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We should all be concerned by abortion stigma //La stigmatisation liée à  l’avortement: Tous concernés

By Oumar Tao, Youth Champion at ABBEF, Burkina Faso // Par Oumar Tao, Jeune Champion à l’ABBEF, Burkina Faso 

Abortion stigma exists in almost every country in the world. Indeed, several layers of society are affected by this stigma, contrary to the belief that only those who have had abortions are victims of stigmatization. Indeed, health workers responsible for this necessary services are also victims of stigmatization. At the African meeting of INROADS members, a health worker gave his testimony in these words:

“I am a churchman, a man of God, every Sunday I go to church. After going to church I usually invited my friends to eat and drink. One day I explained my work to a friend from church and he said to me that it is not good what I do, that the Lord does not endorse these practices. After church I invited my friends over and he refused to come and he told others not to come because I’m paying for the guests with money from abortion. That day I felt stigmatized and I realized how stigmatized the victims of abortion were. “

It should be noted that this is a testimony of a health worker.

Thereafter, a woman who educated the community gave her testimony:

“Every two to three days we raise awareness in the villages about abortion and the stigma associated with abortion. One day we were in a village for sensitization and when we finished, we took the road to the house. On the road, a group of young people joined us and asked us if we are the “abortionists” with a violent tone, we answered: we are not abortionists but we are raising awareness for better access to information for all on abortion. They told us to leave and never return to the village for these kinds of sensitizations. That day I felt stigmatized, I was even afraid for my life.”

These testimonials show us how all those involved in abortion are concerned by the stigmatization in their community or in their place of work. Several organizations like ABBEF work day and night to eradicate this stigma in the world. I remain confident that through our programmes to target abortion stigma, with the support of everyone we will make it.

La stigmatisation sur l’avortement existe dans presque tous les pays du monde. En effet, plusieurs couches de la société sont touchées par cette stigmatisation contrairement aux pensées selon laquelle seules les personnes ayants avorté sont victimes de stigmatisation. En effet, les agents de santé responsable des interruptions nécessaires de grossesses sont aussi victimes de stigmatisation. Lors de la rencontre africaine des membres d’INROADS un agent de santé a rendu son témoignage en ces termes : 

« Je suis un homme d’église, un homme de Dieu, chaque dimanche je me rends à l’église. Apres l’église j’ai pour habitude d’invité mes amis à manger et à boire. Un jour j’ai expliqué a un ami de l’église mon travail et il m’a juste dit que ce n’est pas bien ce que je fais, que le seigneur ne cautionne pas ces pratiques. Apres l’église j’ai invité mes amis et il a refusé de venir et il dit aux autres de ne pas venir car je suis en train de les invités avec l’argent de l’avortement. Ce jour je me suis senti stigmatiser et j’ai compris à quel point les personnes victimes d’avortement souffraient de la stigmatisation. »  

Il faut noter que ceci est un témoignage d’un agent de santé.  

Par la suite une femme qui sensibilise la communauté a rendu son témoignage : 

 « Chaque deux à trois jours nous sensibilisons dans les villages sur l’avortement et la stigmatisation liée à l’avortement. Un jour nous étions dans un village pour des sensibilisations et quand nous avons finis, nous avons pris la route pour la maison. En effet, sur la route, un groupe de jeunes nous rejoignit et nous demandas si nous sommes ‘’les avorteurs’’ avec un ton violent, nous répondîmes à travers ces mots : nous ne sommes pas des avorteurs mais nous sensibilisons pour un meilleur accès à l’information pour tous sur l’avortement. Ils nous ont dit de partir et de ne plus jamais revenir dans le village pour ces genres de sensibilisations. Ce jour je me suis sentis stigmatiser juste par-ce-que je faisais des sensibilisations, j’ai eu même peur pour ma vie ».  

Ces témoignages nous montrent à quel point tous les acteurs de l’avortement sont concernés par la stigmatisation que ce soit dans leur communauté ou dans leur lieu de travail. Plusieurs organisations à l’instar de l’ABBEF travaillent jours et nuit afin d’éradiqué cette stigmatisation dans le monde. Je reste confiant que travers les programmes pour cibler les stigmatisation liées l’avortement , avec l’implication de tous on y arrivera.

Abortion advocacy training in Zambia – Billy

In March and June, 30 young volunteers at the Planned Parenthood Association of Zambia were trained on abortion advocacy. Here, one young person reflects on what he learned:

“Abortion is a matter that really needs attention in our day to day matters. To start with I would say abortion is the termination of a pregnancy. In the past two day workshop I realized and learnt things that I never knew were in existence like the Termination of Pregnancy Act of 1972. The law says that abortion is permitted to save the life of the pregnant woman, to preserve her physical or mental health, in the case of fetal impairment and for economic or social reasons.

I would also like to state that regardless of people being modernized they still practice unsafe abortions. One unsafe practice that left me in a state that was unpleasant is where a person crushes bottles and takes them without realizing she is endangering her life. Having heard this I came to the conclusion that most people regardless of their class or profession need to be sensitized about abortion to reduce the number of unsafe abortions and encourage legal safe abortions that will be done in hospitals by trained doctors.”

Billy Banda, young peer educator in Lusaka

Lusaka during Group Exercise on SRHR Policies and the Law (2)
Training participants in Lusaka discuss abortion law

Abortion advocacy training in Zambia – Mwape

In March and June, 30 young volunteers at the Planned Parenthood Association of Zambia were trained on abortion advocacy. Here, one young person reflects on what she learned:

Abortion is one of the most sensitive topics society shuns to discuss, which from the word go is looked upon as evil. Having attended a workshop on safe abortion advocacy I have a different perspective of abortion.

I feel abortion should be a human right that every woman should be entitled to. It is a fact that unsafe abortions are happening in our society and many deaths result from unsafe abortions. As such, it is vital that we the youths take up the leading role and bring unsafe abortions to an end.

The Zambian law may be restrictive in some areas but the provision of safe services depends on the attitude and willingness of the health care providers and willingness of clients to come through. Reducing the need for abortion, be it unsafe or safe abortion, can be achieved by focusing on; changing the circumstances of women that make them vulnerable to unwanted/unplanned pregnancies; increasing women and men’s knowledge, access to and use of contraception; sexuality education for all, and addressing the poor economic prospects of women.

Mwape Kaunda, young peer educator in Kitwe

 

Unsafe abortion in Benin/ L’avortement à risque au Bénin

by Hélène Hlungbo, IPPF Youth Champion and President of Youth Action Movement in Benin//Par Hélène Hlungbo, ‘Youth Champion’ de l’IPPF et présidente du mouvement d’action jeunesse au Bénin

International conventions on human rights, such as the Convention on the Rights of the Child[1], support the rights of young people to information, education and good health. In Benin, one out of every five deaths occurs in adolescents according to the Benin Demographic and Health Survey (EDSB IV, 2011-2012). The 2003 Act on Reproductive Health is fairly restrictive and authorizes abortion only in three situations: when the woman’s life/health is threatened, when there is malformation of the fetus and in cases of rape or incest.[2] This restrictive law means that many adolescent girls terminate unwanted pregnancies in secret, in places which are unhygienic and often not even recognized by the Beninese state as proper clinics. In most cases, there are complications or even deaths of adolescent girls as a result of these unsafe abortions.

Moreover, a survey carried out in Benin by the students of the University of Abomey Calavi (UAC) in 2015 reveals that the majority of patients referred to both the University Clinic of Obstetric Gynaecology and the Hospital and University Center of the Mother And Children are aged between 15 and 24, according to the various statistics collected in these hospitals. Also, registered abortions, especially those within this age group, exceed 50%.

Furthermore, according to the World Health Organization (WHO), health is a state of complete physical, mental and social well-being, and not merely the absence of disease or disability. From this definition it can be noted that young people have the right to make informed choices and make decisions about sexuality. Although the law exists, it is very restrictive, its implementation limited and far from being a reality for want of political will. Many ‘unofficial clinics’ are providing care to the population at a very high cost. Medical ethics are trampled underfoot in the pursuit of profits, which has the direct consequence of unsafe abortions that are detrimental to the health of adolescents and young people.

[1] http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx

[2] https://www.reproductiverights.org/world-abortion-laws/benins-abortion-provisions

Les Conventions internationales sur les droits humains telles que la Convention sur les droits de l’enfant soutiennent les droits des jeunes à l’information, à l’éducation et à une bonne santé.[1] Au Bénin 1 décès sur 5 est le fait d’une adolescente selon l’Enquête Démographique et de Santé du Bénin (EDSB IV, 2011-2012).[2] La loi de mars 2003 relative à la Santé de la Reproduction est assez restrictive et n’autorise l’avortement que dans trois (03) situations: lorsque la santé de la femme est menacée, lorsqu’il y a malformation du fœtus et en cas de viol ou d’inceste.[3] Cette restriction de la loi fait que de nombreuses adolescentes terminent des grossesses non désirées de façon clandestine dans des cabinets de soins peu adaptés et parfois même non reconnus par l’état béninois et dans des conditions peu recommandables. Dans la plupart des cas, on note des complications ou des décès dans le rang des adolescentes suite aux avortements à risques (non sécurisés).

Par ailleurs, une enquête réalisée au Bénin par les étudiants de l’Université d’Abomey Calavi (UAC) en 2015 révèle que la majorité des patientes référées aussi bien à la Clinique Universitaire de Gynécologie Obstétrique qu’au Centre Hospitalier et Universitaire de la Mère et de l’Enfant (CHU/MEL) ont un âge compris entre 15 et 24 ans, selon les diverses statistiques recueillies dans ces centres hospitaliers. Aussi, des avortements enregistrés, notamment ceux se situant entre cette tranche d’âge, excèdent les 50%.

En outre, selon l’Organisation mondiale de la santé (OMS), la santé est un état de bien-être physique, mental et social complet, et pas seulement l’absence de maladie ou d’incapacité. De cette définition, on peut ainsi retenir que les jeunes ont le droit d’opérer des choix éclairés et de prendre des décisions en matière de sexualité. Bien que la loi existe, elle est très restrictive, sa mise en application limitée et loin d’être une réalité faute de volonté politique. De nombreuses cliniques ne répondant pas aux normes sont opérationnelles et dispensent des soins aux populations à un coût très élevé. La déontologie médicale est foulée au pied au détriment de profits induits ce qui a pour conséquence directe ces avortements à risques préjudiciables à la santé des adolescentes et des jeunes.

[1] http://www.ohchr.org/FR/ProfessionalInterest/Pages/CRC.aspx

[2] http://dhsprogram.com/pubs/pdf/SR206/SR206.pdf

[3] https://www.reproductiverights.org/world-abortion-laws/benins-abortion-provisions

Safe abortion must be one of my rights // L’avortement securise doit faire parti de mes droits

Interview by Sawdate Sawadogo, Youth Champion and Chairperson of the ABBEF Youth Action Movement in Burkina Faso

(En français ci-dessous)

Abortion stigma is a critical issue these days and a sensitive issue for so many girls. Abortion is often not something that is expected…however, the stigma is so strong that some girls are often forced to turn away from their dreams. Malia, a college student in Burkina Faso, faced this stigma:

“Even if social pressure weighs on you, take responsibility for a better tomorrow”

“My name is Malia. I am 16 years old. My dream is to be a lawyer. A few months ago, I had an unwanted pregnancy. As I did not know how the clinic nurse was going to react, so I went for a secret abortion. The next day I did not feel well, but I forced myself to go to school for fear that my parents would notice I was unwell. Arriving in class, I felt very sick, I was weak and I was losing blood. The headmaster took me home but my parents were away. So he took me to the hospital. Along the way, he asked me why I was losing so much blood. I told him I had my period. When we arrived at the hospital, I fell on the terrace. After the diagnosis, the doctor approached the headmaster to inform him that I had undergone a clandestine abortion. The abortion was very badly done by someone who wasn’t a proper doctor and my uterus was affected. When my mum and aunt came, they wanted to learn more about what was wrong with me. The doctor explained the situation to them.

On my return home my aunt explained the facts to my father in the presence of another girl who attends the same school as me. This is how the news spread to school. Some classmates were already coming to ask me at home whether it was true that I had had an abortion. I started to be afraid. Back at school, the students began to bully me by saying that I had aborted and that the headmaster had taken me to the hospital. I felt embarrassed, sidelined. The headmaster brought me back to the office to reassure me. He even threatened the students in collaboration with the teachers, which really comforted me. I told myself that I should not give up, that I could overcome this pain and fight for a better tomorrow. I had exams to do. So I concentrated as much as I could and received a good mark. At the end of this, I was awarded a scholarship for study abroad.

What if I had continued the pregnancy? I do not think I could have passed my exam and continued my studies.

Young people from Burkina Faso, this isn’t something which only happens to ‘other people’. Together, let’s say no to stigma and let girls like me realize their dreams! ”

Propos recueillis  par Sawdate SAWADOGO – Jeune championne/Présidente du Mouvement  d’Action des Jeunes de l’ABBEF

La stigmatisation de l’avortement est un problème crucial de nos jours et une question sensible pour tant de filles. L’avortement n’est souvent pas quelque chose que l’on prévoit… Il survient après analyse de certains paramètres jugés importants liés à la grossesse. Cependant, la stigmatisation est si forte que certaines filles sont souvent obligées de se détourner de leurs rêves. Mais Malia, élève d’un collège au Burkina Faso a relevé le défi. 

« Même si la pression sociale pèse sur vous, prenez vos responsabilités pour un lendemain meilleur »

« Je m’appelle Malia. Je suis en classe de 3ème  et j’ai 16 ans. Mon  rêve est d’être avocate. Il y a quelques mois, j’ai eu une grossesse non désirée ; comme je ne savais pas comment l’infirmière de la clinique allait réagir, je suis allée faire un avortement clandestin. Le lendemain, je ne me sentais pas bien, mais je me suis forcée pour aller à l’école de peur que mes parents ne remarquent mon mal. Arrivée en classe, je me sentais très malade, j’étais faible et je perdais du sang. Le proviseur m’a ramenée à la maison mais mes parents étaient absents. Il m’a donc conduite à l’hôpital. En cours de route, il m’a demandé pourquoi je perdais autant de sang. Je lui ai répondu que j’avais mes règles. Arrivée à l’hôpital, je suis tombée sur la terrasse. Après le diagnostic, le médecin a approché le proviseur pour lui annoncer que j’avais subi un avortement clandestin. L’avortement a été très mal fait et mon utérus était un peu touché. Quand ma maman et ma tante sont arrivées, elles voulaient apprendre davantage sur mon mal. Le médecin leur a expliqué la situation. Après les soins au retour à la maison ma tante a expliqué les faits à mon papa en présence d’une autre fille qui fréquente le même établissement. C’est ainsi  que la nouvelle s’est répandue à l’école. Certains camarades de classe venaient déjà me demander à la maison si c’était vrai que j’avais avorté. J’ai commencé à avoir peur. De retour à l’école, les élèves ont commencé à me héler en disant que j’avais avorté et que le proviseur m’avait amené à l’hôpital. Je me sentais gênée, mise à l’écart. Le proviseur m’a rappelée au bureau pour m’encourager. Il a même menacé les élèves en collaboration avec les professeurs, ce qui m’a vraiment réconfortée. Je me suis dit que je ne devrais pas baisser les bras, que je pourrais surmonter cette douleur et me battre pour un lendemain meilleur. Je devais composer le Brevet d’Etudes du Premier Cycle (BEPC). Je me suis donc concentrée dans les bosses et j’en suis sortie avec la mention ‘très bien’. A l’issue de cela, j’ai bénéficié d’une bourse d’études pour l’extérieur. 

Et si j’avais continué la grossesse ? Je ne pense pas que j’aurais pu réussir mon examen et poursuivre mes études.

Jeunes du Burkina Faso, cela n’arrive pas qu’aux autres. Ensemble, disons non à  la stigmatisation et permettons aux filles comme  moi de réaliser normalement leurs rêves ! »

 

Abortion – a human right

by Arshpreet Kaur, young volunteer at the Family Planning Association of India

Each year, around the world, 19-20 million women undergo unsafe abortions [Source: WHO]. Although the law in India permits safe abortion under certain conditions, here one woman dies every two hours of an unsafe abortion [Source: TIME]. The root cause for this alarming statistic is stigma around abortion and the lack of awareness about sexual and reproductive health and rights.

I have grown up considering ‘miscarriage’ and ‘abortion’ as synonyms. The reason for this misconception is the preference of word ‘miscarriage’ by society due to stigma associated with abortion. In fact, miscarriage is spontaneous loss of pregnancy while abortion means terminating the pregnancy out of choice.

Why unsafe abortion?

Most women in India view abortion as ‘illegal’ so they opt for unsafe abortion. Due to stigma around abortion, it is difficult for women to access it safely; and the fear of discrimination causes them to try unsafe methods at home to induce abortion which can be fatal. The other unsafe abortions are a result of sex-selective abortion. In some parts of India, people still prefer a male child over a female child as they consider sons as breadwinners in their old age. Another reason is young girls are often denied abortion services; hence they are left with no other choice than unsafe abortion.

The MTP Act

Abortion is legal in India under the Medical Termination of Pregnancy (MTP) Act, 1971 which allows for pregnancies less than 12 weeks to be terminated on the opinion of a single doctor. For pregnancies between 12-20 weeks, the opinion of two doctors is required for termination. Women are permitted to terminate their pregnancy by a registered medical practitioner under certain conditions – when there is a risk to the physical or mental health of woman (i.e. in the case of rape, contraceptive failure), and when there is a risk that the child would have “physical or mental abnormalities”.

If a girl is under 18 years of age, written consent from her guardian is required.

Proposed amendments to the MTP Act

In October 2014, the Ministry of Health and Welfare proposed some amendments to the MTP Act: to increase the time frame for abortion from 20 weeks to 24 weeks; to allow for an abortion to be carried out on the request of the pregnant woman instead of due to the opinion of the doctor; and to permit abortion beyond 24-weeks if the foetus has substantial abnormalities.

The draft amendments offer a positive step in the right direction. There is a need to immediately incorporate these amendments into an act which will save women from approaching the court, and from distress and a delay in abortion.

A human right

According to international human rights law, a person is granted with human rights only at birth which means a foetus is not entitled to human rights. It is the basic right of a woman to decide about her body, sexuality, fertility, and hence future. We have to acknowledge that stigma surrounding abortion would never wipe out demand for abortion. So, there is a need to strike a fine balance between abortion laws and the right to bodily integrity allowing women to own and decide about their bodies.

The experience is difficult – step into our shoes

This blogpost is reproduced with permission from the Ipas Youth Act site and is part of a joint initiative between Ipas and IPPF’s Western Hemisphere Region Youth Network.

My name is Josefina*, I’m from Caracas, Venezuela, and I am 26 years old. I’m a lawyer, activist at PLAFAM, and I was part of International Planned Parenthood Federation/Western Hemisphere’s Youth Network.

When I was 23, I experienced firsthand what it is to have an abortion, although in previous years I encountered this issue when a friend became pregnant when we were 18 and her family would not let her have an abortion. I had one, but my family still doesn’t know all the things I lived through during the process. I’m now married and expecting a baby.

What are the main barriers in access to abortion services you’ve seen in your country or community?

Beyond the legal barrier there’s the stigma that exists around abortion, especially when those who discriminate against women who had abortions, or choose this option, are health professionals. [Editor’s note: Abortion is legal only to save a woman’s life in Venezuela.] Another barrier is economic, usually this procedure is very expensive and very few women can afford it. It gets very difficult when you find out how much it will cost, and it’s at this point where many women look for “cheaper” ways, even if it represents a threat to their life.

Why should abortion be legal? What are the consequences of making it a crime? Why do you think it is a right?

Criminalizing abortion does not mean that people will stop doing to it, prohibiting abortion only leads to its clandestine practice without health controls or guarantee that a trained specialist provides it.

We all have the right to decide, there are no second-class citizens, and women are no less than anyone else for wanting to be able to decide about their bodies and lives. No one should force you to carry an unwanted pregnancy.

What is the role of men in the movement for access to safe and legal abortion?

I agree this is an issue that concerns everyone. Men can express their opinions; it would be interesting. They can provide adequate information, empower people and give support to women both at political and personal levels. Be active players like us. However, on the subject of the decision it is something that only women can make.

What is your message for policymakers regarding the right to abortion?

I have two messages. One for women who choose to have an abortion: You should choose the best method and the best person who can do it, keeping in mind that it’s necessary to acquire family planning services to prevent another unwanted pregnancy. Equally, we must be very patient because it is not easy to be in that situation. I lived that experience three years ago and almost died because of it, and even then many judged me and said I opted for the easy way. It is not easy to go to college and work without being able to ask for leave because basically what you did is not legal in your country. It is not easy being in that situation without being able to ask someone for help or support.

And for people in political positions: The experience is difficult. Step into our shoes.

* Using a pseudonym to protect the author’s confidentiality.

 

Check out our youth-led projects in Ghana, Palestine, Spain, Macedonia and Nepal

In 2015, young people in IPPF Member Associations were asked to create projects which would tackle the issue of abortion stigma in their communities. Small grants were awarded to promising projects submitted by young people in Ghana, Palestine, Spain, Macedonia and Nepal. Read this for more information about what these projects set out to do, their methods and the results.

The forged marriage between abortion and poverty in Guyana

By Dennis Glasgow, youth volunteer at Guyana Responsible Parenthood Association (GRPA)

Abortion was legalized in Guyana in 1995. Since the law was relaxed, although abortion is common among Guyanese women there is still some amount of stigma attached to it and this stigma has caused many women to turn to “bottom house” abortion practices, which are not always safe. In our little developing country, we see that legal abortion services are easy to access because the legislation is liberal. Even though the services became easy to access, the law stipulated that it must be done within the first 8 weeks of the pregnancy; and the request must be accompanied by a signature from a health care practitioner. If for some other reason, the person needs to have an abortion further along the pregnancy then the laws get stricter as a means of deterring them from accessing abortion.

In Guyana there are many reasons why women have abortions but one main reason is “the lack of financial support” and what this simply means is that the woman does not have enough money to support a child. Because poverty is often linked to education, poor women who are uneducated do not have knowledge of contraceptives so many times they get pregnant unintentionally. There are many other reasons why women have abortions and these may include unemployment, health reasons, cost of services, lack of support from family and friends, etc.

The “bottom house” practice is very common among poor women in Guyana and the Caribbean at large, and this is evident in a document released by the World Health Organisation stating that 95% of abortions in this part of the world are unsafe. In many impoverished areas in Guyana, where residents lack the requisite knowledge of abortion; there is only one way they know to terminate a pregnancy and that is the “hanger” method which is very unsafe and can be life threatening. The few poor women that do access legal abortions are faced with an $8,000 to $10,000 cost and this sometimes deters them from following through with the abortion. However, the Guyana Responsible Parenthood Association which is a non-governmental organisation tries their best to cater to the women’s needs and many times the services become free; but the problem is that “many persons do not know about the organization” so they would never be able to access the services legally. The sad and quite unfortunate reality is that poor women lose their lives through unsafe abortion; more specifically women from the rural areas like Berbice and Essequibo.

It is my belief that one of the main preventative measures is to raise awareness among the most vulnerable groups of women, since I am convinced that people will be able to make more informed decisions if they are educated about their bodies and their sexual and reproductive health.  Women need to know that they have a right to safe, legal abortion, and where they can access it.

Photo shows the Director of GRPA speaking about abortion access in Latin America and the Caribbean.

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