At the 5th Research Meeting on Unwanted Pregnancy and Unsafe Abortion, Mexico City, 28-30 September 2015, Silvina Ramos presented an excellent new CLACAI publication (in Spanish) on a renewed agenda for abortion research in the LAC region: “Investigacion sobre aborto en America Latina y el Caribe: una agenda renovada para informar politicas publicas e incidencias”. I was asked to comment in the session:

DATA FOR ADVOCACY

-We need to know more about what post-abortion care involves in order to showcase the failure of post-abortion care to resolve the serious public health problem of unsafe abortion. In 2012 an estimated 6.9 million women globally were treated for complications of unsafe abortion. In Latin America, new estimates of the rate of complications show a 31% decline between 2005 and 2012, from 7.7 per 1,000 women to 5.3 women per 1,000. (Singh et al, 2015) But this is still far too high and there is no excuse for it.

-As regards the incidence of abortion, we need to know more about pregnancy among girls aged 8-14 resulting from sexual abuse and whether or not they have access to safe abortion, including as a form of emergency obstetric care given how small they are. This emerged as an issue in Paraguay this year. There is little information on this subject though some research has been done (see http://conta.cc/1NNx4FD, http://conta.cc/1NN3sIn and http://conta.cc/1NMS9zS).

HEALTH PROFESSIONALS

-It is important to underscore the importance of the attitudes towards abortion of health professionals, and the importance of promoting training in abortion provision only for those who support women’s right to safe abortion. The current deficit in training should be a major advocacy issue. Why nurses should be less supportive to women needs to be better understood because abortion no longer requires doctors except in emergencies. Abortion care should be in hands of nurses and/or midwives at primary care and community level today.

-The prevalence of abortions among nurses/midwives and how they themselves are treated as patients might help to explain their views and bring them on board as a profession (http://www.rhm-elsevier.com/article/S0968-8080(07)30314-5/pdf).

-Attitudes towards 2nd trimester abortion are a particular problem. Can the number/proportion of second trimester abortions be reduced with better laws and services? Evidence from Sweden and Norway, particularly with good access to medical abortion, shows this can be done. If we knew why women have abortions after 12 weeks of pregnancy in more countries, it would contribute to change. However, this is not an issue of “women’s fault” but of systemic failures on the part of health and sexuality education, laws and policies, and health systems.

CONSCIENTIOUS OBJECTION

-Many who support abortion rights call for restrictions on conscientious objection but few oppose it altogether. Joyce Arthur of Canada and Christian Fiala of Austria have written several articles together and separately on this subject, opposing the whole concept.

-Sweden does not permit conscientious objection. This policy was challenged earlier this year at European level and their law was upheld.

-I agree with these views. I believe anyone who is unwilling to carry out an essential task in their job description should find another job. Abortion services are almost unique in allowing conscientious objection. It is a leftover of anti-abortion hegemony and should be removed.

PUBLIC HEALTH vs. HUMAN RIGHTS POSITIONS TO SUPPORT ABORTION

-I would like to disagree with one of the book’s authors that the public health arguments for safe abortion are less radical than those related to women’s bodily autonomy and rights.

-Public health arguments are not only relevant but also extremely powerful. I don’t think we use them enough anymore. Yet they are likely to have more resonance with health professionals.

-How to get past the huge, irreconcilable differences in thinking? Especially in the face of growing anti-abortion fanaticism?

RESEARCH FOR LAW AND POLICY ADVOCACY

-Campaigns for safe abortion often focus on calling for specific grounds for abortion to be decriminalised. For example, health grounds, rape, serious fetal abnormality, and in some countries in Latin America even for risk to the woman’s life to be permitted.

-I recently looked at the history of how abortion laws in several countries have changed over time, from almost complete criminalisation to allowing abortion at a woman’s request. This showed that a step-by-step process has taken place in some countries over a period of years, but often over decades. The current, limited law reform bill in Chile and recent examples in Africa show this has resonance as a way forward. But is it the only or best way forward?

-It would be good for this history to be studied in depth in many more countries, across both the 19th and 20th centuries and today.

RESEARCH ON ABORTION LAWS & GOALS

-For me, one of the biggest unresolved advocacy issues is whether we are seeking legalisation of abortion or decriminalisation of abortion.

-There a difference between these legal categories and we need to study it more.

-What reforms should we propose to our current laws on abortion that will lead to health system changes that will meets women’s needs and protect and fulfill their right to a safe abortion as part of their sexual and reproductive health and rights?

-In different countries, the answers may be different, depending on the origins of the laws, and more research and critical thought and analysis are needed.