Skip to 0 minutes and 12 secondsMARGE BERER: Access to safe abortion is important for women because abortion is still restricted by criminal law in almost every country in the world including countries where it is widely available even though about one in four women globally will have an abortion in her lifetime. It is also important because abortion is under constant attack from right wing and conservative groups who believe women should be forced to carry every pregnancy to term, whether they can cope with it or not. The International Campaign for Women's Right to Safe Abortion believes that universal access to safe abortion at a woman's request is essential for women's health and a necessary aspect of women's right of autonomy over their bodies and lives.

Skip to 1 minute and 1 secondAs a human rights issue, access to safe abortion is inextricably linked to the first principle of human rights, that is the right to life. An estimated 1 million women have died from the complications of unsafe abortion in the past 20 or so years. And almost all of their deaths would have been prevented had abortion been safe, legal, affordable, and accessible in their countries. The anti-abortion movement claims that the right to life begins at conception. If this were accepted in human rights principles, it would subsume a woman's right to life to that of any pregnancy she was carrying and no abortion would be permissible.

Skip to 1 minute and 47 secondsIn fact, in human rights terms, all rights, including the right to life, begin at birth after independent life begins. There are, unfortunately, many examples of the ways in which the rights of women are violated. Only one of them is when abortion is criminalised. Rape and sexual abuse are others and are an important reason why safe abortion must be available. Forcing a woman to carry an unwanted pregnancy to term is a form of cruel and degrading treatment according to the special rapporteur on torture. Here are three examples of cases. The first is the case of a woman who was 17 weeks pregnant and began to miscarry.

Skip to 2 minutes and 33 secondsThe miscarriage was inevitable and the baby could not have survived no matter what because it was too early in the pregnancy. Because her cervix was open, she was highly susceptible to infection. And, in fact, she did develop a life-threatening uterine infection. Yet the hospital failed to provide the simple treatment that would have saved her life, that is an abortion, before the infection became uncontrollable because they waited until there was no longer a foetal heartbeat even though the foetus was not viable. She was a young, healthy woman and she died completely unnecessarily. The second case is of another young woman who was an asylum seeker.

Skip to 3 minutes and 19 secondsShe fled the conflict situation in her country of origin where rape was being used as a weapon of war. She had been raped herself. After she arrived in the country that gave her asylum, she discovered she was pregnant as a result of the rape. She was unable to obtain a visa to travel for an abortion. She became suicidal. And although the threat of suicide should have meant she had a right to an abortion, it was refused. Instead, she was kept in a hospital, supposedly for her own protection, until her pregnancy was far enough advanced that the baby could survive independently. And then she was, in effect, forced to have a caesarean section. Both these cases come from Ireland.

Skip to 4 minutes and 6 secondsSomething similar happen to a 10-year-old child in Paraguay who had been sexually abused by her stepfather for two years. She, too, was refused an abortion and kept in hospital until the pregnancy was viable. And when it was clear the continuation of the pregnancy threatened her life, she too was subjected to a pre-term caesarean section to save the baby. These cases represent the worst sort of misogynistic treatment. But for thousands of women every day in many countries, especially in the global south, safe abortions are simply not available unless you can pay. Some 56.3 million women have an abortion every year.

Skip to 4 minutes and 52 secondsUp to half these abortions are unsafe in the following ways, illegal or legally restricted, dangerous or ineffective method, unskilled provider, unhygienic conditions, lack of information or access to help, lack of access to treatment for complication, stigma, fear, and isolation, violence, rejection by family, school, or work, and even murder, both of women and of doctors providing abortion care, and, lastly, threat of arrest, prosecution, and imprisonment. In January 2017, we heard that the president of Rwanda had ordered the release of 62 women and girls from the prison who were imprisoned for abortion before the age of 16. Most had been sexually abused. This was very good news. But many others in Rwanda and elsewhere are still not free.

Skip to 5 minutes and 55 secondsThe situation has been improving in many ways in many places. Many countries are reforming and improving their laws. In many others, positive law reform is being discussed. The African Commission for Human and People's Rights called for the decriminalisation of abortion across Africa in 2016 and has just renewed that call. At the same time, innovative service delivery models for providing medical abortion pills are being put in place in Australia and in many other countries. And a growing number of women who do not have access to safe abortion services are learning through information hotlines and individual health professionals how to have a safe abortion with pills on their own.

Skip to 6 minutes and 45 secondsThey're accessing the pills from pharmacies and from trustworthy providers through the internet and taking control of their lives in spite of laws against abortion. Deaths and serious complications from unsafe abortion have been decreasing since the late 1980s because of this. And that is a very good thing indeed. As you may know, we experienced a major setback in January 2017, however, perpetrated by the new US president on his first day in office. He re-instituted the Global Gag Rule which bans any non-US NGO from receiving US government health funds from giving information on or providing services for safe abortion. This is potentially devastating for those receiving contraception and other sexual reproductive health services from services that receive US funding.

Skip to 7 minutes and 40 secondsBut the global fightback against this death dealing, anti-women policy began the following day with the biggest women's march in history. And we will continue to fight until access to safe abortion is universal. Let me close by saying that up to one in four is a lot of women who will need an abortion in their lifetime. It was me once. And it could be many of you who are listening today or your partners. Safe sex is sex in which you and your partner protect yourselves and each other from unintended and unwanted pregnancy and from sexually transmitted infections. Protection can fail, however, and sometimes people fail to use it.

Skip to 8 minutes and 24 secondsWe need our health system to be there before and after to help us with contraception, condoms, emergency contraception, safe abortion, and prevention and treatment for HIV and other sexually transmitted infections. Each of these is part of the package of essential sexual and reproductive health care. I invite you to study how well your countries are doing in offering these services and urge you to get involved today to make the situation better for everyone, especially for young women and also for yourself in case, tomorrow, you may need it.

Safe access to abortion

In almost all countries access to safe induced abortion is restricted by law. Underlying this is the complex link between access to safe abortion and the first principle of human rights: the right to life. The anti-abortion movement argues that the right to life begins at conception, not birth, but this position undermines the rights of the woman and is contrary to the position of every human rights body in the world.

In this video Marge Berer, the Coordinator of the International Campaign for Women’s Right to Safe Abortion, speaks about access to safe abortion as a human rights issue, and gives examples of women who have been adversely affected in settings where the law prohibits their right to a safe abortion.

However, the situation is improving: more countries are adjusting restrictions on abortion, and the rise of the medical abortion pill means more women can make their own choices and take control of their reproductive health safely.

Barriers to access

In this and the previous step we have seen that family planning and induced abortion are emotive subjects, and that both providers of services and those seeking to use them can face difficulties in doing so. Reflecting on where you live, how do social, political and cultural barriers play a role in the extent to which people have access to family planning and abortion services?

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This video is from the free online course:

Improving the Health of Women, Children and Adolescents: from Evidence to Action

London School of Hygiene & Tropical Medicine