Wednesday, November 14, 2012

Overview of Maternal Mortality, Unsafe Abortion and the Harm Reduction Model: the Legal Platform

(Our thanks to IntLawGrrls for the opportunity to contribute this introductory post)

Maternal mortality, including from unsafe abortion, is a preventable pandemic that disproportionately affects women from the Global South. It is an indicator of the disparity and inequality between men and women and acts as a marker of women’s place in society, including their access to social services, health services, nutrition, and economic opportunities. High rates of maternal mortality reflect historical discrimination against women and the inadequacy of measures applied to remedy this discrimination.
According to a World Health Organization report, in 2010 approximately 287,000 women died due to complications of pregnancy and child birth, including severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. Out of the 287,000, 162,000 deaths occurred in sub-Saharan Africa, and 8,800 in Latin America and the Caribbean, compared to 2,200 in Global North countries.
Generally, where abortion laws are least restrictive there is little or no evidence of unsafe abortion, while legal restrictions increase the percentage of unlawful and unsafe procedures.  In the Global North nearly all abortions, 92%, are safe, whereas in Global South countries, more than half, 55%, are unsafe.  Although abortions performed according to medical guidelines carry very low risk of complications, abortions that do not follow such standards pose undue risks to a woman’s health and may endanger her life.  For men, there is no single cause of death and disability of a magnitude comparable to maternal mortality and morbidity.
Against this background, the harm reduction model marks an important health policy development aimed at advancing the human rights of women and girls. First implemented in the maternal health context by Iniciativas Sanitarias with the collaboration of IPPF/WHR in Uruguay in 2001, it seeks to limit harm to women at risk from unsafe abortion through the provision of neutral and accurate information and counselling, as well as provide relevant reproductive information to ensure that the women in question can avoid unwanted pregnancies in the future.
In essence, the model provides women with unwanted pregnancies with a non-judgmental space within which to make a decision which is facilitated by the provision of all information relevant to the unwanted pregnancy in a non-directive manner.
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It aims to address the massive disparity between the number of women using contraception and the number of women who wish to use contraception; between the number of women who wish to end a pregnancy and the number of women who safely do end a pregnancy; between the number of woman ending a pregnancy who suffer and/or die and the number of women who are forced to resort to dangerous or unsafe methods when terminating a pregnancy.
The harm reduction strategy posits that even in restrictive legal environments, abortion as a procedure has a “before” and an “after”. During these time periods intervention by healthcare providers, in the form of the provision of information, is both appropriate and legal. The model recommends that women considering an abortion have at least one consultation before and another after the termination, and is based on the notion that health professionals not only can, but have the professional and ethical duty to act in order to reduce (and in some cases eliminate) the risks and harm associated with unsafe abortion by offering women information and counselling on their options.
The model aims to replace the use of dangerous means to induce abortion with scientifically based information including information on the risks associated with different means to induce abortion, with a focus on the safe use of misoprostol, which is listed as an essential medicine by the WHO in the context of post-partum haemorrhage and treatment for incomplete abortion.
The model is grounded in, based upon, and vindicates the human rights of women and girls, such as the right to information, the right to health and life, the principle of autonomy, the rights of privacy, confidentiality and integrity and the right to benefit from scientific progress, among others.
In the words of its founders,
'it reduces the number of induced abortions through neutral information and counselling, prevents the risk of unnecessary termination procedures, and identifies medical problems that require attention, as well as cases where abortion is within the local laws. Even more important, the model reduces suffering and complications to women and the cost of treatment to the public health service.'
Since the implementation of the model in Uruguay not a single death from abortion has occurred, a development the implementers cautiously present as suggestive rather than conclusive.
Failure by states to reduce maternal mortality and morbidity rates is a breach of national and international legal obligations. International treaty monitoring bodies, international, and national courts have all found that states can be held accountable for their failure to address high maternal mortality rates.  Moreover, each has placed particular emphasis on the fact that poorer women are more likely to die in childbirth.
Within this context, our new report, Maternal Mortality, Unsafe Abortion and the Harm Reduction Model: the Legal Platform provides an overview of the legal responsibilities of states for failures to reduce high mortality and morbidity rates.  The report thereafter examines in detail the international human rights law obligations that support implementation of the model in the area of sexual and reproductive rights.
The effective implementation of sexual and reproductive health rights requires the interaction of medical and legal professionals. The publication of Maternal Mortality, Unsafe Abortion and the Harm Reduction Model: the Legal Platform provides a step towards the integration of these spheres in the protection of women’s rights. It is part of a series of publications by Women’s Link and IPPF/WHR that offers legal support to health care providers implementing the harm reduction model in order to prevent unnecessary deaths from unsafe abortion.

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