The WHO (World Health Organisation) defines reproductive health as: A state of physical, mental, and social well-being in all matters relating to the reproductive system. It addresses the reproductive processes, functions and system at all stages of life and implies that people are able to have a satisfying and safe sex life, and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so.
It also recognises the human right of a woman to decide freely and responsibly without coercion and violence the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. This is generally considered to come under Article 8 of the European Convention on Human Rights and Article 12 of the Universal Declaration of Human Rights. Many would consider, including the WHO, that access to safe abortion is vital to uphold this human right.
This right was defined at the 1994 International Conference on Population and Development (ICPD). The ICPD was a meeting coordinated by the United Nations (UN) to set out a Programme of Action to empower women and girls by addressing issues such as immigration, family planning and the education of women across the globe.
"As of 2020, there are still 27 countries where abortion is illegal under any circumstance."
Despite being a landmark conference at the time, representing a positive outlook on protecting and furthering the rights of women and girls, the meeting was controversial, being accused by many groups as promoting “abortion as a reproductive right”, despite making no reference to abortion in its definition of Reproductive Rights.
The Programme of Action had on its list of actions, among other things, eliminating all practices that discriminate against women; assisting women to establish and realize their rights, including those that relate to reproductive and sexual health and adopting appropriate measures to improve women’s ability to earn income beyond traditional. We can probably all agree that this has not been achieved and many would argue that having the ability to choose if, when, and how often to reproduce would be one of the surest ways to achieve these goals.
Last year the Nairobi Summit on ICPD25 marked 25 years since the Programme of Action was set out. It reviewed the progress made since the conference took place and promoted the renewed global commitment to the ICPD’s agenda, in order to achieve the Sustainable Development Goals by 2030. The commitments made centred around eradicating unmet need for family planning information and services, preventable maternal deaths and sexual and gender-based violence and harmful practices against women and girls.
Abortion around the world
Abortion is, for many people, an impossible thing to reconcile morally. For others there is an appreciable grey area. This is reflected in the broad range of laws governing access to legal, safe abortions around the world. As of 2020, there are still 27 countries where abortion is illegal under any circumstance. Many more countries have legal abortion only under exceptional circumstances, such as pregnancy resulting from rape or incest, or to save the life of the pregnant person. In much of Europe, abortion is legal under all circumstances up until 10-14 weeks, with abortions carried out later in pregnancy on certain grounds, such as rape or foetal abnormality resulting in a serious congenital defect.
There is little data from countries with the strictest anti-abortion laws, as to annual incidents of pregnancy terminations, however there is much evidence that criminalising abortion does little to prevent it occurring, but rather forces people to obtain unsafe abortions.
"There are still places in Europe where abortion is highly restricted"
The WHO reports that in developed regions where access to contraception is highest, the abortion rate for people aged 15-44 years is around 2%. In developing regions, where contraceptive prevalence is lower, the abortion rate is higher, around 3%, with about half of these abortions being classed as ‘unsafe’. These numbers would suggest that increased access to contraception and by consequence, lower rates of unwanted pregnancies, does reduce, but by no means to zero, the number of people accessing abortions.
Changes to abortion laws are still happening all over the world. In September 2019 abortion was decriminalised in Northern Ireland. In May 2018, abortion was legalised in the Republic of Ireland after a referendum to repeal the 8th Amendment of the Constitution was won. There are still places in Europe where abortion is highly restricted, such as Gibraltar. A referendum to extend abortion rights was scheduled for 19th March 2020, but this has been postponed due to the Coronavirus pandemic.
In the US, there seems to be some movement away from extending and enhancing access to safe abortions, with the recent wave of several “heartbeat bills” in various states, which specifically mention that the detection of a foetal heartbeat would prohibit abortion. A heartbeat can be detected as early as 6 weeks, before many people could know that they were pregnant and before the embryo has actually become a foetus; in essence these bills would totally ban abortion if passed in these states.
Practically speaking, abortions that occur later than 14 weeks of gestation (after the first trimester) only account for about 10% of abortions, and less than 1% occur later than 21 weeks of pregnancy. It is also important to note that the circumstances leading to later abortions are wide-ranging and include previously unknown health issues, socioeconomic background, age and domestic situation. A study of late-term abortions in the US published in 2013 demonstrated that restriction of abortion to 20 weeks or earlier would disproportionately affect younger women and women with limited financial resources.
Abortion in the time of COVID-19
Medical abortions entail taking two medications, between 24 - 48 hours apart, to induce a miscarriage. In England, Scotland and Wales, the law requires that the first of these medications must be taken at an “approved place”, usually an abortion clinic, with the second taken at home. Since Boris Johnson announced the lockdown on 23rd March, temporary legislation has been introduced which permits the use of a telemedical abortion service in England: listing “home” as an approved place to take the first medication, permitting medical abortions under 10 weeks of pregnancy to occur at home.
In Northern Ireland, however, the situation is much more complicated. Despite abortion being decriminalised last year, access to services have yet to materialise and travel to the mainland is still required. In times where travel is being drastically restricted, these restrictions have had tragic consequences.
Rather than extending access to abortion in these unprecedented times, several states in the USA have moved towards further restricting or even totally suspending abortion services, defining abortion as non-essential or elective. Many states quote the conservation of PPE as justification for such action. It is important to note that medical abortion does not necessitate the use of PPE by a medical professional, particularly in the case of telemedical abortion services. The delay in access to termination such restrictions impose could increase the risks associated with abortion procedures or even prevent access due to passing gestational limits.
Wider implications of access to abortion
Internationally, between 2010 and 2014 there were an estimated 56 million induced abortions each year, around 25 million of which the WHO would classify as unsafe. Unsafe abortions occur mainly in developing countries, cause major complications that cost an estimated US$ 553 million annually and are the cause of between 4.7% and 13.2% of maternal deaths that occur each year.
The worst part of all of this is that almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications.
What access to safe abortions can also bring is increased understanding and insight into human development. Access to human embryos is tightly controlled and research on the earliest stages of human development is restricted, across much of the world, to two weeks post-fertilisation. The “14-day Rule” was initially described in 1979 and later endorsed by the Warnock Committee in 1984, dictating that all research performed on excess human embryos created as part of fertility treatments, must be destroyed at this time point. This means that only donated material from abortions are able to give researchers insight into later points of human development and the development of the placenta.
While certain parts of the world are moving away from permitting access to abortion, other countries are striving to achieve autonomy, improve healthcare and enhance the lives of their people by widening access to abortion in addition to education and contraception.
What does it say about humanity that, in 2020, countries are still seeking to eradicate their peoples’ bodily autonomy and ultimately impede the human right of the freedom to decide if, when, and how often to reproduce?