Abortion in Africa Marijke Alblas, Medical Consultant, S.A. Maternal mortality is the most dramatic health inequality on the planet, even more than child mortality. In the developed countries, about 1 in 7,300 women are likely to die from a pregnancy- related cause. One in 7,300. In eastern Asia, that's one in 1,200. In North Africa, one in 210. South Asia, one in 61. And finally, sub-Saharan Africa, one in 22." One of the MDG is to reduce the maternal mortality: 75% cut in the MM rate by 2015 However, in many sub- Saharan African countries the numbers have been rising instead of going down. Every minute, a woman dies from pregnancy-related complications. Most likely, these deaths could easily be prevented if every woman had access to basic primary and emergency obstetric care, including (post) abortion care Why? Major causes of maternal death 0ther Hemorrhage 27 25% Obstruction 8% Sepsis 15% Abortionn 13% Eclampsia 12% World Health Organization (WHO). Mother Baby Package: Implementing Safe Motherhood in Countries. WHO/FHE/MSM/94.11. Department of Reproductive Health and Research, Geneva: WHO;1994. Background • Unsafe abortion is a worldwide problem with 95% occurring in developing countries • Death rate from unsafe abortion is hundred times higher in developing countries than in developed countries • Developed regions: 0,2-1,2 death per 100.000 abortions • Developing regions: 330 death per 100.000 abortions • Sub-Saharan Africa: 680 death per 100.000 abortions Women are dying due to illegal, back street abortions ( deaths form abortions are the third biggest cause of MM). But abortion is still such a controversial issue and therefore difficult to mobilize the public and politicians A study, Testing Community Level Strategies to Reduce Unwanted Pregnancy and Unsafe Abortion in Western Kenya, is an outcome of a research conducted in Suba, a remote area in western Kenya. Conducted between 1999 and 2004, the study sought to find out if communities could be effective in reducing abortion-related deaths. The study reveals that communities in Suba were able to reduce abortion-related mortality. This followed community education and the training of informal community health workers to administer first aid measures to women who had terminated pregnancies, as they ensured timely referrals to nearest clinics with trained medical personnel. "There was a significant decline in abortion-related mortality from 87 percent in 2001/2002 to 13 percent in 2003/2004," says the study. It was conducted by the regional office of the U.S.-based Centre for the Study of Adolescents, the U.S.-based Pacific Institute for Women's Health and the Kenya Medical and educational Trust, a non-governmental organisation. to deny a woman an abortion is a violation of her human rights. There are four human rights that specifically deal with the need for safe and legal abortion which are: Women's Right to life and Survival, Health, Nondiscrimination and Reproductive Self Determination. KHRC has organized a tribunal on 26th June 2007 on abortion rights in Kenya to publicize the negative consequences of criminalization of abortion. This was the first to be organized in Africa, the tribunal was modeled on similar hearings often organized at international meetings to document violations of and women's human rights. "The mock tribunal wanted to seek to dispel the myths about illegal abortions that have pushed the stories and pictures of women hurt and killed through illegal abortions out of sight," said Ms Cynthia Mugo (KHRC). But Kenya did not succeed in changing their restricted law: abortion is only allowed to save a woman’s life. In Nigeria only 6 to 8 % of women is using contraceptives (Saudi Arabia 33%!) ± 15.000 die each year from botched abortions, but the issue of abortion is a NO-GO area. Example of another African countrie: Ethiopia • In 2005: 673 deaths per 100.000 live births (in most developed/ transition nations MM rates have gone down to an average of 10 per 100.000 • at least 55 percent of all maternal deaths are abortion- related, and unsafe terminations are the second biggest killer of women of child-bearing age after AIDS, according to a study by the New York-based Center for Reproductive Rights. Ethiopia has, after South Africa, decided to change their restricted abortion law in May 2005 Incomplete Abortions in South Africa • A study by MRC in 1994 estimated 44686 women with ICA in public hospitals per year • An estimated 425 women die as result of unsafe abortions • Total annual cost was R18 7000 000 in 1994 for treating complications • Included sepsis, haemorrhage, infertility Rees et al SAMJ 1997 Choice on Termination of Pregnancy Act 1996 Act 92 of 1996 • After much debate and support from research & academic institutions showing the burden of ill health and deaths from septic abortions parliament passed the act • The Act aims to give the right to choose safe early TOP & stress that it should not be used as a method of contraception Government Gazette Choice on Termination of Pregnancy Act 1996 Act 92 of 1996 • First twelve weeks - termination of pregnancy on request. • 13- 20 weeks: – Pregnancy as a result of incest or rape. – Continued pregnancy – risk to physical or mental health of woman. – Continued pregnancy – risk to physical or mental health of fetus. – Continued pregnancy – cause major social or economic problems for woman. • Post 20 wks – health of mother or fetus. Overview of CTOPA (2) • First trimester – Abortion trained registered midwife/nurse. • Second trimester –medical practitioner. • No consent from parent or partner required. • Designated facilities. • Penalties: – Outside of provisions. – Obstructing women accessing their rights. Impact of CTOP Act Maternal mortality due to backstreet abortion reduced more than 90%!! In spite of the opposition and conscientious objection.