“[The abortion] was a huge family drama though. My mother was incredibly angry with me… I had already borrowed the 130,000 francs ($252) necessary to go back to the same clinic, when a friend suggested another option. She knew a guy that only cost 35,000 francs ($66).”
The story of Aminata’s desperate plight for a clandestine abortion begins to highlight how factors such as a woman’s disempowered and silenced position in a male-dominated society and her financial situation operate at the individual level as contributors to the global burden imposed by unsafe abortions.
Discriminatory gender norms can constrict women into a silenced and disempowered position, in which they may be refused the right to make decisions about their own body and concomitantly, prevented from accessing a safe means of abortion. Patriarchal values, entrenched in many cultures, give rise to family hierarchies whereby women may feel expected to obey the decisions made by their husbands and fathers. This strips the woman of her power of autonomy, instead making it socially appropriate for men to have the ultimate judgement over a woman’s body.
The use of contraception allows a woman to prevent unwanted pregnancies and therefore avoid the need for an abortion. In developing countries, two-thirds of unintended pregnancies occur as a product of women not using any form of birth control1. This soaring statistic is contributed to by a lack of services, as well as social stigma. It is estimated that 222 million women in the developing world do not use a modern form of contraception, despite wanting to avoid pregnancy.2 Improving utilisation of contraceptives will decrease the number of unintended pregnancies, and in turn decrease the number of abortions, both safe and unsafe. Moreover, in several African countries, there is a prevailing myth that the use of contraceptives may result in impotency,3 motivating husbands to restrict their wives’ access to birth control measures. Although some women are able to acquire discrete contraceptive methods without their husbands’ knowledge, such as injectable contraceptives, these are not widely available in large quantities, which is especially the case in remote areas.4
Financial barriers represent another significant obstacle to a woman obtaining a safe abortion. A woman may desire to avoid pregnancy for a number of reasons, for instance, out of a desire to space out births, or not wanting to bring up a child in an insecure economic situation. In cases where a woman feels that terminating the pregnancy is the only viable option, for example if she is not able to adequately support the rest of her family whilst providing for the child in a financially stable and nurturing environment5, turning to cheaper alternatives is an appealing solution, regardless if it is unreliable and unsafe.
In Mexico, where abortion is illegal apart from when the woman’s life is in danger or in cases of rape or incest, the cost of abortions conducted by reputable physicians can be up to US$1000. For a woman of lower socio-economic status who may not even earn this much in a year, this is simply unaffordable. Even unsafe practices, such as abortions induced by a catheter or a rubber tube, can still cost around US$300. In comparison, an infusion of traditional herbs is only US$1306. Presented with these facts, it becomes apparent why poorer women will so readily risk their health and even their lives for the cheaper alternative.
Given that the issues operating at the individual level which contribute to the burden of unsafe abortions relate to the social and economic disempowerment of the individual woman, it is understandable why the incidence of unsafe abortion is disproportionately high in developing countries. Thus, the solution to preventing unsafe abortion lies in addressing broader issues of social inequity, in order to make it possible for women to decide for themselves when they want to have children, and to be able to have the option of freely and safely terminating a pregnancy.
- Haddad LB, Nour NM. Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics and Gynecology. 2009 Spring;2(2):122-126. Available from: PMC
- Camp SL. It is time for a public health approach to abortion. London: BMJ Opinion; 2012 [cited 2017 Feb 10]. Available from: http://blogs.bmj.com/bmj/2012/10/11/sharon-l-camp-it-is-time-for-a-public-health-approach-to-abortion/
- International Planned Parenthood Fund. Myths and facts about… Male Condoms. London: International Planned Parenthood Federation; 2012 [cited 2017 10/2/2017]. Available from: http://www.ippf.org/blogs/myths-and-facts-about-male-condoms
- Gates M. Let’s put birth control back on the agenda . Berlin: TED Talks; 2012 [cited 2017 Feb 10]. Available from: https://www.ted.com/talks/melinda_gates_let_s_put_birth_control_back_on_the_agenda?language=en#t-10145
- Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 [Internet]. Geneva: World Health Organisation; 2008 [cited 2017 Feb 11]. Available from: http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/
- Warriner IK, Shah IH, eds., Preventing Unsafe Abortion and its Consequences: Priorities for Research and Action. New York: Guttmacher Institute; 2006.
- Cover image: https://mariestopes.org/where-we-work/zambia/
- Pregnant bellies [image]: http://westafricalifestyle.com/girls-rescued-from-boko-haram-are-pregnant-is-abortion-right/#