Abortion in Abortion in AfricaAfrica

Marijke Alblas,Marijke Alblas,

Medical Consultant, S.A.Medical Consultant, S.A.

Maternal mortality is the Maternal mortality is the most dramatic health most dramatic health

inequality on the planet, inequality on the planet, even more than child even more than child

mortality.mortality.

In the developed countries, about 1 in 7,300 women are

likely to die from a pregnancy-related cause. One in 7,300. In eastern Asia, that's one in 1,200. In North Africa, one in 210. South Asia, one in 61.

And finally, sub-Saharan Africa, one in 22."

One of the MDG is to reduce One of the MDG is to reduce the maternal mortality: 75% the maternal mortality: 75% cut in the MM rate by 2015cut in the MM rate by 2015

However, in many sub-However, in many sub-Saharan African countries the Saharan African countries the

numbers have been rising numbers have been rising instead of going down.instead of going down.

Every minute, a woman dies from pregnancy-related

complications. Most likely, these deaths could easily be

prevented if every woman had access to basic primary

and emergency obstetric care, including (post) , including (post)

abortion careabortion care

Why?Why?

Major causes of maternal deathMajor causes of maternal death

Hemorrhage25%

Sepsis15%

Eclampsia12%

Abortionn13%

Obstruction8%

0ther27

World Health Organization (WHO). Mother Baby Package: Implementing Safe Motherhood in Countries. WHO/FHE/MSM/94.11. Department of Reproductive Health and Research, Geneva: WHO;1994.

BackgroundBackground• Unsafe abortion is a worldwide problem

with 95% occurring in developing countries• Death rate from unsafe abortion is

hundred times higher in developing countries than in developed countries

• Developed regions: 0,2-1,2 death per 100.000 abortions

• Developing regions: 330 death per 100.000 abortions

• Sub-Saharan Africa: 680 death per 100.000 abortions

Women are dying due to Women are dying due to illegal, back street abortions illegal, back street abortions ( deaths form abortions are ( deaths form abortions are the third biggest cause of the third biggest cause of

MM).MM).But abortion is still such a But abortion is still such a

controversial issue and controversial issue and therefore difficult to mobilize therefore difficult to mobilize

the public and politicians the public and politicians

A study, Testing Community Level A study, Testing Community Level Strategies to Reduce UnwantedStrategies to Reduce Unwanted

Pregnancy and Unsafe Abortion in Pregnancy and Unsafe Abortion in Western Kenya, is an outcome of aWestern Kenya, is an outcome of a

research conducted in Suba, a remote research conducted in Suba, a remote area in western Kenya. Conductedarea in western Kenya. Conductedbetween 1999 and 2004, the study between 1999 and 2004, the study

sought to find out if communities couldsought to find out if communities couldbe effective in reducing abortion-related be effective in reducing abortion-related

deaths.deaths.

The study reveals that communities The study reveals that communities in Suba were able to reducein Suba were able to reduce

abortion-related mortality. This abortion-related mortality. This followed community education and followed community education and

thethetraining of informal community health training of informal community health

workers to administer first aidworkers to administer first aidmeasures to women who had measures to women who had

terminated pregnancies, as they terminated pregnancies, as they ensured timelyensured timely

referrals to nearest clinics with referrals to nearest clinics with trained medical personnel.trained medical personnel.

"There was a significant decline in "There was a significant decline in abortion-related mortality from 87abortion-related mortality from 87

percent in 2001/2002 to 13 percent in percent in 2001/2002 to 13 percent in 2003/2004," says the study. It was2003/2004," says the study. It was

conducted by the regional office of the conducted by the regional office of the U.S.-based Centre for the StudyU.S.-based Centre for the Study

of Adolescents, the U.S.-based Pacific of Adolescents, the U.S.-based Pacific Institute for Women's Health andInstitute for Women's Health and

the Kenya Medical and educational the Kenya Medical and educational Trust, a non-governmentalTrust, a non-governmental

organisation.organisation.

Kenyan Human Rights Commision: Kenyan Human Rights Commision: to deny a woman an abortion is a to deny a woman an abortion is a

violation of her human rights. There violation of her human rights. There are four human rights that are four human rights that specifically deal with thespecifically deal with the

need for safe and legal abortion need for safe and legal abortion which are: Women's Right to life which are: Women's Right to life

andandSurvival, Health, Nondiscrimination Survival, Health, Nondiscrimination

and Reproductive Self and Reproductive Self Determination.Determination.

KHRC has organized a tribunal on 26th KHRC has organized a tribunal on 26th June 2007 on abortion rights inJune 2007 on abortion rights inKenya to publicize the negative Kenya to publicize the negative

consequences of criminalization ofconsequences of criminalization ofabortion. abortion.

This was the first to be organized in This was the first to be organized in Africa, the tribunal was modeled onAfrica, the tribunal was modeled onsimilar hearings often organized at similar hearings often organized at international meetings to documentinternational meetings to documentviolations of and women's human violations of and women's human

rights.rights.

"The mock tribunal wanted to "The mock tribunal wanted to seek to dispel the myths about seek to dispel the myths about

illegal abortionsillegal abortionsthat have pushed the stories that have pushed the stories and pictures of women hurt and pictures of women hurt

and killedand killedthrough illegal abortions out of through illegal abortions out of sight," said Ms Cynthia Mugo sight," said Ms Cynthia Mugo

(KHRC).(KHRC).

But Kenya did not succeed in But Kenya did not succeed in changing their restricted law: changing their restricted law:

abortion is only allowed to abortion is only allowed to save a woman’s life.save a woman’s life.

In Nigeria only 6 to 8 % of In Nigeria only 6 to 8 % of women is using women is using

contraceptives (Saudi Arabia contraceptives (Saudi Arabia 33%!)33%!)

± 15.000 die each year from ± 15.000 die each year from botched abortions, but the botched abortions, but the

issue of abortion is a NO-GO issue of abortion is a NO-GO area.area.

Example of another African Example of another African countrie: Ethiopiacountrie: Ethiopia

• In 2005: 673 deaths per 100.000 live births (in most developed/ transition nations MM rates have gone down to an average of 10 per 100.000

• at least 55 percent of all maternal deaths are abortion- related, and unsafe terminations are the second biggest killer of women of child-bearing age after AIDS, according to a study by the New York-based Center for Reproductive Rights.

Ethiopia has, after South Ethiopia has, after South Africa, decided to change their Africa, decided to change their restricted abortion law in May restricted abortion law in May

20052005

Incomplete Abortions in South Incomplete Abortions in South AfricaAfrica

• A study by MRC in 1994 estimated 44686 women with ICA in public hospitals per year

• An estimated 425 women die as result of unsafe abortions

• Total annual cost was R18 7000 000 in 1994 for treating complications

• Included sepsis, haemorrhage, infertilityRees et al SAMJ 1997

Choice on Termination of Pregnancy Choice on Termination of Pregnancy Act 1996 Act 92 of 1996Act 1996 Act 92 of 1996

• After much debate and support from research & academic institutions showing the burden of ill health and deaths from septic abortions parliament passed the act

• The Act aims to give the right to choose safe early TOP & stress that it should not be used as a method of contraception

Government Gazette

Choice on Termination of Pregnancy Choice on Termination of Pregnancy Act 1996 Act 92 of 1996Act 1996 Act 92 of 1996

• First twelve weeks - termination of pregnancy on request.• 13- 20 weeks:

– Pregnancy as a result of incest or rape.– Continued pregnancy – risk to physical or mental

health of woman.– Continued pregnancy – risk to physical or mental health

of fetus.– Continued pregnancy – cause major social or economic

problems for woman.• Post 20 wks – health of mother or fetus.

Overview of CTOPA (2)Overview of CTOPA (2)

• First trimester – Abortion trained registered midwife/nurse.

• Second trimester –medical practitioner.• No consent from parent or partner required.• Designated facilities.• Penalties:

– Outside of provisions.– Obstructing women accessing their rights.

Impact of CTOP ActImpact of CTOP Act

Maternal mortality due to backstreet abortion reduced more than 90%!!

In spite of the opposition and conscientious objection.