AFRO-NETS> Communique: March 2003 African consultation on unsafe abortion

[Merrill Wolf <WolfM@ipas.org>]

Communique: March 2003 African consultation on unsafe abortion
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Dear colleagues:

Ipas is pleased to share with you (attached and pasted into this mes-
sage) the communiqué issued by participants of the landmark "Action 
to Reduce Maternal Mortality in Africa" regional consultation on un-
safe abortion, which took place March 5 - 7, 2003, in Addis Ababa, 
Ethiopia. 

The consultation was groundbreaking in several senses. It was the 
first regional meeting to address specifically unsafe abortion and 
ways to expand women's access to abortion-related care, in accordance 
with international commitments. Another unique characteristic was 
that the gathering brought together numerous stakeholders who affect 
and are affected by policies related to provision of safe abortion 
care but who rarely have the opportunity to engage in dialogue. The 
multidisciplinary nature of the consultation proved especially valu-
able. Numerous participants commented that they hope it will mark the 
beginning of fruitful collaborations across sectors and fields toward 
the shared goal of saving women's lives from unsafe abortion. 

The contents of the communiqué are strong testament to their mutual 
commitments. Notable among those attending and contributing to the 
consultation were the Ministers of Health of Ghana and Namibia and 
Deputy Minister of Health from Mozambique; representatives of health 
and other ministries from Ethiopia, Kenya, Nigeria, South Africa and 
Zimbabwe; legislators from Nigeria and Uganda; and the heads of pro-
fessional organizations representing obstetrician-gynaecologists, 
medical women and lawyers in several African countries; and represen-
tatives of several regional and national health training, research 
and policy institutions. Also attending were representatives of 
UNFPA, the World Bank and the World Health Organization (WHO). Re-
flecting WHO's role developing norms and standards and assisting 
United Nations member states in strengthening the capacity of health 
systems, WHO representatives introduced its body of guidance for 
health systems on addressing unsafe abortion.

The Ipas Africa Alliance convened the consultation in collaboration 
with a number of other regional cosponsoring agencies, including the 
Amanitare African Partnership for Sexual and Reproductive Health and 
Rights of Women and Girls, the Centre for Gender and Development of 
the Economic Commission of Africa, the Commonwealth Regional Health 
Community Secretariat, the Ipas Africa Alliance for Women's Reproduc-
tive Health and Rights, the Regional Prevention of Maternal Mortality 
Network and the UNFPA Country Support Team for East and Central Af-
rica. Financial support was generously provided by The David and 
Lucile Packard Foundation, the Swedish International Development Co-
operation Agency (Sida) and the United Kingdom Department for Inter-
national Development (DFID).

Ipas will prepare a detailed report on recommendations from the con-
sultation in coming months. In the meantime, we hope you find this 
communiqué interesting and useful. Please feel free to share it with 
others. 

Sincerely, 

Merrill Wolf 
Communications Ipas 
Tel.: +1-919-960-5612
mailto:WolfM@ipas.org
http://www.ipas.org


--
Communique from the ?Action to Reduce Maternal Mortality in Africa? 
Regional Consultation on Unsafe Abortion 

March 5  7, 2003
Addis Ababa, Ethiopia


Background and Preamble

We, the 112 participants of ?Action to Reduce Maternal Mortality in 
Africa: A Regional Consultation on Unsafe Abortion,? which took place 
March 5  7, 2003, in Addis Ababa, Ethiopia, represent a cross sec-
tion of African Ministers of Health, parliamentarians, directors of 
health services, heads of reproductive-health units, heads of aca-
demic institutions, youth activists, national and regional women?s 
groups, national networks engaged in promoting women?s health, non-
governmental organisations, religious organisations, professional or-
ganisations such as obstetrician-gynaecologists and nurse-midwives, 
lawyers, sociologists and media practitioners.  

During the three-day consultation, we reviewed numerous dimensions of 
the public-health challenge of unsafe abortion, including the so-
ciocultural, legal and policy context in which it occurs. Recognising 
that abortion has always occurred and will continue to occur in all 
cultures, we focused on the need to make it safe in order to reduce 
related deaths and injuries of women. We examined laws, policies and 
international commitments influencing access to safe abortion in Af-
rica; health-care providers? and public and private health systems? 
roles in meeting women?s needs for safe abortion; and strategies for 
creating an enabling environment that supports women?s right to safe 
abortion and related services. 

Based on our own experiences and on presentations and discussions 
during the consultation, we note with alarm that maternal mortality 
rates remain unacceptably high and that unsafe abortion accounts for 
an average of 12 percent of maternal deaths on the African continent. 
At the national level, experts estimate that unsafe abortion contrib-
utes in the range of 10-50 percent of maternal deaths in African 
countries. Of the 68,000 deaths from complications of unsafe abortion 
worldwide, 30,000  or nearly half  are in sub-Saharan Africa. In 
addition to the shocking number of African women whose lives are lost 
each year, unsafe abortion causes thousands more women to suffer se-
rious illnesses and injuries and renders many infertile. These deaths 
and injuries are preventable, since safe and effective technologies 
for contraception, pregnancy termination and post-abortion care are 
available but underutilized. We also know that deaths and injuries 
from unsafe abortion disproportionately affect adolescents, poor and 
other marginalised groups of women, depriving Africa of a valuable 
human resource. 

We recognise that, worldwide, restrictive abortion laws and lack of 
safe abortion services are the major factors contributing to the dis-
proportionately high mortality of women from unsafe abortion. Most 
African countries operate under archaic laws related to abortion that 
were imposed by former colonial powers and have long since been 
changed in those countries. In most countries where abortion laws are 
liberalised, there are almost no deaths from unsafe abortions. We 
note that legislation in most African countries legally permits abor-
tion in limited circumstances  such as in cases of rape, incest or 
to save a woman?s life  but that the majority of women and health-
care providers remain uninformed of their legal rights and obliga-
tions. We further recognise that many of the root causes of unsafe 
abortion  including African women?s lack of access to comprehensive 
reproductive-health information and services to prevent unwanted 
pregnancy, and lack of decision-making power related to sex and re-
production  are the same as those underlying the HIV/AIDS pandemic. 

We note also that all African countries have signed the Programme of 
Action of the International Conference on Population and Development, 
the Platform for Action of the Fourth World Conference on Women and 
other international agreements, compliance with which requires ad-
dressing the public-health problem of unsafe abortion, including by 
making safe abortion available to the full extent of local law. 

We stress that unsafe abortion has significant economic implications, 
including enormous costs to African health systems associated with 
managing its complications. Until women can make their own reproduc-
tive choices safely, poverty alleviation and economic development 
cannot be achieved. Policies of Northern governments and interna-
tional financial institutions such as health-sector reform, debt re-
structuring and structural adjustment severely constrain health and 
social spending by African governments and require revisiting. 

Commitments and Recommendations
Thus, we the participants commit ourselves to: 

* Formulate specific strategies to educate and engage all stake-
  holders in advocacy to reduce the incidence and impact of unsafe 
  abortion;
* Work more effectively within existing legislation and health sys-
  tems to ensure that high-quality, comprehensive reproductive-health 
  care is universally available, with special attention to reaching and 
  responding to the needs of especially vulnerable populations. 

We the participants call on African governments to:

* Include specific and increased funding for reproductive health and 
  to address unsafe abortion in national and health-system budgets;
* Advocate for specific attention to reproductive health and unsafe 
  abortion in programs to achieve the Millennium Development Goals, no-
  tably with regard to objectives specified in Goal 5, ?Improve Mater-
  nal Health;?
* Initiate reviews of existing and in many cases outdated laws crimi-
  nalising abortion, in line with specific commitments under interna-
  tional agreements.

Additionally, we the participants call on multilateral and bilateral 
donor agencies, headquarters and regional country offices of interna-
tional technical support agencies, and the global community to:

* Direct more resources to preventing unsafe abortion and to making 
  safe legal abortion available to the full extent of the law; 
* Provide the necessary leadership in addressing issues of unsafe 
  abortion especially in the dissemination and implementation of tech-
  nical and policy guidance for safe abortion in Africa.  

Finally, we the participants vehemently oppose the Global Gag Rule 
that was reinstituted in January 2001 by U.S. President George W. 
Bush and which clearly impedes efforts to reduce unsafe abortion. We 
call on African governments and the global community to be account-
able to their citizens and other stakeholders by opposing it. 

In conclusion, participants in the ?Action to Reduce Maternal Mortal-
ity in Africa? consultation reaffirm our commitment to doing whatever 
is within our power at the national, regional and local levels to 
halt the needless deaths and injuries of African women and girls from 
unsafe abortion. We do this not only in the interest of the girls, 
women, families and communities affected by unsafe abortion today, 
but also for Africa?s future.

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