Professor Jaya Dantas and Dr Claire Rogers
Co- Convenors, PHAA International Health Special Interest Group
On the 24 June 2022, the Supreme Court of the United States stripped women, and girls of existing legal protections necessary to determine the course of their lives. Legal protections for abortion access and abortion rights have been established under international law as a matter of ensuring women’s ability to enjoy their legally protected human rights to life, health, equality and non-discrimination, and to ensure their freedom from gender-based violence.[1] UN Experts noted that access to legal abortion is essential health care and pivotal to women’s enjoyment of a full spectrum of their human rights and must be supported by equitable access to dignified care, trained healthcare workers and accurate information.[2]
Since 1979, global consensus asserts that all individuals and couples have the basic human right to choose whether to have children, and to decide on their number and spacing.[3] [4] [5] Globally, 29% of all pregnancies (both intended and unintended) end in abortion, equating to an estimated 73 million abortions per year.[6] Provision of affordable, accessible and effective contraception combined with practice, programming and policy to reduce sexual and gender-based violence is critical to reducing unintended pregnancy globally. The legal status of abortion does not determine an individual’s need for an abortion, but it does significantly increase their access and choice to safe abortion and is one of the key determinants for optimal reproductive health outcomes.7 Globally, the World Health Organization (2022) estimates between 4.7% and 13.2% of all maternal deaths annually are attributed to unsafe abortions. Unsafe abortion is a leading, but preventable, cause of maternal mortalities and morbidities around the world.
When healthcare systems fail to provide accessible and appropriate sexual and reproductive health care, including the provision of safe abortion services, the bodily autonomy, dignity, and well-being of individuals are eroded.6 Individual autonomy and choice are the central core of sexual and reproductive health and rights, however, the fulfilment of these fundamental rights takes place within a broader sociocultural, political, legal, economic and healthcare context.[7]
Laws making abortion legal play a fundamental role in access to safe abortion services, but must work in conjunction with permissive sociocultural attitudes and within supportive political environments.[8] In recent years, countries with liberal laws, such as the United States, Turkey and Poland, have increasingly added restrictions that aim to inhibit access to legal abortion.[9]
Countries where access to abortion is decriminalized and legal and contraception is widely available have the lowest rates of maternal mortality. According to the World Health Organization, abortion is a common procedure with 6 out of 10 unintended pregnancies ending in induced abortion globally. An estimated 45% of these abortions are unsafe. Restrictive laws increase the number of women and girls seeking unsafe abortions. They lead to the abuse of women in need of post abortion care and their incarceration. The stigma also affects healthcare workers who deliver the service and face the threat of violence. In countries with legal restrictions or pervasive barriers, safe termination of pregnancy becomes a privilege of the rich, while women with limited resources resort to unsafe providers and practices as they have no choice. This court ruling enables structural discrimination, where socio-economically disadvantaged women of color notably Black, Indigenous women, migrant women, those living with disabilities and victims of sexual violence and sex trafficking, face barriers to reproductive health care services. [10]
Attempts to hinder or eliminate access to sexual and reproductive health services not only impact the mortality, morbidity, and suffering of vulnerable populations, but also have the potential to impact social justice and perpetuate inequalities, particularly for the most marginalised groups.[11]
The recent media around the overturning of Roe v. Wade has brought into focus the ongoing and divisive battle to provide safe, equitable, and accessible abortion services throughout Australia and in the world.
In 2021, South Australia became the final Australian jurisdiction to decriminalise abortion, however, the law is yet to be enacted. And while Western Australia has now enacted “buffer zones” (preventing the harassment of pregnant people outside safe abortion services), State criminal law continues to regulate medical doctors who provide abortions.[12] While Australia has seen increased sexual and reproductive health services for its people especially women, however, barriers to safe, accessible, affordable, and compassionate abortion are still a challenge for many who seek this essential healthcare.
The PHAA stands by the principle that access to sexual and reproductive health services (including safe abortion services) is a human right. We call for Australia and the international community to acknowledge and support the sexual and reproductive health and rights of all people.
Related post: Reproductive Freedom Needs Continual Defence (PHAA, 27 June)
[1] Joint web statement by UN Human rights experts on Supreme Court decision to strike down Roe v. Wade | OHCHR
[2] Joint web statement by UN Human rights experts on Supreme Court decision to strike down Roe v. Wade | OHCHR
[3] UNFPA. Programme of Action. 1994. https://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf
[4] UN General Assembly. Convention on the Rights of the Child. 1989. https://www.ohchr.org/sites/default/files/crc.pdf
[5] UN General Assembly. Convention on the Elimination of All Forms of Discrimination Against Women New York, 18 December 1979. 1979. https://treaties.un.org/doc/Treaties/1981/09/19810903%2005-18%20AM/Ch_IV_8p.pdf
[6] UNFPA. State of World Population 2022. 2022. https://www.un-ilibrary.org/content/books/9789210015004
[7] Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission. The Lancet. 2018;391(10140):2642-2692. doi:10.1016/s0140-6736(18)30293-9
[8] Berer M. Abortion Law and Policy Around the World: In Search of Decriminalization. Health and Human Rights Journal. 2017;19(1):13-27.
[9] Guttmacher Insitute. Unintended Pregnancy and Abortion Worldwide. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
[10] Joint web statement by UN Human rights experts on Supreme Court decision to strike down Roe v. Wade | OHCHR
[11] Kimport K, Weitz TA, Freedman L. The Stratified Legitimacy of Abortions. J Health Soc Behav. Dec 2016;57(4):503-516. doi:10.1177/002214651666997
[12] Millar E. Abortion is no longer a crime in Australia. So why is it still so hard to access? The Conversation. 5 May 2022. https://theconversation.com/abortion-is-no-longer-a-crime-in-australia-so-why-is-it-still-so-hard-to-access-182413
Image: Ian Hutchinson/Unsplash