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African Journal of Reproductive Health
Women's Health and Action Research Centre
ISSN: 1118-4841
Vol. 8, Num. 1, 2004, pp. 99-101
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African Journal of Reproductive Health, Vol. 8, No. 1, April, 2004 pp. 99-101
Conference Communiqué
Communiqué from the "Action to Reduce Maternal
Mortality in Africa" Regional Consultation on Unsafe Abortion
March 5-7, 2003, Addis Ababa, Ethiopia
Ms. Merrill Wolf, Senior Associate, Public Information,
Communications, Ipas, 300 Market Street, Suite 200, Chapel Hill, North
Carolina, USA. Tel: 1-919-960-5612 (Office), Fax: 1-919-929-7687; E-mail:
wolfm@ipas.org
Code Number: rh04017
Background and Preamble
We, the 112 participants of "Action to Reduce Maternal
Mortality in Africa: A Regional Consultation on Unsafe Abortion," which
took place on March 5-7, 2003, in Addis Ababa, Ethiopia, represent a cross-section
of African ministers of health, parliamentarians, directors of health services,
heads of reproductive health units, heads of academic institutions, youth activists,
national and regional women's groups, national networks engaged in promoting
women's health, non-governmental organisations, religious organisations, professional
organisations such as obstetricians/gynaecologists, nurse-midwives, lawyers,
sociologists and media practitioners.*
*Co-sponsors of the consultation were the Amanitare African
Partnership for Sexual and Reproductive Health and Rights of Women and Girls,
the Centre for Gender and Development of the Economic Commission of Africa,
the Commonwealth Regional Health Community Secretariat, the Ipas Africa Alliance
for Women's Reproductive Health and Rights, the Regional Prevention of Maternal
Mortality Network and the UNFPA Country Support Team for East and Central
Africa. Representatives of multilateral and bilateral donor and technical
support agencies also attended. Neither co-sponsorship nor representation
at the consultation implies endorsement by these organisations of the contents
of this communiqué. UNFPA does not support abortion services anywhere
in the world.
During the three-day consultation, we reviewed numerous dimensions
of the public health challenge of unsafe abortion including the socio-cultural,
legal and policy context in which it occurs. Recognising that abortion has
always occurred and will continue to occur in all cultures, we focused on the
need to make it safe in order to reduce related deaths and injuries of women.
We examined laws, policies and international commitments influencing access
to safe abortion in Africa; health care providers' and public and private health
systems' roles in meeting women's needs for safe abortion; and strategies for
creating an enabling environment that supports women's right to safe abortion
and related services.
Based on our own experiences and on presentations and discussions
during the consultation, we note with alarm that maternal mortality rates remain
unacceptably high and that unsafe abortion accounts for an average of 12% of
maternal deaths on the African continent. At the national level, experts estimate
that unsafe abortion contributes a range of 10-50% of maternal deaths in African
countries. Of the 68,000 deaths from complications of unsafe abortion worldwide,
30,000 (or nearly half) are in sub-Saharan Africa. In addition to the shocking
number of African women whose lives are lost each year, unsafe abortion causes
thousands more women to suffer serious illnesses and injuries and renders many
infertile. These deaths and injuries are preventable,
since safe and effective technologies for
contraception, pregnancy termination and post-abortion care
are available but underutilised. We also know that
deaths and injuries from unsafe abortion
disproportionately affect adolescents, poor and other marginalised
groups of women, depriving Africa of a valuable
human resource.
We recognise that, worldwide, restrictive abortion laws and
lack of safe abortion services are the major factors contributing to the disproportionately
high mortality of women from unsafe abortion. Most African countries operate
under archaic laws related to abortion that were imposed by former colonial
powers and have long since been changed in those countries. In most countries
where abortion laws are liberalised, there are almost no deaths from unsafe
abortions. We note that legislation in most African countries legally permits
abortion in limited circumstances, such as in cases of rape, incest or to save
a woman's life, but that the majority of women and health care providers remain
uninformed of their legal rights and obligations. We further recognise that
many of the root causes of unsafe abortion, including African women's lack
of access to comprehensive reproductive health information and services to
prevent unwanted pregnancy, and lack of decision-making power related to sex
and reproduction, are the same as those underlying the HIV/AIDS pandemic.
We note also that all African countries have signed the Programme
of Action of the International Conference on Population and Development, the
Platform for Action of the Fourth World Conference on Women and other international
agreements, compliance with which requires addressing the public health problem
of unsafe abortion, including by making safe abortion available to the full
extent of local law.
We stress that unsafe abortion has significant economic implications
including enormous costs to African health systems associated with managing
its complications. Until women can make their own reproductive choices safely,
poverty alleviation and economic development cannot be achieved. Policies of
northern governments and international financial institutions such as health
sector reform, debt restruc-turing and structural adjustment severely constrain
health and social spending by African governments and require revisiting.
Commitments and Recommendations
Thus, the participants commit ourselves to:
Formulate specific strategies to educate and engage
all stakeholders in advocacy to reduce the incidence and impact of unsafe abortion;
Work more effectively within existing legislation and
health systems to ensure that high quality comprehensive reproductive health
care is universally available, with special attention to reaching and responding
to the needs of especially vulnerable populations.
We the participants call on African governments to:
Include specific and increased funding for reproductive
health and to address unsafe abortion in national and health system budgets;
Advocate for specific attention to reproductive health
and unsafe abortion in programmes to achieve the Millennium Development Goals,
notably with regard to objectives specified in Goal 5 "Improve
Maternal Health;"
Initiate reviews of existing and, in many cases, outdated
laws criminalising abortion, in line with specific commitments under international
agreements.
Additionally, we the participants call on multilateral
and bilateral donor agencies, headquarters and regional country offices of
international technical support agencies, and the global community to:
Direct more resources to preventing unsafe abortion
and to making safe legal abortion available to the full extent of the law;
Provide the necessary leadership in addressing issues
of unsafe abortion especially in the dis-semination and implementation of technical
and policy guidance for safe abortion in Africa.
Finally, we the participants vehemently oppose the Global
Gag Rule that was re-instituted in January 2001 by the US President,
George W. Bush, and which clearly impedes efforts to reduce unsafe abortion.
We call on African governments and the global community to be accountable
to their citizens and other stakeholders by opposing it.
In conclusion, participants in the "Action to
Reduce Maternal Mortality in Africa" consultation re-affirm our commitment
to doing whatever is within our power at the national, regional and local levels
to halt the needless deaths and injuries of African
women and girls from unsafe abortion. We do this not only in the interest of
the girls, women, families and communities affected by unsafe abortion today,
but also for Africa's future.
© Women's Health and Action Research Centre 2004
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