Access to abortion in Africa and Latin America: a question of public health and social inequality

The World Health Organization (WHO) estimates that 3.7 million unsafe abortions are conducted every year in Latin America and the Caribbean, which comes down to nearly one abortion for every three live births. In Africa, where 99% of these interventions are done illegally, the number of unsafe abortions is estimated at 4.2 million, representing one abortion for seven live births. In order better to understand the changes and developments of the situation on these two continents, a research team jointly involving the IRD and "El Colegio de Mexico" examined the results of a range of studies conducted since the early 1990s, approaching this question from a social sciences angle (profile of women concerned by abortion, consequences for their health and life in society, the role of men and so on). They also looked at the legislation on abortion rights, changes in it over the past 15 years and the debates that run concerning these questions. The legislative framework for abortion in Latin America and the Caribbean remains restrictive, but it is even more so in the African countries where it is founded on laws dating from the colonial period.

Data in the area of abortion is still highly fragmented, difficult to obtain owing to the heavy legal and social penalties women risk if they decide to have an abortion in countries where this act is of limited access, even if not completely prohibited. For Latin America, apart from a study run in urban areas of Colombia, wide-ranging surveys based on representative samples of the population are lacking. In Africa, there is still no public debate on the question of abortion, and the few studies conducted, most often among women who were victims of medical complications, showed a particularly marked rise of such interventions in urban areas.

At present, although none of the 53 countries on the African continent totally forbid abortion, only Cap Verde, Tunisia and South Africa permit abortion on the woman's demand. Since the Cairo Conference of 1994, during which the African countries made a commitment to respect women's reproductive rights, 20 of them have made small improvements to the legal framework for abortion. However, in reality, the progress made is quite limited, pregnancy termination most often being allowed strictly for medical reasons. The legal conditions for access to abortion have indeed worsened since the mid 1990s, becoming more restrictive in four countries of Africa. Congo, Malawi and Swaziland now allow it only as a means of saving the mother's life. Algeria only accepts it for such a circumstance and to preserve the woman's physical or mental health, like 17 countries of 41 in Latin America and the Caribbean. In 2006, six other countries (Chile, El Salvador, Honduras, the Dominican Republic, the Dutch part of Saint Martin, Nicaragua) it was still prohibited. Feminist groups and a civil organization of Catholic women in these countries ("Catholics for the right to decide"), are campaigning for decriminalization of abortion. But these movements are confronted with the conservative positions of the institutions, associations and even health care professionals who sometimes oppose pro-abortion legislation for ethical or religious reasons.

The researchers also sought to define better the profile of women who resort to abortion. In principle, the practice concerns all women of child-bearing age. However, in reality teenage girls are the most concerned by unsafe practices. The absence of recognition of their sexuality, or even pure and simple prohibition, makes access to contraception complicated for them, making abortion quite frequent among young women. Yet scientific data on this question for Africa, Latin America and the Caribbean are still extremely patchy. Better knowledge of the situation is essential for defining suitable health policies, making changes to abortion legislation possible and increasing awareness among the different social actors about the health and social repercussions that can be engendered by a legal framework that penalizes abortion. From the public health point of view, unsafe abortion practices significantly accentuate maternal mortality, but limited access to abortion and non respect of reproductive rights also make it a question of social injustice.

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