Efforts to prevent unsafe abortions fall short

Despite efforts to improve sexual and reproductive health across Africa, a new study has shown that over four million women undergo unsafe abortions each year and 34,000 of them die as a result. In a recently released report, Ipas, an international women's health NGO, noted that 10 years after a landmark UN population conference in Cairo, Egypt, women in Africa continued to face "elevated risks" of dying from pregnancy-related causes, with unsafe abortion posing a particularly dangerous threat. At the 1994 International Conference on Population and Development (ICDP), 179 countries negotiated a "Programme of Action", which recognised the importance of preventing unsafe abortions through increased availability of contraceptive services and safe abortion care where this was legal. While the report conceded that "very important strides" had been made in several areas, including contraceptive services and the quality and availability of emergency treatment for women who had undergone unsafe abortion, it found that many African women still turned to clandestine abortions, often with tragic results. According to the Ipas report, 'Lives Worth Saving: Abortion Care in sub-Saharan Africa since ICPD', promises made at the Cairo conference had only partially been kept. "With a few exceptions, Africa's laws concerning provision of abortion – many the legacy of colonial law - are among the most restrictive in the world. Nevertheless, the World Health Organisation [WHO] estimates that more than 4 million African women undergo abortions every year, usually performed by unqualified providers in dangerous conditions," Ipas said. In 1996 South Africa made abortion available on demand during the first-trimester of pregnancy. The study noted that the government had authorised and trained nurse-midwives to perform the procedure, enabling rural women to access safe legal abortion. Since the conference there has been a flurry of policy initiatives focusing on the issue of unsafe abortion across Africa. In July 2003 the African Union called for increased protection of women's reproductive rights, including access to abortion. Post-abortion care programmes have been created or strengthened in numerous countries. However, progress in improving women's access to safe abortion has been scant. The Ipas report outlined numerous challenges in improving African women's access to safe abortion care, including overcoming limitations of poor health infrastructures and addressing abortion in the context of the HIV/AIDS crisis. WHO estimates that a minimum of US $35 to $40 per capita is needed for basic health services, an amount many countries in Africa fall far short of making available. The report also pointed out that in some African countries, women were six times more likely to contract HIV than men. "While they [women] have the same right rights to decide whether or not to bear children, the necessary services are not always available or properly provided for women with HIV/AIDS. Moreover, the health consequences of unsafe abortion may be exacerbated for women with HIV/AIDS," the report observed. Full report: www.eldis.org