Healthy Woma : Safe Abortion: The Missing Piece in Maternal Health and Women’s Rights

Reading the New Times’ recent article “Teenager charged with abortion” was simultaneously sad and frustrating. It is unknown whether the young woman at the center of the case miscarried or induced an abortion. However, it is not difficult to imagine why, given her circumstances, she would have wanted to end the unplanned pregnancy. As a young woman engaged in secondary education, she is exactly the kind of person Rwanda’s government hopes to support and promote as a part of the development of the country. Because of an unintended pregnancy, she is now under indictment by the State. Rwandan women today benefit from improvements not seen in previous generations – increasing GDP, access to secondary education and governmental positions, and entrepreneurial opportunities. However, they have yet to be afforded full control of their own reproductive rights. Rwanda’s leadership has made it clear that it is dedicated to reaching the Millennium Development Goals (MDGs). Goal 5, “Improve Maternal Health”, encompasses not only maternal deaths related to childbirth, but also those from termination of a pregnancy. Although a provocative topic throughout the world, Rwanda must face the facts about abortion if it truly means to use women’s empowerment as a “hallmark of recovery and reconstruction” as President Kagame’s website states. The FactsWhat are the facts? Firstly, abortion is illegal in Rwanda, even in cases of rape, incest, or fetal abnormality. The only exception is when carrying a pregnancy to term would be life-threating to the mother. However, it has been shown that abortion’s legal status has no effect on how many women get one. In Europe, where abortion is legal in most cases, the abortion rate is 28 per thousand women. However, in East Africa, where abortion is illegal in almost every case, the rate is 39 per thousand women. Put differently, you can make abortion illegal, but it doesn’t stop women from having them. In fact, unsafe abortion is one of the three leading causes of all maternal mortalities globally. In the African region, 14 percent of all maternal deaths result from unsafe abortion. The Burden on Developing AfricaIn addition to disparities in economic conditions, disease prevalence, and technology access, women in Africa also endure inequalities in access to the full spectrum of reproductive services. Over 95 percent of abortions on the continent are performed under unsafe circumstances whereas more than 90 percent of abortions in developed regions are safe. The consequences are significant; nearly two million African women are hospitalized annually for complications from unsafe abortions. Furthermore, impoverished women and those living in rural areas (exactly the women the MDGs seek to impact) are more likely than their urban, wealthier counterparts to turn to unsafe methods and untrained providers to end unwanted pregnancies. Consequently, they are at greater risk for severe health consequences such as infection and excessive blood loss. This results in a significant cost to the health systems, and therefore the taxpayers, when unsafe abortions require medical treatment. The Contraception ConnectionBehind virtually every abortion is an unintended pregnancy. In 2008, 40 percent of the 185 million pregnancies in the developing world were unplanned. About 50percent ended in abortion. Approximately 22 percent of African women in their childbearing years have an unmet need for contraception. Those numbers are even higher for young, unmarried and sexually active women (the very women whose family planning needs must be met in order to meet the MDGs). Rwanda is headed in the right direction with its support of family planning. However, even if every woman’s contraceptive needs were met, no method is 100 percent effective. Therefore, access to safe pregnancy termination services must be coupled with access to contraception and family planning. Headed in the Right DirectionThree African countries – South Africa, Tunisia, and Cape Verde –allow for termination of pregnancy without restriction. These laws have real effects on maternal health outcomes. After South Africa legalized the procedure in 1996, infection resulting from abortion decreased by 52 percent. In 2010, the UN Secretary General announced a new “global strategy” for maternal health. Included in the package of “guaranteed benefits” for reproductive services were safe abortion services “when abortion is not prohibited by law.” Clearly, the UN recognizes the importance of providing safe abortion services as an integral part of improving maternal health. It cannot, however, circumvent local laws.Which is exactly why Rwanda should take a bold and progressive stance on the issue, as it has with so many important others. Women matter in Rwanda. This country’s leadership must find the courage to acknowledge that empowering women doesn’t stop with contraception, cooperatives, and education. It also means giving women the power to end unwanted pregnancies. The consequences and implications go far beyond morality and ethics – they can mean life or death and Rwandan women deserve not to ever have to make such a choice. Statistics for this column are taken from the following publications by the Guttmacher Institute. All publications may be accessed on their website.- Facts on Abortion and Unintended Pregnancy in Africa, October 2009- Facts on Induced Abortion Worldwide, February 2011- Unsafe Abortion: The Missing Link in Global Efforts to Improve Maternal Health, Spring 2011. altuyisenge@gmail.com