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Joining The Dots: Why Abortion Care Is Part Of The Picture When It Comes To Universal Health Coverage

27th July 2023

Authored by Sonali Silva, SheDecides Guiding Group Co-Chair.

With the target of achieving the SDGs just a few years away, many are looking at how Universal Health Coverage (UHC) can help achieve global goals on gender equality and health. Isn't it time we prioritize abortion care as an essential part of women and young people’s health and human rights? Guiding Group Co-Chair Sonali Silva explores.

As a passionate abortion rights advocate, I’ve long spoken out for the right to choose and for abortion as essential healthcare for all people, everywhere as a fundamental human right.

That’s why it was important for me to facilitate the SheDecides concurrent session at Women Deliver on Universal Health Coverage (UHC) and abortion care called “Abortion is Healthcare: UHC Best Practices, from Politics to Provision!” The expert panel made Governments, healthcare experts and civil society organisations explores best practices, progress & innovations on delivering abortion as essential healthcare.

But what exactly is Universal Health Coverage - what does it include and how is it linked to abortion care? Let’s unpack it!

What is Universal Health Coverage?
Universal Health Coverage (UHC) is an idea that everyone, regardless of income, social status, or geographical location, has access to essential health services without suffering financial hardship (WHO). This means that all people, everywhere can use the health services they need, when and where they need them, without facing economic barriers.

UHC is a critical part of the Sustainable Development Goals (SDGs) - which sets out a global agenda for sustainable development for all, and promises to “leave no one behind” . UHC is listed as an explicit part of the health goal (SDG 3 - 3,7 and 3.8). As such, all governments in the world have committed to ensuring universal access to sexual and reproductive health care services for all, including for family planning.

UHC can include a range of services, such as preventive health measures (like vaccinations and health education), primary care, outpatient treatment, inpatient care, diagnostic services, and emergency care.

UHC is recognized as an important policy goal by the World Health Organization (WHO), the United Nations (UN), and many governments around the world. It is seen as critical in reducing poverty and achieving the sustainable development goals, as it can improve health outcomes and reduce inequities. By ensuring that everyone has access to quality health services, we can create a healthier, more equitable, and more just world.

But can we truly achieve Universal Health Coverage without addressing the critical issue of access to safe and legal abortion services? Isn't it time we prioritize this essential component of women's and young people's health and human rights?

Why is the provision of abortion services essential to realizing our goal of providing Universal Health Coverage?

Safe and legal abortion services are essential to realizing the goal of providing Universal Health Coverage (UHC) for several reasons.

  • Access to safe and legal abortion is a human right and essential health care, as recognized by the World Health Organization (WHO). Unsafe abortions are a leading cause of maternal mortality worldwide, and many women and girls are forced to turn to unsafe methods of terminating pregnancies due to restrictive laws and limited access to safe and legal abortion services. By including access to safe and legal abortion services within UHC, we can ensure that all women and young people have the right to make choices about their bodies and health, reducing the risk of unsafe procedures.
  • Safe and legal abortion services can save women’s lives and improve health outcomes. When women and young people are unable to access safe and legal abortions, they may turn to illegal, unsafe, or self-induced abortion, which can lead to complications such as infection, hemorrhage, and perforation of the uterus or other organs.
  • Access to safe and legal abortion services is a key component of reproductive health care and a fundamental aspect of women's  and young people's health and human rights. All women and young people should have access to the full range of reproductive health care services, including contraception and safe and legal abortions, in order to make informed choices about their health and their futures. This requires that abortion services are accessible, affordable, and of high quality.

What happens when health systems don't provide safe abortion services?

When health systems do not provide safe abortion services, it can burden the health system in both the short and long term. Short-term consequences of lack of safe abortion services include:

  • Increased risk of maternal deaths and illnesses: Women and girls who are unable to access safe abortion services may resort to using unsafe methods that can result in severe complications, such as hemorrhage, infections, and perforations. This may require hospitalization, blood transfusions, or other medical treatments, which can place an immediate burden on the health system.
  • Reduced quality of care: When women and young people can't access safe abortion services, they may delay seeking care or turn to untrained providers, who may offer substandard care and contribute to a decline in the quality of health services.
  • Limited access to comprehensive reproductive healthcare: When abortion services are not part of UHC, it creates a gap in access to comprehensive reproductive health services, limiting the ability to provide universal health coverage.

Long-term consequences of lack of safe abortion services include:

  • Increased healthcare costs: When women experience complications from unsafe abortions, it can lead to increased healthcare costs, both for the individual and the health system. This includes costs associated with hospitalization, surgery, antibiotics, and blood transfusions.
  • Economic and social costs: Women in low-to-middle-income countries who are unable to access safe abortion services may suffer significant economic and social costs, limiting their ability to participate in the workforce and care for their families. This can lead to further poverty and inequality.

How does SheDecides and the abortion rights movement align with the goal of universal health coverage?

UHC aligns fundamentally with the SheDecides movement's push for reproductive rights, including access to safe and legal abortion UHC provides a platform for ensuring free access to complete reproductive care, embracing decisions on pregnancy and childbirth, and acknowledging the importance of informed choices around sexuality, reproduction, and family planning.

Conclusion: Abortion is Healthcare!

Access to safe and legal abortion care must be recognized as an essential aspect of Universal Health Coverage. There is no Universal Health Coverage without abortion care!

Governments have an obligation to protect and promote the right to healthcare for all individuals, as stated in the SDGs (3.7 and 3.8). States must work to prioritize access to abortion services as part of their UHC package if we are to achieve the global goals by 2030 and leave no one behind. No individual should be discriminated against and denied sexual and reproductive healthcare based on their income, location, race, or gender.

It is time we prioritize access to safe and legal abortion services in our vision for Universal Health Coverage, to create a world where SheDecides about her body, life and future. Without question.

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