Unsafe abortion

Nurses & Midwives Can Make Abortions Safer in India

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In India, abortion under certain conditions has been legal for almost five decades. You would imagine that further legalising abortion would make it safer and more accessible for all. However, this has not been the case.

Abortion is a complicated subject within Indian society. It can be challenging for people to seek safe abortion services due to service providers’ personal beliefs, societal stigma, and lack of knowledge. But even for those able to overcome these challenges, safe and affordable abortion remains elusive.

Part of the problem is that Indian public healthcare systems face an acute shortage of staff and infrastructure in all corners of the country.

Hospitals with advanced facilities are generally present at district level. However, remote rural areas with limited connectivity are more likely to rely on Primary Health Centres (PHCs). The government-ordained one-doctor-minimum at all PHCs remains unmet in most regions.

Without doctors, people run the risk of unsafe or precarious abortions by self-treating or consulting untrained providers. When they do seek allopathic medicine, it is often through pharmacies where shopkeepers give medicines without proper guidance. 

Appointing enough trained doctors to PHCs and clinics is a protracted process. However, there are other ways to mitigate the incidence of unsafe abortions. One is to employ nurses and Auxillary Nurse Midwives (ANMs) to administer safe abortion services in remote places. These trained practitioners can task-share in areas where supply falls short of demand. The World Health Organisation (WHO) deems this an “increasingly important public health strategy”.

Data shows that 87% of all abortions happen within the first twelve weeks of pregnancy (first trimester). A first trimester abortion generally requires a ‘Medical Abortion’, rather than an invasive procedure. This involves the pregnant person taking a combination of two drugs in the form of tablets and monitoring consequent bleeding. The process can be easily managed by most people at home and does not necessarily require a health facility. If, in rare cases, emergency services are required, these can be accessed at some 24/7 PHCs and/or Community Health Centres (CHCs).  

Nurses form the biggest healthcare providers’ workforce and are involved in all reproductive healthcare service provisions.

This includes independently managing normal deliveries, assisting C-sections and even surgical abortions. ANMs are trained to provide maternal and child health and family planning related resources to the community at the grassroots level. They also give vaccinations to newborns and nutritional advice to new mothers.

Therefore, adding Medical Abortion assistance to ANMs’ vocation is not a stretch. In fact, it is beneficial to include abortions in the larger ethos of reproductive healthcare. Not only will it make abortion more accessible in remote areas, it will play a critical role in normalising it. Safe abortion advocates have identified the significance of making abortion-related information just as readily available as labour and childcare information.

Providing a holistic basket of choice to a pregnant person ensures that they possess the agency to make informed choices about their own life.

For abortion to be recognised as a valid choice during pregnancy, it is imperative to ensure a certain quality of care. As health workers from within the community, ANMs are more approachable and readily available. Similarly, in poorly-staffed health facilities in rural parts of the country, nurses are often the first point of contact with patients – including abortion seekers. They can provide the necessary patient-centred care that makes abortions more comfortable.

Amendments to the Medical Termination of Pregnancy (MTP) Act of 1971, which initially legalised abortion in India, are currently pending discussion in the upper house of the Indian Parliament. The proposed changes aim to improve access by increasing the gestational limit for legal abortions. Several important aspects are missed out of the proposed amendments, though. There is no mention of expanding the provider base, for instance. 

We think this is a critical time to consider the abortion provider base, since the Indian Government is currently setting up a pilot curriculum for specialised nursing courses in midwifery. Nepal, a neighbouring country with a similar socio-economic context and comparable health infrastructure, has already authorised training programmes for nurses on providing abortion services. Nurses who have received this training are now successfully managing abortions. We asked one nurse about contributing to comprehensive abortion care. She highlighted the myriad ways in which nurses can improve services:

“Nurses should be trained and legalized to provide abortion services just like doctors. [They come in contact] with the clients and patients more, patients feel more comfortable with them. [Health] emergencies are the results of inaccess, lack of awareness, societal stigma and poverty. Who would be better than a provider nurse of a local place to fill those gaps? Health education and timely safe abortion provision can prevent the situation getting worse, it can prevent health deterioration.”

Nurses and midwives around the globe help create a care-centered health system that affirms a rights-based approach to healthcare.

It is only natural, then, to place them at the forefront of task-sharing for sexual and reproductive care that encompasses safe abortions. On this World Health Day, WHO commemorate the International Year of the Nurse and Midwife by highlighting the indispensable contribution of nurses and midwives to health systems worldwide. In that spirit, we hope to recognise their efforts by advocating for their inclusion in rights-affirming abortion service delivery. We believe that this will benefit society in significant ways. 

The YP Foundation is a youth run and led organisation that supports and develops youth leadership to advance rights of young women, girls and other marginalised youth. It strives to make access to sexual and reproductive health and rights easier for young people, including the right to safe abortion. The YP Foundation is a Safe Abortion Action Fund grantee partner.

The Fight for Legal Abortions Continues in Latin America

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450,000 clandestine and unsafe abortions take place in Argentina every year, according to Amnesty International.

Currently, Argentina only allows abortions in cases where a pregnancy is the result of rape, if the mother is mentally ill, or if her own life is at risk. On August 8 2018, Argentina came very close to legalizing abortion. The Senate narrowly rejected a bill that would have made abortions legal within the first 14 weeks of pregnancy, with 38 votes against, 31 in favor and 2 abstentions.

On the streets, thousands of people gathered to show their support or opposition for the bill, divided in two different sides in front of the Congress building.

It was a disappointing result for many women, not just within the country but in Latin America as a whole. Activists planned demonstrations in support of the legislation in several countries like Mexico, Chile, Peru and Uruguay – as well as around the rest of the world too, like in New York City.

Photo credit: Maria Rendo

Currently in Latin America, only Uruguay, Cuba, Guyana and Mexico City allow women legally to have early-term abortions. This means that 97% of women in the region live in countries that ban abortion or allow it only in rare instances.

Since the bill in Argentina passed in the Congressional vote, similar projects to legalize abortions have been energized throughout Latin America. These movements have not been discouraged by the end result in Argentina this month. Right after the final vote in Argentina, a bill to legalize abortion was introduced in Chile, where abortions are currently legal only under 3 circumstances:  when the mother’s life is at risk, when the pregnancy is the result of rape, or when the fetus is non-viable.

Around the same time, Brazil’s supreme court began to consider decriminalizing abortion through the 12th week of pregnancy. Women wearing red robes resembling those worn on the television adaptation of The Handmaid’s Tale gathered outside the supreme court to show their support for decriminalization. Meanwhile, the church sounded its bells as a sign of protest.

Argentine activists and lawmakers haven’t given up either. They are determined to introduce the bill again next year and make sure that this time, it goes through. Most of the Senators who voted against the law argued that it was too broad and missing relevant details that still needed to be debated. One example is the issue of parental consent when the pregnant woman is a minor.

Photo credit: Maria Rendo

In the meantime, the federal government is considering decriminalization of abortion in the penal code. This wouldn’t give women access to safe abortions, but it would save them from the threat of being imprisoned as a result of an abortion. This is yet to be presented and debated, but it would do part of what the proposed law intended to do (leaving out the need for better sex education, access to contraceptives and safe abortions in hospitals and under the care of health professionals).

On a personal note, it was incredibly moving for me to have the opportunity to join the women who had gathered in front of Congress to show their support for the law. I saw women of all ages and all sectors of society together, supporting the same cause. The air was filled with hope and solidarity.

Photo credit: Maria Rendo

These women spent a cold night out in the rain, sharing umbrellas and blankets while they waited for the decision, encouraging each other even though they knew the law was very unlikely to pass. Their strength is what keeps this movement going, and it’s the reason this law will be approved, sooner or later.

If you want to support Argentinian activists, they have created The Young Feminist Fund for Argentina to support projects designed and led by young women’s rights defenders until abortion is legal in the country. You can find them on Twitter as @FondoFeminista.

Share their work and encourage others to donate!

Argentina’s Abortion Law is History in the Making

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This month, Argentina reached a turning point in its abortion legislation. After years of campaigning by a coalition of organizations and activists, the law on legal, safe and free abortions was finally debated in the Lower House and, after almost 24 hours of debate, a bill that would decriminalize abortion up to the first 14 weeks of pregnancy passed.

The debate in the Lower House was extensive and controversial, just like the issue being discussed. The final vote was very close, with 129 votes in favor, 125 against and 1 abstention. The law has yet to be debated and voted on by the Senate, but the fact that it made it this far for the first time is already impactful. President Mauricio Macri has stated that he won’t veto the law if it passes in the Senate, even though he is personally against abortions.

The National Campaign for Legal, Safe and Free Abortions has a very clear mission:

“Educación sexual para decidir, anticonceptivos para no abortar, aborto legal para no morir”, meaning “sexual education to decide, contraceptives to not terminate, legal abortions to survive”. Campaigners are asking for much more than the right to decide when to have an abortion. They’re asking for proper sexual education and for access to contraceptives so women can avoid having to make the decision of whether or not to have an abortion in the first place.

This vote was historical because of the level of professionalism shown by those who organized the vigil and online campaign for the day. In a country where protests tend to end in violence and the destruction of public spaces, it was moving to witness a peaceful vigil. It is estimated that around a million people joined in front of Congress to wait for the final vote count. While some people spent a few hours there and then went home, others stayed for the entire duration of the debate. They camped outside of Congress all night in the cold to show their support for this legislation. They even held a concert!  

People were well-prepared to campaign online, too. A website called Activá el Congreso (Activate Congress) was set up to make it easier for people to reach their representatives through phone calls or tweets to try to convince them to vote in favor. The website can now be used to help the general public contact their Senators and express their support for the law.

There was also an online map called Aquí Estamos (Here We Are), where Argentinians who weren’t in Buenos Aires at the time could check in to show their support. Today, the map says that 18,914 people checked in from different parts of Argentina, but also from across the entire Western Hemisphere and Europe.

It has been particularly moving for me to see that even in a deeply politically polarized country like Argentina, people from different political parties and ideologies can join together for a cause. People on social media were shocked to find they could agree on something with someone they had considered an enemy because of party alliances. At a time like this, when people are losing their faith in democracy and their representatives, I think it was good for the public to see that they can make their voices heard and actually influence a government’s decision. It was refreshing to be reminded that we have enough power when we make our voices heard.  

In fact, it was not only the Lower House that heard Argentinians’ voices – the rest of Latin America heard them too. This vote has had an impact on the rest of the region. Now, a week later, other countries like Ecuador, Mexico, Costa Rica, Colombia, Chile and Peru are organizing similar movements and campaigns, inspired by the achievement in Argentina.

During the debate, I received messages from friends from some of these countries telling me how they wish something similar could happen in their home, both in terms of the effective organization of civil society and the fact that the bill passed in the Lower House.

This is a momentous step forward for women’s rights, and the feminist movement in Latin America is now saying, “if Argentina can do it, so can we!”

Girls must be central to the Post 2015 Agenda

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The health and status of women and girls are inextricably linked to the well-being and prosperity of families, communities, and economies. Yet today, nearly 15 years on from the launch of the MDGs, progress on reproductive health lags seriously behind. Approximately 800 women and girls die every day from complications related to pregnancy or childbirth, and 99 percent of these occur in developing countries.

Infographic c/o Women Deliver

Additionally, over 222 million women have an unmet need for modern contraception. Investing in the sexual and reproductive health and rights of women and girls has never been more critical. The largest-ever cohort of young people is entering their reproductive years, and their access to sexual and reproductive health information and services will have enormous implications for the trajectories of their lives. Advancing the reproductive health of women and girls also pays enormous dividends for development – poverty rates go down, education rates go up and greater prosperity follows.

As the 58th session of the UN Commission on the Status of Women is underway in New York, USA discussions and negotiations are taking place to shape the post-2015 development agenda.   Hence, now is the time to ensure that sexual and reproductive health and rights is a priority in the post-2015 agenda. I think it is essential that we realise that when we talk about sexual reproductive health and rights we are talking about young women and girls.

As a young woman and youth advocate, I am committed to ensuring that young women and girls are central to the Post 2015 agenda. I say this as the Post 2015 agenda must address the most marginalised populations and as girls and young women are two of these key populations they need to be part of the decision making process. In order to do this young women and girls must be empowered and engaged in meaningful participation. Meaningful engagement of young women can be understood as a series of empowering moments that move in the direction of the ‘decision-making table.’ She can advise, share, sing or cry her opinions on political reforms, policies, programmes and development initiatives that directly affect her and will allow for effective use of resources, both human and natural.

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Image c/o Flickr Creative Commons

In a world where ‘one in three women will be beaten or raped in her lifetime,’ successful and sustainable change will require transformative leadership. This means leadership that will challenge and change the status quo and the systems and structures that perpetuate discrimination, inequality and denial of human dignity. In order for this to happen young women and girls need safe spaces to be themselves, share experiences, access information and discuss ‘taboo’ subjects without fear or judgement.

At the World YWCA (where I am lucky enough to work), we have developed a model of safe spaces which has emerged from our programming on sexual reproductive health and rights in Sub-Saharan Africa. Globally there is a frightening unmet need for family planning and as the world’s population saws we must ask ourselves what are we doing to address this? Sub-Saharan Africa has the highest adolescent fertility rate in the world, with girls under the age of 16 years of age facing four times the risk of maternal mortality than women over the age of 20. In Mexico 42% of young men and 26% of young women between 15 and 19 years have had a sexual relationship; only 47% of these young men and 15% of young women had used a condom during their first sexual intercourse. The HIV and AIDS rates are increasing in Eastern Europe. In Nepal 86% of married adolescents aged 15-19 are not using a modern contraceptives, every 4 hours one girl died from pregnancy relation complications. This is a global issue! The lack of adequate, accessible and youth friendly sexual and reproductive health services not only affect the educational and economic opportunities of present and future generations, but threaten their very survival.

Young people, particularly young women, must be educated and empowered on their own sexual reproductive health and rights. Without access to non-judgmental, confidential and evidence-based sexual and reproductive health information and services, young women remain vulnerable to unwanted pregnancies, unsafe abortion and sexually transmitted infections. Many young women are confronted with the consequences of early and forced marriage and child bearing.

Girls' Globe blogger Marcia Banasko at CSW58 in New York City
Girls’ Globe blogger Marcia Banasko at CSW58 in New York City

If we are to achieve a world of peace, equality and justice, we must be accountable to the world’s 860 million young women. We are more than a statistic – we are a valuable asset to nations, a critical population group for achieving sustainable human development and our voices must count in shaping the future of humanity. It is essential gender equality is retained as a stand-alone goal and that gender is mainstreamed across all the targets.

For Information:

World YWCA Global Call for Act: The Future Young Women Want

UNFPA Launches Advocacy Platform for Post-2015 Development Framework

Cover image courtesy of Flickr Creative Commons.

Teenage Pregnancy: Still a Great Killer of Teenage Girls in Kenya

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Reproductive health and rights have been conceptualized under several human rights instruments that Kenya has ratified. These instruments seek to entrench gender equality by stemming out discrimination against women and guaranteeing comprehensive rights to women including to control their reproductive health and to put an end to female genital mutilation. In spite of these instruments, abortion is restricted in Kenya and only applies in very limited situations, that is, where the continuation of the pregnancy poses a threat to the life of the woman.

All human beings are born free and equal in dignity and rights and thereby every human being has a right to life. This right is safeguarded by the Universal Declaration of Human Rights (UDHR) which states that no one shall be subjected to torture or cruel, inhuman or degrading treatment or punishment.

Teenage pregnancy remains the biggest killer of teenage girls in the developing world.

Young women aged 15 to 19 are twice as likely to die from complications in pregnancy as compared to older women. The chances of death in the first year of life for a baby born to a woman under the age of 18 is 60 per cent greater than that of one born to woman aged 19 or older. Teenage pregnancy has been on the rise in Kenya for many years and the situation is likely to get out of hand if nothing is done. Several factors, including peer pressure, rape, cultural practices, lack of sexual awareness and abuse of alcohol and drugs have been attributed to teenage pregnancies, but the biggest association is with poverty.

This explains why teenage pregnancies are more usual in the rural parts of Kenya, especially among poor households. In the northern parts of Kenya for instance, early marriages are very common especially in times of crisis, a trend that has been referred to as drought brides. Violence against women also exposes many young girls to unwanted pregnancy and its various consequences.

The high mortality rate in the country can be linked to insufficient availability of comprehensive reproductive health services, lack of availability of safe abortion services and high rate of teenage pregnancy.

Considering that early marriages are more prominent in areas where poverty is high and education levels are low, awareness campaigns, as well as, initiatives that could raise the living standards of those affected could go a great way in alleviating cases of teenage pregnancies. Sex education is also critical to teenagers especially as most parents shy away from discussing sex with their children.

Kenya

In the Kenyan culture, sex is still a taboo subject and any issues related to sex are meant to be discussed in the married couple’s bedroom. It is rarely discussed in public although some communities offer sex lessons to brides-to-be, but in isolation. However, the society in general has changed, and sexual activity is frequently shown through the media with children as young as 10 years old being exposed and the internet is the least controlled media.

The confusing absence of discussion by parents and educators, yet the seeming promotion of sexual activity on TV and the internet and indeed advertising, could well be a factor in promoting teenage experimentation, and eventual pregnancy. Increased levels of knowledge about modern methods of contraception, as well as, making them available and affordable is very essential.

If teenage pregnancy is to be controlled and reduced we must realize that the solution lies in a shared responsibility that incorporates communities, the government and other stake holders and the teenagers themselves.

The Kenyan government should recognize and respect and raise awareness on Article 14 of the Protocol to the African Charter on the Rights of Women in Africa (the Maputo Protocol), which calls upon state parties to to ensure that the right to health of women, including sexual and reproductive health, is respected and promoted. And also the Africa Health Strategy developed and adopted during the 3rd Ordinary Session of the AU Conference of Ministers which provides in Article 86 that,

The health system should mainstream gender into health policy, seek elimination of all forms of violence against women, amongst other factors, recognizing the morbidity and mortality from unsafe abortions, safe abortion services should be included, as far as the law allows.

Read more related posts on Girls’ Globe:

Image credit: Nelly Lukale

 

New Report @Guttmacher: "Benefits of Meeting Women's Contraceptive Needs in Burkina Faso"

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This new report, published by the Guttmacher Institute and l’Institue de Recherche des Sciences de la Santé and supported by the World Bank, shows us the benefits of investing in access to contraceptive supplies and services.

The report studies the unmet need of contraception of Burkinabe women, and the societal and economic implications of meeting these needs. In Burkina Faso the maternal mortality ratio was estimated to be as high as 560 per 100,000 live births in 2008, which is much higher than the rest of the developing world (WHO, Trends in Maternal Mortality, 2010). WHO claims that the maternal mortality ratio represents the risk associated with each pregnancy, i.e. the obstetric risk. It is also a MDG indicator.

Throughout society in Burkina Faso, from the poorest quintile to the richest, there is an unmet need of contraception, i.e. the majority of women in Burkina Faso have more children than they desire. This leads to a heavy burden on society linked with the implications of unintended pregnancies, through a sustained high rate of maternal mortality and morbidity as well as economic implications through high spending on healthcare services. The report shows that the benefits of meeting the need by providing access to modern contraception would be lowered rates of unintended pregnancies and induced abortions, decreased maternal mortality and morbidity, as well as lowered overall costs related to reproductive health care.

I truly recommend this report! Download it here, or see a nice Powerpoint here. The report, Powerpoint and the picture above are linked through www.guttmacher.org.