Introduction
Unsafe abortion is a worldwide phenomenon that has existed throughout recorded history, but only a few governments have instituted policy frameworks to address this problem which is seen as a significant cause of maternal mortality and morbidity at a global level (Puri et al., 2012).
However, despite the sustained absence of abortion in serious policy discussion in many countries, it continues to be a highly charged, contentious concern, elevating excessive passions among lay people, as well as politicians, church ministers, and health and rights campaigners (Shah and Ahman, 2009).
Unsafe abortion is characteristically stigmatized and potentially life-threatening both for women seeking the service and for those providing it, but this information is yet to filter through to the 19 million women who undertake unsafe abortions out of the 46 million who perform it annually (Warriner, 2006). Such statistics embolden our belief that abortion should be legalized to safeguard the health, reputation and status of women in need of abortion services.
There exists a multiplicity of reasons as to why governments across the world should consider legislating policy towards the legalization of abortion so that it is practiced in a healthy environment and by qualified health personnel. Some of these reasons are detailed in the ensuing sections.
Consequences of Criminalizing Abortion
Extant literature demonstrates that the act of criminalizing abortion has only led to unsafe abortion practices, which are increasingly becoming a significant cause of maternal morbidity and mortality (Puri et al., 2012). Perhaps this line of thought can be illuminated more by borrowing the World Health Organization’s definition of unsafe abortion “…as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both” (Banerjee & Clark, 2009 p. 8).
This definition demonstrates that criminalizing abortion has two obvious ramifications, namely (1) persons lacking necessary skills are entrusted to carry the procedure, and (2) abortion is carried out in unsafe environments. It therefore follows that women in countries that criminalize abortion often face premature deaths under the hands of unprofessional and inexperienced ‘doctors’, who conduct the procedures in an environment lacking the minimal medical standards to handle emergencies.
This should not be the case because a central objective of any country, either developed or developing, should be to empower and enable women and adolescent girls to enjoy their sexual and reproductive choices (Ely, 2007), hence the need to legalize abortion.
A second consequence of criminalizing abortion relates to the health and wellbeing of women who are in need of abortion services. Criminalizing abortion leads women to seek care from more convenient but illegal providers, including untrained people, traditional practitioners and pharmacists operating chemist shops, who employ unsafe technology with far-reaching consequences such as excessive bleeding, severe abdominal pain and sudden death (Banerjee & Clark, 2009).
The global burden of criminalizing abortion is often witnessed in women who end up losing their ability to conceive again or carry another pregnancy to term after undergoing the most horrific circumstances in the hands of unskilled providers. Legalizing abortion seems the only viable way that could encourage women to seek medical assistance from qualified personnel, hence reducing the risk of entirely preventable injuries, infections or even death from unsafe abortions.
Third, it is generally felt that criminalizing abortion has only led to a thriving back-street illegal trade, whereby inexperienced providers and death merchants continue to benefit economically at the expense of the health of victims.
A common objective of any government’s policy towards women would be to make abortion ‘safe, legal and rare’, but extant literature demonstrates that criminalizing abortion has only led to a thriving illegal backstreet trade spearheaded by people who are only keen on furthering their economic interests at the expense of unsuspecting women (Joffee, 2013).
These ‘providers’ employ cheap, obsolete medical technologies to induce abortion and are not answerable to any legal or regulatory authority should any problem arise, leaving the health and wellbeing of women in outmost disarray. This orientation, in my view, can be corrected by legalizing abortion services.
Criminalizing Abortion not the Panacea for Reducing Abortion Cases
To date, there is no evidence demonstrating that criminalizing abortion has been an effective strategy in reducing the number of abortion cases reported worldwide. On the contrary, there is evidence that most developed countries that have legislations legalizing abortion are reporting minimal abortion cases, while developing countries exercising strict anti-abortion laws are becoming increasingly overburdened with a large number of unsafe abortions.
Evidence has been adduced to the fact that “…Africa accounts for 25% of all illegal abortions performed worldwide and less than 1% of all legal abortions” (Baggaley et al., 2010 p. 1). It is ironical that despite the high figures of illegal abortions, many countries in Africa completely prohibit abortion and only allow it if the life of the mother is at risk.
It is indeed true that unsafe abortion practices are on the increase in countries implementing strict anti-abortion regulations. Available statistics confirm that a staggering 98% of all unsafe abortions occur in low-resource (developing) countries in Africa, Latin America and Asia (Baggaley et al., 2010).
As suggested by these authors, it is interesting to note that many of these low-resource countries have very strict laws that view abortion as a criminal offence and punishable by law, but still have the highest number of maternal morbidity and mortality resulting from unsafe abortion practices. This implies that criminalizing abortion by implementing harsh sanctions against it neither deters women from seeking the service nor makes the lives of these women any healthier.
Moving on, it is clear that women who seek abortion services from unskilled people do not benefit from the education and counselling initiatives offered by qualified providers, hence end up carrying other unwanted pregnancies in the future and visiting the same unskilled people for assistance.
Most health facilities providing abortion services undertake patient education and counselling to not only explain to the patient the actual technical aspects of the procedure and possible complications involved, but to also address their feelings about the impeding procedure (Joffee, 2013).
Women visiting established health facilities in need of abortion services are also educated on how to make use of family planning methods and how to deal with complications. Such benefits, in my view, are non-existent in backstreet abortion hubs.
Guaranteeing the Reputation & Social Standing of Women
Available literature demonstrates that legalizing abortion will ensure that it is carried in a safe and secure environment which upholds the reputation and pride of those in need of the services (Upadhyay et al., 2010).). The upholding of these values has been found to lead to success and patient satisfaction in medical abortions (Ely, 2007). Similarly, the absence of these values lead to low self-esteem and emotional drain because an abortion is often an emotionally noteworthy experience in a woman’s life (Upadhyay et al., 2010).
Coinciding with the above, it is generally felt that many women suffer image and reputation crisis immediately after securing abortion services from unskilled providers due to inadequate preparation.
Available literature demonstrates that although women usually arrive at an abortion decision without any undue coercion, they obviously are in need of interacting with qualified medical experts, who are tasked with the important responsibilities of helping to inform their decisions and supporting their physical and emotional needs before and after abortion to ensure that their self-worth, self-esteem and emotional stability are not affected (Upadhyay et al., 2010).
These responsibilities are critical in ensuring image and reputation of women are guaranteed, but they are unachievable in a scenario where abortion is criminalized.
Lastly, legalizing abortion will ensure that it is provided in a conducive and supportive environment, and hence women will not have to put up with feelings of guilt that may end up adversely affecting their longer-term personal and career aspirations. Indeed, studies have found that the act of an abortion alone may trigger mental health problems in women who were ill prepared to undergo such an experience (Upadhyay et al., 2010).
These mental health issues, according to the authors, are reinforced by feelings of guilt that women experience after undertaking an abortion without adequate preparation. Seeking abortion in illegal settings is typified by several attributes, including fear of stigmatization, psychological distress, long-term feelings of pain and/or guilt, and loss of social and family prestige or honour (Puri et al., 2012).
Conclusion
From the ongoing, it is clear that nations should move with speed to legalize abortion not only to safeguard the health and well-being of women in need of the services, but also ensure that their reputation, honour and status in society are closely guarded.
Sanctions against abortion have never solved the real issues. In this regard, it is highly felt that maternal mortality and morbidity arising from unsafe abortions will easily be prevented when countries ease these sanctions and legalize abortion to allow women have access to safe abortion services.
References
Baggaley, R.F., Burgin, J., & Campbell, O.M.R. (2010). The potential of medical abortion to reduce maternal mortality in Africa: What benefits for Tanzania and Ethiopia? PLoS ONE, 5(10), 1-9.
Banerjee, S.K., & Clark, K.A. (2009). Exploring the pathways of unsafe abortion: A prospective study of abortion clients in selected hospitals in Madhya Pradesh, India. Web.
Ely, G.E. (2007). The abortion counselling experience: A discussion of patient narratives and recommendations for best practice. Best Practice in Mental Health, 3(2), 63-74.
Joffee, C. (2013). The politicization of abortion and the evolution of abortion counselling. American Journal of Public Health, 103(1), 57-65.
Puri, M., Lamichhane, P., Harken, T., Blum, M., Harper, C.C., Derney, PD., & Henderson, J.T. (2012). “Sometimes they used to whisper in our ears”: Health care workers’ perceptions of the effects of abortion legalization in Nepal. BMC Public Health, 12(1), 297-305.
Shah, I., & Ahman, E. (2009). Unsafe abortion: Global and regional incidence, trends, consequences and challenges. Journal of Obstetrics & Gynaecology Canada, 31(12), 1149-1158. Web.
Upadhyay, U.D., Cockrill, K., & Freedman, L.R. (2010). Informing abortion counselling: An examination of evidence-based practices used in the emotional care for other stigmatized and sensitive health issues. Patient Education & Counselling, 81(3), 415-421. Web.
Warriner, I.K. (2006). Unsafe abortion: An overview of practices and needs. In I.K. Warriner & I.H. Shah (Eds.), Preventing unsafe abortion and its consequences: Priorities for research and action (pp. 1-14). New York, NY: Guttmacher Institute.