Remove the Gag, Support Safe Abortion in Africa

(WOMENSENEWS)–Globally, unsafe abortion claims the lives of nearly 70,000 women every year. Nearly half of those deaths–and countless related injuries–occur in Africa. In Ethiopia alone, more women die in hospitals from complications of unsafe, usually illegal, abortions than from almost any other cause, the World Health Organization reports. In Ethiopia, as in other countries, most of the women affected are very poor and very young.

These deaths are senseless. The technologies and knowledge required to stop women’s deaths from unsafe abortion exist, but to date, those in positions of power–including the U.S. government, some international donor agencies and many African politicians–have failed to take effective action. The world could readily be rid of the senseless scourge of unsafe abortion if political leaders showed compassion toward women who are victims of unsafe abortion, reformed restrictive policies and invested the relatively modest resources required to make safe services available.

To this end, I would like to revisit what recently happened in early March, while the world’s attention and anxiety were focused on the impending war in Iraq.

Convening in Addis Ababa, Ethiopia, a group of more than 100 high-level African health leaders, lawyers, women’s advocates and others representing 15 African countries joined forces in another kind of battle–a campaign to save women’s lives. They assessed the tragic consequences of unsafe abortion for African women, their families and communities. Participants cited restrictive abortion laws and lack of safe abortion services as the major reasons so many women die and are injured by unsafe abortion. After all, when performed by qualified medical personnel in hygienic conditions, abortion is one of the safest of all medical procedures.

Global Gag Rule Leads to Unwanted Pregnancies

Time and time again, participants directed attention to the harmful impact of the U.S. government’s Mexico City Policy (so named because it was introduced at an international population conference in the Mexican capital). Also known as the Global Gag Rule, the policy denies U.S. family-planning assistance to groups that provide counseling on abortion, provide legal abortion services except in very narrow circumstances such as in cases of rape, incest or immediate danger to the woman’s life, or participate in political debate surrounding abortion.

The experts gathered in Addis know from first-hand experience that these restrictions impede efforts to combat unsafe abortion by curtailing the availability of contraceptive services to prevent unwanted pregnancy. In Ethiopia and Kenya, for example, cuts in U.S. funding to local family planning organizations have led to severe cutbacks in services, including closing clinics. Services in underserved rural communities have been particularly affected.

Contrary to the intentions of those who support it, the Global Gag Rule in fact leads to more unwanted pregnancies, more unsafe abortions, and more deaths and injuries of women and girls.

The Gag Rule policy of the Bush Administration imposes a moral agenda on developing countries that not only conflicts with local values and practices in many countries but also actively harms their people–especially women. In a number of African countries, for example, where local laws and values permit abortion if a pregnancy threatens a woman’s health, the Gag Rule precludes facilities that receive U.S. funds from providing counseling or safe abortion services in this circumstance. In addition, adherence to the policy prevents many organizations and women’s health advocates from participating in current, very active debate in several countries on reform of abortion laws.

In the end, participants in the Addis consultation felt compelled by their consciences to oppose the Gag Rule, not only in their hearts but in their final communique. Proclaiming that enough is enough–and calling on their governments to do the same–was no small step for these leaders.

Regrettably, it is not at all inconceivable that their outspokenness could have negative repercussions for both individuals and organizations, including professional ostracism, loss of funding and employment. That risk is exactly what has kept so many public-health professionals around the world (including many in the United States) from speaking out against the Global Gag Rule.

As a former senior official in international family planning at the U.S. Agency for International Development during the Reagan-Bush era–when the same policy was in effect–I know all too well the personal anguish that can result from being obligated to carry out policies at odds with one’s personal convictions and professional judgment.

Calls for Other Life-Saving Recommendations

The communique from the Addis consultation includes several other significant recommendations which, if taken seriously by the international community, could save tens of thousands of women’s lives. One of these calls on governments to meet their obligations to make safe abortion available to women in circumstances permitted by local laws, such as in cases of rape, incest or to save a woman’s life. All African countries do permit induced abortion in some circumstances and all have joined international consensus agreements to address unsafe abortion as a major public-health concern, by taking such steps as increasing couples’ access to comprehensive contraceptive information and services and providing safe abortion to the full extent of the law.

In addition, the Addis communique aptly stressed that “until women can make their own reproductive choices safely, poverty alleviation and economic development cannot be achieved.” The recently adopted United Nations Millennium Development Goals–which include an objective of reducing pregnancy-related deaths of women by 75 percent by 2015–have no hope of being realized unless unsafe abortion, one of the leading causes of maternal mortality, is addressed effectively.

Participants in Africa’s first regional consultation on unsafe abortion showed bravery and clear-sightedness in tackling one of the most sensitive political issues in the world today. They deserve the gratitude and respect of all who are concerned about women’s reproductive health and rights around the world for speaking out against the Bush administration’s harmful anti-choice policies.

Abortion has always occurred and will continue to occur in every society. The challenge, and the imperative, is to make it safe and accessible. Research indicates that 46 million abortions take place every year and that, worldwide, the average woman will have one abortion during her lifetime. Behind these statistics are the real women in all our lives–mothers, sisters, daughters and wives.

To defend the right of these women to safe reproductive choice, we should all support each other’s efforts, especially in Africa, where unsafe abortion takes it greatest toll.

Elizabeth Maguire is the president and chief executive officer of Ipas, and former director of the Office of Population of the U.S. Agency for International Development.