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EVERY WOMAN'S LIFE IS WORTH SAVING: The Right to Safe Abortion in Asia.

Abortion, safe or unsafe, takes place as a response to unintended pregnancies and is an undeniable part of many women's lived realities. Between 2010 to 2014, globally 44% of the 227 million pregnancies per year were unintended and 56% of unintended pregnancies end in an abortion. (1) There are many well-known reasons and drivers to abortion, including socio-economic reasons, non-readiness, partnership situation, low age, threat to the mother's life, failed or lack of contraception, choices, birth-spacing, the desire to stop having children, changing circumstances, rape, and incest. Making abortions safe and accessible must be prioritised in any reproductive health and rights strategy. (2,3)

This article shares global and regional estimates on access to safe abortion. It presents a framework for how safe abortion has to be addressed as a rights issue and shares the work of the Solidarity Alliance for the Right to Safe Abortion, a global South alliance for action.

Key Trends. Between 2010-2014, 55-9 million abortions occurred each year, most of which took place in developing regions (49.3 million). Globally, 35 abortions were done annually per 1,000 women aged 15-44, with 36 per 1,000 women having abortions in the developing world. (4) The annual abortion rate in Asia during 2010-2014 was around 36 per 1,000 (married women) and 24 per 1,000 (unmarried women) with 27% of pregnancies ending in abortion. (5) Between 1995-2000, unsafe abortions varied substantially by age across regions, which requires further attention in addressing the effects of unsafe abortion. Within this, adolescents (15-19 years) account for less than 25% of all unsafe abortions in Asia. (6)

Complications from unsafe abortions can lead to maternal mortality and morbidity over the short and long term. Globally, between 2010-2014, 14% of all abortions were least safe. 49% of those in the developing world are considered unsafe. (7) Around 4.6 million women of reproductive age in Asia were treated for complications from unsafe abortion in 2012 and around 6% of all maternal deaths in 2014 were from unsafe abortion. (8)

The consequences of unsafe abortion continue to affect women's mortality and morbidity. (9) Women seek treatment after an abortion depending on legal restrictions and accessibility, often when symptoms have become life-threatening. Some women, particularly poor and from rural areas, may forgo treatment altogether. Annually, 8.2 per 1,000 women of reproductive age were treated in facilities for post-abortion complications in Asia as of 2012. From 2010-2014, in Asia, 62 of 100,000 induced abortions led to death. (10)

The cost of treating these complications adds to the burden of health service budgets, as well as to families and women affected by unsafe abortions. Annually, costs are estimated at US$232 million; costs that would drop to US$20 million if abortions were provided safely. Related costs, such as child care, transportation and others would increase estimates of post-abortion care costs. (11)

The figures for abortion rates and its impact on maternal health and post-abortion care have to be considered together with fertility rates and access to contraception. Available data shows that wanted fertility rates are declining and reflect a wide unmet need for contraception amongst women in unions (12) globally and in the least developed countries. (13)

A Framework for Ensuring the Right to Safe Abortion. Recognising abortion as a human right presents avenues to address barriers and ensure the provision of holistic services. As a result, every woman's needs and circumstances are considered, acknowledging the need to address socioeconomic injustices that contribute to unintended pregnancy and unsafe abortion. Women are supported to make and act on reproductive health decisions freely and safely. Furthermore, drivers of marginalisation, discrimination, and inequalities are identified to be addressed as part of a holistic rights-based solution. (14)

Table 1 presents the interlinked issues, potential barriers and considerations for ensuring abortion as a human right. It includes not only the more clear-cut aspects of ensuring access to safe service, but also shows how barriers can form and change at various junctures. Further, it presents the broad-range of actions that need to be undertaken in the path to ensuring the right to safe abortion.

Global South Alliance. The Solidarity Alliance for the Right to Safe Abortion, launched in 2018, currently comprises six civil society organisations committed to realising the right to safe abortion for all women through strategic interventions that recognise abortion as a rights issue. Bringing the experience and expertise of six organisations from the Global South--Bangladesh (Naripokkho), Cambodia (Reproductive Health Association of Cambodia or RHAC), India (CommonHealth), Nepal (Beyond Beijing Committee or BBC), and the Philippines (Women's Global Network on Reproductive Rights or WGNRR)-the alliance aims to improve evidence on the drivers of unsafe abortion to inform regional and local advocacy and advocate for safer access to abortion.

The Alliance will implement interventions in varied contexts of legality, striving to ensure accountability towards the reproductive rights of women, including young women. Firstly, this will be done by improving awareness on the legality of abortion and availability of services in order to address the barriers that prevent access to some women over others. Secondly, the Alliance will ensure the right to abortion by addressing factors that cause stigma and prevent access to safe services and ensuring autonomy to claim these rights. Thirdly, the Alliance will focus on addressing barriers to access caused by the conscientious objection by service providers that denies services, including referrals. Lastly, it will work towards improving the quality of abortion services, including post-abortion care to help address the impact on maternal mortality and morbidity.

The diversity of Asia and legal restrictions around abortion means that targeted interventions to ensure access to safe services cannot be deprioritised. Efforts such as this come at a critical time, when conservatives in the region are threatening past gains, particularly for those who are most vulnerable, including younger women and those unable to access health services. Access to safe abortion is severely curtailed as a result and tends to be the most marginalised in efforts to ensure sexual and reproductive rights. It is time to change that as part of ensuring human rights for all and in the fight to leave no one behind.

By Azra Abdul Cader

Programme Manager, Asian-Pacific Resource and Research Centre for Women

Email: azra@arrow.org.my

Notes & References

(1.) Susheela Singh et al., Abortion Worldwide 2017: Uneven Progress and Unequal Access (New York: Guttmacher Institute, 2018), https://www.guttmacher.org/sites/default/files/report_pdf/abortion-worldwide-2017.pdf.

(2.) Singh et al., Abortion Worldwide 2017.

(3.) David A. Grimes et al., "Unsafe Abortion: The Preventable Pandemic," Sexual and Reproductive Health 4, Lancet 368 (2006): 1908-19, https://doi.org/10.1016/S01406736(06)69481-6.

(4.) Singh et al., Abortion Worldwide 2017.

(5.) Guttmacher Institute, Abortion in Asia: Factsheet (New York: Guttmacher Institute, 2018), https://www.guttmacher. org/sites/default/files/factsheet/ib_aww-asia.pdf

(6.) Grimes et al., "Unsafe Abortion."

(7.) Singh et al., Abortion Worldwide 2017.

(8.) Guttmacher Institute, Abortion in Asia.

(9.) Complications include haemorrhage, sepsis, peritonitis, and trauma to the cervix, vagina, uterus, and abdominal organs. Grimes et al., "Unsafe Abortion."

(10.) Grimes et al., "Unsafe Abortion."

(11.) Grimes et al., "Unsafe Abortion."

(12.) Data often does not include sexually active single women and adolescents. Singh et al., Abortion Worldwide 2017.

(13.) Singh et al., Abortion Worldwide 2017.

(14.) Evelina Borjesson, Karah Pedersen, and Laura Villa Torres, Youth Act for Safe Abortion: A Training Guide for Future Health Professionals (Chapel Hill, NC: Ipas, 2014), http://ifmsa.org/ wp-content/uploads/2015/01/Youth-ACT-for-safe-abortion.pdf.
TABLE 1: ISSUES ENCOMPASSED WITHIN THE RIGHT TO SAFE ABORTION

BROADER FACTORS TO CONSIDER:

* Every woman is a rights holder, capable of making informed
decisions about her body and life choices.

* How barriers manifest depends on the context and multiple
levels of marginalisation of women.

* Women are a heterogeneous group and intersectionality has
to be considered.

* Lived realities and experiences of women guide decisions
to end pregnancy.

Legislation, Policy,
and Programming                   Perceptions and Attitudes

* Amending laws including         * Not influenced and
penal codes                       bound by conscientious
* Broader legality                objection
continuum allowing                * Addressing social cultural
abortion, including               barriers that position
outside the context of            women as inferior and
marriage                          within a reproductive role
* Decriminalisation or            * Enabling progressive
conditional access to             narratives of abortion,
abortion--gestational              right to choice,
period, medical approval,         pro-choice, and others
waiting periods,                  * Addressing perception
mandatory counselling,            across spheres, including
and others                        informal (family)
* Ensuring laws do not            * Abortion outside the
leave room for                    context of the institution
interpretation when               of marriage
implemented
* No conflict with other
laws on reproductive
health
* Guidelines for
implementation
documents of laws to
ensure rights-based
quality services, including
post-abortion care
* No third-party
authorisation
* Removal of third-party
punitive actions
* Decision rests solely with
the woman
* Non-use of conscientious
objection

Addressing Stigma                 Access to Services

* Stigma has many                 * Follows WHO Technical
dimensions                        Guidelines to provide
* Women themselves                comprehensive care
perpetuate stigma                 * Abortion services are an
* Women, providers, and           integral part of healthcare
advocates face stigma             * Availability and access to
* Fear mongering through          quality services, including
stigma                            pre- and post-counseling
* Stigma is dynamic--it           and contraception
changes over time and in          * Service provision by a
relation to the space             broader range of skilled
* Ensuring rights-based           practitioners
interventions to address          * Abortion services are
stigma and its effects            integrated into youth-
                                  friendly services
                                  * Free of stigma, judgment,
                                  discrimination, and
                                  violence
                                  * Maintaining privacy and
                                  confidentiality
                                  * Political will and
                                  resources to ensure safe
                                  service provision
                                  * Cost and affordability
                                  * Privacy and
                                  confidentiality
                                  * Post-abortion care

Access to Information

* Availability and access
to quality information on
bodies, rights, social
networks, RH, and
abortion
* Integration in healthcare
services curriculum
* Sources of information
that are reliable
* Accurate information

Sources: Created using Evelina Borjesson, Karah Pedersen, and Laura
Villa Torres, Youth Act for Safe Abortion: A Training Guide for
Future Health Professionals (Chapel Hill, NC: Ipas, 2014) and
Susheela Singh et al., Abortion Worldwide 2017: Uneven Progress and
Unequal Access (New York: Guttmacher Institute, 2018).
COPYRIGHT 2018 Asian-Pacific Resource & Research Centre for Women
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:spotlight
Author:Cader, Azra Abdul
Publication:Arrows For Change
Geographic Code:90ASI
Date:Mar 1, 2018
Words:1650
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