Problem Analysis: Each year an estimated 600,000 women die of pregnancy-related causes, of which the World Health Organisation attributes close to 80,000 to unsafe abortion - 219 every day – nine each hour. More than one third of these deaths occur in South Asia, where it is estimated that 37% of all maternal deaths result from unsafe abortion. Between 10-50% of women who undergo unsafe abortion in the region need medical care for complications, resulting in approximately 29,000 deaths per year.

In 1994 the ICPD Programme of Action agreed, “All governments and relevant intergovernmental and non-governmental organisations are urged to strengthen their commitment to women’s health, to deal with the health impact of unsafe abortion as a major public health concern,” (section 8.25). Despite all the countries in South Asia being signatories to the ICPD Programme of Action, there have been few initiatives to tackle this problem and the situation at the grassroots level for most women has not improved.

Abortion is legal in India and Nepal but most other countries in the region have at least one legal indication for abortion, if only in cases of rape, incest or to save a women’s life, yet there remains a restrictive environment including the imprisonment and sporadic arrests of women in several countries in the region. In addition, women are often judged for immoral behaviour, and there is even greater difficulty in accepting the principle of a woman’s right to bodily integrity. Meanwhile, women across the region when faced with unwanted pregnancy, are forced to resort to abortion regardless of whether it is illegal or not^.[2] For many, the only choice is to undergo an abortion performed by unqualified individuals in unhygienic circumstances.

An analysis of the compulsions that drive women to seek unsafe abortion and endanger their lives reveals the stark realities of abrogation of human rights, especially the right of choice and the right to a healthy life.

• While there is no data on the number of deaths from unsafe abortion, it is believed that women suffering from the consequences of induced abortions occupy at least 10% of beds in gynaecology units.
• In Iran, Pakistan and the Maldives there are severe penalties for carrying out abortions and very little data on morbidity or mortality rates arising from unsafe abortion.
• In India, where abortion is legal, unsafe abortion remains one of the leading causes of maternal mortality – it is estimated that 12-15% maternal deaths are due to septic abortions. · Unsafe abortion is closely intertwined with female foeticide and gender discrimination in the South Asian region

Strategic Direction: As the abrogation of human rights lies at the root of unsafe abortion SARO, will support safe abortion by lobbying and advocating for the universal right of women to live healthy and safe lives free from the fear of death and disease.

Goal: Recognition of the universal right of women to choose and have safe abortion

Objectives: To raise awareness of communities, programme implementers and policy makers about the public health and social justice impact of safe abortion in all the 7 countries of south Asia

Activities:

• Support MAs to conduct baselines and other situational and needs assessments on existing barriers to safe abortion.
• Gather info on how abortion related morbidity impacts on the well being of families and its economic costs on societies.
• Conduct regionally media surveys on the extent of media coverage of issues relating to safe abortion
• Support the creation of regional centres of excellence in countries where abortion is legal to catalyse change in the region by increasing awareness about the legal issues about abortion and expanding the abortion services. ·
• Use the knowledge base generated to develop an IPPF regional policy on abortion and to develop innovative pilot approaches in 3 countries to stir a public debate on unsafe abortion in the context of human rights. E.g. using peer counselling as a means of social mobilisation or linking with gender based violence (GBV) movements.
• Mobilise resources to improve the quality of existing facilities for unsafe abortion and post abortion care.
• Build capacities of staff and volunteers in IPPF to advocate for pro choice issues by building strategic partnerships with other organisations and movements in South Asia.
• Document success with media partners through a women’s empowerment lens – recording women’s voices through media fellowships.

Outcomes and Indicators: