Pregnant women who do not wish to—or aren’t able to—carry pregnancies to term have been largely absent in discussions at the GMNHC in Mexico City this week. The focus on reaching every mother and newborn with quality care effectively leaves these women out despite the significant contribution of unsafe abortion to maternal morbidity and mortality in areas of the world where abortion remains heavily restricted. One of today’s concurrent sessions, “Improving Access and Quality of Safe Abortion Services: Global Lessons and Questions,” filled this gap at the conference and made clear the need for integration of prevention and management of unintended pregnancy—as well as post-abortion care for incomplete induced abortion and miscarriage—into global efforts to meet the newly agreed upon SDGs. The panel highlighted several countries’ experiences incorporating safe abortion into maternal mortality reduction strategies and demonstrate the promise of such efforts.
As Swadesh Gurung from Ipas illustrated in his presentation, Nepal is one example of a country which has met MGD 5 in part by integrating safe abortion and post-abortion care into its national Safe Motherhood plans since liberalization of the abortion law occurred in 2002. Particularly interesting are efforts to integrate emergency obstetric and abortion care training for auxiliary nurse midwifes in order to reach the hardest to reach rural populations with health care workers trained to provide comprehensive services for pregnant women. Nepal is among several countries honored at the recent FIGO conference for achieving MDG 5 through inclusion of family planning and abortion in national strategies to address maternal mortality.
Other countries have legalized abortion more recently and are also making inspiring progress towards implementation of quality services. In Ethiopia, where abortion was legalized in 2005, nationally representative assessments in 2008 and 2014 have examined the availability of safe abortion, the incidence of abortion, and the magnitude of abortion-related morbidity. Publications of results comparing the progress made between these two time points are forthcoming. Sally Dijkerman of Ipas presented on the findings related to availability of services using the Safe Abortion Care (SAC) model, which is based on the Emergency Obstetric Care (EmOC) model, and highlighted success in expanding availability as well as areas for future improvements.
In Mexico City, impressive efforts by the government and NGO sector since legalization of first trimester abortion in 2007 have led to rapid integration of legal abortion services into the health system. Patricio Sanhueza, head of the Mexico City Ministry of Health’s Reproductive Health Program, highlighted key factors leading to the city’s success, including the development of clinical guidelines, the “ILETel” information hotline and the more recent launch of a website dedicated to providing information about accessing abortion, decentralization of services to the primary care level, and training of various cadre of health workers involved in abortion care.
Finally, a panelist from the Ministry of Health in Uganda, Collins Tusingwire, demonstrated what can be done in the absence of abortion law liberalization to address unsafe abortion. According to his presentation, 26% of maternal deaths in Uganda are from unsafe abortion, approximately double the worldwide rate. A diverse group of stakeholders in Uganda worked together to develop guidelines that would be acceptable to all parties and would address prevention and management of unintended pregnancy (including safe abortion for the limited indicators allowed by law) and post-abortion care. Ensuring these guidelines are in place is a first step in expanding access to quality care for women with unintended pregnancies.
At the upcoming Women Deliver conference, the new global and regional estimates of induced abortion will be released by the WHO and the Guttmacher Institute and will provide important information on progress towards decreasing unsafe abortion incidence. The maternal newborn health community represented at GMNHC – including donors and key players setting the agenda in the new SDG era—must pay attention and mainstream efforts to promote access to high-quality, safe abortion care as a central part of the strategy for ending preventable maternal mortality.
Photo: “Pro-abortion demonstration in Machala, Ecuador” ©2008 vesselthefilm, used under a creative commons Attribution-NonCommercial 2.0 license.