Safe abortion is health care
Edinah Masiyiwa, Feature
IT is time we pass effective laws and policies that promote women’s choices when it comes to keeping or terminating a pregnancy especially now when it is so difficult for many women and girls to access Sexual and Reproductive Health and Rights (SRHR) in the Covid-19 era. We also cannot afford to keep seeing policy agreements passed that are never fulfilled.
The truth is maternal mortality remains high across the Southern Africa Development Community (Sadc) region, despite political commitment to reduce it. Fourteen countries in Sadc out of 16 countries remain below the target of 70 deaths per 100 000 women. It appears leaders are quick to sign regional and international declarations and agreements such as the Sustainable Development Goals and the International
Conference on Population in Development without putting in place country strategies for ensuring implementation.
I acknowledge the efforts and commitments that have been made at regional level by civil society organisations through several declarations and strategies and campaigns like #VoiceAndChoice and #SheDecides, but these campaigns are not being given a listening ear by our governments.
Just last year, global leaders gathered in New York during the annual United Nations (UN) General Assembly for a summit focused on universal health coverage. Global leaders, including those from Sadc agreed to a political declaration, adopted in October 2019, which is committed to universal access to SRH care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes.
Yet, to date, the region is not fulfilling its promises as it grapples to supply basic services such as contraceptives. The low access is resulting in an increase in unwanted pregnancies and no doubt an increase in unsafe abortion.
Even before the reduced access which was further exacerbated by the Covid-19 pandemic, the Guttmacher Institute reports that 24 percent of all pregnancies in southern Africa end in abortion, and many are unsafe (Barometer 2020).
In Zimbabwe, the Guttmacher Abortion Incidence Study revealed that more than 65 000 abortions occurred in 2016. According to a press release by the women’s rights organisation Gender Links, unsafe abortion accounts for 10 percent to 13 percent of maternal mortality in the region. This figure is unacceptably high considering that if abortion is provided in a safe space, these deaths might be avoided.
Unsafe abortions in the region occur because of the varying restrictive laws on access to abortion, with Madagascar and Angola having nearly completely outlawed abortion. These laws don’t stop abortions; indeed, women are clear that punitive laws will not stop unsafe abortions. So, they still occur, and unsafe abortions are costly to treat compared to safe abortion and will strain the already burdened health delivery systems in the Sadc region.
A study in Zambia, for instance, found that post-abortion care following an unsafe abortion can cost 2,5 times more than post-safe abortion care. Given this context and the work I personally do to improve women’s reproductive health, I was excited when Gender Links launched the Sadc Gender Protocol Barometer in mid-August focused on SRHR. It highlights that the fragile gains in areas such as teenage pregnancies, safe abortion, child marriages, HIV and Aids are now threatened by time, effort and resources being diverted to fight the Covid-19 pandemic.
It shows how Covid-19 has exposed the gaps that exist in the health sectors in the region. It has been reported that millions of women and girls have failed to access contraceptives and safe abortion services worldwide. This has seen a rise of unplanned pregnancies in the region as women and girls fail to access contraceptives. The Sadc Barometer highlights that in Zimbabwe, for example, the onset of Covid-19 resulted in border closures that meant many Zimbabwean women could no longer access a safe abortion in South Africa. Of course, even before Covid-19, access to abortion was a class issue with those who could afford to pay private doctors accessing safe abortion despite the restrictive laws. Policies should protect the poor.
It was promising to see the Sadc SRHR strategy focus on trying to reduce the rates of unplanned pregnancies and unsafe abortion. The strategy also acknowledges that unsafe abortions are often the result of the policy and legal barriers that women and girls in the region face when they require safe abortion services, which is a significant contributory factor towards the high-levels of maternal mortality in the region.
This is the time to seriously consider putting laws and policies that ensure women have access to safe abortion and save lives — and putting the funds behind them to ensure they are enforced. Considering that our health delivery systems in the region are strained, I call upon the leaders of the Sadc region to ensure that they create an enabling environment for women and girls to access safe abortion. In the long run, it will reduce health costs, and, more importantly, save lives.
The time to stop women in our region from dying due to unsafe abortion is now. We cannot afford to keep on having agreements that are never fulfilled. Safe abortion is health care.
*Edinah Masiyiwa is the Executive Director of Women’s Action Group in Zimbabwe.