The what, why and how of health and development

Abortion rights: getting the law on women’s side is just the first step

“I have to tell what happened to me. I hope that everybody can know what is going on here in Peru. Those women should know that they aren’t alone, that there is a law that protects them and that someone out there cares.”

These passionate words come from a girl who has to be referred to as LC for legal reasons.  As a 13-year-old in Peru, LC was raped and fell pregnant. Filled with anger and shame, she jumped from a rooftop and seriously injured her spine.

“They took me to surgery”, she says. “Then it all changed because they learned I was pregnant.”

To save her legs LC needed an abortion. Although Peru’s abortion laws are restrictive, abortions are allowed if continuing the pregnancy would endanger a woman’s health. The petition filed for therapeutic abortion by LC’s family should have been accepted, however doctors refused to carry out the procedure. When LC miscarried it was too late for surgery; she’s now a quadriplegic.

LC’s case highlights many issues concerning abortion access. Not only was she discriminated against, she lives in a country with restrictive abortion laws. If she hadn’t damaged her spine she may have sought an illegal abortion and risked becoming one of the 47,000 women who die from these unsafe procedures each year or one of five million hospitalised annually because of abortion complications. Introducing progressive pro-choice laws are vital to reduce these figures. However, for legislative changes to be effective other issues surrounding access to abortion and attitudes towards women who seek them must be addressed.

According to Michael Tirrell, Communications Manager for Marie Stopes International, changing law is definitely a first step.

“Women can have access to safe, legal abortion services but because of reasons including stigma, poverty, or lack of knowledge aren’t able to access the services available to them,” he says.

A doctor commenting on LC’s case at the time claimed medical staff refused to operate because of the fear of stigma from offering abortion services. This case isn’t unique. In 2010 a study carried out by the World Health Organisation in South Africa, where abortion has been legal since 1996, had similar findings. Interviews with 34 healthcare professionals involved in abortion provision found various moral, religious and personal choices meant some interviewees felt unable to provide abortion services. Some suggested those who did frequently felt stigmatised.

“They make it difficult for you,” one public sector nurse said. “They spread the word in the community and isolate you. You often find midwives not providing abortions because they fear the victimisation.”

Examples of individuals denying women’s right to abortion services can be found elsewhere. In Colombia’s judiciary system, accountability for failures to implement a legal mandate that allows abortion in cases of rape, foetal deformity, or when the women’s health is in danger has been difficult.

“The Inspector General, who is charged with ensuring government officials fulfil their mandates, is against the court ruling and will not pursue cases where officials have refused women service to which they are entitled,” says Amanda Klasing, Researcher at Human Rights Watch.

“Very few women have been able to use the legal protections provided by the court.”

International pressure can help ensure rights are recognised. In LC’s case, the UN declared in November 2011 that Peru was to be held accountable, stating for the first time that denial of access to legal abortion services was discrimination and demanding that Peru change its abortions laws to protect women’s health and rights. Peru is now under close scrutiny from human rights and health organisations to ensure it fulfils these expectations.

As well as campaigning for better access to abortion services, many organisations try to reduce the number of unsafe abortions by improving access to contraception, which could prevent 94,000 maternal deaths if every woman who wanted it had it. But like abortion, women can be stigmatised for using contraception.

“Abortion can be a contentious issue, but family planning can be too.” says Tirrell.

“In some countries religious leaders or community leaders might be very opposed to expanding family planning provision. Reducing religious opposition to contraception, rather than opposition to abortion is a real priority for us.”

However, unwanted pregnancies are inevitable. Even if every woman had access to contraception, abortion services would still be needed. For International Planned Parenthood Federation (IPPF), part of providing these services is helping to combat the sense of shame and guilt felt by some women who have an abortion.

“Reassuring her that she has the right to make that decision and that we trust her to know what’s best for her is an important part of our service,” says Programme Officer in IPPF’s Abortion Team Upeka de Silva.

De Silva believes that local communities don’t often need a huge amount of convincing about the importance of women accessing safe abortion services because they see the consequences of not doing so, something which also applies to IPPF healthcare workers.

“[IPPF healthcare workers] are fully aware of the realities the women in their communities face when it comes to sexual relationships and the lack of decision making powers they have over their bodies,” de Silva says.

She suggests that efforts to tackle the anti-choice community are more often needed in capital cities.

“It’s usually the policy makers that need convincing. We can’t change the opinions of many [anti-choice supporters] so it is really about correcting public perception and through that, influencing decision makers.”

But de Silva reminds us that even if breakthroughs are made, successes are never secure.

“Having liberal laws does not mean the elimination of anti-choice opinion,” she says.

“The attacks on BPAS [British Pregnancy Advisory Service, whose website was hacked by anti-abortion activists] recently is an example of it happening in the UK and in the US, liberal legislation is constantly under attack. Situations in countries change all the time and while they move forward they can also move backwards and that’s why the pro-choice community can never rest – sad as it is.”

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