One hundred and eighty-eight women died today. You didn’t read about it in the paper. No earthquake or flood killed them; they were
not the victims of a war. Their deaths
were entirely preventable. They died
because the world’s commitment to ending maternal mortality does not extend to
making abortion safe.

While hemorrhage,
eclampsia, sepsis, and obstructed labor account for many maternal deaths, the
most easily prevented of the top maternal death culprits, unsafe abortion,
remains a political, rather than health, issue in most of the world. Maternal mortality is a phenomena largely
confined to the developing world, with 99% of maternal deaths — over half a
million women per year — concentrated in low income countries. The World Health Organization estimates that almost 13% of all maternal
deaths are caused by complications from unsafe abortions.

Reducing maternal
deaths from unsafe abortion is one of the most straight-forward public health
problems to remedy. It requires
increases in access to safe abortion and contraceptives. It is well-documented that countries with the
lowest rates of abortion are those with the greatest access to legal abortion
services and contraceptives. According
to the Guttmacher Institute, Belgium,
where abortion is legal and accessible, has an abortion rate of 7 per 100,000
women. Contrast this to Peru, where the
procedure is illegal, and the rate skyrockets to 56 per 100,000. Despite the evidence, reproductive health
targets were not initially included in the MDGs. These targets came late to the process in
2006 — almost half way to the end date of the campaign — and were added under the
goal of reducing maternal mortality only after significant pressure from UN
member states, including members of the EU and several developing nations such
as Cambodia, Cuba, Madagascar, and Nigeria.

MDG subgoal 5B sets out
to ensure universal access to reproductive health by 2015. Unlike other MDG’s, reducing maternal
mortality and achieving universal access to reproductive heath care will take
more than technical expertise and material resources. Reducing maternal mortality, unsafe abortion,
and increasing access to reproductive health care requires that governments,
societies, and donors confront not only
the issue of abortion but also medically-accurate sex education for women and
girls and access to contraceptives. These measures alone would decrease by 90% incidents of unsafe
abortion — and go a long way to reducing maternal mortality.

Abortion is a reality
of many women’s reproductive lives. The
underlying political gap is standing in the way of women’s access to comprehensive
reproductive health care. Without added
pressure from donor governments, local women’s health advocates in the
developing world can only do so much to stop deaths from unsafe abortions in
their countries. Donors who place
restrictions on reproductive health funding, including the United States — which
prohibits any organization accepting these funds from offering abortion as part
of their comprehensive reproductive health care programs — do so at the peril of
women’s lives. Other developed nations,
such as Great Britain and EU members, have made a commitment to unrestricting
their reproductive health funding.

Reducing maternal deaths is a laudable goal,
and one that must be achieved if the rest of the millennium development goals
are to be realized. But reductions in
maternal mortality can never be fully realized unless the global community of
donors, governments, and public health starts including abortion in realistic
approaches to protecting women’s health.
If the world wants to promote development, it needs to start promoting
comprehensive reproductive health care.