Unsafe abortion is one of the most pressing issues affecting humanity today (Abouzahr 1994; Gomperts 2002). Worldwide, it kills about 80,000 women every year, and this figure only represents the tip of the iceberg, since an estimated 25 times that number of women suffer various ill-health effects as a result of unsafe procedures (Ciment 1999; Ahman and Shah 2002).
In Nigeria, where abortion is legal only to save the life of a woman, restrictive legislation and pervasive stigma conspire to drive abortion underground. The vast majority of the estimated 760,000 abortions that occur every year in Nigeria are clandestine (Bankole et al. 2006), and the majority of these fatalities go unreported. There is no doubt that the primary casualties of unsafe procedures are poor women (Braam and Hessini 2004), and based on this reality, we can safely conclude that lack of access to safe abortion (not to mention effective methods of pregnancy prevention) represents a clear-cut case of socioeconomic inequity, as well as a reliable index of underdevelopment (Brookman-Amissah 2004).
At the global level, access to safe abortion services seems to correlate to the existence of functional, democratic and representative governments and societies where there is rule of law and an enabling environment for citizens to assert their fundamental human rights (Oye-Adeniran et al. 2004a). In other words, the more politically liberal a country is in terms of citizenship rights and equitable distribution of resources, the more likely women are to have access to safe abortion services. Tunisia, Cuba and post-apartheid South Africa are all examples of this phenomenon (Sidley 1996; Rasch et al. 2004, 2005). By contrast, the more human rights are generally violated in a society, the more vulnerable women and young people are likely to become – a situation that is exacerbated by women’s subordinate status in many societies. Additionally, within each national context, unsafe abortion is more prevalent among people of lower social and economic status – for example, people living in poverty, or adolescents who are either in or out of school (Okonofua 2004; Grimes et al. 2006). Thus, a strong link exists not only between unsafe abortion and individual lack of access to resources, but also as part of a wider lack of functional democracy and good governance, with significant implications for those working to expand women’s access to safe services.
Despite the clear links between unsafe abortion, poverty and social inequity, the issue of abortion is still largely discussed and addressed as an issue of women’s reproductive health and rights alone (Gasman et al. 2006; Fredrick 2007; Ortiz Ortega 1993; Sangala 2005). A parallel can be drawn here between the issue of unsafe abortion and the issue of HIV/AIDS, which was initially treated merely as a public health problem. But whereas it took only a decade to begin to acknowledge HIV/AIDS as a development issue and to initiate a multi-disciplinary and multi-sectoral response at global, national and local levels in most countries of the world, the issue of unsafe abortion – a grave problem probably as old as humanity itself – has yet to attract the same kind of high-powered global response (De Bruyn 1999).
Since the link between abortion and development has only been weakly established, advocacy for expanded access to safe abortion services is rarely integrated into the strategy, rhetoric and messages of organisations focused on women’s rights, poverty, democracy, human rights, health, education and good governance in many developing countries, including Nigeria. This situation calls for a deeper investment in consciousness-raising and sensitisation about the development dimensions of unsafe abortion, in order to shift the paradigm away from thinking about abortion merely as a matter of women’s reproductive health and rights and toward acknowledging it as a crucial issue for development policymakers and practitioners worldwide. This article analyses the Campaign Against Unwanted Pregnancy’s (CAUP) efforts to provide a more broadbased response to unsafe abortion in Nigeria, and discusses the challenges associated with addressing unsafe abortion as a development issue.
This article comes from the IDS Bulletin 39.3 (2008) Unsafe Abortion and Development: A Strategic Approach