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Interpreting and Implementing Existing Abortion Laws in Africa 2013

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Interpreting and Implementing Existing Abortion Laws in Africa 2013 Content INTRODUCTION 8 SUMMARY OF LAWS REGULATING ABORTION IN AFRICA 11 WORLD HEALTH ORGANIZATION GUIDANCE ON SAFE ABORTION 13 CARE . TRANSLATING HEALTH AND HUMAN RIGHTS STANDARDS INTO ACTION: BRIEF CASE STUDIES FROM THREE COUNTRIES (GHANA, ETHIOPIA, 17 Zambia) CONCLUSION 21 ANNEX I: SOURCES TO CONSIDER WHEN INTERPRETING AND IMPLEMENTING 23 ABORTION LAWS ANNEX II: FURTHER INFORMATION ON HUMAN RIGHTS STANDARDS 33 3 Foreword The promotion of maternal, newborn and child health (MNCH) across the African continent is a priority of the African Union Commission. The continent has, no doubt, recorded significant improvement with regard to MNCH status. The economic growth being experienced across the continent provides a further window of opportunity to consolidate on those gains and cover more ground. Maternal, Newborn and Child Health status is a very critical indicator that provides an insight into the quality of life of any nation’s citizens. Women account for about fifty percent of the continent’s population. Therefore sustainable economic growth cannot be engendered unless they are empowered and their overall quality of life is improved. Unsafe abortion unfortunately continues to contribute to morbidity and mortality in Africa. Each AU member state has laws in place to regulate the practice within its sovereign responsibility to promote community wellbeing. Evidence has shown that if these laws, irrespective of their apparently liberal or restrictive nature, are implemented with a view to saving women’s lives and improving their health, the contribution of unsafe abortion to maternal mortality will be significantly contained. Evidence further shows that restrictive laws result in higher levels of unsafe abortion. Failure to implement the laws, as they are, stems from several factors which include ignorance of the provisions of the laws. Therefore the AUC, in collaboration with Ipas, has developed this publication to empower the broad range of stakeholders to identify their rights (for right holders) and responsibilities (for duty bearers) within the existing laws. It is my hope that this publication will serve as a practical and effective tool to improve maternal health status in Africa by stemming the tide of morbidity and mortality. H.E Dr Mustapha .S. Kaloko Commissioner for Social Affairs 5 Executive Summary Unsafe abortion is one of the largest causes of maternal mortality and morbidity globally. In Africa, of the 6.4 million abortions carried out in 2008, only 3 percent were performed under safe conditions. The World Health Organization (WHO) estimates that in 2008, 29,000 African women died from complications of unsafe abortion, constituting a full 13 percent of maternal deaths in the region. In some individual countries, unsafe abortion accounts for up to 30 to 40 percent of maternal mortality. Unsafe abortions occur primarily in countries with restrictive abortion laws or practice regimes. One of the reasons unsafe abortion occurs is because safe abortion services frequently are not available, even when they are legal, forcing women to undergo illegal and unsafe abortions. According to WHO, legal status and availability of lawful abortion do make a difference to the safety of abortions. While there are many steps that can be taken to prevent maternal mortality and morbidity, all African Union member states must take the important step of implementing current laws regulating abortion. All African Union member states allow abortion at least to save a woman’s life and many more permit it on broader grounds, including health grounds. However, few countries have taken positive steps towards ensuring women access to abortions they are entitled to under the law, causing women to seek unsafe abortions. World Health Organization standards and United Nations and regional commitments to reducing maternal mortality call upon states to take measures to ensure access to safe abortion, where legal, including by developing strategies and guidelines for providing safe abortion services. International and regional human rights bodies and courts also have given increasing attention in recent years to abortion and its link to women’s health and human rights. They have called on states to remove barriers to safe abortion services, including by implementing existing abortion laws. They require that laws, even when restrictive, are interpreted broadly and implemented to promote and protect women’s health and human rights. Examples from African Union member states show that when governments commit to ensuring that access to safe abortions is available within the law, incidence of unsafe abortions is reduced, as are maternal deaths from unsafe abortion. African Union member states must enact an enabling regulatory and policy environment, including development and dissemination of strategies and guidelines and training of providers, to ensure that every woman who is legally eligible has ready access to good-quality abortion services. South Africa, Ghana and Ethiopia are examples of countries where this is being done successfully. This document offers guidance to African Union member states for effectively implementing existing abortion laws in ways consistent with prevailing human rights and public health guidance and to fulfill states’ obligations to protect women’s reproductive health and rights. 6 (C) Richard Lord Introduction There are approximately 22 million family planning and safe abortion. This will unsafe abortions annually worldwide, 98 reduce unwanted pregnancies and unsafe percent of them in developing countries. abortions8. Globally, unsafe abortion results in death for approximately 47,000 women and International and regional human rights disabilities for an additional 5 million each bodies and consensus documents also have year1. This accounts for roughly 13 percent consistently recognized that unsafe abortion of maternal mortality, the third largest cause leads to high rates of maternal mortality and of maternal mortality, globally2. African have called on states to take measures to women bear the burden of more than half of reduce such preventable deaths, by ensuring these maternal deaths, with 29,000 deaths3. that abortion is available and safe. The In many African Union member states, the problem is recognized as so acute in Africa percentage of maternal deaths resulting from that the Protocol to the African Charter on unsafe abortion is much higher4. And young Human and Peoples’ Rights on the Rights of women are disproportionately impacted: Women in Africa (Maputo Protocol), ratified more than 60 percent of all maternal deaths by the majority of African Union member from unsafe abortion in Africa are among states, expressly requires governments to women under the age of 255. “protect the reproductive rights of women by authorising medical abortion in cases of Restrictive abortion laws and policies are a sexual assault, rape, incest” and when the major contributor to unsafe abortion. African pregnancy threatens the life or mental or Union member states have some of the most physical health of the woman, and in cases pervasive legal and practice restrictions in where there is a threat to the life of the the world, resulting in high rates of maternal foetus. mortality and morbidity. In Eastern Africa, unsafe abortions are estimated to account All existing African national abortion laws, for almost 1 out of 5 maternal deaths (18 in fact, provide for legal abortion in some percent), the highest rate in the world, or all of the circumstances in the Protocol; while in Western Africa, it is 1 out of 8 (12 no country in Africa has an absolute ban on percent). The Southern Africa region has the abortion. Following global trends towards lowest rate in the region, at about 1 out of liberalising abortion laws—30 countries, 10 maternal deaths (9 percent). As explained including several in Africa, have liberalised in a recent report by the African Union their abortion laws over the past 20 years—a Commission on Maternal Newborn and few countries in Africa also go beyond the Child Health, Eastern Africa’s poorer abortion minimal grounds of the Maputo Protocol indicators could be partly attributed to its and allow abortion also for socioeconomic more restrictive abortion laws compared reasons, or on request (Tunisia, South Africa, with the other regions6. Cape Verde, Zambia and Ethiopia). Several other countries have taken positive steps World Health Organisation estimates confirm towards effective implementation of existing that the legal status of abortion does not abortion laws by issuing protocols and reduce the number of induced abortions, as guidelines for the provision of safe abortion. women will seek abortions if they need them, In Ghana, for example, the current abortion regardless of abortion’s legal status. While law remained unimplemented for 25 years According to the World abortion is a safe procedure when performed after it was enacted, although it allows Health Organization, the first by skilled health care providers in sanitary abortion on grounds of physical and mental steps for avoiding abortion- conditions, clandestine and illegal abortions health. Recently, since 2005, the Ministry of related maternal deaths are generally are unsafe and lead to high rates of Health is working to correct this situation to ensure that women have complications and deaths7. According to the by making safe, legal abortion accessible to access to family planning World
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