A woman (left), with her mother-in-law, at their home in rural Nepal. Two years ago, the woman had a safe abortion with the help of a nurse/midwife. She continues to receive sexual and reproductive health services from the same nurse.
Abortion
WHO defines health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Making health for all a reality, and moving towards the progressive realization of human rights, requires that all individuals have access to quality health care, including comprehensive abortion care services – which includes information, management of abortion, and post-abortion care. Lack of access to safe, timely, affordable and respectful abortion care poses a risk to not only the physical, but also the mental and social, well-being of women and girls.
Induced abortion is a simple and common health-care procedure. Each year, almost half of all pregnancies – 121 million – are unintended; 6 out of 10 unintended pregnancies and 3 out of 10 of all pregnancies end in induced abortion. Abortion is safe when carried out using a method recommended by WHO, appropriate to the pregnancy duration and by someone with the necessary skills. However, when women with unwanted pregnancies face barriers to obtaining quality abortion, they often resort to unsafe abortion.
Ensuring that women and girls have access to abortion care that is evidence-based – which includes being safe, respectful and non-discriminatory – is fundamental to meeting the Sustainable Development Goals (SDGs) relating to good health and well-being (SDG3) and gender equality (SDG5).
Restricting access to abortion does not reduce the number of abortions; however, it dramatically affects whether abortions attained are safe.
Nearly half of all abortions are unsafe, and developing countries bear the burden of 97% of these unsafe abortions. Globally, unsafe abortions account for 4.7–13.2% of all maternal deaths, disproportionately affecting people in developing regions. Moreover, each year an estimated 7 million women in developing countries are treated in hospital facilities for complications from unsafe abortion.
Barriers to safe, timely, geographically reachable, affordable, respectful and non-discriminatory abortion care can cause emotional distress and violate women’s and girls’ right to privacy; right to equality and non-discrimination; and right to be free from torture, cruel, inhuman and degrading treatment and punishment. It also has financial and social implications for people and communities including negatively impacting women’s and girls’ possibilities to obtain education and full and effective participation in society.
Abortion regulations that force people to travel to attain legal care, or that require mandatory counselling or waiting periods, burden health systems and can result in women experiencing travel costs, loss of income or the need to resort to unsafe abortion.
A disproportionate share of resources is used for post-abortion care: in developing countries, treatments of complications of unsafe abortion cost health systems US$ 553 million per year, while households experience US$ 922 million in income loss due to disabilities.
Abortion can be safely and effectively performed in a range of settings and by a variety of people, including different types of health workers, and in early pregnancy by the woman herself.
Person-centred, equitable and accessible abortion care supports efficient use of resources and enables women to attain care in line with their values, preferences and circumstances. This is supported by well functioning health systems; availability and accessibility of information; and respect for human rights within a supportive framework of law and policy.
Ensuring that safe and dignified abortion care is attainable in practice by all who need it implies, among other things, that
- enough health workers, of different types, provide abortion care within reach;
- access to abortion care is enabled through a variety of delivery approaches, including self-management of abortion;
- abortion care does not cause financial hardship to women;
- laws and policies that cause barriers to quality abortion care (including criminalization of abortion, mandatory waiting periods and third-party authorization requirements) are removed;
- health workers are trained to provide safe and respectful care, and to interpret laws and policies in a human rights-compliant way;
- access to abortion is not negatively impacted by health workers refusing to provide care based on personal beliefs; and
- people have access to accurate and non-biased information to prevent unintended pregnancies and make autonomous decisions about abortion.
