Breaking the Cycle of Unwanted Pregnancy and Unsafe Abortion: A Call to Action

This article is adapted from remarks made at the International Conference on Family Planning, Dakar, Senegal.

Millions of women in Africa and the developing world suffer and die needlessly from unwanted pregnancy and unsafe abortion. As we know, 215 million women want to space their births but do not have access to contraception, or contraception may fail – but for a variety of reasons, women are do not have access to the care that they need.

Actions to break this cycle are a major focus at the International Conference on Family Planning now underway in Dakar, Senegal, and we are pleased that participants will be sharing successful strategies for giving women ready access to contraceptive information and services and to life-saving treatment for complications of unsafe abortion. Thanks to many organizations and governments represented at here, we have seen major progress in both these important areas.

But much remains to be done and a much more comprehensive approach is needed. Even the best contraceptive and postabortion services are not enough to prevent women from suffering and dying from unsafe abortion. A third component that is often stigmatized and neglected even in the context of reproductive health programs is safe, legal abortion.

Unsafe abortion is a major – and entirely preventable — public health crisis. But eliminating it requires a comprehensive, holistic approach addressing all three of these components.

African women are at particularly high risk of unwanted pregnancy and unsafe abortion, because unmet need for family planning is higher here than in other regions of the world. An estimated 47 million women in sub-Saharan Africa want to limit or space births but cannot obtain the information and care they need to do so.  Each year, over 6 million women risk their lives with unsafe abortion because they have no other option; of this number, 29,000 die needlessly, or in other words, hundreds of thousands in the space of a decade.  Africa accounts for more than half of all abortion-related deaths in the world.

These statistics – and the human stories that lie behind every number – are simply intolerable. Evidence tells us that abortion is one of the safest of all medical procedures when performed by trained health care providers in sanitary conditions and, with medical abortion pills, an early abortion is safe in the hands of women themselves with medical back-up nearby.

Globally, all but a handful of countries have at least one indication for legal abortion. In Africa, every country permits abortion at least to save a woman’s life, and, in more than 40 percent of African countries, in cases of rape, incest and fetal impairment.

But safe services, even to the extent of the law, are unavailable or inaccessible in most parts of Africa.

Today, we call on the global family planning and health community to take three steps that are completely feasible to help break this cycle. 

  • First, stop avoiding discussion of abortion. It is part of many women’s lives and always has been. Not talking about it will not make it go away.  We are glad this conference has made the space to talk about abortion. This must be the beginning of a greatly expanded dialogue on this critical issue.
  • Second, do a better job of ensuring that every woman who has an abortion or is treated for complications is offered contraceptive counseling and a choice of methods – on site and ideally by the same health workers who provided the abortion or postabortion treatment.
  • But we cannot simply hide behind postabortion care as if the job is done.  A third and most important step within the power of family planning programs and providers is to ensure that each woman experiencing an unwanted pregnancy receives counseling, and, if she wishes to terminate the pregnancy, is referred for a safe, legal abortion in the same or a nearby facility.  Currently, few programs require or train family planning providers to offer such counseling or referral.

In summary, the family planning community – and the wider global health community – must honestly confront the realities of unwanted pregnancy if we claim to value women’s lives and well-being and if we truly respect their rights. We must ensure that women everywhere have access to a full continuum of care:  contraceptives, postabortion care and safe induced abortion. 

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