Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations

Abstract

Background. Abortion is the termination of an already established pregnancy. The abortion may be induced, voluntarily performed or spontaneous, but when it is done by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, it is considered unsafe. The Southern African Development Community (SADC) has a robust policy framework for combating unsafe abortion.Objectives. To examine the relationship between abortion laws and access to safe abortion services in the SADC region as an important and necessary yardstick for measuring the progress of a nation in securing reproductive and sexual health. To analyse the relationship between laws governing abortion, abortion and post-abortion national guidance, and access to safe abortion services by adolescent girls and young women.Methods. A desk review of all legal, policy and national guidelines for all 16 SADC member states was done. Secondary data were collected, and the knowledge, attitudes and practices reflected on abortion surveys were examined in 15 out of 16 of the member states in both rural and urban settings. Sixty-three focus group discussions were held across 15 out of 16 countries, and 127 key informant interviews were held with non-governmental organisations, government ministries and relevant departments in the 15 countries.Results. Countries with restrictive abortion laws are more likely to have a relatively high proportion of unsafe abortions. The results indicated a proportion of unsafe abortions ranging from 43% to 79% for those countries where the legal framework does not lend itself to ease of access. Liberal abortion laws and guidelines do not necessarily mean a reduced incidence of unsafe abortions, especially for adolescents, girls and young women. Multiple barriers still exist in practice. Conclusion. Limits and bounds of the law as a tool to enhance safe abortion exist. The importance of alignment of laws, policies and practices is noted, recognising that all may influence and affect access to safe abortion, and in turn, sexual reproductive health rights for women and girls.