13 October 2009

Statement by Dr Kelly Culwell, Senior Abortion Adviser (IPPF), on the occasion of the release of
“Abortion Worldwide: A Decade of Uneven Progress”
by the Guttmacher Institute.

IPPF is a global network of service providers and advocates of sexual and reproductive health and rights operating in 171 countries. 

We welcome this report by the Guttmacher Institute as it puts the issue of abortion in a comprehensive context that mirrors what our clinics and healthcare providers see every day.

I’d like to speak briefly about the aspects of the report which have particular relevance to our work on the ground.

It is encouraging to see the overall increase in contraception use rates and associated decrease in unintended pregnancy rates in the past decade. 

However, the inequities around unintended pregnancy and unsafe abortion in this report are glaring. 

Unsafe abortion rates have changed very little during the period of this report and it is the poor, adolescent, and rural women who suffer the most.

We must address unmet need for contraception as a start. Even though globally contraceptive use rates have increased, not enough has been done – particularly for young and unmarried women. 

Over 200 million women have an unmet need for effective contraception and this number will only increase as history’s largest cohort of young people becomes sexually active.

It is also encouraging that globally the trend is towards liberalization of abortion laws. Our experience, however, is consistent with the report in that the law is not enough. 

Without a healthcare system in place which can provide safe abortion services and healthcare providers willing to provide these services, women will continue to have to resort to unsafe means to terminate their unwanted pregnancies. 

I was recently in South Africa where I saw first hand the lack of access to safe abortion services, despite a law which allows legal abortion in many circumstances. 

This is consistent with the report which states that only one third of approved facilities are actually providing abortion services leading to an estimated 2 unsafe abortions being performed for every 1 safe abortion. 

A similar situation is seen in India where an estimated 6 million abortions are performed unsafely outside the public health system every year. 

This is in contrast to the situation in Mexico City where hospitals and healthcare centres were ready to provide services within 24 hours of the liberalization of the abortion law.

As a medical doctor, it is particularly concerning to me that 2 out of the 3 countries which restricted their abortion laws during this period made abortion illegal in all circumstances – even when it is necessary to save a woman’s life. 

Tragically, since restriction of the law in such a way in Nicaragua, we have seen reports of increased maternal deaths and an increase in suicides among pregnant teenagers. 

Laws like this pit doctors’ and healthcare providers’ ethical obligations to their patients against a fear of prosecution.

In countries with restrictive laws, abortion rates are similar to or greater than those of the rest of the world but virtually all of these abortions are unsafe. 

This poses a huge burden on the healthcare system in these countries. For example, in Kenya, as many as 60% of admissions to the Kenyatta National Hospital maternity ward are due to complications of unsafe abortion.

Restrictive policies aimed at abortion can decrease access to contraceptive services as well. IPPF knows all too well about the negative effect of such policies. 

The recently rescinded Mexico City policy prohibited organizations in receipt of US funds from using their own money to provide abortion information or services, or even from discussing abortion or criticizing unsafe abortion. 

This had a dramatic effect on IPPF Member Associations as well as many other organizations which refused to agree to the Gag Rule and consequently lost much of their funding for contraceptive supplies. 

As an example, the IPPF Member Association in Ghana, Planned Parenthood of Ghana, reported a decrease by half of the number of condoms and other contraceptive supplies distributed and a doubling of clients seeking post-abortion services in their clinics after the loss of US funding.

In summary, we would like to thank the Guttmacher Institute for this comprehensive look at the issue of abortion which provides evidence to inform our education, advocacy, and service delivery efforts. 

Press release