Earlier this month I attended a historic medical conference with over 8000 ob-gyns from around the world, gathered together in Cape Town, South Africa, for the International Federation of Gynecology and Obstetrics (FIGO) conference. Many FIGO participants are physicians living in developing countries where access to comprehensive health care may pose a challenge for women. But for those living in countries with restrictive abortion laws, a large part of their practice is to care for women suffering from the complications of unsafe abortion. Attending sessions and meeting with my colleagues from around the world, it was clear what a rare opportunity it was to meet other doctors facing the same challenge.
FIGO had never been held before in Africa, and having the conference in Cape Town enabled many more participants from the region to attend this tri-annual conference than normally do. This is important because the vast majority women living in Africa live with restrictive abortion laws. As we know, this does not reduce the incidence of abortion, but it does make it particularly dangerous: according to a recent study from the Guttmacher Institute, although only 13 percent of all the world’s abortions occur in Africa, more than half of all abortion-related deaths take place there.
And this is perhaps what was most inspiring to me, coming from the United States: in this country, doctors may be afraid to discuss abortion in public, much less provide it in their practices. FIGO participants really get the importance of safe abortion care, in a way that many U.S. audiences just do not. For them abortion is not a political issue; for them and their patients, it’s an issue of life or death. And the conference provided a safe place for them to discuss abortion openly and forthrightly.
In Nigeria, for example, where abortion laws are particularly strict, conservative Christian or Muslim cultures make discussion of safe abortion care difficult. And yet, it is estimated that unsafe abortion is the leading cause of maternal mortality. How does a physician provide appropriate care to his or her patients in this setting? Where does he or she get her information? Or in a poor country like Zambia, where abortion is more accessible, but where few providers are trained; how can a country with just a handful of ob-gyns spare them to travel to be trained to provide safe abortion care? How can they get access to the most recent research or techniques needed to save women’s lives? Thus, interest was high in interventions and strategies that could prevent unsafe abortion and improve access to safe abortion care in Africa.
A number abortion-related sessions were held to provide technical, political and moral support to those trying to increase access to safe abortion care — such as sessions on the expanded use of appropriate medications and technologies, and the importance of documenting the impact of restrictive laws. One session addressed the challenge of tackling unsafe abortion through international policy bodies. “If the UN and WHO [the World Health Organization] are supposed to be evidence-based in their guidelines,” asked one participant, “and safe abortion care clearly saves lives, why doesn’t WHO, the UN, and other multilateral agencies recommend access to safe abortion care? ” Under the administration of President George W. Bush in the United States, the government withdrew its support for UNFPA, the UN Population Fund, and the Human Reproduction Program of WHO because it did not believe safe abortion care was legitimate healthcare. In cases such as this, NGOs like Ipas play an important role of being free to speak out about the need for safe abortion care where government bodies may not. We can provide training to physicians and midlevel providers, act as a conduit to share information about policy approaches and conduct and share findings from research.
Medical abortion was another hot topic for discussion throughout the conference, particularly its potential to increase access to safe abortion care in settings where doctors may be few and far between. Ipas staff and colleagues held a session to teach providers to train other providers on the use of medical abortion. Most participants were from Africa, where medical abortion is just beginning to be available, and where there is a great need to extend safe abortion care to remote settings and save lives. However the tricky part is inspiring confidence in a new and unfamiliar technique. Participants know that medical abortion is safe and effective, and that we need more safe and effective methods to save women’s lives. But it’s hard to implement a new technology without a network with which providers can consult and exchange insights.
Another session discussed the role religious health-care providers play in increasing access to safe abortion care. Religious groups in some low resource countries provide 60-70 percent of all health care services (by comparison, approximately 15 percent of all hospital admissions are in Catholic hospitals), so if we are going to increase access to safe abortion care in these settings, the pro-choice community must engage, not exclude, the religious community. We may not agree on all issues, but we can speak to each other through showing impact…the impact of saving women’s lives. The evidence shows that populations where women have access to reproductive health information and contraception also have the lowest abortion rates. We also know that unsafe abortion has a disproportionate effect on poor women while women of means can find safe abortion care regardless of legal restrictions. Can we not work together to ensure that poor women have access to information and services?