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Abortion Is Healthcare: SheDecides hosts Women Deliver Concurrent Session

27th July 2023

Last week SheDecides, in partnership with the Global Safe Abortion Dialogue, hosted a concurrent session at Women Deliver 2023. The session, titled “Abortion is Healthcare: UHC Best Practices, from Politics to Provision” explored best practices, progress and innovations on delivering abortion as essential healthcare.

With leading expert speakers from Governments, CSOs, service providers and youth leaders from across the globe, the panel event took three parts and provided diverse perspectives on why abortion is healthcare and must be part of Universal Health Coverage.

Sonali Silva, Co-Chair of SheDecides Guiding Group and passionate abortion rights advocate facilitated the panel. Opening the session, Sonali welcomed all guests and explained the concept of Universal Health Coverage:

“Universal Health Coverage is the concept that all people everywhere can use the health services they need, where and when they need them, without discrimination of any kind or financial hardship. This must include abortion care.”

Dr. Bela Ganatra, Unit Head, Preventing Unsafe Abortion, Department of Sexual and Reproductive Health and Research, World Health Organization (WHO) was the first panelist to speak. Pointing to the evidence within the WHO’s Abortion Care Guidelines, Dr Bela explained that abortion care should not sit in isolation from the wider health system:

"Evidence shows that what we used to think of as hospital-based care, abortion care is actually a series of very simple primary healthcare interventions that can be provided by a wide range of health workers, and easily integrated into existing health infrastructures at minimum additional cost and effort."

Dr. Bilguissou Balde, Regional Director of Ipas Francophone Africa and the Interim Director of le Centre ODAS, was next to speak and pointed to where progress on abortion is happening including in Benin, DRC and Sierra Leone. Highlighting the critical role CSOs have played in securing law reform in the region, Dr Bilguissou emphasized the importance of collaboration between different actors to achieve change.

“In 2022, le Centre ODAS hosted the second Regional Safe Abortion Dialogue which brought delegates from Africa, Asia and Latin America to share best practices, innovation and strategy from across the abortion ecosystem. These meetings where abortion champions, CSOs, government stakeholders and funding partners come together are vital because the key takeaways and recommendations can be used to inform policy initiatives, such as integrating SRH, particularly safe abortion into UHC.”

Esi Asare Prah, Advocacy and Donor Relations Manager MSI Reproductive Choices Ghana, wrapped up the first panel by highlighting the importance of meeting the health needs of young people.

“There is inadequate information for young people – and comprehensive sexuality education (cse) across Sub-Saharan Africa is being highly opposed. There is a generation of young people going to school incorrectly thinking that abortion is illegal, when it is not always the case. The ambiguity in communication and lack of information around safe abortion services are key barriers to accessing services. We need innovative systems & new channels to reach young people - like telemedicine and services within the school system. That's how we will advance care for young people.”

The next panel was made up of three Governments – Benin, France and Nepal, and highlighted political progress and the role that Governments play in ensuring their citizens can access essential healthcare. Jean-Pierre Wangbe, Head of the Legal unit, Ministry of Health, Government of Benin was the first to speak. Benin recently expanded legal grounds for women seeking an abortion, making it one of the most progressive countries in Africa when it comes to access to abortion care. On the necessity of the change, Jean Pierre said:

“For the government of Benin it was a matter of human rights and public health. The statistics showed that 3 out of 4 abortions were clandestine and contributed to 15% of the maternal deaths. More than 200 women died in silence every year in our country due to unsafe abortions and restrictive laws. That is why we needed to change the laws to better ensure and expand women’s rights to terminate a pregnancy, to prevent these deaths.”

Next, SheDecides Champion Delphine O, Ambassador, Secretary General of the Generation Equality Forum, Government of France gave a powerful statement, reaffirming that being “pro-family” means being pro-choice:

“Being “pro -family” means being pro- women, it means pro –women in all their diversity, being pro families of all kinds including LGBTIQ+ families, pro bodily autonomy, pro SRHR, pro comprehensive sexuality education and of course it means being pro-abortion.”

She went on to highlight how SRHR and the right to abortion is a cornerstone of France’s feminist foreign policy and international strategies:

“Access to safe and medical abortion is one of our priorities. We don’t and won't shy away from saying that abortion is a fundamental human right.”

Dr Sangeeta Kaushal Mishra, Additional Health Secretary, Ministry of Health and Population, Government of Nepal wrapped up the section by sharing how Nepal provides free access to abortion care within the health system. Speaking of the importance of Governments properly financing and decentralizing abortion services, Dr Sangeeta also spoke of the journey Nepal has been on to where it is today: a clear voice on progress, centering access to abortion as a human rights issue for its citizens.

“Nepal had one of the most difficult and regressive laws before 2002, where people were criminalized and penalized for having an abortion. Now Nepal takes abortion as a basic human right issue, and we are trying to integrate it to achieve universal health access for all. Evidence based advocacy was very important in achieving this. We were able to show that unsafe abortions were linked to maternal mortality, and that we could mitigate this by providing safe legal abortion care.”

The final panel focused on innovations in abortion healthcare, and included Dr Sarah Onyango, Senior Technical Advisor, Self-Care, PSI and Project Director of the Self-Care Trailblazer Group. Dr Sarah Onyango highlighted how self-managed abortion provides a feminist solution to expanding access to healthcare to women and girls worldwide:

“Many women die from complications due to unsafe abortion. The WHO guidance clearly shows that medication abortion is a safe intervention. We know that self-managed abortion gives women and girls the power and opportunity to access these services in their own spaces, privacy and at their convenience”.

Following on, Sarah Thomsen, Lead Policy Specialist for Health and SRHR at The Swedish International Development Cooperation Agency (Sida) highlighted how Governments, like Sweden and others, are working together to find solutions to finance SRHR services in Universal Health Coverage.

“We are supporting Government to Government dialogue. Last year our partner in Rwanda hosted an inter-governmental dialogue with the Governments of Rwanda, Benin and Burkina Faso to look at how sustainable financing for primary healthcare and SRHR - including abortion care - can be implemented. It’s about listening and sharing experiences, and it's about getting abortion care into the healthcare system like Benin is doing, making sure it is free and available.”

Sonali wrapped up the session with a simple but powerful closing statement, greeted by applause:

“There is no Universal Health Coverage without safe abortion care!”

Following the panel, participants stayed to network with other guests. Taking place almost one year since the reversal of Roe Vs Wade in the United States, the session highlighted that despite attempts by opposition groups to rollback hard won gains, progress is happening and taking place across the globe. With the target of the SDGs just a few years away, including abortion care in UHC provides a clear solution to achieving global goals on health and gender equality, ensuring that we leave no one behind.