Young Women, Unwanted Pregnancy and Abortion: Are We Achieving Global Goals?

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Young Women, Unwanted Pregnancy and Abortion: Are We Achieving Global Goals?

Maria de Bruyn

Young women are the most vulnerable to maternal morbidity and mortality. A panel at the UN Commission on the Status of Women examines the reasons.

The Commission on the Status of Women is a body of the United Nations Economic and Social Council (ECOSOC), dedicated exclusively to gender equality and advancement of women. It is the principal global policy-making body on these issues and meets every year at United Nations Headquarters in New York to evaluate progress on gender equality, identify challenges, set global standards and formulate concrete policies to promote gender equality and advancement of women worldwide. The CSW is now in session in New York and this is one of a series of posts from side panels and open discussions being held concurrently with the formal proceedings.

The UN member states are devoting the 54th meeting of the Commission on the Status of Women (CSW)  to a review of the Beijing Platform for Action (BPFA), adopted in 1995 at the Fourth World Conference on Women. So on the first day of the CSW, taking place starting this week in New York City, the government of The Netherlands partnered with Ipas and International Planned Parenthood Federation (IPPF) to host a session on the unmet needs of young women in relation to preventing unwanted pregnancy and, when neceesary, accessing safe abortion services. The topic was of obvious interest as the 170-person room was filled to capacity.

The BPFA acknowledged that young women are even more vulnerable than older women to maternal morbidity and mortality. Arushi Singh of IPPF  pointed out that young women face a number of restrictions on their right to choose, even in decisions concerning the most fundamental aspects of their lives.

“What does the right to choose mean for the four out of five young women whose parents never consulted them on the timing of their marriage and the two out of three married young people who reported that they had met their spouse for the first time on their wedding day?” asked Singh.

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She pointed out that in 1995, the rate of unsafe abortion in India was 12 per 1000 women; in 2003, the rate was almost the same at 11 per 1000 women. Even in countries with more liberal laws, young women’s access to safe abortions remains curtailed. They lack awareness of the fact that abortion is legal and don’t know where to go for safe services. Often, they don’t recognize the early signs of pregnancy and when they do realize they’re having an unwanted pregnancy, they face negative attitudes from healthcare providers, especially if they are unmarried.

The situation can change. For example, young women in rural Nepal who were trained on sexual and reproductive health are now members of village youth forums that organize regular dialogues between young people and parents on sexual and reproductive health. In Bangladesh, a school headmaster persuaded the community to provide free board and lodging so that girls can remain in school, leading one girl to remark: “If I were married today, what would I lose? My independence, my vision, my dreams.” Singh commented that such progress should inspire us to continue our endeavors in protecting the right to choose and creating enabling environments that take us as close to free choice for young women as possible. The evolving capacities of adolescents mean that young women must be enabled to make their own decisions, including about marriage, pregnancy and abortion.

Marie Khudzani Banda, of the International Community of Women Living with HIV/AIDS (ICW) in Malawi, spoke about a project with grassroots women in which ICW facilitators organized community dialogues about contraception, unwanted pregnancy and abortion. Since pregnancy termination is only allowed to save a woman’s life, almost everyone believes abortion is totally illegal and that it cannot be done safely; the subject is also taboo and rarely discussed openly.

With support from important policy-makers, such as representatives of the Ministry of Health, the national Commission on Human Rights and the National Nurses Council, ICW members offered women in villages information and the chance to share their own and family members’ experiences with unwanted pregnancies and abortion care. Many women talked about unsafe procedures, one woman describing how a 14-year-old girl lost her uterus and subsequent chances of marriage, and another telling about her 15-year-old cousin who lost her life due to an unsafe abortion.

By the end of the dialogue series, the women were expressing opinions about changes needed, both at their own individual level and the wider community and societal levels. They acknowledged a need for parents to talk with young people, especially young women, about sexuality and reproductive health matters. They felt that community members should be sensitized and educated about emergency contraception, especially young girls and boys, and that more community dialogue and education sessions should be held on topics like safer sex, pregnancy, contraception and abortion, including sessions at schools.

And as one participant said:

“HIV-positive mothers who become pregnant are making a responsible choice for the children they already have if they end the new [unwanted] pregnancy early and in a safe way.”

The ICW members want to see more women receiving information and education about the differences between unsafe and safe abortion care.  Participants said that safe abortion should be legalized in Malawi so that girls, their mothers and other women can freely request this service. They also would like hospitals to ensure that they have a client-friendly atmosphere so that girls and women feel comfortable asking for reproductive health services. As a result of the project, ICW has produced a booklet with women’s testimonies and policy recommendations and they are starting to collaborate with other civil society groups on advocacy around women’s sexual and reproductive health and rights.

Alexis Hernández, of Ipas Mexico and the MenEngage Alliance, noted that it is women who experience pregnancy and abortion in their bodies. They face the health consequences and most of the emotional, material and other burdens of an unwanted pregnancy. It is mostly women who receive legal punishment where abortion is illegal and it is women who are denied the right to decide due to restrictive abortion laws. He added that it is women who die and suffer the consequences of unsafe abortions and  young and poor women who are most at risk.

As a nurse and youth activist, Hernández commented:

“We men, both young and adult, should take responsibility for our own sexuality and reproduction. Why do we leave most responsibility to women? What would we men do if we became pregnant? Women do not make themselves pregnant.”

He said that some men would like to protect their partners and wish they could have the abortion instead of the woman. But they can’t and then feel fear, worry, stress and guilt. However, men don’t often have this sympathy with women before it gets to the point of pregnancy termination. So organizations that work with men in Latin America are using experiential exercises to build empathy in men about reproduction. They use a story called “It is the last, my dear, the last”. The story tells of a man who originally refuses to use contraception, but who is transformed when he witnesses his partner giving birth.

Hernández said that health-care providers in Mexico have seen the emotional impact on men when they witness an event like insertion of an IUD, childbirth, abortion or pregnancy. For example, when men are invited to cut the cord at delivery, they can feel excitement, shock, fear, nervousness, or sometimes even cry or faint. Health workers report that more men are interested in this kind of participation in reproductive health events and in caring for and raising children.

We must acknowledge that men are frequently involved in abortion-related decisions and care, said Hernández, and this can be positive or negative for the women involved. It is negative when men pressure women to have or not have an abortion. This pressure shows itself in different ways: intimidation, violence against women, abandonment, refusing financial aid or other support, or denial of paternity so that the woman thinks abortion is her only option.

We need to make men allies, he avowed, in order to increase women’s access to safe abortion. To involve young men, we must put aside some of our ideas about youth and keep an open mind because gender relations and sexual and reproductive health may be different for young people than what we assume. Generally, men are not welcome in abortion clinics. Providers think they are there to hold the woman’s coat, drive, or pay for the procedure. One study in the United States showed that 73 percent of men wanted to go with the woman to the clinic, but only 23 percent of the clinics allowed this.

Hernández remarked that the BPFA said that men are “necessary allies for change.” He said that members of the MenEngage Alliance know the importance of the women’s movement in creating possibilities for men to be more just and caring human beings. He ended his presentation by inviting adult men, young men, and boys to embrace healthy models of masculinity and non-violence and to take responsibility for working alongside women and girls to achieve gender justice:

“Now we men must unite to say: No more deaths and complications from unsafe abortions. No more abuse and denials in health services. No more women identified, stigmatized, and imprisoned for deciding to terminate a pregnancy.”

Ariana Childs Graham, of SIECUS, spoke to session participants about why young people should care about the work being done by conservatives opposed to choice in sexual and reproductive health. She noted that these groups work on many issues, including opposition to comprehensive sexuality education, opposition to young people’s access to contraception, preserving the “traditional family” (which means a heterosexual couple with children rather than allowing other forms of families), and opposition to rights for people of various sexual orientations in addition to condemning abortion.

She noted that conservatives often speak “on behalf of” constituencies, claiming that they represent all families, parents or faith-based groups. Progressive youth advocates need to indicate that they, too, speak on behalf of peers and on behalf of poor and marginalized young people who have specific needs. Young people can emphasize the complexity of decision-making involved in sexual and reproductive health issues, as well as the diversity of women’s experiences, which means that decisions cannot always be simple and the same for everyone.

Childs Graham pointed out that youth advocates should stay informed about the claims of conservative groups so that myths which stand in the way of sexual and reproductive rights can be debunked. For example, some groups say that having an abortion significantly increases a woman’s chances of developing breast cancer. The U.S. National Cancer Institute, however, convened a meeting of over 100 world experts who study pregnancy and breast cancer risks and they concluded that research shows that having an abortion or a miscarriage does not increase a woman’s subsequent risk of breast cancer.

Childs Graham concluded by urging young people who work for sexual and reproductive rights to learn about critical issues so that they can present evidence and factual information, to speak out about their experiences and those of family and friends, to adopt positive and pro-active strategies, and to assume leadership roles in educating key stakeholders, including parents, community and religious leaders, and policymakers.

During the discussion period, the young panelists addressed important questions raised by audience members. Childs Graham said that promoting comprehensive sexuality education means young people must have the opportunity to build skills in an ongoing and age-appropriate manner. Education cannot comprise only a three-hour session for 13 year olds, for example. Rather, education should begin at younger ages, always adjusted to the students’ cognitive levels, and then progress through adolescence until young adulthood. It is also critical to garner support from policy-makers to promote such a cumulative process by addressing concerns with evidence. For example, studies show that teaching younger adolescents about sexuality does not result in their engaging in sexual behavior at an earlier age.

When asked by a teen pregnancy program manager how one can identify the maturity of young people, Singh stated that it is not so difficult to gauge the evolving capacity of an adolescent: if she is able to approach a healthcare provider and request a service in clear terms, she has developed the capacity to understand and deal with the situation involved. Singh also said that healthcare providers must actively seek ways to help young women avoid unsafe abortions and protect their health and lives in any legal setting.

A Kenyan member of Parliament attending the session thanked the panelists for what she called their “brilliant presentations”, commenting that they had caused her to perform a “self-audit” about how she had educated her 24-year-old daughter and 22-year-old son. She had to acknowledge that it was mostly in terms of “the don’ts” rather than giving them the space to talk about their needs. She said that adults must consider how they can make today’s situation in sexual and reproductive health better than it was when they were young themselves and this can be partly accomplished by connecting with young people.

Wieke Vink, a member of the Youth Coalition who co-moderated the session, concluded that all the panelists were “pro-life”, but pro-life also for those who are already living. She said we must acknowledge the wide range of perspectives and opinions among young people on sexual and reproductive health issues and give youth have the opportunity to express them rather than restrict their freedom of expression and choice.

Carlien Scheele, head of The Netherlands’ CSW delegation this week and a representative of the Dutch Ministry of Education, Science and Culture, emphasized that the Dutch government will continue to support comprehensive sexuality education and sexual and reproductive health services for young people. Her words were echoed by the former Dutch Minister of Development Cooperation, Bert Koenders, who addressed the session participants in a short video message.