Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007)

ACKNOWLEDGMENTS

Thank you to all of the members of the Youth Coalition who helped in the writing
and reviewing of this guide. The authors would also like to thank Emily Turk,
Communications and Outreach Officer, for her help in the design and editing of
this publication, and Laura Villa Torres for her valuable assistance. As well, a
large thank you goes to Ipas for their generous financial support of the
publication of this book.

- Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy –

A Publication of:
The Youth Coalition
Suite 405, 260 Dalhousie Street
Ottawa, Ontario
K1N 7E4

Tel +1 (613) 562-3522
Fax +1 (613) 562-9502
E-mail: admin@youthcoalition.org
Website: www.youthcoalition.org

Copyright © 2007 The Youth Coalition

This publication may be reproduced in whole or in part for educational or non-
profit purposes without special permission from the copyright holder, provided
that acknowledgment of the source is made. The Youth Coalition would
appreciate a copy of any document that uses this publication as a source.

No part of this publication may be used for commercial or resale purposes.
The contents of this booklet solely represent the opinions of the authors and not
necessarily the views or policies of its financial contributors.

Freedom of Choice

A Youth Activist’s Guide to
Safe Abortion Advocacy

By Pamela Pizarro, Tanya Baker,
Joana Chagas, María Eugenia Miranda
& Nadia Ribadeneira González

TABLE OF CONTENTS

Introduction 1

Chapter 1
Governing Abortion: Global Abortion Policies 3

Chapter 2
Access to Safe Abortion Care 14

Chapter 3
Abortion and Human Rights 28

Chapter 4
Mass Media, Abortion and Sexual and Reproductive Rights 44

Conclusion 56

Bibliography 58

About the Authors 62

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

INTRODUCTION

The Youth Coalition for Sexual and Reproductive Rights (YCSRR) is an
international network of young people that works to increase access to, and
quality of, sexual and reproductive health and the rights of adolescents and
young people throughout the world. The Youth Coalition envisions a world where
the diversities of all young people are respected and celebrated, and where they
are empowered and supported to fully and freely exercise their sexual and
reproductive rights. Sexual and reproductive rights are human rights, and
therefore apply equally to young people. Young people have a valuable
contribution to make to society and must be given ample opportunities to voice
their needs and opinions in all policy and decision-making processes in a way
that is respected and fully incorporated.

The Youth Coalition also believes that all women, irrespective of age, have the
right to access medically safe and legal abortion care. Unplanned and unwanted
pregnancies are a common situation faced by women throughout the world.
Many circumstances put women in situations where they have to make a
decision regarding whether or not to continue their pregnancies. Ethical, legal,
medical and social situations can influence a woman’s decision. However in the
end, regardless of the legal or moral prohibitions, or the lack of economic or
social resources, millions of women decide to electively terminate their
pregnancies even if it runs the risk of costing them their lives.

Advocating for Choice

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy is a guide
for young people, individuals who work with young people, leaders, or advocates
for any issue related to sexual and reproductive health and rights, who would
like to improve their information, knowledge and skills related to advocating for
safe abortion care services.

This guide intends to:

- Discuss the state of abortion legislation around the world, and how
different restrictions affect access to abortion care for young women;
- Give an overview of important human rights arguments that can be
used when advocating for safe abortion care services;
- Look at access to safe abortion care services around the world, as well
as the impact of unsafe abortion;
- Relate tips on how to deal with the media and the opposition;

1


- Demonstrate how to use the information contained in each chapter to
advocate for safe abortion care services.

The sexual and reproductive rights movement faces its biggest challenge when it
comes to abortion. In many countries, as we will review in Chapter 1, abortion is
illegal, or is limited to specific circumstances. Yet, in other countries where
abortion has been decriminalized, access is not guaranteed by the state. For
these reasons, the two main challenges when advocating for safe abortion are:
1) liberalizing the legislation in those countries where abortion is restricted and
2) guaranteeing access to comprehensive abortion care for all women. The task
is not easy, and we, as young people and as youth advocates, need to be
prepared to take action in this area.

Advocacy is a complex process that has the principal purpose of changing
specific situations affecting a specific group of society. Mapping the situation of
abortion in our own countries, reviewing international and local legislation in the
field, developing power maps, and building effective messages are just a few of
the activities and skills we need to develop in order to have a clear and effective
advocacy process.

By advocating for law reform and equal rights, pro-choice advocates are fighting
to give women the opportunity to make autonomous choices and to exercise
their sexual and reproductive rights.

2


CHAPTER 1 Governing Abortion: Global Abortion Policies

By Pamela Pizarro, Canada

Introduction

Around the world there are many laws and policies governing abortion. Most of
these are meant to limit the circumstances under which a woman may access
safe abortion care, and a few restrict access altogether by making abortion
completely illegal. Abortion laws in different countries fall into seven general
categories based on the conditions under which an abortion can be legally
provided; sometimes these categories overlap (for example, a law may permit
abortion to preserve physical and mental health and in cases of rape and
incest):

1. Completely illegal under any circumstance or only to save the life of the
pregnant woman
2. Preservation of a woman’s physical health
3. Preservation of a woman’s mental health
4. Pregnancy resulting from rape or incest
5. Suspicion of foetal impairment
6. Unwanted pregnancy for economic or social reasons
7. Available on demand and without restriction1

In some instances, abortion laws are decided at a regional (e.g., provincial or
state) or local level rather than a national one. For example, in Mexico, each
state can determine its own abortion laws with its own restrictions, meaning that
women across the country do not have standardized access to abortion. In the
United States, federal law guarantees a woman’s right to abortion, but some
states where legislatures do not support abortion impose restrictions (such as
parental involvement requirements) or will not fund women’s clinics that offer
safe abortion care.

Currently, 40.5% of the world’s women live in countries where abortion is
available without restriction2. This means that nearly half of the world’s women
live in countries where they should theoretically be able to access safe abortion
regardless of the reason behind their decision. In practice, however, access to
safe abortion is often complicated by obstacles such as: waiting times between
1
United Nations Population Division, Department of Economic and Social Affairs, Abortion Policies – A Global Review, Explanatory
Notes, 2001.
2
Center For Reproductive Rights, The World’s Abortion Laws: Categories of Abortion Laws from Most to Least Restrictive,
2005.

3


consultation and abortion, having to go before a medical committee to explain
why they want to have an abortion, requirements to undergo counselling before
having the procedure, and gestational limitations (weeks of pregnancy).
Worldwide, 59.5% of women live in countries that restrict abortion on some
grounds, with a full 26% (of the nearly 60% who live with restrictions) of women
living in countries where abortion is completely illegal or allowed only in order to
save a woman’s life3. Regrettably, even these statistics do not accurately reflect
the state of abortion access since many physicians refuse to perform abortions
even when there is grave danger to a woman’s life. Physicians may also refuse
to provide care citing conscientious objection or fear of being legally prosecuted.

Nearly every country in the world has abortion codified in some way under its
laws. This means that in every country some form of abortion can be:
• illegal and a punishable criminal offence;
• illegal but not a punishable criminal offence; or
• legal under certain circumstances that are stipulated by the State as
qualifying for safe abortion care.

Abortion laws can not only stipulate punishments for women who have had an
induced abortion, but also for the health-care professionals who provide them,
as well as for any other individuals who provide assistance (for example, those
who help women locate or access abortion care). The legality of abortion, and
the circumstances under which it is a punishable offence, differ in each nation.
For example, in a country like Nicaragua where abortion is illegal with no
exceptions, safe abortions cannot be performed under any circumstances, even
if the life of the woman is in danger; in Indonesia, abortion is not allowed unless
it is to save a woman’s life. In contrast, Sweden’s laws allow abortion under
many circumstances, including risk of harm to the mental and/or physical health
of the woman, and socio-economic reasons.

In some countries, abortion may either be illegal or legal only under certain
circumstances, but the procedure has been de-criminalized. For example, if a
woman were to obtain an abortion under a circumstance that is not clearly
defined by law (for example, for socio-economic reasons in a country that does
not have this exception), there is no legal punishment for her action or in other
words she would not be sent to jail for her actions. Canada is the only country
in the world where no abortion legislation exists. In 1988, the Supreme Court of
Canada struck down the law that criminalized abortion, declaring the law to be

3
Ibid.

4


unconstitutional because it infringed upon a woman’s right to “life, liberty, and
the security of the person”.4

The laws of many countries specify the process a woman must follow in order to
obtain a legal abortion. This can include mandatory waiting times, parental or
spousal consent laws, stipulations on who can perform the abortion, gestational
limitations, and whether or not the service is paid for by the state. In France, for
example, abortions are available under any circumstance. However, abortions
are only allowed up until 12 weeks’ gestation and only after a 7-day waiting
period. Additionally, pre-abortion counselling is obligatory in France, but only for
minors under 18, even though they do not need parental consent for abortions.5
In Turkey, a married woman must obtain her husband’s authorization prior to
obtaining an abortion; however, a single woman is not required to have her
partner’s consent.6

For young women and youth, accessing abortion services is considerably more
complicated. In many countries, even those with “liberal” abortion laws, there
are age restrictions, mandatory reporting to parents and the reluctance to take
young women’s requests for abortion seriously. Many women who become
pregnant at an early age are scared that if they visit a doctor or ask about
abortion services, their parents will find out. This fear can cause young women
to resort to unsafe abortions under unsanitary conditions and/or with unskilled
practitioners.

This chapter will examine what types of abortion laws exist, and where young
pro-choice activists can advocate for change. The various laws and clauses
examined can highlight effective advocacy points for youth activists, with the
ultimate goal being to have abortion laws free from any restriction that impedes
a woman in accessing safe abortion care.

Background

Recently, there have been many articles from the medical and international
development communities describing how illegal and unsafe abortions affect
women’s health and longevity. By making abortion illegal, governments are
endangering the lives of a significant portion of their population, not to mention
ignoring the long-term effect of women’s death and disability from unsafe
abortions on the population at large. In their 2006 “Sexual and Reproductive

4
Canadians for Choice website, “Historical Background,” (Retrieved January 2006),
http://www.canadiansforchoice.ca/historicalbackground.html.
5
Pinter, B., et al., “Accessibility and Availability of Abortion in Six European Countries”, The European Journal of Contraception and
Reproductive Health Care (10.1: March 2005), 54.
6
Ibid., 56.

5


Health Series”, The Lancet medical journal described unsafe abortion as “the
preventable pandemic”.7 One article estimated that 19–20 million unsafe
abortions take place every year, with 97% taking place in developing countries.8
The authors also estimated that 68,000 women die every year from unsafe
abortions (which translates into roughly 8 every hour), while many more are
injured during unsafe or illegal abortions.9 However, it should be pointed out
that illegal abortion does not automatically mean unsafe abortion. In some
countries, women who are in a position to pay more for the procedure can have
access to safe abortion care. It is largely women who cannot afford to pay for
the services that suffer the effects of unsafe illegal abortions.

Many countries around the world have laws on abortion that date back to
colonial rule. Many nations that were colonized tend to maintain the colonial
laws that made abortion illegal. Today, most countries with liberal abortion laws
are in North America, Western and Eastern Europe, and parts of Asia. However,
there are exceptions, such as South Africa, which has safe abortion available
without restriction, and Poland, which only allows abortion to preserve a
woman’s physical health. In the latter case, women cannot even be sure that
they can obtain such legal abortions. For example, Polish physicians refused to
give one woman a legal abortion even though carrying her pregnancy to term
worsened her deteriorating eyesight; she finally had to take her case to the
European Court of Human Rights to obtain compensation.10

One of the most hazardous obstacles facing women today is restricted access to
safe abortion care. In many countries where abortion is free from numerous
legal restrictions, the lack of access prevents many women from obtaining safe
abortions. In Canada, for example, there is no federal law against abortion and
there are no limits on terminations according to the gestational time of the
foetus; nevertheless, health care is managed provincially and many local
governments restrict access to abortion by not funding these services in
hospitals. Furthermore, in areas that are remote or rural, women often do not
have a choice about where to go for medical help. This means that if an anti-
choice doctor is servicing the area, women could be intimidated into unwanted
pregnancies or into having unsafe and clandestine abortions that could cost
them their health or lives. The impediments to accessing abortion services and
how it affects young women will be covered in Chapter 2.

7
Grimes, D., et al., “Unsafe abortion: the preventable pandemic.” The Lancet (Nov 2006), 1.
8
Ibid.
9
Ibid.
10
Center for Reproductive Rights, “CENTER FOR REPRODUCTIVE RIGHTS APPLAUDS LANDMARK ABORTION DECISION BY EUROPEAN
COURT OF HUMAN RIGHTS”, Press Release (March 20, 2007),
http://cmiskp.echr.coe.int/tkp197/view.asp?action=html&documentId=814538&portal=hbkm&source=externalbydocnumber&table=F
69A27FD8FB86142BF01C1166DEA398649.
Federation for Women & Family Planning, Poland, Polish Repro news (2:21, March 20, 2007), http://Hwww.federa.org.plH.

6


Definitions of Restrictive Laws

The introduction of this chapter mentioned that abortion laws could be classified
into 7 – sometimes overlapping - general categories. Below we will examine
each one in detail.

I. Completely Illegal or Only Allowed to Save a Woman’s Life
Throughout the world, the most common exception to laws that penalize
abortion is when an abortion is permitted to save a pregnant woman’s life. Some
countries may explicitly state what they consider to be life-threatening
situations, but in general it is left up to the physician(s) performing or approving
the abortion to make that decision. The only countries that do not have any
exceptions to their abortion laws are: Chile, Malta, El Salvador, and most
recently, Nicaragua.11 In the countries with this type of abortion law or
restriction, it is extremely difficult to obtain a safe abortion. Physicians are often
unwilling to perform abortions even if it is medically necessary. This is also the
most dangerous type of law as it forces women into unsafe situations. In
countries where induced or elective abortions are punishable by law, many
women turn to unsafe methods to end their pregnancies. Because these
methods are often performed by untrained individuals, oftentimes in unhygienic
conditions or with unsafe instruments or drugs, or because women self-induce
abortions, women who have undergone unsafe procedures frequently end up
seeking emergency care in hospitals or other health facilities. Here they can be
reported for inducing an abortion and can be reported to authorities. This
situation obviously discourages women from seeking appropriate medical
attention and may lead to high numbers of maternal mortality or morbidity in
some cases. However, in the case of Chile, although abortion is illegal, women
rarely die due to the complications of unsafe abortions because of the high level
of emergency medical care that they can access. Nevertheless, this is more of an
exception than a rule.

II. Preservation of a Woman’s Physical Health
This indication for abortion permitted by law allows women to access safe
abortion care when it is necessary to preserve their physical health. The term
“physical health” is open to a variety of interpretations, with some countries
having narrow definitions and a list of conditions that they consider to fall under
this term, and other countries having no set definitions and thus allowing room
for interpretation. In some countries, the term “health” is not specifically
limited to physical health and may encompass mental health as well; in this
case, abortion is allowed for any threat or risk of injury to the pregnant woman’s

11
Abortion Policies – A Global Review, op. cit.

7


overall health. Although this exception to the term health is uncommon, it is a
ground on which many women have challenged abortion laws. 12

III. Preservation of a Woman’s Mental Health
In many countries, legal abortions may be obtained when pregnancy endangers
a woman’s mental health. Definition of the term “mental health” varies from
country to country, with most British Commonwealth countries including:
emotional distress caused to existing children, and/or emotional distress caused
to the pregnant woman as a result of her situation. This allows for abortions
based on socio-economic grounds. As well, many countries that permit
abortions on the grounds of mental health follow the ruling of the British Courts
in Rex v. Bourne, which states that although a law may not specifically allow
abortions for physical or mental health reasons, abortions performed for either
reason are considered lawful.13

IV. Unwanted Pregnancy Resulting from Rape or Incest
This indication for legal abortion allows women to obtain safe abortion care when
they have suffered rape or incest. This indication for abortion permitted by law is
very common throughout the world; some countries name rape and incest
specifically in their laws, while others only mention “criminal offence” in the law,
thus allowing abortions to be sought under other circumstances such as
statutory rape. However, some countries require that a woman first contact the
police to bring charges against the rapist in court before they are granted
permission for an abortion. This requirement is extremely detrimental and
discourages many women from trying to obtain legal abortions. In other cases,
authorities place the burden of proof of rape or incest on the woman, or take a
long time in filing the necessary documents, causing women to be unable to
obtain abortions due to gestational time limitations.14

V. Foetal Impairment
Some countries allow women to obtain legal abortions if there are foetal
impairments. The term foetal impairment is open to interpretation and each
country has its own list of what constitutes such impairment. In general, foetal
impairment “refers to the existence of life-threatening or serious anatomical
signs that will lead to either an impaired quality of life or at worst lethal
anatomical malformations which renders the foetus unable to survive outside a
pregnant woman’s body.” 15

12
Ibid.
13
Ibid.
14
Ibid.
15
Wikipedia Online Encyclopedia, http://en.wikipedia.org/wiki/Foetal_impairment.

8


VI. Economic or Social Reasons
Legal permission to terminate a pregnancy for economic or social reasons varies
greatly among countries that have this indication for abortion. Some countries
specifically mention social or economic conditions that may qualify. For example,
in Barbados, the abortion law specifies that in determining whether the
continuation of the pregnancy would involve a risk of injury to the health of the
woman, the medical practitioner must take into account the “pregnant woman’s
social and economic environment, whether actual or foreseeable.” In New South
Wales, Australia, reference is made to social or economic stresses. Other
countries, such as Burundi and Ethiopia, do not permit abortions on social and/or
economic grounds, but allow the reason to be taken into consideration when
sentencing a woman who has obtained an abortion illegally. In the case of
Ethiopia, there was a review of the country’s criminal code in 2005, which
included a revision of its abortion legislation. In this revision there was inclusion
of abortion permitted for minors who are physically or psychologically
unprepared to raise a child.16 Most countries that have laws that take social and
economic grounds into consideration allow for very liberal interpretations of the
law, and in practice are very similar to countries where abortions are available
on request.17

VII. Availability upon Request: Abortion Permitted on all Grounds
Countries with laws that permit abortion upon request do not ask the woman to
qualify her decision. In these countries, women must only find a physician that is
willing to perform the abortion. Some countries, such as Albania, France and
Belgium, require the woman to state that she is in a situation of crisis or
distress. However, in many countries with the most liberal abortion laws,
gestational time limits are imposed, often making abortion available only in the
first trimester. After this time, a woman must present a “valid” reason for
terminating her pregnancy.18 Even if a country has laws and policies that allow
abortion under any circumstance, this does not mean that the government will
take the responsibility to ensure that safe abortion care is accessible or
available. In other instances countries allow for regulations that restrict access
to abortion care by applying some of the conditions explored below.

How Do These Restrictions Impact Youth?

All of the situations described above are situations in which abortion is permitted
by law. However, young and adolescent women may have more difficulties in

16
Ipas website (Retrieved April 25, 2007), http://www.ipas.org/english/press_room/2005/releases/06072005.asp.
17
Abortion Policies – A Global Review, op. cit.
18
Ibid.

9


accessing legal abortions because of added stipulations regarding consent,
mandatory reporting to parents, cost and other restrictions.

Consent Laws

Abortion consent laws require that women be of a certain age in order to give
consent to an abortion. Consent conditions, which vary from country to country
and even within regions of the same country, mean that women under 18 or 16
are seen as unable to make an individual choice and must consult their parents
or guardians when seeking an abortion. As we will see in Chapter 3 on abortion
and human rights, there are many international treaties that govern sexual and
reproductive health. In terms of adolescents’ ability to make their own decisions,
the United Nation’s Convention on the Rights of the Child addresses young
people under the age of 18, and it distinguishes that while parents have the right
to make decisions in regards to their children’s welfare, parental rights should be
balanced with the evolving decision-making capacities of the child.19 This means
that although parents have rights over their children, their decisions should not
take precedence over the decision of a minor who is capable of making it.
Therefore if a young woman has taken the decision to seek an abortion free from
coercion, then her decision supersedes the wishes of her parents.

Mandatory Reporting to Parents

In keeping with consent laws, mandatory reporting to parents implies that
women under a certain age must fully inform their parents of their pregnancy
and their decision to obtain an abortion. In some cases, parents must be present
when a young woman or adolescent obtains an abortion.

Waiting Periods

Although not specific to young women, some countries have mandatory waiting
periods from the moment a woman requests an abortion to the moment it is
performed. In some countries it can be 24 hours, while in others it can be as
long as 5 days or a full week. This waiting time is proposed as a way to give a
woman time to think over her decision. However, in reality, it means that
women may have to travel more than once to access abortion services, and
must spend more time and money that they may not necessarily have. Women
who live in rural areas generally have to travel to urban centres to find a health-
care provider willing and/or able to perform the procedure. By imposing a
waiting time, this may incur greater costs, and if they hope to undergo the
abortion without having a partner or family know, it may raise the risk of
19
Ahumada, C. and Kowalski-Morton, S., A Youth Activist’s Guide to Sexual and Reproductive Rights (2005), 11.

10


discovery. Often, waiting periods are not necessarily about allowing a woman
the time to “think over” a decision, but rather to give her the chance to “repent”
and change her mind, or to keep her from accessing services.20

Payment

In some countries, where abortion is legal, services are covered by the state.
This is usually in the case of countries that have state sponsored health-care
systems. However, in many countries, government support for safe abortion
care, even if abortion is legal, is non-existent and women are required to cover
the cost of care themselves. Payment restrictions mean that poor women, often
young or adolescent women with little personal income or economic means, are
unable to pay for needed services. For example, it may be difficult for young
women, who are not covered by health care, to earn income and pay for
abortion care while going to school or working in the home.

Location and Lack of Providers

Many countries also restrict who can perform an abortion and in which type of
facility it can be performed. For example, in The Netherlands, general
practitioners are able to perform safe abortions in separate clinics. In contrast,
other countries specify that only doctors specifically trained in abortion care can
perform the procedure, or that abortion services can only be obtained in
hospitals or operating rooms. While health facilities must guarantee adequate
and appropriate equipment and spaces, unnecessary facility requirements are
also sometimes imposed.

Conclusion

Women around the world are faced with many barriers and restrictions when
they try to access safe abortion care. In most cases these barriers are built into
the laws of a county. For young women, abortion laws often not only define the
age at which they can access services but may also demand that they inform
their parents of their decision. Young people already have hindered access to
sexual and reproductive health services, and when facing unwanted pregnancies,
the restrictions imposed on women due to their age may make it impossible for
them to access safe services, even if abortion may be legal in their country.

It is crucial that laws take into consideration that young women have the
capacity to make informed decisions. Two-tiered laws, which restrict access on

20
Center for Reproductive Rights, Crafting an Abortion Law that Respects Women’s Rights: Issues to Consider, Briefing Paper (August
2004).

11


the basis of age, are specifically discriminatory to young women. Other, more
general restrictions tend to impede young women’s access to safe abortion care,
because they face more economic barriers than older women.

Abortion laws can make abortion illegal with specific exceptions, or legal under
certain circumstances. When a country criminalizes abortion, the need for
women to access safe abortion care is not acknowledged. The need for abortion
services does not disappear once a country decides to make abortion totally
illegal. Instead, it places women in desperate situations where they may risk
their lives by undergoing unsafe abortions. Universal access to safe abortion care
should be a right enjoyed by all women, regardless of their age, ethnicity, or
circumstance.

Advocacy Tips: What Can I Do?

• Find out about the law concerning abortion in your country. For which
indications is it illegal or legal? Are there any restrictions? If you feel that
the law in your country impedes a young woman’s ability to access
abortion services, start researching ways in which to influence a
progressive change in the law.

• Research a case in your country where a woman has been denied an
abortion. Has she been denied her rights, even though abortion is legal in
certain circumstances in your country?

• Research a case in your country where a woman has successfully
challenged the abortion law in order to obtain a safe abortion. How can
you use this case to change the law? Can you use this case to start
lobbying decision- and policy-makers for a change in the law? Find out if
there are any groups working to challenge the abortion laws in your
country and get involved!

• Join an abortion advocacy group. Usually there are groups of women who
are trying to mount a challenge to restrictive abortion laws.

• One organization that supports the autonomy of women over their own
bodies and supports women’s reproductive rights is Ipas. They can
provide you with advocacy resources (documents, statistics) and
information about the training of providers and advocates, etc. Similar
organizations include the International Planned Parenthood Federation

12


(IPPF), local family-planning clinics and associations, feminist groups, and
the United Nations Population Fund (UNFPA) offices. To get more
information you may want to consult the following websites:

Ipas - http://www.ipas.org/
IPPF – http://ippf.org/
UNFPA - http://www.unfpa.org/
WHRnet - http://www.whrnet.org/

• Contact your country’s Ministry of Health. Inform them that you think
that unsafe abortion is a serious threat to women’s life and that it is a
public-health concern that must be taken seriously.

• Contact your local government representative. Tell him or her that you
think that your government should do more for women’s reproductive
rights and that they should take the initiative to legalize abortion or strip
away any restrictions that impede access to safe abortion care.

• If your country has progressive or liberal abortion laws, research how this
change happened. See if this process of change can be used to change
laws in other countries that restrict abortion.

• Start your own reproductive rights group. Using this guide, invite other
young people or youth allies to a discussion on abortion and talk about
the myths and challenges surrounding abortion. Discuss the abortion laws
in your country and how they are hurting or supporting women’s health.
Find ways for your group to get involved in pro-choice and equality
movements: you could attend workshops relevant to the issue, research
and write fact sheets about regional obstacles or initiatives, start a
consciousness-raising group, or broaden your mission and ask other
organizations that work in the field of sexual and reproductive rights to
join you in discussing crosscutting issues (such as LGBTQ, gender, and
social violence issues).

13


CHAPTER 2 Access to Safe Abortion Care

By Tanya Baker, Canada/Trinidad and Tobago

Introduction

Decriminalization and legalization of safe induced abortion is an important aspect
of abortion advocacy. However, often the legal status of abortion may mean
little for protecting women’s health or supporting their human rights. In fact, the
legal environment does not necessarily affect the incidence of abortion, but
rather how a woman will end an unwanted pregnancy or how safe the procedure
will be.21 Since abortion is a medical procedure, it is part of a country’s broader
health system, which may already have significant barriers for women who want
to access health services. In many countries where abortion laws are liberal,
such as India, safe abortion services are still not readily accessible.22

Safe abortion, which involves a trained and properly equipped health-care
provider under sanitary conditions, is one of the safest medical procedures.23
The provision of safe abortion care (SAC) is an essential medical treatment for
any health system, not only to induce an abortion when the law permits, but
also to treat complications from unsafe or spontaneous abortions. Spontaneous
abortions, also known as miscarriages, are a common occurrence ending
approximately 15% of all pregnancies; induced abortions end roughly another
22% of all pregnancies.24 In order to reduce the mortality rate of young women
due to unsafe abortion and improve their lives, health systems must be able to
effectively manage SAC, which comprises three elements:25

1. Safe induced abortion for all indications permitted by law
2. Treatment of abortion-related complications
3. Provision of post abortion contraception.

Unsafe Abortion: An Overview

Abortion has been present throughout history, sometimes as the only means of
fertility control; accordingly, many providers and techniques have emerged over
21
Rao, K. A. and Faundes, A., “Access to safe abortion within the limits of the law.” Best Practice & Research Clinical Obstetrics &
Gynaecology (2006).
22
Duggal, R. and Ramachandran, V., “The abortion assessment project-India: Key findings and recommendations”. Reproductive
Health Matters, (2004).
23
World Health Organization (WHO), Safe abortion: Technical and policy guidelines for health systems, 2003.
24
Rogo, K., “Improving technologies to reduce abortion-related morbidity and mortality.” International Journal of Gynecology &
Obstetrics (2004).
25
Healy, J., et al., “Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care
services”, International Journal of Gynecology & Obstetrics (2006).

14


the years. The World Health Organization (WHO) defines unsafe abortion as “a
procedure for terminating an unintended pregnancy either by persons lacking
the necessary skills or in an environment lacking the minimal medical standards,
or both”.26 The procedure is associated with high rates of poor health outcomes,
including death, and a significant strain on over-burdened health systems.
Unsafe abortion primarily imperils women in developing countries. Conversely,
legal abortion in industrialized countries has minimal hazardous outcomes or
complications, and almost no risk of death.27

The statistics are disturbing28:
• 19–20 million unsafe abortions take place annually all over the world.
• About 68,000 women die every year due to unsafe abortion, representing
13% of all maternal deaths; many more are permanently injured.
• Although rates according to age vary by region, generally young women,
between 15 and 25 years, are disproportionately affected by unsafe
abortion.
• In many countries, 50% of the hospital obstetric/gynecological budget is
allocated to the treatment of unsafe abortion.

Figure 2.0 Global and regional estimates of number of unsafe abortions and of mortality
due to unsafe abortion, around the year 200029

26
World Health Organization (WHO), 207.
27
Grimes, 204.
28
World Health Organization, “Unsafe abortion: Global and regional estimates of incidence of unsafe abortion and associate mortality
in 2000”, (2004).
29
Ibid. 8. Note: Figures may not exactly add up to totals because of rounding; * Japan, Australia and New Zealand have been
excluded from the regional estimates, but are included in the total for developed countries; ° no estimates are shown for regions
where the incidence is negligible.

15


It is important to be familiar with some public health concepts, such as mortality
and morbidity, in order to understand the impact of unsafe abortion on women’s
health.

I. Mortality
A death due to an unsafe abortion is categorized as a maternal death. Maternal
deaths are recorded or deduced to give a number of deaths in a given area,
using the term maternal mortality. The exact definition from the International
Classification of Diseases defines a maternal death as “the death of a woman
while pregnant or within 42 days of termination of pregnancy, irrespective of the
duration and site of the pregnancy, from any cause related to or aggravated by
the pregnancy or its management but not from accidental or incidental
causes.”30

Although this definition may be helpful for epidemiologists who monitor health
trends and statistics, the 42-day mark is actually arbitrary and the associations
with using the term ‘maternal’ have far-reaching implications.31 In the social
sphere, maternal is associated with motherhood, not specifically pregnancy.
Many women, especially young women, seeking a termination of pregnancy do
not wish to be associated with the term or concept of motherhood at the time.
Rather they choose not to be a mother, to be a mother at a later date, or to be a
healthier mother to her current children; in any case, they are women with their
own agency separate from being a mother. Furthermore, when deaths due to
unsafe abortions are grouped within a broader category of maternal mortality,
the underlying cause of the death is not readily apparent, making the social,
legal and political implications easier to ignore. Consequently, we recommend
using the more scientifically accurate terms:

• Death due to unsafe abortion
• Unsafe abortion mortality
• Pregnancy-related death
• Pregnancy-related mortality

Improving maternal health by reducing maternal mortality is Goal 5 of the
Millennium Development Goals, which were agreed upon by all UN (United
Nations) Member State leaders in 2000.32 Reducing the number of unsafe
abortions is inherent in this Goal; however, measuring abortion-related deaths is
difficult. In general, pregnancy-related mortality is difficult to measure due to
lack of vital registration systems and many deaths occurring outside of hospitals.

30
World Health Organization (1992), 208.
31
World Health Organization, “Maternal mortality: The measurement challenge”, (2001), https://www.who.int/reproductive-
health/publications/maternal_mortality_2000/challenge.html.
32
United Nations Millennium Development Goals, www.un.org/millenniumgoals/goals.html.

16


Abortion-related mortality is further undercounted due to its illegal and
clandestine nature, which promotes powerful disincentives for reporting. Thus,
decriminalizing abortion is an important step towards providing safe pre- and
postabortion care.

II. Morbidity
Morbidity is the term used to designate illness, side effects and poor health
outcomes that do not lead to death but that can be life-long and much more
common. The risk factors for unsafe abortion mortality and morbidity are the
same, associated with an unskilled provider or an unclean/unequipped
environment. There are high rates of complications with unsafe abortions, with
an estimated 20–50% of women undergoing unsafe abortions requiring
hospitalization post procedure.33 The complications associated with unsafe
abortion that can lead to long-term poor health include:

• Uterine perforation and haemorrhage (profuse bleeding)
• Anaemia (low iron); malaria or HIV infection can worsen the effects of the
bleeding
• Sepsis (infection throughout the whole body)
• Peritonitis (infection of the uterus/abdomen)
• Trauma (to vagina, cervix, uterus and abdominal organs).

It is very difficult to determine the rates of unsafe abortion morbidity; however,
while an estimated 68, 000 women die yearly from unsafe abortion, millions
more are significantly, and oftentimes permanently, debilitated34. These
complications must be treated in a health centre with trained personnel, which
can take significant health system resources.

Young women are at increased risk for developing complications. They tend to
undergo an abortion later in pregnancy, for various reasons including lack of
finances, social networks and support, information and understanding of the
health implications; abortions done after the first trimester (12 weeks of
gestation) are considered more difficult and have higher rates of complications.
In addition, young women tend to seek treatment for complications later, citing
stigma and discrimination and lack of funds, transportation and understanding of
when to seek help. Accordingly, young women have unique needs with respect
to unsafe abortion.

33
Grimes, D.A.,et al., 204.
34
Grimes, D.A., et al., 2.

17


Young Women and Unsafe Abortion
It is important to understand the prevalent ages of women seeking unsafe
abortions in order to target interventions and provide effective postabortion
care. The age distribution varies widely over regions. In Africa, almost 60% of
unsafe abortions are in women under the age of 25, while in Asia it is 30%.35
Figure 2.1, a World Health Organization (WHO) graph, highlights the regional
distribution, but generally unsafe abortion continues to be a young women’s
issue.

Figure 2.1 Per cent of all unsafe abortions, by age group36

Latin America
and the 15 29 56
Caribbean

Asia 8 22 70
15-19
20-24
25-49
Africa 26 33 41

Developing
14 26 60
countries

0% 20% 40% 60% 80% 100%

The Public-Health Perspective

It is widely held that many women are dying and disabled due to an understood
and preventable cause - unsafe abortion. People working in public health analyze
the incidence, risks and causes of death and disability in a population with the
primary aim of preventing such an occurrence. However, it should be recognized
that abortion will never be entirely prevented because contraceptives are not
100% effective and sexual violence and coercion continue to exist; abortion will
still be necessary and provision of SAC should always be accessible.

35
Shah, Iqbal and Elisabeth Åhman, "Age Patterns of Unsafe Abortion in Developing Country Regions", Reproductive Health Matters
12, (No. 24, 2004), 206.
36
World Health Organization website (Retrieved January 21, 2007), http://www.who.int/reproductive-
health/unsafe_abortion/index.html.

18


The primary prevention strategy for unsafe abortion is to reduce the number of
unwanted pregnancies, primarily through the provision of legal, safe and
accessible abortion and the provision of contraception. Broader programs that
aim at increasing knowledge and information, such as sexuality education or
reducing sexual violence and coercion, also contribute to the primary prevention
strategy.

Secondly, treatment of the complications that arise from an unsafe abortion
must be made available. This is included in the provision of SAC under the limits
of the law. Finally, those women who have long-term disabilities associated with
unsafe abortion must be treated and cared for. Postabortion care services should
also include contraception counseling in order to prevent future unwanted
pregnancies, especially in adolescents and young women. All three levels of
public health approaches are necessary to address some of the issues associated
with unsafe abortion.

Access to Care

There are 3 primary dimensions of access to health care:
• Availability
• Affordability
• Acceptability

The following conditions are needed to ensure the availability of SAC for young
women:

I. Health-care Providers
Health-care workers must be able to provide care to young women seeking SAC
in a non-judgmental, youth-friendly manner. Furthermore, they must be able to
diagnose pregnancy and effectively determine the gestational age of the foetus,
which informs them about the methods of abortion which can be safely used.
Health-care providers should be trained in surgical and medical (pharmaceutical)
methods for inducing an abortion, including treating or referring complications
that can arise, primarily haemorrhage and infection. Postabortion provision of
contraception and counselling is an important component of SAC, which ideally
would be conducted by a peer counsellor or someone trained in the sensitivities
of young women’s lives. Midlevel providers such as nurses and midwives have
been shown to safely conduct first-trimester abortions (up to 12 weeks’
gestation); however, second-trimester abortions require a specially trained
physician.37
37
WHO, 2003.

19


II. Equipped Facilities
Health-care facilities must meet sanitary standards and be sufficiently and
sustainably equipped with necessary medical/surgical supplies (see Fig. 2.2 for
methods of abortion):

Figure 2.2 Methods of Abortion38

Pharmaceuticals for medical abortion:
• Mifepristone – an anti-progesterone agent. Progesterone is a hormone
that is needed to keep a pregnancy viable; if mifepristone is used, the
continuity of the pregnancy will be interrupted.

• Misoprostol – a prostaglandin analogue, this enhances uterine
contractions and helps expel the products of conception. This drug can
also be used to treat excessive bleeding from the uterus
(haemorrhage).

38
WHO, Safe Abortion: Technical and Policy Guidance for Health Systems (2003).

20


Equipment:
• Vacuum aspiration - this involves evacuation of the contents of the
uterus through a plastic or metal cannula attached to a vacuum
source. It can be managed electrically (Electric Vacuum Aspiration -
EVA) or manually (Manual Vacuum Aspiration- MVA).

• Dilatation and evacuation (D&E) - this involves dilating the cervix with
mechanical (laminara) or pharmacological agents (mainly
misoprostol) and then using an electric vacuum aspirator and other
instruments to evacuate the contents. Dilating the cervix adequately
can require 2 hours to one day. This should only be used in the
second trimester by a specially trained provider.

• Dilatation and curettage (D&C) – this involves dilating the cervix and
using a sharp metal curette to scrape the uterus. This carries
significantly more risk of complications due to infection and
haemorrhage than a vacuum aspirator and is no longer recommended
in the first trimester.

Postabortion care:
• Antibiotics - used to treat bacterial infections, including some sexually
transmitted infections. Routine use post-procedure is recommended;
however, an abortion should not be denied if antibiotics are
unavailable.

• Contraceptives - used for post-abortion care, can include short- or
long-term contraceptives.

Pain management:
• Pain management should be available but is not mandatory for early
abortions. Options include oral painkillers and local anaesthetic
(numbing) around the cervix. General anaesthesia (being put to
sleep) is not generally recommended but can be considered under
special circumstances such as an abortion following rape. Pain
management also includes emotional and verbal support throughout
and following the procedure.

Other resources:
• Ultrasound (optional) - this technology projects sound waves onto a
computer screen to give a picture of the contents of the uterus. This
is a helpful tool to determine the gestation of the pregnancy or
whether all uterine contents have been effectively removed.

21


Ultrasound technology should be available in a centre that offers
comprehensive SAC.

It is recommended that there be a minimum of 5 facilities per population of
500,000 that offer SAC, one of which can offer more comprehensive SAC (see
text boxes below).39

Functions of Basic SAC services Functions of Comprehensive SAC services

Available during regular outpatient hours: Perform all basic SAC functions
• Perform induced abortion for uterine
size < 12 weeks for all legal Available during regular outpatient hours
indications • Perform induced abortion for uterine
• Provide postabortion contraception size > 12 weeks, for all legal
indications
Available 24h per day, 7 days per week
• Administer essential antibiotics Available 24h per day, 7 days per week:
• Administer intravenous replacement • Perform removal of retained products
fluids for uterine size > 12 weeks
• Administer oxytocics • Perform blood transfusion
• Perform removal of retained products • Perform laparotomy
for uterine size < 12 weeks
• Provide postabortion contraception

Roads and Transportation

Since complications from an abortion can arise suddenly and constitute a
medical emergency, the length of time required to reach a facility that provides
SAC is crucial. Also, delays in accessing SAC can postpone procedures to a later
gestation, increasing the risk of complications. UNICEF defines access to health
services as the “percentage of the population that can reach appropriate local
health services by the local means of transport in no more than one hour”.40
Effectively distributing the centres that provide SAC and improving roads and
transportation will help improve access to services.

Knowledge and Information

Young women must be aware of when and how to access safe abortion services
when needed; this includes an understanding of:

• what an abortion is;

39
Healy,J., et. al., “Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care
services”, International Journal of Gynecology & Obstetrics (95.2, November 2006), 200.
40
UNICEF, 1996.

22


• who conducts it;
• when it is allowed under the law;
• when is the safest time to obtain an abortion;
• what are the indications to seek treatment from complications arising from
an abortion;
• where are the facilities that provide SAC located;
• what are the times of operation;
• what are the costs associated, etc.

This information needs to be provided in a clear, comprehensible, friendly
manner that is readily distributed to, and accessible to young people.

Health-care providers must also be aware of Symptoms that could indicate
their national laws governing legal complications resulting from
indications for inducing an abortion and the unsafe abortions:
consent laws pertaining to minors or
• Bleeding that lasts longer than 2
spouses. If parental involvement is required, weeks
they should inform young women about • Fever, chills, weakness, nausea,
exceptions, such as judicial bypass vomiting, muscle aches
• Tenderness when pressure is
procedures, and how these exceptions can
applied to the abdomen
be obtained. Patients must be informed and • Abdominal pain
supported to provide SAC to the full extent • Cramping, backaches
permitted by law. • Prolonged or heavy bleeding
• Foul-smelling discharge from the
vagina
When young women want to undergo an • Delay in the return of
abortion outside the law there is little menstruation for more than 6
information regarding the safety and weeks
training of illegal abortion providers.
Furthermore, such services often cost a significant amount, and the young
women and provider may live in fear of being caught and penalized.

Affordability of Safe Abortion Care

Cost of Services
SAC costs money, which often requires the woman to pay for some or all of such
care. Unsafe abortion is firmly rooted in deep social and economic inequalities.41
In countries where abortion is severely restricted, wealthy women may still be
able to pay for SAC while poor women may have to use an untrained provider
and/or unhygienic conditions. Governments must be held accountable to their

41
Gasman, N., et al., “Abortion, social inequity, and women's health: Obstetrician-gynecologists as agents of change”, International
Journal of Gynecology & Obstetrics (94.3, September 2006), 310-316.

23


citizens for essential medical procedures such as SAC, and in efforts to reduce
maternal mortality and improve women’s health.

Young women are even less likely to be able to afford safe abortion services due
to their restricted economic and social independence. Alternative
payment/financial schemes must be developed to ensure that costs for services
or transportation to the health centre are not the leading barrier to accessing
SAC. Social health insurance, community-based health insurance, donor-funded
non-governmental organization services and vouchers can all play a role in
reducing barriers associated with cost.

Commodities/Supplies
SAC requires a sustainable supply of medical commodities including
pharmaceuticals and equipment. In 2005, WHO added mifepristone and
misoprostol to the essential medicines list, which advises governments on which
drugs doctors should have available. As a result, these medicines along with
antibiotics, painkillers and contraceptives should be readily and cheaply available
within a national health system.

Safe abortion equipment is also a necessity; the safest and most economical for
all settings is the Manual Vacuum Aspirator (MVA). Some MVA equipment can be
sterilized and reused, depending on manufacturing and local regulations.

Acceptability of Safe Abortion Care

Even when SAC is available and affordable, young women still may not access
such services due to a perceived or real mistrust of the care provided42. SAC
may not adequately address the underlying issues associated with the need to
seek such care, including sexual violence, coercion or the need for sexual and
reproductive health counselling. Some health-care providers discriminate against
unmarried sexually active young women, while others may not respect the
requirement of privacy and confidentiality. Policies and training must also
incorporate non-discriminatory, youth-friendly services as part of a
comprehensive sexual and reproductive health package.

Quality of care is also an important factor. Many health systems and health-care
professionals are working beyond capacity, which diminishes the quality and
consequently, the acceptability of such care. More resources must be added to
strengthen health systems and increase the number of health-care providers. In
addition, the training that medical providers receive is primarily focused on
physiology and treatments; there is little focus on the gendered and human
42
World Bank, 2003.

24


rights aspects of the care that they provide. Consequently, it can be more
difficult to build capacity on the social issues associated with abortion in
traditional or rigid hierarchal institutions.

Additionally, social and cultural norms can pose a barrier to acceptability of
receiving SAC. More efforts should be made to discuss issues surrounding
abortion with communities and governments.

Conclusion

Improving access to health services is difficult and complex with a number of
actors and a significant amount of resources required. The barriers to providing
SAC to young women are further compounded by the controversies and social
stigma associated with such an issue. In many countries there are currently a
number of health-sector reforms that are reviewing how to improve and
strengthen health systems, where to allocate finite resources and which care
packages are considered essential. Accordingly, it is an important time to
advocate for the inclusion of comprehensive SAC into the health-sector reforms
of your country. This can be done by teaming up with health-care professionals,
health-care policy-makers, women’s health activists, community leaders and
young people.

Advocacy Tips: What Can I Do?

These advocacy points, actions and messages are specifically designed to help
you advocate to professionals, policy makers or activists in the areas outlined
below. However, in order to build stronger advocacy messages, it is an excellent
idea to build partnerships with professionals or other advocates working
specifically in these fields.

► Health-care Professionals
Work with local professional health associations such as the
obstetrics/gynaecology association or midwifery association to advocate for:

• Adequate training of health-care workers to provide SAC
• Sustainable and dependable medications and equipment for the provision
of SAC
• Mifepristone and misoprostol should be included on the national essential
medicines list

25


• Postabortion contraceptives should be readily available and offered
• Further training of health-care workers providing SAC in providing non-
judgmental, youth-friendly services, counselling and comprehensive care
(including violence and STI prevention), gender and human rights
• Expansion of health-care providers’ knowledge and understanding of the
laws and policies regulating provision of SAC and limits of using the
conscientious objection clause (which is not applicable when the women’s
life is at risk)
• Increase statistics and research on the incidence and complications
related to unsafe and safe abortion, disaggregated by age
• Have real stories of women on hand. It is important to put a face to the
numbers. Develop qualitative research as a powerful advocacy tool.

► Health-Sector Reformists
Develop an understanding of the health-sector reforms that are taking place in
your country; many of these reforms began in the 1990s with loans or grants
from the World Bank. Further review of national health-sector reforms should
include civil society consultation. Possible advocacy points include:

• Include SAC as part of an essential service package for every country
as a means to reduce women’s mortality and improve women’s health
• Include SAC as an indicator for access to emergency obstetric care
• Design affordable payment schemes for essential services, including
contraceptives and SAC
• Special attention should be given to marginalized groups, especially
young women
• Strengthen broader health systems to improve regulations and quality
of provision of health care.

► Health-Policy Makers
Health-policy makers in governments, hospitals, or large organizations have
the ability to make and change policies related to the provision of SAC.

• Remove policies related to parental/spousal consent for a safe abortion
• Remove mandatory waiting periods and conscientious objection clauses
for the provision of a safe abortion
• Promote comprehensive sexual and reproductive health care policies
related to safe abortion services (i.e. referrals for counselling, STI
testing, contraceptives).

26


► Community Leaders
Social and cultural stigmatization related to abortion is significant and must be
addressed through dialogue within a community.
• Engage community leaders, teachers and young people in a discussion
about young women’s health and abortion
• Highlight indications where abortion is permitted under law
• Inform young women of locations where they can receive good quality
SAC
• Advocate for comprehensive sexuality education.

► Legal Framework – Lobbyists/ Human Rights Lawyers
• Have available legislation, guidelines, technical norms or/and regulations
of any sexual and reproductive issue that highlight specific responsibilities
of the health sector to caring for the sexual and reproductive health of
women and young people, specifically related to abortion and
postabortion care.
• Analyze the political environment to see the possibility of legislation
change; this need not involve complete decriminalization but might move
towards incremental change or changing policies to allow for abortion in
certain circumstances.

27


CHAPTER 3 Abortion and Human Rights

By Joana Chagas, Brazil

Introduction

Today, one of the biggest challenges facing the women’s rights agenda is gaining
recognition of abortion as women’s right. This chapter will focus on how the
human rights language in international treaties and consensus documents can be
interpreted and used in advocacy for the recognition of women’s right to
abortion. Furthermore, this chapter will introduce you to the main international
human rights treaties and consensus documents and it will offer you an
interpretation of how specific human rights relate to women’s right to abortion.

Although this chapter will only focus on human rights treaties and consensus
documents adopted under the United Nations, it is worth mentioning that
regional human rights treaties and consensus documents have important
language on human rights, sexual and reproductive rights and the right to
abortion, and they sometimes have more progressive language than the UN
documents.43

Lastly, although much of the interpretation of how specific human rights relate
to women’s right to abortion is derived from treaty monitoring bodies’ concluding
and general recommendations/comments, it is not limited to them. Here you will
find a more progressive interpretation of rights, that is, how we would like to see
such rights interpreted, rather than how they have been interpreted so far. This
is what advocacy is for!

The Right to Abortion is a Young Woman’s Right

Human rights advocacy means actively participating in decision-making spaces
in order to influence policies and legislation so that they embrace human rights.
Thus, it is fundamental that we know what ‘human rights’ means to us.
Specifically, if we want to defend ‘abortion as a young woman’s right’, we need
to have clear reasons, arguments and concepts.

43
The Youth Coalition expects to expand this guide in the future to include regional systems for the protection of human rights. In the
meantime, please check our website for updates: http://www.youthcoalition.org/.

28


Human rights are universal rights to which Some Basic Definitions
every person is entitled, simply because they
are human. Women’s human rights mean Respect: States must refrain from
that these same human rights also apply to violating human rights
women and cannot be denied to them on the
basis of their sex. All human rights treaties Protect: States must prevent violations of
include the principle of non-discrimination human rights by third parties (individuals,
corporations, etc)
based on sex; the Universal Declaration of
Human Rights (UDHR), for example, affirmed Promote: States must take action to
that “[e]veryone is entitled to all the rights realize human rights (policies, laws,
and freedoms set forth in this Declaration, services, campaigns, etc)
without distinction of any kind, such as race,
colour, sex, language, religion, political or other opinion, national or social origin,
property, birth or other status.”44 Similarly, both the International Covenant on
Civil and Political Rights (ICCPR)45 and the International Covenant on Economic,
Social and Cultural Rights (ICESCR)46 reaffirmed this principle.47 The equality
that is formally recognized in legislation is called ‘formal equality’. However, the
non-discrimination-based-on-sex principle, despite its importance, has not been
able to prevent violations of women’s human rights.

When we advocate for women’s human rights, we advocate for the recognition of
the equality of women and men: that all the rights set forth in all human rights
treaties must be respected, protected and promoted without discrimination of
any kind, including discrimination based on sex. The term ‘of any kind’, can also
be interpreted as including age-based discrimination, which is particularly
important for young people’s sexual and reproductive rights.

Women’s rights, on the other hand, are rights that specifically pertain to human
beings of the female sex who suffer discrimination due to the fact that they are
female. So, when we advocate for women’s rights, we advocate for the
recognition of the difference between women and men. Some examples of
women’s rights violations are harmful traditional or cultural practices such as
female genital mutilation/cutting, child marriage, female infanticide, and violence
against women. Abortion is a women’s right, since pregnancies only take place in
women’s bodies; it is therefore only women who have the right to choose to
continue or interrupt a pregnancy.

44
Universal Declarations on Human Rights (from now on, UDHR), article 2, http://www.unhchr.ch/udhr/.
45
International Covenant on Civil and Political Rights (from now on, ICCPR), article 2, http://www.ohchr.org/english/law/ccpr.htm.
46
International Covenant on Economic, Social and Cultural Rights (from now on, ICESCR), article 2,
http://www.ohchr.org/english/law/cescr.htm.
47
For a comprehensive account of how human rights instruments address equality and discrimination, see Charlesworth, H. and
Chinkin, C., The Boundaries of International Law: A Feminist Analysis (Manchester: Manchester University Press, 2000); and COOK R.
(ed.), Human Rights of Women: National and International Perspectives (University of Pennsylvania Press, 1994).

29


Likewise, the right to abortion is a young woman’s right. All human rights must
be respected, protected and promoted without discrimination of any kind,
including that based on sex and age. Young women’s rights to safe legal abortion
is of particular importance given that evidence shows young women represent
almost half of the total number of women who go through unsafe abortion
procedures due to unwanted pregnancies (see data from the World Health
Organization in Fig. 3.1).
48
Figure 3.1 Per cent of all unsafe abortions, by age group

Latin America
and the 15 29 56
Caribbean

Asia 8 22 70
15-19
20-24
25-49
Africa 26 33 41

Developing
14 26 60
countries

0% 20% 40% 60% 80% 100%

In addition, there are more obstacles for young women seeking safe abortion
services than for women of other ages (parental consent requirements, lack of
resources for private services, discrimination when accessing health services,
lack of recognition as decision-makers over their own bodies, etc.). Laws that
require parental consent for an abortion procedure and non-accessible, non-
affordable and non-youth-friendly health-care services constitute examples of
discrimination against young women.

The History of Abortion in the Human Rights Agenda

At the UN – or international – level, abortion has not yet been explicitly
recognized as a right.49 Nevertheless, the UN has recognized a set of human

48
World Health Organization website (Retrieved January 21, 2007), http://www.who.int/reproductive-
health/unsafe_abortion/index.html.
49
At the regional level, however, more progressive language has been adopted. The Protocol to the African Charter on Human and
Peoples’ Rights on the Rights of Women in Africa call on states to “take all appropriate measures”, to “protect the reproductive rights

30


rights that can be interpreted to protect women’s right to abortion. Each of these
rights will be analyzed in the last section of this chapter. Before that, let’s briefly
see how they came to be.

Although some human rights principles can be traced back to ancient times, the
understanding we have of them today dates back to the adoption of the
Universal Declaration of Human Rights (UDHR), in 1948. The UDHR emphasizes
that everyone, men and women, is equally entitled to the rights set forth in its
text, including:

• right to life, liberty and security of person;
• right to non-discrimination;
• right to freedom of thought, conscience and religion;
• right to seek, receive and impart information;
• right to education;
• right to health;
• right to scientific advancement and its benefits; and
• right not to be subjected to torture or to cruel, inhuman or degrading
treatment or punishment.

As a non-binding declaration, the UDHR does not have the weight of
international law and lacks a mechanism for enforcement. In order to make the
human rights expressed in the UDHR binding and, therefore, enforceable, the
United Nations Member States drafted two covenants. In 1966, the International
Covenant on Civil and Political Rights (ICCPR) and the International Covenant on
Economic, Social and Cultural Rights (ICESCR) were adopted, entering into force
ten years later.

Together, the UDHR, the ICCPR and the ICESCR and their protocols form the
International Bill of Human Rights.50 Although these documents expressly affirm
the principle of non-discrimination based on sex, violations to women’s rights,
and more specifically to young women’s rights, have continued to be
widespread. For this reason, in 1979 the United Nations General Assembly
adopted the Convention for the Elimination of All Forms of Discrimination Against
Women (CEDAW)51, which entered into force in 1981.52

of women by authorizing medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the
mental and physical health of the mother or the life of the mother or the foetus”, http://www1.umn.edu/humanrts/africa/protocol-
women2003.html.
50
International Bill of Human Rights, http://www.ohchr.org/english/about/publications/docs/fs2.htm.
51
Convention on the Elimination of All Forms of Discrimination Against Women (from now on, CEDAW),
http://www.un.org/womenwatch/daw/cedaw/cedaw.htm.
52
For a short history of CEDAW, see http://www.un.org/womenwatch/daw/cedaw/history.htm.

31


Also known as the Women’s Convention, CEDAW introduces the idea that
women, because of their sex,
suffer specific forms of
discrimination and violence that Declarations are collective consensus statements on
violate their human rights. The principles that do not have the status of law. States
Convention calls on States that sign them, however, express an intention to
parties to modify or abolish honor their recommendations and these consensus
discriminatory customs and statements can serve as sources of legal
practices carried out by interpretation for international law with the passage of
government agencies, time.
organizations, enterprises or
individuals; to revoke legislation Charters, Conventions, Covenants, Pacts,
and penal codes that Protocols, or Treaties are all different names for
discriminate against women; to international agreements that become legally binding
ensure that women have access when States ratify them.
to family planning education
and services; to decide the
number and spacing of their children and to have access to the information and
means to do so.

In 1989, the General Assembly adopted the Convention on the Rights of the
Child (CRC)53, recognizing various children’s rights, including the right to life; the
freedom to seek, receive and impart information of all kinds; the children’s right
to education; and the children’s right to the highest attainable standard of
health. This treaty entered into force in 1990.

The ICCPR, IESCR, CEDAW and CRC are the most important international human
rights treaties that contain human rights provisions that can support young
women’s right to abortion. However, three other Conventions can also provide
protection under specific situations: the Convention for the Elimination of All
Forms of Racial Discrimination (CERD)54, the Convention against Torture and
Other Cruel, Inhuman or Degrading Treatment (CAT)55, and the International
Convention on the Protection of the Rights of All Migrant Workers and Members
of Their Families (ICRMW)56. The most recent international human rights treaty,
the Convention on the Rights of Persons with Disabilities, is likely to enter into
force in 2007; it, too, calls on States parties to “provide persons with disabilities
with the same range, quality and standard of free or affordable health care and

53
Convention on the Rights of the Child (from now on, CRC), http://www.unhchr.ch/html/menu3/b/k2crc.htm.
54
Convention for the Elimination of All Forms of Racial Discrimination, http://www.ohchr.org/english/law/cerd.htm.
55
Convention against Torture and Other Cruel, Inhuman or Degrading Treatment, http://www.ohchr.org/english/law/cat.htm.
56
Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families,
http://www.ohchr.org/english/law/cmw.htm.

32


programmes as provided to other persons, including in the area of sexual and
reproductive health and population-based public health programmes.”57

The Covenants and Conventions are human rights treaties, that is, they have the
value of international law, and countries that sign and ratify these documents
are bound to observe their provisions. But there are other documents that
identify key issues and define strategies to be taken in order to advance human
rights. These consensus statements include plans, programmes or platforms for
actions, which are the result of the negotiations and consensus-building
processes during world conferences sponsored by the United Nations. As
mentioned before, these consensus statements are not legally binding, but they
impose moral obligations on governments and provide guidelines for the
interpretation of already recognized human rights. The most important
consensus statements regarding sexual and reproductive rights are:

► The International Conference on Population and Development (ICPD)
Programme of Action (PoA)58 was adopted in 1994 at a UN-sponsored
international meeting of States in Cairo, Egypt. The PoA defines reproductive
rights as

“Rest[ing] on the recognition of the basic right of all couples and
individuals to decide freely and responsibly the number, spacing and
timing of their children and to have the information and means to do so,
and the right to attain the highest standard of sexual and reproductive
health. It also includes their right to make decisions concerning
reproduction free of discrimination, coercion and violence, as expressed in
human rights documents.”59

Importantly, the document recognizes that reproductive rights are not just for
adults, but that they are fundamental for the well being of adolescents and
youth as well.60 The ICPD PoA emphasizes that reproductive health services
should be designed to serve the needs of adolescent women61, safeguarding
their right to privacy, confidentiality, respect and informed consent.62
Furthermore, it affirms that in circumstances in which abortion is not against the
law, such abortion should be safe and that in all cases, women should have
access to quality services for complications arising from abortion.63

57
Convention on the Rights of Persons with Disabilities, article 25(a), http://www.ohchr.org/english/law/disabilities-
convention.htm#II.
58
International Conference on Population and Development (ICPD) Plan of Action, http://www.unfpa.org/icpd/icpd_poa.htm.
59
Ibid., paragraph 7.3
60
Ahumada, C. and Kowalski-Morton, S., 2.
61
ICPD, supra note 17, paragraph 7.7.
62
Ibid., paragraph 7.45.
63
Ibid., paragraph 8.25.

33


► The Fourth World Conference on Women Platform for Action (PFA)64
was adopted in 1995 at a UN-sponsored international meeting of States in
Beijing, China. The PFA called on States to "consider reviewing laws containing
punitive measures against women who have undergone illegal abortions."65 As
well, it demanded that States "understand and better address the determinants
and consequences of unsafe abortion."66

► In 1999, when the United Nations General Assembly convened a special
session to review and evaluate the implementation of the ICPD PoA, they
adopted the report ICPD +5: Key actions for the further implementation of
the Programme of Action.67 This document called on States to “deal with the
health impact of unsafe abortion as a major public-health concern and to reduce
the recourse to abortion through expanded and improved family planning
services”68 and stated that “[c]ountries should ... remove legal, regulatory and
social barriers to reproductive health information and care for adolescents69. In
addition, it stated that States should “train and equip health-service providers
and should take other measures to ensure that such abortion is safe and
accessible”,70 in circumstances where abortion is not against the law.

► In 2000, a UN meeting entitled “Women 2000 – gender equality, development
and peace for the twenty-first century”71 was convened to review and evaluate
the implementation of the Beijing Platform for Action. The political declaration
and a consensus outcome document entitled Further actions and initiatives
to implement the Beijing Declaration and Platform for Action (Beijing
+5)72 reaffirmed the previous commitments to women’s sexual and reproductive
rights.

Abortion and Human Rights: Interpreting Rights

Abortion has not yet been explicitly recognized as women’s right at the United
Nations. However, as shown in the previous section, the international human
rights framework has developed a rich language of fundamental rights and
freedoms that can be interpreted to protect women’s right to abortion.

64
Fourth World Conference on Women (FWCW) Platform for Action, http://www.un.org/womenwatch/daw/beijing/index.html.
65
Ibid, paragraph 106(k).
66
Ibid, paragraph 109(i).
67
Key actions for the further implementation of the Programme of Action of the International Conference on Population and
Development, 8 November 1999, http://www.unfpa.org/icpd/icpd5.htm.
68
Ibid, paragraph 63 (i).
69
Ibid, paragraph 73(f).
70
Ibid, paragraph 63(iii).
71
To find out more about the Beijing+5 process, see http://www.un.org/womenwatch/daw/followup/beijing+5.htm.
72
Further actions and initiatives to implement the Beijing Declaration and Platform for Action (Beijing +5),
http://www.un.org/womenwatch/daw/followup/ress233e.pdf.

34


Moreover, treaty-monitoring bodies (TMBs)73 – committees that oversee States-
parties compliance with international human rights commitments – have
addressed abortion in their recommendations to various governments. This
section will give you some arguments that reflect and expand such
recommendations.

a) Right to life

“Every human being has the inherent right to life. This right shall be protected by law. No
one shall be arbitrarily deprived of his [or her] life.”
ICCPR, article 6(1)

“States Parties recognize that every child has the inherent right to life.”
CRC, article 6(1)

• Forcing a woman to undergo a life-threatening pregnancy is a violation to her
right to life;
• Forcing a woman to undergo an unwanted pregnancy can severely affect her
mental health; in cases where the pregnancy is a result of rape and/or
incest, or when the foetus has a fatal abnormality, it may even drive her to
suicide, constituting a violation to her right to life;
• A lack of safe abortion care services may force a pregnant woman to seek
unsafe procedures that may put her life under high risk;
• Denying or delaying post-abortion care to a woman who presents with
complications resulting from a miscarriage or an unsafe abortion violates her
right to life;
• The burden of child-bearing and -rearing can restrict a woman’s access to
education, employment, and other opportunities for personal development,
thus, violating her right to life, if we understand ‘life’ in an unrestrictive
manner, as the ability of a person to have conditions to enjoy life
(livelihood).

The right to life is the claim most used by opposition against women’s right to
choose whether or not to have an abortion. There is a huge debate around the
concept of life and when it begins: from fertilization to conception to birth. While
the opposition argues that the foetus has a right to life, we argue that the
woman’s right to life takes precedence. A foetus cannot be considered a person
and it cannot be more important than the life and rights of the woman.

73
For more information on treaty monitoring bodies, see http://www.unhchr.ch/html/menu2/convmech.htm.

35


b) Right to liberty and security of person

“Everyone has the right to liberty and security of person ... No one shall be
deprived of his liberty except on such grounds and in accordance with such
procedure as are established by law.”
ICCPR, article 9(1)

• A woman is only free if she can control her own body;
• Forcing a woman to undergo an unwanted pregnancy is a violation of her
bodily integrity, that is, forcing her to experience something she does not
want to experience;
• Prohibitive legislation on abortion is a State’s arbitrary intrusion in a woman’s
body and unnecessary to protect public health;
• When a woman does not seek health-care services because she fears her
confidentiality will not be respected, or she will be reported to parents,
husband/partner, or the police, a violation of her right to liberty and security
of person occurs;
• Pressuring or forcing a woman to undergo an abortion (for example, because
she is HIV-positive or of a certain ethnic/racial group) is a violation of her
right to liberty.

c) Right to privacy

“No one shall be subjected to arbitrary or unlawful interference with his [or her]
privacy, family, home or correspondence, nor to unlawful attacks on his [or her]
honour and reputation.”
ICCPR, article 17(1)

“No child shall be subjected to arbitrary or unlawful interference with his or her
privacy.”
CRC, article 16(1)

• Decisions a woman makes about her body are private and individual and
must not be subjected to interference or coercion from parents,
husband/partner, or the State;
• Policies and legislation that require parental or spousal authorization for
abortion violates women’s right to privacy;
• Policies and legislation that require health-care services providers to report
abortion cases to law enforcement agencies violate women’s right to privacy
and the doctors’ duty to observe physician-patient confidentiality;
• A woman’s right to privacy entitles her to have access to confidential health
services.

36


d) Rights to freedom of thought, conscience and religion

“Everyone shall have the right to freedom of thought, conscience and religion.”

“Everyone shall have the right to freedom of expression; this right shall include
freedom to seek, receive and impart information and ideas of all kinds,
regardless of frontiers, either orally, in writing or in print, in the form of art, or
through any other media of his [or her] choice.”

• A woman must not be forced to comply with laws based on religious beliefs
or faith that are not her own;
• The separation of religion and the State is fundamental for the respect of
human rights in general, and sexual and reproductive rights in particular,
especially regarding pregnancy and abortion care services;
• Forcing a woman to carry a pregnancy against her will infringes upon her
freedom of conscience;
• Health-care services providers who refuse to offer abortion care services
permitted by law for religious reasons violate women’s rights when they do
not refer women promptly to facilities nearby where they can obtain these
services.

The opposition is increasingly using the right to freedom of thought, conscience,
and religion to deny women’s access to abortion care services, advocating for
observance of “conscientious objection” clauses for health-care services
providers. We argue that this right has a limit; freedom of conscience cannot
justify a refusal to provide health-care services, including abortion, especially
when it represents a risk to the life and well being of the woman. In addition,
the right to conscientious objection applies only to individual persons and not to
institutions such as hospitals and clinics and States are required to ensure that
women have reasonable access to all legal medical procedures.74

e) Right to health

“The States Parties to the present Covenant recognize the right of everyone to
the enjoyment of the highest attainable standard of physical and mental health”
ICESCR, article 12(1)

74
Cook, Rebecca and Dickens, B. M., “The scope and limits of conscientious objection”, International Journal of Gynecology and
Obstetrics, (71, 2000), 71-77.

37

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007)

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007)

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007)

Ähnlich wie Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007) (8)

Mehr von Y-PEER Hacioglu

Mehr von Y-PEER Hacioglu (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy (2007)