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Taking action to address unsafe abortion in Africa

A report from November’s Keeping Our Promise conference

Tuesday, December 21, 2010

Dancers at the opening ceremony of Keeping Our Promise: Addressing Unsafe Abortion in Africa

More than 230 participants from more than 20 African countries gathered in November in Accra, Ghana, to discuss, deliberate, learn and share their experiences working to address the problem of unsafe abortion in Africa. The conference was organized by Ipas and co-sponsored by the United Nations Economic Commission for Africa, the Ghana Ministry of Health, the International Planned Parenthood Federation Africa Regional Office, Marie Stopes International and the African Women's Development and Communication Network (FEMNET).

New figures from the World Health Organization report that though the number of deaths from unsafe abortions worldwide has declined from roughly 67,000 to 47,000, the burden of unsafe abortion mortality remains problematically high in Africa and improvements in maternal health have been slow. In Africa, especially in Eastern and Middle Africa, women continue to risk their lives to end unintended pregnancies, facing myriad barriers to access safe abortion care, including legal restrictions, social and religious stigma, geographic distances and lack of rural services.

"Most of the African conventions would have solved these problems, but they have not been implemented. It's time to lift the veil on this experience shared by so many African families," said plenary speaker Hon. Maiga sina Damba, Minister for Women's, Children's and Family Affairs, Mali, about the problem of unsafe abortion.

Dr. Richard Turkson, Ghana's High Commissioner to Canada, noted Ghana was a fitting host location for this conference, as the country has made progress in expanding women's access to safe abortion care: "In 1985, long before the African Union adopted the Maputo Protocol and Plan of Action, Ghana amended its archaic law on abortion to considerably expand the scope of abortion permissible under the law. What now remains is to apply these rules vigorously to achieve our common objective, access by our women to safe, legal abortions."

Aissatou Gueye, of the United Nations Economic Commission for Africa, charged the attendees with making good on promises in her keynote address during the opening ceremony: "We must mount a multifaceted social response to address the underlying causes [of unsafe abortion] to end the mistreatment of women and to eliminate all forms of gender discrimination."

Also in the opening ceremony, delivering a speech on behalf of Ghana President John Atta Mills, Ghana Deputy Minister of Health Rojo Mettle-Nunoo set the tone for the week ahead: "It is indeed time to break the culture of silence [around unsafe abortion]. Women have a choice, they have a need and they need to know their rights."

Keeping promises

All participants, including health providers, youth, advocates, policymakers, ministers of women's and social affairs, NGO workers, researchers and journalists, reaffirmed their commitment to keep Africa's promise to save the lives of women and families, by working to prevent deaths and injuries from unsafe abortion.

Attendees and speakers themselves committed to:

  • Provide leadership to accelerate action to expand African women's access to safe abortion care and end needless deaths and injuries from unsafe abortion;
  • Recognize the unique barriers that youth and adolescents face when seeking safe abortion care and create safe spaces for discussion and youth-centered services;
  • Strengthen partnerships at all levels to achieve these goals.

Major themes

Youth participation and youth-centered issues featured prominently during the proceedings. Youth attendees started the conference early with a day-long workshop designed to increase their knowledge on abortion and reproductive health issues in Africa and to build their capacity to do work on abortion in their own communities. During the workshop and throughout the conference, youth perspectives and experiences were shared. Overwhelmingly, youth attendees agreed that in their own adolescence, they had not been given key reproductive health information and this formed the basis for their own work, as peer educators in South Africa, for example, to using coffee ceremonies in Ethiopia to involve young women in discussions about abortion and sexual health and rights.

Throughout the four days, the promise of medical abortion to increase African women's access to safe abortion care was a thread in many sessions, including lessons learned from Ethiopia, Tunisia, Zambia and South Africa, where implementation of medical abortion is ongoing.
"The advantages of these medicines are many," according to Dr. Davy Chikamata, Medical Advisor for the Concept Foundation, Africa. "Medical abortion is proven safe and effective," he said. "It offers a choice to women and providers, and increases access to safe care through public health centers in both urban and rural areas."

How to deliver safe abortion care effectively, particularly through mid-level providers such as midwives, also featured prominently at the conference. In preparation for the International Conference of Midwives, to be held in Durban, South Africa, in June 2011, more than 50 interested attendees planned for the meeting and shared lessons learned from four countries—Ethiopia, Ghana, South Africa and Nigeria—working to build the capacity of midwives through clinical training and education.

Restrictive laws and policies continue to have an impact on safe abortion care, access and women's use of services in Africa. Several sessions delved into various policy-related issues. In "Using the WHO Strategic Approach to strengthen policies, programmes and services related to abortion" the room was packed and participants listened attentively to speakers from Zambia, Malawi, Ghana and Senegal describe how the three-part approach, beginning with intense assessments in communities to determine specific country needs, can improve access and quality of abortion services.

Speakers shared their experiences in using credible research to influence policy change. In Ethiopia, for example, Dr. Yirgu Gebrehiwot, of the Ethiopian Society for Obstetrics and Gynecology, said that key research findings, particularly abortion mortality figures and provider attitude information, helped form the basis for advocacy efforts which eventually led to the 2005 law change.

"Credibility is a major question…we need credible research and data, followed by investment in advocacy," said Godfrey Kanguade, of Ipas Malawi.

One area of research that draws interest from African ministries of health and policymakers is the cost of unsafe abortion. "Unsafe abortion is happening now…but parliamentarians who have no idea about public health need help to understand the magnitude of the problem, so for those who are money-minded, this sort of research is timely and relevant," said Hailemichael Gebreselassie, Senior Research and Evaluation Associate for Ipas. Gebreselassie also, along with many speakers during the conference, noted that key to reducing unsafe abortion is contraception: "We need to have postabortion family planning in place."

Leading the charge to save women's lives

The conference ignited passionate commitment from attendees—from young participants to seasoned health providers and policymakers—many of whom have a personal connection to the problem of unsafe abortion in Africa. Most Africans, said one youth presenter, know someone who has experienced an unsafe abortion. Many know women who have lost their lives because of their desperate need to terminate an unintended pregnancy.

Fred Sai, whose work in reproductive health was celebrated at the conference, wrote in his recent book With Heart and Voice: Fred Sai Remembers: "The question I ask myself, my government and all who are against abortion is how do we continue to fight against a public health problem so easy to solve?"

Keeping our Promise attendees committed to follow Sai's lead in making reproductive health—including safe abortion care—an issue that African governments cannot ignore:

"As IPPF we are happy to support this conference…to make sure women in Africa have access to safe abortion care and the right to decide when and if to have a child," said Manuelle Hurwitz of International Planned Parenthood Federation UK between sessions.

And in the closing ceremony, Honorable Juliana Azumah-Mensah, Minister for Women and Children's Affairs, Ghana, said: "I wish to add my voice to the call to end unsafe abortion. This is a matter of human rights."

Litha Musyimi Ogana, Director of Women, Gender and Development for the African Union, added: "The issue of unsafe abortion demands our attention. We have the words of commitment. What we need now is action." Getachew Bekele, senior advisor for Marie Stopes International, Ethiopia, echoed her call, adding that MSI viewed the conference as not only "an excellent opportunity to review our progress, but more importantly, to translate our commitments into meaningful action."