Making Abortions Safe: A Matter of Good Public Health Policy and Practice

Abstract

Globally, abortion mortality constitutes at least 13% of maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing abortion mortality and morbidity in countries where they remain high is a matter of good public health policy, based on good medical practice, and an important part of initiatives to make pregnancy safer. This paper examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands: changes at national policy level; abortion training for service providers; the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. Ó 2000 Bulletin of World Health Organization. Published by Elsevier Science on behalf of Reproductive Health Matters.

Policy Implications of a National Public Opinion Survey on Abortion in Mexico

“…[2][3][4] Not only do these laws create a subculture of clandestine, unsafe abortion, they also reinforce an environment in which abortion is socially shameful and unacceptable. 5,6 In Mexico, although accurate data on the number of abortions practised is unavailable, complications from unsafe abortions are estimated to be the third or fourth leading cause of maternal mortality, 7,8 and legal access to abortion is highly restricted. Each Mexican state decides its own abortion laws.…”

Characteristics of private abortion services in Mexico City after legalization

“…Such a transition should be based in best practice; mindful of women's needs; rooted in public awareness of the existence of these services; and ensure access to all women, including those with special needs, such as adolescents, single women and women seeking later abortions. 19,20 While it was beyond the scope of this research to ascertain the total number of abortions in the private sector, our study suggests that many women are still accessing private abortion services and may keep doing so, because these are their regular doctors anyway. However, their reasons may also include expectation of a better quality of care in the private system, absence of bureaucratic hurdles and conscientious objectors, lack of awareness of the new law and privacy concerns.…”

“…5,15,21 Studies of clandestine services pre-legalization generally focus on issues related to access and women's perspectives. 5,13,[19][20][21] More recently, much attention has been paid to evaluate Mexico City's public facilities, where efforts have been successfully focused on improving quality of care, methods used and providers' attitudes. 4,22 Some other aspects of our findings are worth highlighting.…”

From unwanted pregnancy to safe abortion: Sharing information about abortion in Asia through animation

“…This stigma is reflected in restrictive laws, the lack of trained providers and the general lack of awareness of the laws on abortion, which drives large numbers of women to unsafe abortion. 8 As a regional network promoting the right to safe abortion, the Asia Safe Abortion Partnership (ASAP) has to address the lack of access to safe abortion both as a transnational phenomenon and as a highly localized experience. In order to increase knowledge about specific barriers to safe abortion through educational materials for its regional advocacy, ASAP funded the making of an animated short film entitled From Unwanted Pregnancy to Safe Abortion.…”