By: Celeste Kauffman*
Outside of Western Europe and parts of Asia, we are collectively failing women’s right to health and life, by restricting access to reproductive healthcare, in particular abortion.
Today, 60% of the world’s 1.55 billion women of reproductive age live in one of the 74 countries that permit abortion on broad grounds, or without restrictions regarding reasons. However, this means that 40% of women live in countries where abortion is either illegal or highly restricted. This 40% is concentrated in the Global South: 97% of women in Latin America and 92% in Africa live in countries where abortion is either prohibited or severely restricted.
However, the legal status of abortion does not reduce abortions, but rather impacts the safety of the women obtaining them. Researchers estimate that between one-third and one-half of the 46 million worldwide annual abortions are illegal. For example, in Uganda around 300,000 abortions are performed annually. In Indonesia, this number is one to two million. In both countries, abortion is prohibited except to save a woman’s life. These numbers mean that, ironically, many women’s lives are put in danger by illegal and unsafe abortions. Illegal abortions are often performed by those with no training, and in unsanitary and unsafe environments. The graph below compares the number of safe and unsafe abortions performed each year in different regions of the world.
Making abortion more accessible does not increase demand for the procedure. Similarly, increased access to legal abortion does not increase abortion rates. For example, after lifting some abortion restrictions, Canada, Turkey, and Tunisia did have not seen an increase in abortion rates. Additionally, the Netherlands, which offers free abortion services, has one of the lowest abortion rates in the world.
Even when states have taken steps to improve access to abortion, access to abortion services in practice are tempered by local laws, as well as hostile social perceptions of abortion, which limit access to abortion, regardless of official laws.
For example, within the United States, although in 1973 the Supreme Court has determined that states may not prohibit abortion (hence the green color in the above map), individual states may regulate the safety of abortion. As a result, in the past four years, state legislatures have adopted 231 measures that ostensibly regulate the safety of abortion, but in reality restrict women’s access to such service. The Guttmacher Institute has determined that while in 2000, 31 percent of American women lived in states that were considered to be hostile to abortion (with four or five restrictions), in 2014, 57% of women lived in states that were either hostile or extremely hostile (more than six restrictions) to abortion. The entire South is considered hostile or extremely hostile, and rural women in many states do not have any access to abortion.
Similarly, in Colombia, abortion is legal in cases of rape, incest, fetal abnormality, and risk to the health or life of the woman. However, in reality, women who seek legal abortions through the Colombian healthcare system face excessive administrative and legal barriers. Doctors and entire hospitals often refuse to perform abortions based on their beliefs, or they create unnecessary delays and administrative proceedings. Such practices often prevent women from obtaining legal abortions, which either leads them to obtain illegal, unsafe abortions, or carrying an unwanted pregnancy to term. They also disproportionately affect poor, rural women, who have limited options regarding healthcare providers. It is not a surprise that, due to these barriers, about 99% of abortions in the country are performed outside the law.
The public health implications of such abortion restrictions were what initially led countries such as the United States to legalize abortion. Women or untrained individuals perform abortions using unsafe and often dangerous methods, which have devastating consequences for women. Approximately 40% of women who obtain illegal abortions suffer complications that eventually require medical treatment, including sepsis, hemorrhage, and uterine perforation, acute renal failure, chronic pelvic pain, pelvic inflammatory disease, infertility, and an increased risk for as well as a high risk of ectopic pregnancy, premature delivery, and miscarriage in future pregnancies.
Thus, in countries such as Uganda, illegal abortions are a leading cause of pregnancy-related death, and around half of all women require treatment for complications related to abortion at some point in their lives. By contrast, admission to hospitals for abortion related complications was cut nearly in half within six months of liberalizing abortion restrictions in Guyana, and death due to unsafe abortion dropped by half after abortion restrictions were lifted in South Africa.
Women’s rights to life, health, self-determination, equality, and freedom from inhuman and degrading treatment requires that States guarantee their access to quality reproductive services, including abortion. We know that criminalizing and limiting access to abortion does not lower abortion rates; it just endangers the lives of women who resort to illegal, clandestine, and dangerous forms of abortion.
*Celeste Kauffman is a researcher at the Center for the Study of Law, Justice, and Society (Dejusticia)