Unwanted pregnancies are a fact of life. Globally, nearly a fourth of all pregnancies are unplanned and 22 percent of pregnancies end in abortion. Women experience unwanted pregnancies because they have forced sex, (worldwide, one in three women are survivors of sexual violence), they don’t have access to contraceptives, or they simply didn’t plan on becoming pregnant.
Women who have unwanted pregnancies should be respected and their rights to choice upheld. However, in many countries, government policies, and societal practices do not uphold women’s right not to continue a pregnancy and women with unwanted pregnancies are forced into motherhood. Certainly this is evident in the United States; just before the new year, the governor of Virginia quietly signed legislation designed to close abortion clinics in the state. These laws are punitive, restricting women’s reproductive autonomy and freedom and creating categories of who can and can’t obtain abortions.
Fortunately for women, pills have changed the landscape of abortion. Abortion with pills, also known as medical abortion (MA), provides a safe, low-cost and easy to use method to terminate pregnancies. In addition to being safe and effective, medical abortion has changed the dynamics of who can provide abortions, where women get them, and who has control over the process. Evidence shows that those closest to women—community health workers and midwives—and women themselves can be trained to use abortion pills to safely terminate a pregnancy, thus giving women back the control of their own bodies. In fact, it was women in Brazil who first discovered the potential of misoprostol (cytotec) to safely end an unwanted pregnancy and who shared this knowledge through their social networks.
In order for women to benefit from the potential of medical abortion, however, they must be active participants in decisions related to where drugs are distributed and for what cost, what information is shared and by whom, and what social and medical support is needed.
Sex. Abortion. Parenthood. Power.
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Last month, Ipas hosted a meeting—“In Women’s Hands: Increasing Access to Medical Abortion Drugs and Information through Pharmacies and Drug Sellers”—in Nairobi, Kenya, that brought together 66 participants from 11 countries to discuss these important issues. Participants included a Kenyan hotline program manager, president of the Ugandan Midwives Association, several pharmacy managers from South Africa, and a Nepali senior public health officer in the Ministry of Health and Population, to name a few. The broad swath of countries and professionals represented illustrates commitment to a movement—to give women control of their reproductive lives, particularly through abortion with pills. In different countries, women, advocates and providers have developed innovative strategies to meet this goal.
In Tanzania, the Women’s Promotion Centre founded its own small pharmacy in a rural community as an alternative model for supporting women’s access to safe motherhood and abortion. This effort was born out of the “fire of anger about unnecessary deaths and suffering of women and… passion to save mothers’ lives in Kigoma,” said Martha Jerome of the Centre. Because no pharmacies were selling the lifesaving drug misoprostol, they founded a pharmacy to provide the drug themselves. They trained staff to provide counseling and support and they formed an alliance with like-minded doctors to help women with any complications. They also supply contraceptives as well as other medicines. The competition that resulted from their lower prices has driven down the cost from other private drug sellers, making these medicines more affordable for women who need them.
In Kenya, the Aunty Jane Hotline recently launched with the catchy motto “I’d like to phone a friend.” It provides safe, reliable, and confidential information on medical abortion in a country where restrictions have only recently been eased and where many women are unaware of their rights. Because mifepristone (a medication often used in conjunction with misoprostol) has only recently been introduced in Kenya, the hotline will provide timely information on the latest and safest options for termination of pregnancy and where women can go for help.
And in Mexico, where abortion is legal only in Mexico City but restricted throughout the rest of the country, advocates are working to increase women’s access to medical abortion. Strategies include a creative interactive website aimed at youth called www.notebaja.org (which was covered by Rewire last month), a gestational wheel for calculating length of pregnancy, and eligibility for abortion with pills, informational materials for women on how to use MA drugs, including a symptom diary for keeping track of the process, a support network of allied doctors to which women can safely be referred, and training of community “accompaniers” who will escort women through using misoprostol.
It’s time for all of us to join this movement. Women must be able to plan their futures—they must be in control of their reproductive lives. We know unintended pregnancies will continue. So let’s give women safe options. Let’s put access to safe medical abortion in their hands.
For more information on the meeting in Nairobi, please contact Alyson Hyman at [email protected].