Abortion is the voluntary ending of a pregnancy, either medically or surgically. An abortion qualifies as ‘safe’ when it is carried out by a WHO-recommended method and appropriate to the duration of the pregnancy. When people with uteruses are denied access to safe abortions, they often resort to unsafe means to end their unwanted pregnancies. These ever-persistent barriers to safe abortion can be legal (not permitted, or restricted, by their country’s law), socio-cultural (stigmatization of seekers and providers, general inequality of the sexes, etc.), socio-economic (lack of financial capacity, institutional and social support), and others, all of which are deeply complex and interconnected. These barriers exist in varying magnitudes everywhere, often pushing people with uteruses into ‘back-alley’ or unsafe abortions.
Accordingly to global estimates, 48% of all abortions conducted worldwide are unsafe, and almost all of these are carried out in developing countries (Abortion, 2021). This piece attempts to explore what these barriers are, why they exist, and what they mean for people seeking abortions.
Safe abortion is widely recognized by international institutions like the United Nations and several countries around the world as a fundamental human right. Human rights organizations categorically define unsafe abortions as a violation of human rights – the right to life, health, equality, privacy, and to live free from discrimination (Human Rights and Abortion, 2021).
Everyone has the right to exercise autonomy over their own health and body, particularly over the monumental decision of whether or when to give birth. In fact, we firmly argue that it is not enough to frame abortion as simply a health issue. Not every person who chooses to have an abortion does so out of health emergencies. Each person seeking an abortion is unique, their circumstances and reasons are unique, and it is painfully reductive to qualify how ‘justified’ an abortion is.
It can simply be a preference, a choice, and it can just as simply be granted. But the deep polarization that characterizes public view on abortion continuously stigmatizes, vilifies, and demonizes people who seek one. To these people, abortion is often understandable if the pregnancy was a result of rape. But if it was consensual voluntary intercourse? Then it is simply a consequence of her shameful decision to have sex. They are shamed, called names, chastised, and their pregnancy treated as the punishment for sex. Turns out, pregnancy is a beautiful miracle when society deems it appropriate (i.e. within the narrow constraints of marriage, heteronormativity, and age), but is a consequence and a punishment for an irresponsible/loose person if they try to exercise autonomy over their own body.
This speaks to the age-old, heavily gendered expectation of people’s role in society primarily as birth-givers and caregivers. They are expected to want motherhood, seek it, nay- live for it. If they don’t, for whatever reason, they are branded an evil child killer. A person’s fundamental human right to safe abortion must never, ever be linked with why they may want or need it, or how or why they got pregnant in the first place. That is a flimsy, easy argument, meant to drive attention away from what this lack of access to quality healthcare can push a person to do. Perhaps this quote by Frederica Matthews-Green best sums up what this piece aims to convey- “No one wants an abortion as she wants an ice cream cone or a Porsche. She wants an abortion as an animal, caught in a trap, wants to gnaw off its own leg.”
About Unsafe Abortions.
There are several ways unsafe abortions are carried out. They could be oral (drinking toxic substances like turpentine or bleach), direct injuries to the vagina (inserting foreign objects like coat hangers or sticks), or attempts at external injury (falling downstairs, jumping off a roof, or blunt trauma to the abdomen. People also often approach untrained providers who exploit them financially and whose methods end up causing irreversible damage like uterine perforations and infections (Grimes, et al., 2006).
It takes quite deep a dive into the internet to find first-hand, detailed, non-anonymous accounts of harrowing unsafe abortion stories, for the stigma surrounding abortion stifles people from speaking up. But global facts and figures on abortion speak for themselves, and what they say is quite alarming.
Worldwide, some 5 million people with uteruses are hospitalized each year for treatment of abortion-related complications such as hemorrhage and sepsis (Grimes, et al., 2006). The main causes of death from unsafe abortion are hemorrhage, infection, sepsis, genital trauma, and necrotic bowel. The sparsely documented data on non-fatal long-term health complications includes poor wound healing, infertility, consequences of internal organ injury, and bowel resections (WHOU, 2003).
And so far, we haven’t even touched upon the emotional and psychological damage caused by unsafe abortions. That conversation remains for another day, another article, and another attempt by us to bring you all the information and support on abortion that we can.
While legal provisions for abortions around the world keep changing, it is interesting to note just how severe their impact is on the rates of unsafe abortions, depending on the direction in which the law changes. There seems to be a general assumption that motivates restrictive abortion laws – that if it is illegal, it won’t happen. It is, in fact, quite the opposite. All that restrictive laws do is increase the rates of unsafe abortions. The median rate of unsafe abortions in the 82 countries with the most restrictive abortion laws is up to 23 of 1000 people with uteruses, compared to 2 of 1000 in nations that allow abortions. Abortion-related deaths are more frequent in countries with more restrictive abortion laws (34 deaths per 100,000 childbirths) than in countries with less restrictive laws (1 or fewer per 100,000 childbirths) (WHOU, 2003).
In Romania, abortion was available upon request, and the abortion mortality ratio was 20 per 100,000 live births in 1960. New legal restrictions imposed in 1966 drove the ratio to 148 deaths per 100,000 live births in 1998. The restrictions were reversed in 1989, and within a year the ratio dropped to 68 of 100,000 live births; by 2002 it was as low as 9 deaths per 100,000 births (Hadded & Nour, 2009).
In South Africa, after abortion became legal and available on request in 1997, abortion-related infection decreased by 52%, and the abortion mortality ratio from 1998 to 2001 dropped by 91% from its 1994 level (Jewkes, 2005).
What these numbers so descriptively tell us is that where abortion is safe and legal, no one is forced to have one. Where abortion is illegal and unsafe, people are forced to carry unwanted pregnancies to term or suffer serious health consequences- even death.
Every single account of abortion is a reminder that people’s sexual rights are not up for debate. Abortion is not like Santa Claus- only made real if you “believe” in it. Abortion is normal. Abortion is common. Abortion is one of many reproductive outcomes that people across the world are very likely to deal with.
Taking a careful page out of the pro-life (or anti-abortion, anti-woman, anti-humanity, essentially) book, these people seem to forget that it is not very pro-life of them to have a child be born to a person who does not want to raise one. Besides, if it is immoral to end a pregnancy, is it not immoral to force an ill-advised one to completion?
A person does not owe the world a minimum of one unwanted birth in their lifetime. Meanwhile, institutions, cultures, governments, education and healthcare systems, and society at large – collectively owe all people the access to safe, skilled, legal, affordable, accessible, confidential, compassionate, and dignified abortion – their fundamental right to reproductive justice.
- Abortion. (2021, November 25). Retrieved from World Health Organization: https://www.who.int/news-room/fact-sheets/detail/abortion
- Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003. Geneva: World Health Organization.
- Grimes, D., Benson, J., Singh, S., Romero, M., Ganatra,, B., Okonofua, F., & Shah, I. (2006). Unsafe abortion: the preventable pandemic. Lancet.
- Hadded, L., & Nour, N. (2009). Unsafe abortion: unnecessary maternal mortality. Reviews in obstetrics and gynecology, 122–126.
- Human Rights and Abortion. (2021). Retrieved from IPAS Partners for Reproductive Justice: https://www.ipas.org/our-work/human-rights-and-abortion/
- Jewkes, R. R. (2005). The impact of age on the epidemiology of incomplete abortions in South Africa after the legislative change. International journal of obstetrics and gynecology, 355-359.
- WHOU. (2003). Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality. Geneva: World Health Organization.