for International Women’s Day 8 March 2021
In collaboration with Groupe Tawhida Ben Cheikh, Tunisia
by Shaima Aly – Network FP
Why women should have access to safe abortion in the MENA region:
reality and recommendations
Background
The message of this year’s International Women’s Day is “Choose to Challenge”. Therefore, we in the network, Women’s Rights and Access to Safe Abortion in the North Africa and Middle East (RAWSA MENA), which brings together feminist and human rights organisations and activists for regional advocacy in favour of the right to abortion, chose to challenge and change the social norms related to sexual reproductive health and rights (SRHR). On this important day we call for access to equitable health services for women, including safe abortion services for those who need it.
It is women’s right to control their own bodies and decide on their family size. The right to say if and when they will have children. Since the International Conference on Population and Development (ICPD) in Cairo in 1994, [1] sexual and reproductive health and rights have been recognised as key parts of the international development agenda. They also form part of two Sustainable Development Goals: No.3 (on good health and well-being) and No.5 (on gender equality and empowerment). Although the ICPD final report did not recognize abortion as a woman’s right, it emphasised that in the countries where it is legal, women should have access to safe abortion.
In the MENA region, only the Maputo Protocol (Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, 2003) calls for safe abortion to be provided in specific circumstances. It says:
“States Parties shall take all appropriate measures to … protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus.” (Article 14.2.c)
Only a few North African countries have signed or ratified the Maputo Protocol, and those
few have done so only very recently.…[2] Yet access to legal, safe and comprehensive abortion care, including post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health.
MENA regional context
Three out of ten of all pregnancies end in induced abortion. Nearly half of all abortions are unsafe, and almost all of these unsafe abortions take place in developing countries., including MENA region. Mortality from unsafe abortion… disproportionately affects women in Africa… led by MENA region countries. Even so, UNICEF reports that from 1990 to 2015, the maternal mortality ratio (MMR) declined by 50% in the MENA region (from 220 to 110 maternal deaths per 100,000 live births), and under-5 mortality rates dropped 59% (from 71 to 29 deaths per 1,000 live births). Between 4.7% and 13.2% of all maternal deaths could be attributed to unsafe abortion. [3]
The impact of illegal abortion on women’s health in the Middle East and North Africa is understudied; reliable data are limited or non-existent because where abortion is illegal, data are not collected. The Occupied Palestinian Territories are often absent from official statistics, as they are not formally recognised as a State….
Wars and displacement in the MENA region contribute to high levels of maternal deaths (including unsafe abortions). The Fragile States Index, produced by the Fund for Peace, currently places five MENA countries (Afghanistan, Iraq, Sudan, Syria, and Yemen) on “very high alert” or “high alert”.
Most abortion laws in the region are punitive and were promulgated during the colonial period, when French and British regimes supported patriarchal policies to increase the population. As colonial laws criminalising abortion became entrenched in society, legal and medical services for women needing abortions have remained restricted.
Recommendations
– Regardless of profound values and beliefs in MENA region related to sexual relations and
abortion, it is a fact that many women are sexually active, whether married or not, and that both pregnancy and abortion are part of women’s experiences. The prevention of unwanted pregnancy and the provision of safe abortions are equally important for meeting the reproductive health needs of women in the various stages of their reproductive life and achieve all indicators of SDG3 and SDG5.
– A general recommendation for addressing women’s need for safe abortion in the MENA region is to
acknowledge that not addressing these needs has a negative impact on the health and well-being of women and their families, economic productivity and public budgets. Donors and other policy makers should encourage holistic interventions that address both access to contraception and safe abortion as part of an integrated reproductive health service delivery, which requires skilled, equipped and incentivised public and private health care providers and well-functioning systems. Such efforts to improve women’s reproductive health cannot succeed in the long term without addressing underlying causes as well, such as gender inequality and social vulnerability.
– Expand scientific research to expand safe abortion options, such as:
• Expand on methods that can be used both as contraception and for medical abortion, and
• Provide early medical abortion methods that can be obtained from pharmacies and other
providers for use at home.
– Design programmes that are needs-driven, rights-based, community-based, youth-friendly, and include both males and females.
– Apply the core principles of harm reduction:
• Neutrality: Health professionals and others should focus on people’s sexual and reproductive health needs in the MENA region in a non-judgmental way.
• Humanism: Every woman, irrespective of age, religion, sexual orientation, race, socio-economic status, disability or HIV status, should be treated with dignity and respect regardless of her choices.
• Pragmatism: Accepting that women in the MENA region, young and old, will seek access to contraception or abortion regardless of laws, regulations or culture because women’s need to control their fertility is part of their lives.
Notes
1. Every individual has the right to decide freely and responsibly – without discrimination, 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 (ICPD 1994).
2. In 2015, Beji Essebsi, then president of Tunisia, signed the protocol, but Tunisia did not ratify it until 2018, and laws have yet to be harmonized according to its principles. Sudan has signed but not ratified it. Algeria officially ratified the protocol in 2016, but its application is problematic, as abortion in the cases indicated above is not considered a human right under the country’s laws. Mauritania ratified the protocol in 2005, but it has not changed its laws. Abortion in Mauritania is still criminalised under Article 293 of the Penal Code. Egypt, Morocco, and Libya have neither signed nor ratified the protocol.
3. https://www.unicef.org/mena/health#:~:text=The%20maternal%20mortality%20ratio%20(MMR,deaths%20per%201%2C000%20live%20births).
FULL STATEMENT: https://www.facebook.com/rawsanetwork/posts/229925165481336?comment_id=229933992147120¬if_id=1615236808069290¬if_t=feed_comment&ref=notif