human resource development and mobilisation of people. (3) The US-based Centre for Reproductive Rights has widely published a briefing paper as an advocate's guide to the work of UN treaty monitoring bodies in the area of sexual and reproductive rights.

Advocacy is almost the only means whereby laws, policy and practice can be changed. Sharing of experiences among concerned and committed people and organisations is surely the way forward.

[] Endnotes

(1.) United Nations Economic and Social Council for Asia and the Pacific and United Nations Population Fund. 2002. Reproductive Health. Including Family Planning Fifth Asian and Pacific Population Conference Bangkok: UNESCAP.

(2.) Ahman, Elisabeth; Iqbal Shah. 2002. Unsafe abortion: Worldwide Estimates for 2000, Reproductive Health Matters vol 10, no 19. London: RHM.

(3.) White, G Louis. 1990. Implementing Policy Reforms in LDCs. A Strategy for Designing and Effecting Change. London: Lynn Rienna Publishers.

Center for Reproductive Rights. 2002. Bringing Rights to Bear: An Analysis of the Work of UN Treaty Monitoring Bodies on Reproductive and Sexual Rights. New York: Center for Reproductive Rights and University of Toronto International Programme on Reproductive and Sexual Health Law.

[] By Sandra Kabir, Programme Advisor, International Council on Management of Population Programmes, No 534, Jalan Lima, Taman Ampang Utama, 68000 Ampang, Selangor, Malaysia. Tel: (603) 42566122. Fax (603) 42560029. Email:
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Author:Kabir, Sandra
Publication:Arrows For Change
Date:May 1, 2003
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