International Health Service

he widely overlooked global crisis in unsafe abortions has received timely support with a £3 million grant from the UK government to reinforce women’s sexual and reproductive health services.

It is estimated that one woman dies every minute as a result of pregnancy and childbirth, meaning over half a million maternal deaths every year. Unsafe abortion accounts for at least 13% of these, but research indicates this figure may be vastly underestimated. In Kenya for example, where abortion is illegal, 300,000 unsafe abortions take place every year, with a causal connection in up to 50% of maternal deaths.

The World Health Organisation (WHO) estimates that nearly 70,000 women annually – mostly the youngest and poorest - die agonising deaths from sepsis and haemorrhage as a result of unsafe abortions. Around 19 million women have an unsafe abortion every year, one in 10 pregnancies worldwide.

The Global Safe Abortion Programme (GSAP), developed by the International Planned Parenthood Federation (IPPF), will help to ensure that internationally agreed targets to reduce the number of maternal deaths in the world’s poorest countries are achieved by 2015.

The IPPF programme will help its member associations to do more to stop unsafe abortions as well as helping support groups such as Marie Stopes International and Manuela Ramos in Peru, and others which have seen a decline in their family planning and reproductive health services.

A number of NGOs working in maternal health have struggled in recent years because of the “Global Gag Rule” which requires any organisation applying for US funds to sign an undertaking not to counsel women on abortion - other than advising against it - or provide abortion services. The Global Gag was first introduced in 1984 by President Reagan. It was revoked during the terms of President Clinton, but was reinstated by President George Bush in 2001.

The gag prevents NGOs such as the IPPF and Marie Stopes from receiving funding from the US if they are involved in any work related to promotion or discussion of safe abortion services, even when that work is funded from other sources. This includes work in countries where abortion services are legally available. Organisations that refuse to sign up to the gag automatically disqualify themselves from receiving any US assistance for family planning and reproductive health.

The GSAP will support work on abortion that has suffered or been neglected as a result of the Global Gag Rule. It will help improve access to safe abortion services and will help support those groups who have been forced to cut back on reproductive health services.

“I think the UK is being very brave and very progressive in making this commitment,” said Steven Sinding, director general of the IPPF. “We’re deeply grateful for this gesture not only financially but also politically.” Such enthusiasm is not universal and at least one anti-abortion group has criticized the move.

In February 2006 UK Development Minister Gareth Thomas launched the IPPF report Death and Denial: Unsafe Abortion and Poverty which seeks to address the pressing need for an open and informed discussion on the causes, consequences and actions needed to prevent unsafe abortion.

“We know from experience that the absence of sexual and reproductive health services results in an increase in unintended pregnancies and inevitably, a greater number of unsafe abortions.” he said.

“That is why the UK will support organisations like the IPPF and Marie Stopes that are providing medical care and information to help save women’s lives.”

Abortion, he said, had been made a focal point and touchstone for public and political disagreement, “more so than almost any other single contemporary health issue”.

This prevented “considered discussion and is blind to the actions that could help save women’s lives, and blind to the consequences of inaction.”

“Some cultural, social and religious norms leave many women, particularly adolescent girls and young women, including married women, highly vulnerable to sexual exploitation. Their unequal status in society acts to prevent equality of sexual and reproductive rights and so women are denied the right to control what happens to their own bodies. Without the power to say no and have their wishes respected, and often without the ability to control their own fertility, many millions of women face an unwanted pregnancy.”

The reality for the poorest and most vulnerable “is a choice between risking death from unsafe abortion, or risking a similar fate through social rejection and abandonment”.