Ipas

This conference report document from Marie Stopes International, Ipas, and Abortion Rights summarises the exchanges of almost 800 public health experts, government representatives, and women’s health advocates from more than 60 countries at the October 23-24 2007 London, United Kingdom (UK), conference on safe abortion. It included such topics as the impact of unsafe abortion, access to and quality of services, advocacy, the increasing recognition of abortion as a human right, legal and policy influences, and the need to dismantle the stigma surrounding abortion. Like the conference itself, the report devotes special attention to developments in abortion law, policy, and practice in the UK, which in 2007 observed the 40th anniversary of its Abortion Act.

The Global Safe Abortion Conference was held to offer an opportunity to exchange ideas and experiences, to strengthen existing partnerships, and to form new alliances and strategies. These alliances and strategies were directed towards ending unsafe abortion and expanding access to safe, comprehensive abortion care, including contraception.

The conference was held against a background of 66,500 deaths yearly of women and girls, mostly in developing countries, from complications of unsafe abortion, with an estimated 5 million more hospitalised. As stated here, research shows that managing complications of unsafe abortion costs health systems much more than providing preventive contraceptive services or safe elective abortion - hence imposing economic and health burdens on developing countries that include lost productivity, social stigmatisation, and children left motherless. "Actions needed to reduce unsafe abortion and its health, economic and social consequences include improving the availability and quality of postabortion care, which includes emergency treatment for complications of unsafe abortion and contraceptive counselling and services to help women prevent repeat unintended pregnancy. But postabortion care alone is insufficient; from a health and human rights standpoint, it is also necessary to make safe abortion accessible. Also required are better data on the incidence and impact of unsafe abortion and on the needs of groups whom it disproportionately affects."

According to this document, key needs include "stronger commitment and greater investment by governments and international donors, particularly in the context of meeting the Millennium Development Goals. Governments, international treaty-monitoring bodies, and others need to increasingly recognise abortion as an intrinsic human right, integral to women’s ability to make their own decisions about the number and spacing of their children." The United Nations Human Rights Council (UNHRC), the Committee on the Elimination of Discrimination against Women, the European Court on Human Rights, Colombia’s Constitutional Court, and Ministers of Health and delegates from 48 African countries (through the Maputo Plan of Action), have, as stated here, advocated for decriminalising abortion and reducing unsafe abortion. Between 1995 and 2007, 17 countries liberalised abortion laws, so that abortion is permitted on broad grounds or without restriction in 70 countries, where more than 60 percent of the world’s population lives. Safe abortion strategies include: liberalising laws and providing safe services through training providers, making medical technology more available, issuing evidence-based clinical and policy guidance, reducing stigma, and making available to women information on legal rights and availability of services.

According to this report, the access and quality of services is negatively affected by the prohibition of mid-level providers such as nurses and midwives - often the only healthcare workers accessible to women - from performing abortion, but with proper training and supervision, these personnel can, as stated here, be made competent to offer abortion care, especially medical abortion. "Medical abortion has the potential to make safe first-trimester abortion accessible to women in even the most remote settings, including the privacy of their own homes, is less costly and carries lower risk of infection than other methods. Currently, however, this important method is insufficiently available." The conference providers supported “pre- and in-service training for all cadres of healthcare workers in aspiration and medical abortion techniques and related clinical skills, with special emphasis on mid-level providers. Important steps include ensuring use of appropriate technologies; providing confidential, client-focused counselling; and integrating postabortion contraceptive services with abortion care."

Strategies for dismantling stigma included speaking out about women's experiences with abortion, providing qualitative research on the factors influencing women's experience, and adopting and advocating for a proactive rather than a defensive stance that affirms women's right to and ability to be rational, competent, and moral agents. A Global Call to Action for Women’s Access to Safe Abortion was issued and appears on page 27 of the document, as well as in a format that may be electronically signed on the conference website. It includes the following goals:

• "Women’s rights to contraception and safe abortion are protected and supported through reformed laws and policies at all levels.
• Governmental authorities and donors commit increased resources to ensure that comprehensive sexual and reproductive health care, including contraception and safe abortion services, is widely available through skilled providers in both public and private health systems.
• Medical training institutions routinely provide training in abortion-related care for physicians, nurses, midwives, and other healthcare workers.
• Women and healthcare providers are informed about women’s legal rights and reproductive options, and know where contraception, safe abortions and other reproductive health care can be obtained.
• Women in vulnerable circumstances have access to comprehensive sexual and reproductive health care that responds to their special needs - including young women and women who are poor, are refugees or displaced, or are survivors of sexual violence."

Press release from Diana Thomas to The Communication Initiative on June 19 2009, and email from Nicole Brown to The Communication Initiative on October 12 2009.