Saving women's lives

Calling for a giant leap in international abortion policy

While the public health impact of unsafe abortion has long been recognised, little has been done to tackle the strategic and policy barriers to saving women's lives.

The World Health Assembly identified unsafe abortion as a serious public health problem as early as 1967. Later the 1994 International Conference on Population and Development (ICPD) highlighted the concept of reproductive rights and established goals and targets, including universal access to reproductive health (services) by 2015.

The ICPD Programme of Action called for all parties to deal with the health impact of unsafe abortion and improve family planning services. It noted that abortion should be safe when it is legal, whilst in all cases, women should have access to quality services to manage complications from abortion. To help to avoid repeat abortion, post-abortion counselling, education and family planning services should be offered.

In June-July 1999, the Special Session of the United Nations General Assembly urged health systems to train and equip health professionals to provide safe abortion and post-abortion care where legal.

In 2004, the World Health Assembly approved the Reproductive Health Strategy of the World Health Organization (WHO) noting that unsafe abortion must be dealt with as part of the Millennium Development Goal on improving maternal health.

In September 2006, the Special Session of the African Union Conference of Ministers of Health held in Maputo, agreed on a Plan of Action to:

• enact policies and legal frameworks to reduce the incidence of unsafe abortion
• prepare and implement national action plans to reduce the incidence of unwanted pregnancies and unsafe abortion
• provide safe abortion services to the fullest extent of the law
• educate communities on available safe abortion services as allowed by national laws
• train health providers in preventing and managing unsafe abortion.

Putting plans into action

Unsafe abortion is generally accepted as being an important and preventable cause of maternal death. It is agreed that safe abortion services should be provided to the full extent of the law and that post-abortion care should be provided everywhere. Expansion of access to family planning services for prevention of unsafe abortion is universally supported. However, reducing legal restrictions on access to safe abortion services remains a highly contentious issue.

It is paradoxical to identify reducing maternal mortality as a priority but fail to put in place effective interventions to prevent unwanted births.

Iqbal H. Shah
UNDP/UNFPA/WHO/World Bank Special Programme in Human Reproduction, World Health Organization, 1211 Geneva 27, Switzerland
T +41 22 7913332
shahi@who.int

The author alone is responsible for the views expressed in this article. The views do not necessarily represent the decisions or the stated policy of the WHO.

See also

Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa: Maputo Plan of Action for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights 2007-2010, Addis Ababa: African Union, 2006
www.unfpa.org/publications/docs/maputo.pdf

Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets, Geneva: World Health Organization, 2004
www.who.int/reproductive-health/publications/strategy.pdf

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