Africa has the highest percentage of maternal deaths due to unsafe abortion in the world. In sub-Saharan Africa, an estimated 4.7 million abortions occur each year, and of these, about 98 percent are performed either by persons lacking the minimal skills, or in an environment lacking the minimal medical standards, or both. According to data from the World Health Organisation (WHO), in 2003, unsafe abortions accounted for 14 per cent of maternal deaths in Sub-Saharan Africa, the equivalent of 120 deaths per 100,000 live births.

A new study by the Guttmacher Institute has actually managed to quantify the direct costs of treating the complications that result from unsafe abortions on health systems in the global south. Based on two different methods of calculation, —a World Health Organization model and a comparison of 20 empirical studies, 9 from sub-Saharan Africa—the authors calculate that on average, treating post-abortion complications costs an estimated USD83 per patient in Africa (based on 2006 reported costs). When overhead and capital costs are included, these averages jump to USD114 for Africa. Assuming women continue to pay for their own abortions, if able to access safe, legal abortion services, the reduction in costs to healthcare systems in all African nations is undeniable.

These new estimates of the direct costs of treating abortion complications lend incredible weight to raising the profile of access to safe and legal abortion on the development agenda. We have seen the world community come together to discuss development on many occasions. A working committee drawn from a range of UN bodies, special agencies and specialists, including the World Bank, the International Monetary Fund, UNICEF, the Population Fund and the World Health Organization, put together the 18 specific targets and 48 indicators that formed the Millennium Development Goals, based on the Millennium Declaration of September 2000. Along with education and gender equality, health is a major focus of the MDGs and yet reproductive health seems to have received only cursory attention.

It was only in 2005 that a new target under MDG 5 (improved maternal health) was added: to ensure universal access to reproductive health by 2015. Quantitative measures now include contraceptive prevalence, adolescent pregnancies, antenatal care coverage and unmet need for family planning. The issue of maternal mortality certainly draws global attention. However, even when advocates highlight the correlation between unsafe abortions and maternal mortality, some of the world’s most restrictive abortion laws have remained in place.

So perhaps this new study is the impetus needed to advance the abortion agenda. It is indeed frustrating to need to put figures on the table. Ultimately, this is a woman’s life, health and rights we are talking about and it is easy to ask why money should matter. But when we have talked rights in the past, laws have not changed. The 2003 Protocol to the African Charter on Human and Peoples' rights on the Rights of Women in Africa, adopted by the African Union mandates countries to protect the reproductive rights 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 fetus. In the context of women’s health programs and the high maternal mortality rates resulting from unsafe abortions, the Africa Health Strategy 2007-2015 recommends “safe termination of pregnancy and post-abortion services should be included as far as country’s law allow”. However, few African governments have implemented the Protocol’s recommendations. As of January of this year, for a host of African countries, abortion remains illegal in all circumstances or is permitted only to save a women’s life, including in Angola, Benin, Côte d'Ivoire, Kenya, Lesotho, Mali, Nigeria, Senegal, Somalia, Tanzania, Togo and Uganda. It is clear that change requires a fundamental shift in knowledge, attitudes and incentives.

For example, a study conducted in Nigeria by the Women’s Health and Action Research Centre in December 2008 involving interviews with 49 policy makers in 6 regions of the country on knowledge and perceptions of the causes of abortion-related maternal mortality found that policymakers were guided by moral and religious considerations rather than by current evidence-based considerations. Only four participants recognized the fact that abortion will go on regardless of the law. One-third of key informants were opposed to liberalizing the laws on abortion in Nigeria, while only one-fifth supported liberalization on “medical grounds” and to deal with unwanted pregnancies due to rape and incest. So will money talk? Arguments about the costs of abortion-related mortality and morbidity have been made several times over the past few decades. So will the cost argument succeed this time around?

A significant proportion of aid is spent on advancing healthcare systems in the global south. This study by the Guttmacher Institute evidences unnecessary and avoidable costs, money that could be diverted and invested elsewhere in the healthcare systems of many African nations. If aid money is aimed at creating cost-effective, efficient and sustainable health care systems, African nations and the global community cannot ignore the high number of unsafe abortions that continue to occur on a daily basis and the heedless money spent addressing complications. Let’s see whether money can break down the moral, religious and non-evidenced based perceptions that have thus far acted as barriers to change.