African Journal of Reproductive Health Women's Health and Action Research Centre ISSN: 1118-4841 Vol. 8, Num. 1, 2004, pp. 11-12

African Journal of Reproductive Health, Vol. 8, No. 1, April, 2004 pp. 11- 12

Saving African Women's Lives from Unsafe Abortion — Everyone Has a Role to Play

Eunice Brookman-Amissah¹

¹ Vice-President for Africa, Ipas Africa Alliance, Rhapta Road/Mvuli Road Junction, Westlands, P.O. Box 1192-00200, Nairobi, Kenya, Tel: 254-2-4445900/4443557 (Office); Fax: 254-2-4449177; brookmanae@ipas.or.ke

Code Number: rh04003

Ten years ago, a meeting where participants openly discussed unsafe abortion's tragic toll on the lives and health of African women, such as was held in March 2003 in Addis Ababa, was unthinkable. In many countries, sex, reproductive health and abortion were subjects no one talked about, even in the privacy of their homes with family members.

That remains true in many of our societies, even though unprotected sexual activity can have deadly consequences today. HIV/AIDS and other sexually transmitted infections are devastating the continent, while unwanted pregnancy and unsafe abortion continue to endanger the lives and well being of millions of African women, families and communities.

What has changed in the last decade, however, is the fact that many government officials (public health experts, among others) now recognise that they can no longer remain silent on these issues if they are to fulfil their duties toward African citizens. The public health imperative to stop preventable deaths and injuries from unsafe abortion is at last beginning to outweigh the social taboos that have hindered discussion of and progress in addressing this problem. The conference with the theme "Action to Reduce Maternal Mortality in Africa: A Regional Consultation on Unsafe Abortion," which took place from March 2 to 5, 2003, in Addis Ababa, Ethiopia, was truly a watershed event in the history of efforts to protect and promote the health and lives of African women, who are without question one of the continent's greatest resources.

One unique and especially valuable aspect of the consultation was its diverse composition. More than 100 participants came from 15 African countries. These individuals represented a broad spectrum of perspectives and specialties that do not often interact professionally. There were doctors, lawyers, politicians, activists, journalists, youth leaders, religious leaders, researchers and others; all of whom eagerly shared their experiences and thoughts and respectfully listened to other people's views.

In addition to being richly informed by a great diversity of views and experiences, the discussions in Addis were notable for their scope, which extended far beyond describing and bemoaning the terrible impact unsafe abortion has in Africa. Participants very consciously focused their discussions on the `how', that is, on the actions needed to prevent unsafe abortion including helping to prevent unintended pregnancies and improving women's access to safe abortion, and not on the `what'. One theme that was stressed repeatedly and which seemed to be a revelation for many participants was that, in every African country there are circumstances in which it is legal to perform abortion, yet safe legal abortion is very rarely available or accessible to the full extent of the law. Correcting that disparity between the law and practice is an obvious starting point for all those committed to saving women's lives and ensuring their rights.

The Addis Ababa consultation was also significant in that it served as the forum for the introduction of the World Health Organization's new document, Safe Abortion: Technical and Policy Guidance for Health Systems. This valuable and unprecedented tool is intended to help health systems fulfil the commitment made at a 1999 special session of the United Nations General Assembly, specifying that in circumstances where abortion is not against the law, health systems should train and equip health service providers and should take other measures to ensure that such abortion is safe and accessible. Additional measures should be taken to safeguard women's health. This long-awaited document represents very significant progress at the global level in addressing this important public health problem that was first universally acknowledged in 1994 at the International Conference on Population and Development in Cairo.

The articles in this volume of African Journal of Reproductive Health reflect the rich discussions that took place in Addis Ababa. They raise many very important questions and, perhaps more importantly, suggest many very doable strategies for ending unsafe abortion. Many of the solutions to this problem are well-known, available and affordable; what we need now is the will to use them. The promising (and in many cases proven) approaches outlined in these articles address several critical dimensions including laws, policies and international commitments to making safe abortion accessible; health systems' role in providing safe and accessible abortion care; and elements of the enabling environment necessary to ensure women's access to safe abortion. Effective action to end the scourge of unsafe abortion requires an integrated approach addressing these and other elements and involving all sectors of the society.

The communiqué issued by participants at the Addis Ababa consultation (reprinted in this issue of AJRH) specifies numerous actions that various actors need to take if progress is to be made in saving women's lives from unsafe abortion. Everyone has a role to play. It is the hope of organisers of this consultation that this report on the discussions in Addis will embolden a growing network of concerned individuals and organisations to make personal commitments to do what needs to be done. African women, girls, families and communities are depending on it.

© Women's Health and Action Research Centre 2004