Africa has the highest
percentage of maternal deaths due to unsafe abortion in the world. In sub-Saharan Africa, an estimated 4.7 million abortions occur each year,
and of these, about 98 percent are performed either by persons lacking the
minimal skills, or in an environment lacking the minimal medical standards, or
both. According to data from the World Health Organisation (WHO), in 2003, unsafe
abortions accounted for 14 per cent of maternal deaths in Sub-Saharan Africa,
the equivalent of 120 deaths per 100,000 live births.

A new study by the Guttmacher Institute has actually managed to
quantify the direct costs of treating the complications that result from unsafe
abortions on health systems in the global south. Based on two different methods
of calculation, —a World Health Organization model and a comparison of 20
empirical studies, 9 from sub-Saharan Africa—the authors calculate that on
average, treating post-abortion complications costs an estimated USD83 per
patient in Africa (based on 2006 reported costs). When overhead and capital
costs are included, these averages jump to USD114 for Africa. Assuming women
continue to pay for their own abortions, if able to access safe, legal abortion
services, the reduction in costs to healthcare systems in all African nations
is undeniable.

These new estimates of the direct costs of treating
abortion complications lend incredible weight to raising the profile of access
to safe and legal abortion on the development agenda. We have seen the world
community come together to discuss development on many occasions. A working
committee drawn from a range of UN bodies, special agencies and specialists,
including the World Bank, the International Monetary Fund, UNICEF, the
Population Fund and the World Health Organization, put together the 18 specific
targets and 48 indicators that formed the Millennium Development Goals, based on the
Millennium Declaration of September 2000. Along with education and gender
equality, health is a major focus of the MDGs and yet reproductive health seems
to have received only cursory attention.

It was only in 2005 that a new target under MDG
5 (improved maternal health) was added: to ensure universal access to
reproductive health by 2015. Quantitative measures now include contraceptive
prevalence, adolescent pregnancies, antenatal care coverage and unmet need for
family planning. The issue of maternal mortality certainly draws global
attention. However, even when advocates highlight the correlation between
unsafe abortions and maternal mortality, some of the world’s most restrictive abortion
laws have remained in place.

So perhaps this new study is the impetus needed
to advance the abortion agenda. It is indeed frustrating to need to put figures
on the table. Ultimately, this is a woman’s life, health and rights we are
talking about and it is easy to ask why money should matter. But when we have
talked rights in the past, laws have not changed. The 2003 Protocol to the African Charter on Human and Peoples’ rights
on the Rights of Women in Africa, adopted by the African Union mandates
countries to protect the reproductive
rights of women by authorizing 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. In the context of women’s health programs and the high maternal
mortality rates resulting from unsafe abortions, the Africa Health Strategy 2007-2015 recommends “safe termination of pregnancy and
post-abortion services should be included as far as country’s law allow”. However, few African governments have implemented the Protocol’s recommendations.
As of January of this year, for a host of African countries, abortion
remains illegal in all circumstances or is permitted only to save a women’s
life, including in Angola, Benin, Côte d’Ivoire, Kenya, Lesotho,
Mali, Nigeria, Senegal, Somalia, Tanzania, Togo and Uganda. It is clear that
change requires a fundamental shift in knowledge, attitudes and incentives.

For example, a study conducted in Nigeria by the Women’s Health and Action Research Centre
in December 2008 involving interviews with 49 policy makers in 6
regions of the country on knowledge and perceptions of the causes of
abortion-related maternal mortality found that policymakers were guided by moral and religious
considerations rather than by current evidence-based considerations. Only four
participants recognized the fact that abortion will go on regardless of the
law. One-third of key informants were opposed to liberalizing the laws on
abortion in Nigeria, while only one-fifth supported liberalization on “medical
grounds” and to deal with unwanted pregnancies due to rape and incest. So will
money talk? Arguments about the costs of abortion-related mortality and
morbidity have been made several times over the past few decades. So will the
cost argument succeed this time around?

A significant proportion of aid is spent on
advancing healthcare systems in the global south. This study by the Guttmacher
Institute evidences unnecessary and avoidable costs, money that could be
diverted and invested elsewhere in the healthcare systems of many African
nations. If aid money is aimed at creating cost-effective, efficient and
sustainable health care systems, African nations and the global community cannot
ignore the high number of unsafe abortions that continue to occur on a daily
basis and the heedless money spent addressing complications. Let’s see whether
money can break down the moral, religious and non-evidenced based perceptions
that have thus far acted as barriers to change.