Abortion policy and women's health in developing countries

Abstract

The World Health Organization estimates that almost half a million women in developing countries die in pregnancy and childbirth every year. Unsafe induced abortion is responsible for perhaps one-quarter of these deaths. In this article, the author reviews the legal, medical, and social contexts in which women in developing countries resort to clandestine abortion. Despite intensified international concern with reducing high rates of maternal mortality and morbidity, national policy makers and participants at international conferences on maternal health--with a few important exceptions--have not recommended that safe, legal services for terminating unwanted pregnancies be offered as an essential element of basic reproductive health care. United States international policy on funding abortion-related activities in maternal health and family planning programs is especially restrictive. A new policy approach is clearly needed if unacceptably high rates of maternal morbidity and mortality in many countries are to be reduced.

PIP: Unsafe clandestine abortion is responsible for an estimated 100-200,000 deaths among women in developing countries each year and accounts for 25-50% of all maternal deaths in some regions, especially Latin America. A third of the population of the Third World lives in countries where abortion is illegal or permitted only in extreme cases. Mortality from clandestine abortions in developing countries may be as high as 400/100,000 procedures compared with 6/200,000 in situations where abortion is legal. Even when women survive the procedure, there are numerous possible physical complications (incomplete abortion, pelvic infection, hemorrhage, shock, and secondary sterility), emotional sequelae, and enormous costs to the health care system for treating abortion complications. Given professed concern with improving maternal health, the refusal of so many governments to liberalize their abortion laws seems inconsistent. Even international conferences on maternal health generally refrain from issuing recommendations that safe, legal services for terminating unwanted pregnancies be offered as an integral part of national primary health care systems. Countries that have passed liberal abortion laws are reluctant to require all health care facilities to perform abortions. The US Government's decision to refuse to fund family planning programs that include abortion represents a major setback to women's reproductive rights and has forced many private voluntary organizations in the Third World to choose between continuing to provide safe, legal abortion and losing their funding. Since family planning has been defined as a basic human right in international documents, there is an urgent need for governments and medical institutions to examine the legal, medial, and ethical principles upon which they base their restrictive, discriminatory abortion policies.