Advocating for Abortion Access: Eleven Country Studies Copyright: Women’s Health Project 2001. The publication may be reviewed, abstracted or reproduced in part when fully referenced, but not for sale or for use in conjunction with commercial purposes. Published by: The Women’s Health Project School of Public Health University of the Witwatersrand Johannesburg South Africa P O Box 1038 Johannesburg 2000 South Africa Fax: 27 11 489 9922 Telephone: 27 11 489 9917 E-mail: [email protected] Website: www.sn.apc.org/whp/ Project managed by Zanele Hlatshwayo Publication edited by Barbara Klugman and Debbie Budlender Copy edited and proof-read by Cheryl Hunter Layout by ITL Communication and Design Cover photograph taken by Daniela Colombo during a rally in Rome in 1977. The women carry placards with names of women who had died after undergoing clandestine abortions. Printed by Witwatersrand University Press, Johannesburg ISBN No 1-86383-283-4 Also available in Spanish Acknowledgements The Johannesburg Initiative is funded by the Government of the Netherlands and the Swedish International Development Cooperation Agency (Sida). The South African case study was supported by the Health Systems Trust. We thank them all for their willingness to support a ‘south- based’ initiative and one which seeks to explore this contro- versial yet critical issue for women’s rights and health. We would like to thank all the participants in this Initiative for their commitment to this endeavour. We would like to thank our colleagues at Women’s Health Project (WHP) including our financial officer, Lynn Reynolds, operations manager Jennifer Harris and administrator Thandi Mosiane, for man- aging the logistics of the Initiative. We would like to thank Debbie Budlender for her insights, pace, positive working style with all authors, and commitment to producing a fine publication. Dedication This publication is dedicated to all the women who have had unsafe abortions and as a result have been criminalised, hu- miliated and can no longer have children. It is dedicated to those who have died because they were denied the right to choose whether or not they wanted to have a child. Advocating for Abortion Access: Eleven Country Studies Produced through the collective input of participants in the Johannesburg Initiative: Ana Cortes Mexico Antonietta Cillumbriello Italy Barbara Klugman South Africa Cait Calcutt Australia Chantal Birman France Esmeralda Kuliesyte Lithuania Fred Nunes Guyana Friday Okonofua Nigeria Hailemichael Gebreselassie Ethiopia Halida Hanum-Akhter Bangladesh Katini Nzau-Ombaka Kenya Maria Gutierrez Argentina Marlene Gerber Fried United States of America Martha Rosenberg Argentina Noeleen Hartigan Ireland Sanjani Varkey South Africa Sarah Pene Fiji Shelia Clarke United States of America Sunita Bandewar India Wanda Nowicka Poland Wilza Villela Brazil Zanele Hlatshwayo South Africa CONTENTS Preface ............................................................................................. vi Glossary ..........................................................................................xiv Conceptual framework ...................................................................... 1 Strategy and action for abortion access: a comparative analysis .......................................................... 7 The Australian Pro-Choice Movement and the Struggle for Legal Clarity, Liberal Laws and Liberal Access: Two Case Studies ............................................................... 41 Current Status of Policy and Access to Abortion: The Bangladesh Experience ........................................ 71 Expanding Women’s Access to Abortion: The Brazilian Experience ................................................ 87 Implementing a Liberal Abortion Law in Guyana: Experiences and Lessons ..................................... 109 Abortion Legislation and Access to Safe Abortion Care Services: The Indian Experience ............................ 135 The Fight for Reproductive Rights in Italy .................................... 157 Alternative Access to Abortion Services Under Restricitive Law: The Kenyan Experience .......................... 173 August 2000 Reforms to Mexico City Abortion Legislation: The Long, Hard Struggle ............................. 199 Struggles For and Against Legal Abortion in Poland ........................................................................ 223 From Policy Development to Policy Implementation: The South African Choice on Termination of Pregnancy Act .................................... 251 Expanding Abortion Access: The US Experience ........................................................................ 283 Preface PREFACE This publication is the result of work undertaken in phase one of ‘The Johannesburg Initiative’. This is the name given by participants to an international project of which the full title is “Capacity building for advocacy on expanding abortion policy and access: sharing of national experiences between countries from diverse regions.” Background to the initiative The initiative was the Women’s Health Project’s response to repeated questions by activists from all over the world: ‘How did South Africa win such a liberal abortion law?’ We realised that the political and social context that had created the space for legal change was very specific to South Africa and that it was simplistic to think that telling our story would help activists elsewhere. For this reason, we thought we might learn more by comparing abortion advocacy experiences from different parts of the world. Would this comparison, for example, show us that under certain circumstances it was impossible to change the law? Or that all countries which had been successful had taken specific actions or had a certain context? After we had begun to shape an idea for this research, activists from Poland (Wanda Nowicka) and Colombia (Maria Isabel Plata) heard our analysis of the contextual factors and activist strategies which had resulted in the legal victory in South Africa. They suggested that it would be helpful not just to read analyses from different countries, but also to engage in a process of interaction between activists in different countries. With their input, and that of Marlene Fried in the United States of America (USA), this initiative was shaped and funds raised. To identify potential participating countries, we sent out a call via actors in the field of reproductive rights in different parts of the world. We asked them to assist in identifying non-govern- vii Advocating for abortion access mental organisations that have worked or currently are work- ing in abortion advocacy in their own countries, rather than at an international level. As names came in, we looked for a mix of countries from all regions of the world and with diverse ex- periences of abortion advocacy. The aim of the initiative is to build capacity amongst those of us engaged in advocacy for improving abortion access, whether through legal change or by increasing access to and quality of services. By providing case studies of different experiences, activists can interrogate the strategies used by other activists in different countries and learn from their successes and mistakes. The project also aimed to provide an example of southern- initiated activism that builds bridges and facilitates learning between regions and countries of the north and south. One particularly dynamic aspect of the initiative was having people from countries in the north and south, as well as coun- tries in transition, working together as equals. This approach allowed not only for a collective analysis of the different coun- try studies, but also for the inclusion of countries that were not initially part of the initiative or the research group. To facilitate this, some researchers in the initiative drew fewer funds than were originally allocated for individual country studies in or- der to release funds to incorporate additional studies. Eighteen countries participated in the Johannesburg Initiative. Of these, ten conducted research and documented their coun- try experiences. Their reports are carried in this publication. The other participants contributed actively to the research de- sign and analysis in order to ensure that this research talked to their concerns and experiences and would be helpful in sup- porting activists in their own countries. The publication there- fore is not only a product of the authors, but of all those in the initiative. Participants were invited as representatives of their NGOs. In a few cases, however, the NGOs contracted an activist re- searcher to represent them and do the research. In two cases, participants had been key players in their countries’ abortion struggles but the organisational impetus was over. Neverthe- The Johannesburg Initiative viii Preface less, we felt the stories needed to be shared. The overall inten- tion, however, was for participation in this project to strengthen NGO advocacy efforts. The participants are: Argentina, Foro por los Derechos Reproductivos, Martha Rosenberg, Maria Gutierrez Australia, Abortion Rights Network of Australia, Cait Calcutt Bangladesh, Bangladesh Institute of Research for Promotion of Essential & Reproductive Health and Technologies, Halida Hanum-Akhter Brazil, Feminist Health and Sexuality Collective, Wilza Villela Ethiopia, IPAS, Hailemichael Gebreselassie Fiji, Fiji Women’s Crisis Centre, Sarah Pene France, Chantal Birman Guyana, Fred Nunes India, Centre for Enquiry into Health and