Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations

Main Article Content

N Matshalanga
M Mehlo

Abstract

Background. Abortion is the termination of an already established pregnancy. The abortion may be induced, voluntarily performed or
spontaneous, but when it is done by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, it is considered unsafe. The Southern African Development Community (SADC) has a robust policy framework for combating unsafe abortion.
Objectives. To examine the relationship between abortion laws and access to safe abortion services in the SADC region as an important and necessary yardstick for measuring the progress of a nation in securing reproductive and sexual health. To analyse the relationship between laws governing abortion, abortion and post-abortion national guidance, and access to safe abortion services by adolescent girls and young women.
Methods. A desk review of all legal, policy and national guidelines for all 16 SADC member states was done. Secondary data were collected, and the knowledge, attitudes and practices reflected on abortion surveys were examined in 15 out of 16 of the member states in both rural and urban settings. Sixty-three focus group discussions were held across 15 out of 16 countries, and 127 key informant interviews were held with non-governmental organisations, government ministries and relevant departments in the 15 countries.
Results. Countries with restrictive abortion laws are more likely to have a relatively high proportion of unsafe abortions. The results
indicated a proportion of unsafe abortions ranging from 43% to 79% for those countries where the legal framework does not lend itself
to ease of access. Liberal abortion laws and guidelines do not necessarily mean a reduced incidence of unsafe abortions, especially for
adolescents, girls and young women. Multiple barriers still exist in practice.
Conclusion. Limits and bounds of the law as a tool to enhance safe abortion exist. The importance of alignment of laws, policies and
practices is noted, recognising that all may influence and affect access to safe abortion, and in turn, sexual reproductive health rights for women and girls.

Article Details

How to Cite
Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations. (2022). Southern African Journal of Public Health, 5(3), 68-76. https://doi.org/10.7196/SAJPH.2022.v5.i3.133
Section
Original Articles

How to Cite

Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations. (2022). Southern African Journal of Public Health, 5(3), 68-76. https://doi.org/10.7196/SAJPH.2022.v5.i3.133

References

HoffmanBL,SchorgeJO,BradshawKD,HalvorsonLM,SchafferJI,CortonMM(editors).Williams Gynecology, 3rd ed. New York: McGraw Hill, 2016 . https://obgyn.mhmedical.com/content. aspx?bookid=1758&sectionid=118167822 (accessed 3 August 2020).

UnitedNations.2018ReportoftheInternationalConferenceonPopulationandDevelopment. A/94/10/18. Programme of Action. New York: UN, 2018. https://www.un.org/en/development/ desa/population/events/pdf/expert/27/SupportingDocuments/A_CONF.171_13_Rev.1.pdf (accessed 10 August 2020).

UN Women. Action for Equality, Development and Peace. Beijing: UN, 1995. https://www. un.org/womenwatch/daw/beijing/platform/health.htm (accessed 3 August 2020).

Glasier A, Gülmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: A matter of life and death. Lancet 2006;368(9547):1595-1607. https://doi.org/10.1016/ S0140-6736(06)69478-6

Gender Links. Voice and Choice Barometer 2019. Johannesburg: Gender Links, 2019. https:// genderlinks.org.za/wp-content/uploads/2019/08/Chap4-Baro2019-ABORTfin.pdf (accessed 3 August 2020).

Southern Africa Development Community. Strategy for Sexual and Reproductive Health and Rights in the SADC Region 2019 - 2030. Gaborone: SADC, 2019. https://hivpreventioncoalition. unaids.org/wp-content/uploads/2020/07/SADC-SRHR-Strategy-2019-2030-for-public.pdf (accessed 3 August 2020).

Cook RJ, Dickens BM, Bliss LE. International developments in abortion law from 1988 to 1998. Am J Public Health 1999;89(1999):579-586. https://doi.org/10.2105/AJPH.89.4.579

Ngwena C. An appraisal of abortion laws in southern Africa from a reproductive health rights perspective. J Law Med Ethics 2004;32(4):708-717. https://doi.org/10.1111/j.1748-720x.2004. tb01976.x

Sai F. International commitment and guidance on unsafe abortion. AfrJ Reprod Health 2004;8(1):15-28. https://www.jstor.org/stable/3583301 (accessed 3 August 2020).

Tadele M, Habte D, Tsima BM, et al. High levels of post abortion complication in in a setting where abortion service is not legalised. PLoS ONE 2017;12(1):e0166287. https://doi. org/10.1371/journal.pone.0166287

Guttmacher Institute. Factsheet Abortion in Africa. Washington, DC: Guttmacher Institute, 2018. https://gutmacher.org/sites/default/files/factsheet/ib_aww-africa-pdf (accessed 6 August 2020).

PolisCB,MhangoC,PhilbinJ,ChimwazaW,ChipetaE,MsusaA.Incidenceofinducedabortion in Malawi, 2015. PLoS One 2017;12(4):e0173639. https://doi.org/10.1371/journal.pone.0173639

Ngwena C. An appraisal of abortion laws in southern Africa from a reproductive health rights perspective. J Law Med Ethics 2004;32(4):708-717. https://doi.org/10.1111/j.1748-720X.2004.

tb01976.x

Gebremedhin M, Semahegn A, Usmael T, et al. Unsafe abortion and associated factors among reproductive aged women in sub-Saharan Africa: A protocol for a systematic review and meta- analysis. Syst Rev 2018;7:130. https://doi.org/10.1186/s13643-018-0775-9

Ganatra B, Gerdts C, Rossier C, et al. Global, regional, and subregional classification of abortion by safety, 2010 - 14: Estimates from a Bayesian hierarchical model. Lancet 2017;390(10110):2372-2381, https://doi.org/10.1016/S0140-6736(17)31794-4

International Planned Parenthood Federation Africa Region 2020. Database on DHS from 1990 to 2016. IPPF Africa region. www.ippfar.org (accessed 3 August 2020).

Post-Abortion Care Family Planning Project, USAID, Engender Health. Madagascar PAC- FP Country Brief. Washington, DC: PAC-FP2020. https://www.postabortioncare.org/sites/ default/files/Madagascar-PAC-FP.pdf (accessed 3 August 2020).

Favier M, Greenberg JMS, Stevens M. Safe abortion in South Africa: “We have wonderful laws but we don’t have people to implement those laws”. Int J Gynecol Obstetr 2018;143(S4):S38-S44. https://doi.org/10.1002/ijgo.12676

Harries J. Abortion services in South Africa: Challenges and barriers to safe abortion care: Health care providers’ perspectives. PhD thesis. Cape Town: University of Cape Town, 2010. http://hdl.handle.net/11427/10623 (accessed 6 August 2020).