The past decades have brought modest improvements to women’s reproductive health around the world. Over the past 30 years, global rates of unintended pregnancies have thankfully declined by almost 20 per cent, presumably in part because of better access to education and contraceptives.
In 1973, the US Supreme Court, ruling in Roe v. Wade, declared an American woman’s right to an abortion to be fundamental and constitutionally protected. This landmark decision helped inspire many countries around the world to enshrine the individual right to bodily autonomy in law or expand access to abortion services – including Canada and India. Many women have been able to access safe abortions and post-abortion care.
Then the 2022 US Supreme Court overturned Roe v. Wade. The ramifications of this reversal will be felt across the globe, threatening to set back modest policy gains, strengthen anti-abortion advocates and hamper progress in reproductive health and human rights.
Of course, unintended pregnancy is bound to happen. Sometimes, horrifically, it is the result of violence. From 2015 to 2019, there were 121 million unintended pregnancies a year on average – that’s 64 for every 1,000 women ages 15 to 49.
In March this year, a study produced the first global estimates of unintended pregnancy and abortion rates for 150 countries. In sub-Saharan Africa the rates are particularly high: In Uganda, unintended pregnancy affects 145 women per 1,000.
The important thing is whether these women have access to good information and health services. Many of them are increasingly seeking abortion: From 1990 to 2019, the rate of abortion for unintended pregnancies globally has increased from 51 per cent to 61 per cent.
Not surprisingly, and appallingly, the new report notes that the rate of unsafe abortions is nearly 45 times higher in countries with highly restrictive abortion laws than in countries where abortion is legal and available.
Unsafe abortion is already one of the leading causes of maternal injury and death, killing an estimated 22,800 to 31,000 women annually worldwide. Every year, seven million women suffer complications from unsafe abortions. This is entirely avoidable, but only with a supportive legal framework and a health system capable of delivering needed information and services.
Global advocates fear that the overturn of Roe v. Wade will erode progress in that direction. Outside of the US, access has generally increased.
Already we have seen and heard alarming things in international meetings about women’s reproductive health that indicate a change in the tide. On July 19, for example, a UK-hosted joint multi-national human rights statement was amended, removing any mention of “abortion,” “sexual and reproductive health and rights” and “bodily autonomy” from the document. The advocacy group Humanists UK is protesting the change.
And Right to Life UK reports that India is now planning its first national March for Life for August; one of its organizers said she hopes the march will “carry on for years to come until the day the [Medical Termination of Pregnancy] Act is completely revoked just like Roe v. Wade was revoked this year.”
A major concern is that power and funding will now increase for US-based anti-abortion groups that are already active in many countries around the world, including Human Life International, which has campaigned against contraception and abortion in sub-Saharan Africa for more than a decade; the East African Centre for Law and Justice, a Christian organisation with roots in the socially-conservative, anti-abortion American Centre for Law and Justice; and Heartbeat International and Human Life International, two anti-abortion groups that have set up “crisis pregnancy centres” in practically every continent to dissuade women seeking abortions from terminating their pregnancies.
An emboldened anti-abortion movement is a threat to the hard-won gains in sexual and reproductive health and rights worldwide.
It is already hard for low-income nations to fund women’s reproductive health services. The use of US foreign aid funds specifically for the performance of an abortion as a method of family planning is illegal under the 1973 Helms Amendment (this July, Democratic senators introduced a bill attempting to repeal this amendment).
And while the Bill and Melinda Gates Foundation, the major US private donor to global health, does fund family planning programmes, it does not fund abortion advocacy, information or services. This already makes it hard for countries that are significantly dependent on external funding for their health sector to provide safe abortion services and post-abortion care; the new court decision may make it even harder.
The US Supreme Court’s decision blatantly ignores public health and the plethora of data that demonstrates the harms caused by these sorts of restrictions. We can only hope that other nations will learn from places where abortion is now safe and legal, such as Argentina, Ireland and, more recently, Sierra Leone, and stop turning to the US as a defender of human rights, or as an example of educated policymaking.
- Knowable Magazine report