Abortion, reproductive rights and maternal mortality.

Abstract

Women prefer to prevent unwanted pregnancies. Women do not prefer abortion. Unsafe abortion kills and contributes to 40% of maternal mortality worldwide or an estimated 200,000 deaths/year. More than 50% of abortions are performed by unskilled persons. Legal abortion i 11 times safer than childbirth in the USA. About 7 out of 10 women would have an unwanted pregnancy, even if fertility were reduced to 2 births/woman. There are costs beyond death, pain, and suffering of the women themselves; costs are incurred by families and communities and health services. The costs of after care exceed the cost of performing an abortion. Women are frequently denied autonomy to prevent pregnancy. When contraception is denied, the only possible option for women to take control of their lives and destiny is abortion. Male-dominated cultures prescribe the role of woman as procreation and motherhood, without contraception or abortion options. The Roman Catholic encyclical "Veritatis Splendor" espouses such a belief. Women in fact share a multiplicity of roles. Socially sanctioned norms have never been able to control sexual relations, and development initiatives must address functional behavior, rather than idealized behavior. For example, Safe Motherhood programs integrate family planning in educational and health care services, but the emphasis is on contraception among high risk women, and unsafe abortion is ignored. Abortion has not only been viewed as an option for contraceptive failure, but as a means of fertility control. Communist bloc countries frequently provided no other option, except abortion. Poverty and social status were considered tied to access to contraceptive advice and appropriate, safe technology. Poor women may seek unsafe abortion as an inexpensive option; safe abortion even in illegal circumstances can be purchased for those able to afford it. Although rape and incest are socially unacceptable, many countries will not provide abortion even in these circumstances. State funding of abortion may have limits for provision of services only to those in severe mental or physical conditions. Son preference has contributed to the abuse of abortion. The abortion issue should be viewed as an issue of human rights and women's empowerment, and unsafe abortion must be addressed as part of health policy.