Statement on access to safe, quality and legal abortion Peoples Health Movement (PHM) Following on the fourth People’s Health Assembly (PHA) of the global People's Health Movement (PHM) concluded in Savar, Bangladesh on 19 November 2019, the PHM reiterates girls’ and women’s rights to health and life, to equality, and sexual and reproductive autonomy. The PHM stands in solidarity with the struggles in countries around the world where the right to abortion is banned, restricted or access to safe and quality abortion care, inaccessible. As of 2017, 26 countries, including Iraq, Egypt, Philippines, Nicaragua ban abortion altogether, regardless of the consequences to the woman’s health, and even if it is a result of rape or incest; 37 other countries, including Brazil, Mexico, Nigeria, Indonesia, UAE, permit abortion only if it is perceived as necessary to save the life of the woman. Thirty six and twenty four countries allow abortion only if it is necessary to protect the woman’s physical and mental health respectively (Singh S et al 2017). Overall, only 37% of the world’s 1.64 billion women of reproductive age live in countries where abortion is permitted without restriction. Although a progressive legal mandate alone does not ensure access, it is an important first step towards the availability of safe and legal abortion services. However, even in countries where abortion is broadly legal, the limited provision of affordable services is a barrier to the access of safe abortion. Moreover, prevalent stigma, patriarchal and other biases, a poorly functioning health system impact the provision of abortion services (Singh S et al 2017). For example, despite India’s broadly legal status, the absence of adequate numbers of trained, legally registered health care providers throughout the country and the necessary facilities continue to pose significant challenges to those accessing abortion care. Moreover, evidence points to the abysmal access to information and knowledge about the legal provisions amongst girls and women, as well as among health care providers, often compromising access to abortion care (Nadimpally et al 2017). Thus, along with legal provisions, their implementation towards safe, quality abortion services, and post abortion care is critical to girls and women’s health and lives. Full implementation of the law towards comprehensive access to safe, quality abortion care, regardless of girls and women’s ability to pay is necessary. During 2010-2017, the proportion of unsafe abortions was significantly higher in developing countries at 49·5% compared to 12·5% in developed countries, with the higher proportion of unsafe abortions coinciding with countries having highly restrictive abortion laws than in those with less restrictive laws (Ganatra, B et al 2017). An estimated 30 women die from every 100 000 unsafe abortions. That number rises to 220 deaths per 100 000 unsafe abortions in developing regions and 520 deaths per 100 000 unsafe abortions in sub-Saharan Africa (WHO 2011), an indication also of global inequities in health and health care. The World Health Organisation (WHO) estimates that 7 million women are hospitalised each year in developing countries as a result of unsafe abortions, and between 4% and 13% of maternal deaths in the world stem from abortions performed under precarious conditions, concentrated in poor countries. One such avoidable and tragic death was that of Savita Halappanavar, a woman of Indian origin, who died of septicemia that resulted from denial of medical care following a miscarriagein Ireland. Her death rekindled the movement in Ireland and in 2018, Ireland changed its abortion law, becoming part of the group of about 28 countries that have changed their abortion law since 2000, most of them expanding legal grounds to access abortions more widely. However, there is a need to be vigilant about the gradual shifts, which are visible in several countries including the United States, Poland, China, South Korea and others towards regressive laws. In South Korea, for example, the already criminalized and restricted environment around abortion has worsened. Punishment for doctors who perform abortions has been made more stringent and provision of abortion services has been labeled as an ‘immoral medical practice’ by the Ministry of Health. Further, the imposition of the Global Gag Rule affects access sexual and reproductive rights globally and also threatens access to safe abortion services, pushing women to seek unsafe abortions that places their health and lives at great risk (The Guardian 2017).[5] This, despite the recognition of the right to safe abortion by the international Human Rights Instruments such as the International Covenant on Economic, Social, and Cultural Rights (ICESCR), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) Committee the Committee on the Rights of the Child (CRC). The UN Committee Against Torture reinforces that the denial of safe abortion services—especially with regard to sexual violence, incest, and foetal abnormalities— and the consequent forced carrying to term of these pregnancies, as a form of torture (ARROW 2018). The year 2018 was historic in the context of abortion, with the referendum in Ireland in May overwhelmingly asserting legal reform. Following this, in June, millions of Argentineans stormed the streets in support of a Bill to legalise abortion in the first 14 weeks of pregnancy. Unfortunately, however, the Bill was defeated by a very narrow margin by the Senate, disregarding the tremendous public support for it. The waves of green created by the green bandanas by the people of Argentina, remains a symbol of resistance and a strengthened movement for the right to abortion in the country as well as globally. The PHM stands in solidarity with ongoing struggles and campaigns around the world and reiterates its commitment to sustained advocacy for the access to safe, quality and legal abortion as well as respectful treatment of women accessing abortion by providers. Recognition of the right to safe quality abortion as a human right of all women and girls is urgent and necessary towards fulfilling the rights to their health and lives. Contact: Sarojini Nadimpally & Deepa V on behalf of PHM Gender Justice and Health Rights Thematic Circle (Sarojini at phmovement.org) References Susheela Singh et al (2017) Abortion Worldwide 2017, Uneven Progress Unequal Access, Guttmacher Institute. Nadimpally, S. et al (2017)India’s abortion wars, Deccan Chronicle, 16 April 2017. Ganatra, B. et al. (2017) Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model, Lancet. Available at ARROW for Change (2018) The Right to Choose, Vol 24, No. 1 2018. ARROW World Health Organisation (2011) Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. -- 6th ed. ________________________________________ [4]http://www.who.int/mediacentre/factsheets/fs388/en/ [5]https://www.theguardian.com/world/2017/jan/23/trump-abortion-gag-rule-international-ngo-funding [6]https://www.theguardian.com/world/2017/jan/23/trump-abortion-gag-rule-international-ngo-funding [7]https://www.pri.org/stories/2016-01-28/zika-virus-has-reignited-brazil-s-abortion-debate-0 [8]http://www.huffingtonpost.com/entry/poland-abortion-protest_us_57fced3ae4b068ecb5e1af88 [9]https://mic.com/articles/180798/poland-makes-emergency-contraception-a-prescription-only-drug-even-for-rape-survivors#.yp2r9qlob