Statement on behalf of Ipas

to the United Nations Commission on Population and Development

 

April 3, 2002

 

Barbara B. Crane, Ph.D., Executive Vice President

 

 

Mr. Chairman, distinguished delegates, colleagues in the NGO community, and friends: 

 

It is a privilege to speak to you this afternoon.  My name is Barbara Crane.  I represent Ipas, an international nongovernmental organization working globally to protect women’s health and advance their reproductive rights.

 

We welcome the comprehensive and informative overview of these issues provided by the Secretary General in this year’s report on world population monitoring.  

 

I want to focus this afternoon on one of the most critical concerns raised in the report, the continuing worldwide toll from the complications of unsafe abortion.  In the nearly eight years since the International Conference on Population and Development (ICPD) in 1994, millions of women have suffered trauma and injuries due to abortions performed unsafely.  WHO estimates that over half a million women have died.  If we do not succeed in reducing these deaths and injuries, we will not be able to achieve the reductions in maternal mortality called for in the ICPD Programme of Action and more recently in the Millenium Development Goals.  We know that in fact we could succeed.  With concerted action, the deaths and injuries from unsafe abortion are entirely preventable.

 

Fortunately, the international community is responding.  At ICPD in 1994, the consensus was that where abortion is legal, it should be safe.  In 2000, at the Special Session of the General Assembly for ICPD+5, governments agreed that “in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible.”   Significantly, all but four countries in the world allow abortion under some circumstances. 

 

Yet, even in countries where abortion is legal for various indications, the reality is that services are often not available or affordable.  And they are not safe.  Women who are in vulnerable positions – including poor women, adolescents, and refugees -- have the least access to contraception or to safe abortion care.  In answer to this need, bilateral and multilateral donors, private foundations, governments, and international and national nongovernmental organizations, including Ipas, are mobilizing resources and forming new partnerships to take action. 

 

The resources available are still minimal relative to the scale of the need.  Ironically, while abortion often dominates international debates on reproductive health, both, postabortion treatment of complications and elective abortion care are among the most neglected components of reproductive health policies, training, expenditures, or service delivery. 

 

Much of the programmatic effort to date has focused on postabortion care, and the progress achieved since ICPD is indeed heartening.  A recent multi-country study found that more than 40 countries have undertaken programs to improve postabortion care.  Last month, delegations from 15 countries of the Francophone Africa region met in Senegal to discuss how to strengthen programs in this area.  Two years ago, representatives from 21 countries from around the world met in Kenya to develop action plans for postabortion care.  But in the words of one African health official at that meeting, “Postabortion care services are as if we are mopping the floor and the tap is broken.  We say we don’t want to fix the tap, but we keep mopping and mopping and asking for more mops.”

 

To “fix the tap,” that is, to prevent unsafe abortion and its consequences, the ICPD Program of Action, together with the General Assembly ICPD+5 recommendations and the Beijing Platform for Action, provide strong guidance on the actions required.  Everyone has a role to play. 

 

• We can work together to ensure at the outset that women and men are empowered, informed, and capable of healthy, loving, respectful, and responsible sexual relationships. 

 

• We can give women access in their communities to effective methods of contraception, including emergency contraception. 

 

• We can help women understand how to recognize the signs of pregnancy as well as where to seek pregnancy testing, and, as appropriate, counseling on their options. 

 

• We can train providers -- doctors, midwives, or other midlevel professionals -- in clinical procedures and counseling; ensure that they understand applicable laws, norms, and protocols; and prepare them to treat women with compassion and respect. 

 

• We can ensure that facilities are equipped and put referral systems in place to assure that women have access in their communities to the full range of reproductive health care they need.   

 

• Most basic of all, we can create awareness of this problem, promote a constructive dialogue around the solutions, and reform policies and laws, particularly those that are punitive toward women or their health care providers.

 

The Secretary-General’s report, in highlighting HIV/AIDS, drew attention to the wider reproductive health care needs of sexually active HIV-positive women.  We must ensure that these needs are being addressed, including information and services to prevent unwanted pregnancy and, if an HIV-positive woman is pregnant, to enable her to make a free and informed choice about her pregnancy.  

 

While I have been speaking to you in the last few minutes, some 200 desperate women – daughters, sisters, wives, and mothers -- have decided to put themselves in the hands of a clandestine or unsafe provider.  What would they say to us if they could be here now?   What are the hopes and dreams they would share for themselves, for their children, for their families, and for their communities?   How can we turn our backs on them?   What choices do we offer them?  While debate in the international media, universities, and in this forum here is open and free, what avenues do these women have to make their voices heard?  Too often, they and the NGOs or providers who speak for them are effectively gagged by donor policies or by other forms of cultural and institutional intimidation.

 

Mr. Chairman, we believe it is the responsibility of the UN Commission on Population and Development to provide leadership and inspire action on behalf of all of the recommendations of the ICPD Program of Action.  The UNCPD can promote accountability and strong monitoring, ensuring that adequate resources are devoted to measuring the prevalence of unsafe abortion, assessing its consequences for maternal mortality and morbidity, and tracking health systems’ responses.

 

In the words of Mahmoud Fathalla, one of the most respected global health leaders of our time, “Women are not dying because of diseases we cannot treat.  They are dying because societies have yet to make the decision that their lives are worth saving.”   Let us find the political will.  Let us make the decisions to save women’s lives – the lives of our daughters, sisters, wives, and mothers -- and let us work closely together in this most noble endeavour.