AFRICA: Keeping the Promise to Save African Women

According to statistics, roughly 5.5 million unsafe abortions are performed annually in Africa and the deaths from the dangerous exercise account for approximately 14 per cent of all maternal deaths in the region.

Director of the African Centre for Gender and Social Development at the United Nations Economic Commission for Africa (ECA), Ms. Thokozile Ruzvidzo, made the statement recently quoting World Health Organisation (WHO) data.

"An estimated 36,000 young adults of school going age die needlessly of unsafe abortion in Africa. On the African continent, the debate needs to address legalising abortion and making it a safe practice; this must go hand in hand with prevention against unwanted pregnancies and HIV infection, which is also a result of unprotected sex," the WHO report said. Ruzvidzo said in the west, abortion has been as important an issue as to determine who to vote for, it has been a totally disregarded issue in Africa, which carries a huge brunt of the preventable pandemic.

It was as a result of this that stakeholders and health experts met recently in Accra, Ghana to make true their promise that more African women should not continue to die unnecessarily as a result of unsafe abortion. Welcoming participants at the conference, Chairman of the opening ceremony, Dr. Richard B. Turkson began with a story from the Old Testament of the Bible.

He said the story about the creation and the original sin, the Almighty God, whose wrathful displeasure Adam and Eve had incurred, is recorded in the book of Genesis, Chapter 3 verse 16, as having addressed Eve as follows: "I will greatly multiply thy sorrow and conception; in sorrow thou shall bring forth children; and thy desire shall be to thy husband, and he shall rule over thee".

"From time immemorial and in virtually all cultures, men have misinterpreted this to mean their so-called "mandate" from God Himself to lord it over women and to show very little concern, if any, for women's fertility-related problems. Over time, God's anger seems to have abated in many parts of the world; it appears, however, that in sub-Saharan Africa it continues unabated. Unnecessarily hazardous pregnancies and child bearing largely govern women's lives in sub-Saharan Africa; similarly their death is often dictated by pregnancy and childbirth.

"Worse still, everywhere in Africa it is the women, not the men, who suffer from mutilation, disease and death in pursuit of the high premium which we traditionally place on fertility, particularly male children," he emphasised, explaining that the question of unsafe abortion, within the context of safe motherhood generally, has been addressed in every major international consensus building forum, beginning with the ICPD Conference in Cairo, which was a significant landmark in the long, dark and difficult process of achieving consensus on the concept of reproductive rights.

According to his, the ICPD recognised unsafe abortion as a major public health and human rights concern and elicited commitments- commitments-from nearly 200 governments to address this entirely preventable problem. The forum pledged action to reduce the tens of thousands of preventable deaths and millions of injuries that occur every year because women and girls lack access to effective modern contraception and safe abortion.

While urging the participants to expose the evil of unsafe abortion, Turkson acknowledged that there has been notable progress in addressing unsafe abortion in the last 16 years. He said though the stigma surrounding abortion is still very strong, but no longer absolute. "We know more about the extent and impact of unsafe abortion, thanks to seminal abortion magnitude studies, including in several African countries."

Turkson, who is also the Ghanaian Ambassador to Canada said in countries such as South Africa and Ethiopia, enlightened legislators have liberalised laws restricting abortion, in an effort to protect women's health and lives and to support their fundamental rights, while at regional levels "we have seen greater acknowledgment of the need for action on unsafe abortion in such agreements as the Maputo Protocol. Technologies for safe abortion, including manual vacuum aspiration and medical abortion, are more widely available, and governments have trained health workers to make care accessible to women."

These are important advances, but the chairman of the occasion however said they are not enough. "The promises that African and global leaders made to African women in and since Cairo have not been fully kept. We are here, collectively, to set a clear path to ensuring that they are. Women's right to sexual and reproductive health, including the right to safe legally permitted abortion, is a basic human right. Like every human right, this should translate into the necessary social, economic and cultural conditions and facilities under which their legitimate aspirations and dignity may be fully realised.

"Indeed, there is now a world-wide movement of ideas whose compelling logic suggests that any system of human rights, however elaborately structured and whatever its substantive content, which fails to ensure that its implementing facilities are unrestricted, is, by reason of that failure, and to the extent of such failure, hopelessly defective. "At the end of the day, the question which we in the field of sexual and reproductive health and rights-whether non-government organisations, government, development partners or individual members of civil society-should constantly ask ourselves is: what kind of world do we want our children, grandchildren and great grandchildren to inherit?" he emphasised at the four-day conference organised by Ipas.

He said "if we succeed in finding the political will to address these important issues-if we build meaningful and productive networks and develop innovative programmes-we have every right to expect that our children, grandchildren and great grandchildren will inherit such a world. On the other hand, if we do not succeed, our children, grandchildren and great grandchildren will inherit a vastly different kind of world. The prospect of failure is so frightening that, rather than demoralise us, it should strengthen our collective will and determination to succeed."

Dr. Eunice Brookman-Amissah, Ipas vice president for Africa, in a remark said several countries, including Ghana, Zambia, Malawi and Senegal, have applied an approach pioneered by the World Health Organisation to study unwanted pregnancy and abortion. Ministries of Health in Kenya, Ethiopia and Malawi have supported studies on the magnitude and impact of unsafe abortion, while other countries, including Ghana, Ethiopia, Mali, and Zambia have developed national standards and guidelines for abortion care, she said.

In both the public and private sectors, Brookman-Amissah said there has been more training for diverse cadres of health care workers, including nurses and midwives, in post-abortion and safe abortion care, while in some countries, governments and donors are taking steps to ensure that technologies and supplies for safe abortion-including drugs for medical abortion-are approved and available, so that, finally, African women can benefit from them.

"These are great achievements - unheard of only 10 years ago. When I joined Ipas in 2001 to work full time in this area the word "abortion" or the 'A' word as I call it, could barely be uttered in polite African company While we all celebrate new data indicating that globally maternal mortality is at last falling, we are disheartened that so little progress has occurred on our continent.

"Obtaining real political commitment to address unsafe abortion remains very hard, but this needs to happen if we are to eliminate this totally preventable cause of maternal deaths in our countries. When leaders fail to implement known, affordable solutions to this entirely preventable problem, we can only conclude that they do not sufficiently value the women and girls whose lives are at stake.

"African women in most countries remain subject to archaic 19th century laws imposed by colonial masters-all of which, including most recently Portugal-have since revoked these injurious laws in their own countries, in recognition of public health and women's rights. We have also seen an increase in recent years in active political and religious opposition to abortion rights - much of it guided and funded by external actors. The recent constitutional reform process in Kenya, where I live, is just one such example," she said.

Brookman-Amissah admonished that "we must resist the efforts by fundamentalists and the conservative patriarchal lobby to make Africa the last frontier for the struggle to control women's lives and deny them the right to reproductive self-determination. These are indeed challenges, but they are challenges that we CAN overcome, together."

For the achievement of Millennium Development Goal (MDG5) and to protect African women and girls, she said it is essential that "we take the next step in effectively addressing unsafe abortion, including improving women's access to safe abortion. And the time for that is NOW-before many more women die. We need strategies to overcome the iniquities and inequities that restrictive abortion laws and lack of safe services pose for women in our continent."

In a keynote address, the United Nations Economic Commission for Africa (UNECA) representative said unsafe abortion is frequently the only recourse young, poor, uneducated and rural women have to avoid unwanted pregnancies.

They take place in situations characterised by inadequate provider skills, the use of hazardous techniques and in unsanitary facilities, and endanger the lives of thousands of African women, the organisation said. According to UNECA, approximately 67,000 women die annually as a result of complications of unsafe abortion; additionally between two million and seven million women each year survive unsafe abortions but sustain long-term damage or disease. More than half of the deaths from unsafe abortion-an estimated 35,000-occur in Africa.

The World Health Organisation estimates that in Africa, one in seven maternal deaths result from unsafe abortion, the organisation emphasised. Stated that so many African women resort to unsafe abortion reveals how women on the continent do not enjoy the basic freedoms and rights to which all human beings are entitled, thus limiting their full potential for development.

Each year, UNECA said an estimated 14 million women in Africa experience unintended pregnancy. In large part, this reflects the persistent, unacceptably high-unmet need for contraception. As many as a quarter of all African women who want to practice family planning lack the information or effective contraceptive methods they need to do so. Although there has been progress in addressing this gap in recent years and decades - more in some countries than in others - by and large, UNECA said the unmet need for contraception remains a gross injustice for women in this region.

It stressed that a main challenge to women's maternal health arises from inequitable distribution of health care services, particularly in rural areas as well as the fact that service delivery in Africa is characterised by many challenges, not limited to the lack of availability of emergency obstetric care. Furthermore, UNECA said the lack of health facilities that can care for women who have experienced an unsafe abortion, and these women's own barriers to accessing health services when complications due to unsafe abortion arise, are a major contributing factor to maternal mortality.

UNECA identified other factors to include sexual violence, poverty and lack of employment opportunities and laws that discriminate against women. "The role of the social status of women in African countries in contributing to the prevalence of unsafe abortion cannot be ignored. It is widely accepted that promoting gender equality, women's empowerment and ending violence against women is essential to achieving human development, poverty eradication and economic growth on the African continent," UNECA said at the event co-sponsored by Ghana Ministry of Health and the Local Ghana Host Committee, United Nations Economic Commission for Africa- ECA, The International Planned Parenthood Federation (IPPF) Africa Region, Marie Stopes International, The African Women's Development and Communication Network (FEMNET) and the African Network for Medical Abortion.

According to Dr. Charles Fleischer-Djoleto, Office Focal Point, World Health Organization, Ghana, globally, 13 per cent of maternal deaths are due to unsafe abortion-this means that about 130 women die every day from unsafe abortion and, 99 per cent of them live in a developing country. He said as far back as 1967, the World Health Organisation recognised that unsafe abortion constituted a serious public health problem in many countries. He said recognising the full scope of this problem, WHO worked to advance recognition of unsafe abortion as a major public health concern and to offer guidance to member states to address it.

Fleischer-Djoleto explained that WHO activities aimed at eliminating unsafe abortion include developing and mapping evidence, testing interventions, improving technologies, developing norms, standards and guidelines and providing technical support to countries. Others include looking at legal provisions governing access to safe abortion, as well as the availability and quality of legal abortion services.

"I wish to emphasise that WHO does not tell countries what to do with regard to their national laws and policies. However, WHO does provide evidence those countries can use to make their own decisions about health. According to the recently released WHO report, Women and Health: Today's Evidence Tomorrow's Agenda (2009), "the evidence shows that women who seek an abortion will do so regardless of legal restrictions where there are few restrictions on the availability of safe abortion, deaths and illness are dramatically reduced."

"A critical component of eliminating unsafe abortion is preventing unintended pregnancies. If contraceptive needs were fully met globally, unsafe abortions would decline by 73 per cent-from 20 million to 5.5 million per year and the number of women requiring treatment for abortion complications would decline from 8.5 million to 2 million per year. Can you imagine the impact this would have on African women's lives and the lives of their families?" Fleischer-Djoleto asked rhetorically.

In an interview later, Ipas Country Director in Nigeria, Dr. Ejike Oji, expressed satisfaction on the outcome of the conference because of the massive attendance and challenge by government to do more in stopping more women, especially in the rural areas from dying unnecessarily from complication arising from unsafe abortion. Prof. Brian Adinma, a gynecologist and obstetrician and a lecturer at the Nnamdi Azikiwe University, Anambra State, Nigeria said the experience from the conference was very fulfilling. He said he has recognised the importance of co-opting the mass media in the championing the cause of African women. He promised to apply the experience he garnered in the conference back home in Nigeria.

As participants rose from the four-day conference, there was the resolve to go back home and intensify the fight to see that more African women do not die unnecessary death as a result of complications arising from unsafe abortion and other reproductive health problems