Securing the right to safe and legal abortion: perspectives from the Guttmacher-Lancet Commission

In March 2018, the Democratic Republic of Congo moved to enact the Maputo Protocol, under which signatory states agree to authorise legal access to abortion in a range of circumstances. Two months later, voters in Ireland delivered a decisive victory for reproductive rights, choosing overwhelmingly to repeal the country’s near-total ban on abortion. The following month, Argentina’s lower house of Congress voted in favour of a draft bill that would permit abortion up to 14 weeks; although the upper house narrowly rejected the legislation, this was the closest the country ever came to legalising abortion. While progress remains uneven, these developments speak to a shifting consensus on abortion rights around the world and unfold alongside mounting efforts of advocates to position safe and legal abortion as a human right. The seeds of this shift were planted in Cairo in 1994. Until the International Conference on Population and Development (ICPD) that year, there had not been a global agreement that created common language on sexual and reproductive health, or on the rights people have when it comes to making reproductive decisions. The Programme of Action that emerged from ICPD mapped out the linkages between social and economic growth, sustainable development, and individual and collective wellbeing. It also identified key components of sexual and reproductive health care, which included the provision of safe abortion services in settings where such care is not against the law. Since 1994, more than 30 countries, many in the developing world, have amended their laws to expand access to safe and legal abortion. Nonetheless, abortion is often viewed as a separate domain entirely, rather than as a core component of sexual and reproductive health care. This lack of integration makes it much easier to neglect, and in some cases exclude, abortion care in both programming and policy-making. In recognition of the value of taking a more holistic approach to sexual and reproductive health and rights, the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights convened in 2016. Composed of 16 experts with multidisciplinary experience from Africa, Asia, Europe, the Middle East, and North and South America, the Commission set out to gather the most current evidence on sexual and reproductive health and rights at the global level, with the aim of driving transformational change, through an evidence-based agenda, focused on policy and political action. Its resulting report, released inMay 2018, reveals enormous gaps in sexual and reproductive health and rights worldwide, and quantifies the toll those gaps take on individuals, countries and regions as a whole. The Commission’s report presents a new, comprehensive definition of sexual and reproductive health and rights, which integrates the full range of people’s sexual and reproductive health needs. Drawing on international and regional agreements of the past 25 years, this new definition highlights the fact that achievement COMMENTARY