A Youth Activist's Guide to Safe Abortion Advocacy by Youth Coalition

ACKNOWLEDGMENTS Thank you to all of the members of the Youth Coalition who helped in the writing and reviewing of this guide. The authors would also like to thank Emily Turk, Communications and Outreach Officer, for her help in the design and editing of this publication, and Laura Villa Torres for her valuable assistance. As well, a large thank you goes to Ipas for their generous financial support of the publication of this book.

- Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy – A Publication of: The Youth Coalition Suite 405, 260 Dalhousie Street Ottawa, Ontario K1N 7E4 Tel +1 (613) 562-3522 Fax +1 (613) 562-9502 E-mail: admin@youthcoalition.org Website: www.youthcoalition.org Copyright © 2007 The Youth Coalition This publication may be reproduced in whole or in part for educational or nonprofit purposes without special permission from the copyright holder, provided that acknowledgment of the source is made. The Youth Coalition would appreciate a copy of any document that uses this publication as a source. No part of this publication may be used for commercial or resale purposes. The contents of this booklet solely represent the opinions of the authors and not necessarily the views or policies of its financial contributors.

Freedom of Choice A Youth Activist’s Guide to Safe Abortion Advocacy

By Pamela Pizarro, Tanya Baker, Joana Chagas, María Eugenia Miranda & Nadia Ribadeneira González

TABLE OF CONTENTS Introduction

Chapter 1 Governing Abortion: Global Abortion Policies

Chapter 2 Access to Safe Abortion Care

Chapter 3 Abortion and Human Rights

Chapter 4 Mass Media, Abortion and Sexual and Reproductive Rights

Conclusion

Bibliography

About the Authors

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

INTRODUCTION The Youth Coalition for Sexual and Reproductive Rights (YCSRR) is an international network of young people that works to increase access to, and quality of, sexual and reproductive health and the rights of adolescents and young people throughout the world. The Youth Coalition envisions a world where the diversities of all young people are respected and celebrated, and where they are empowered and supported to fully and freely exercise their sexual and reproductive rights. Sexual and reproductive rights are human rights, and therefore apply equally to young people. Young people have a valuable contribution to make to society and must be given ample opportunities to voice their needs and opinions in all policy and decision-making processes in a way that is respected and fully incorporated. The Youth Coalition also believes that all women, irrespective of age, have the right to access medically safe and legal abortion care. Unplanned and unwanted pregnancies are a common situation faced by women throughout the world. Many circumstances put women in situations where they have to make a decision regarding whether or not to continue their pregnancies. Ethical, legal, medical and social situations can influence a woman’s decision. However in the end, regardless of the legal or moral prohibitions, or the lack of economic or social resources, millions of women decide to electively terminate their pregnancies even if it runs the risk of costing them their lives. Advocating for Choice Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy is a guide for young people, individuals who work with young people, leaders, or advocates for any issue related to sexual and reproductive health and rights, who would like to improve their information, knowledge and skills related to advocating for safe abortion care services. This guide intends to: -

Discuss the state of abortion legislation around the world, and how different restrictions affect access to abortion care for young women; Give an overview of important human rights arguments that can be used when advocating for safe abortion care services; Look at access to safe abortion care services around the world, as well as the impact of unsafe abortion; Relate tips on how to deal with the media and the opposition; 1

Freedom of Choice: A Youth Activistâ&#x20AC;&#x2122;s Guide to Safe Abortion Advocacy

Demonstrate how to use the information contained in each chapter to advocate for safe abortion care services.

The sexual and reproductive rights movement faces its biggest challenge when it comes to abortion. In many countries, as we will review in Chapter 1, abortion is illegal, or is limited to specific circumstances. Yet, in other countries where abortion has been decriminalized, access is not guaranteed by the state. For these reasons, the two main challenges when advocating for safe abortion are: 1) liberalizing the legislation in those countries where abortion is restricted and 2) guaranteeing access to comprehensive abortion care for all women. The task is not easy, and we, as young people and as youth advocates, need to be prepared to take action in this area. Advocacy is a complex process that has the principal purpose of changing specific situations affecting a specific group of society. Mapping the situation of abortion in our own countries, reviewing international and local legislation in the field, developing power maps, and building effective messages are just a few of the activities and skills we need to develop in order to have a clear and effective advocacy process. By advocating for law reform and equal rights, pro-choice advocates are fighting to give women the opportunity to make autonomous choices and to exercise their sexual and reproductive rights.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

CHAPTER 1

Governing Abortion: Global Abortion Policies By Pamela Pizarro, Canada

Introduction Around the world there are many laws and policies governing abortion. Most of these are meant to limit the circumstances under which a woman may access safe abortion care, and a few restrict access altogether by making abortion completely illegal. Abortion laws in different countries fall into seven general categories based on the conditions under which an abortion can be legally provided; sometimes these categories overlap (for example, a law may permit abortion to preserve physical and mental health and in cases of rape and incest): 1. 2. 3. 4. 5. 6. 7.

Completely illegal under any circumstance or only to save the life of the pregnant woman Preservation of a woman’s physical health Preservation of a woman’s mental health Pregnancy resulting from rape or incest Suspicion of foetal impairment Unwanted pregnancy for economic or social reasons Available on demand and without restriction1

In some instances, abortion laws are decided at a regional (e.g., provincial or state) or local level rather than a national one. For example, in Mexico, each state can determine its own abortion laws with its own restrictions, meaning that women across the country do not have standardized access to abortion. In the United States, federal law guarantees a woman’s right to abortion, but some states where legislatures do not support abortion impose restrictions (such as parental involvement requirements) or will not fund women’s clinics that offer safe abortion care. Currently, 40.5% of the world’s women live in countries where abortion is available without restriction2. This means that nearly half of the world’s women live in countries where they should theoretically be able to access safe abortion regardless of the reason behind their decision. In practice, however, access to safe abortion is often complicated by obstacles such as: waiting times between 1

United Nations Population Division, Department of Economic and Social Affairs, Abortion Policies – A Global Review, Explanatory Notes, 2001. 2 Center For Reproductive Rights, The World’s Abortion Laws: Categories of Abortion Laws from Most to Least Restrictive, 2005.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

consultation and abortion, having to go before a medical committee to explain why they want to have an abortion, requirements to undergo counselling before having the procedure, and gestational limitations (weeks of pregnancy). Worldwide, 59.5% of women live in countries that restrict abortion on some grounds, with a full 26% (of the nearly 60% who live with restrictions) of women living in countries where abortion is completely illegal or allowed only in order to save a woman’s life3. Regrettably, even these statistics do not accurately reflect the state of abortion access since many physicians refuse to perform abortions even when there is grave danger to a woman’s life. Physicians may also refuse to provide care citing conscientious objection or fear of being legally prosecuted. Nearly every country in the world has abortion codified in some way under its laws. This means that in every country some form of abortion can be: • illegal and a punishable criminal offence; • illegal but not a punishable criminal offence; or • legal under certain circumstances that are stipulated by the State as qualifying for safe abortion care. Abortion laws can not only stipulate punishments for women who have had an induced abortion, but also for the health-care professionals who provide them, as well as for any other individuals who provide assistance (for example, those who help women locate or access abortion care). The legality of abortion, and the circumstances under which it is a punishable offence, differ in each nation. For example, in a country like Nicaragua where abortion is illegal with no exceptions, safe abortions cannot be performed under any circumstances, even if the life of the woman is in danger; in Indonesia, abortion is not allowed unless it is to save a woman’s life. In contrast, Sweden’s laws allow abortion under many circumstances, including risk of harm to the mental and/or physical health of the woman, and socio-economic reasons. In some countries, abortion may either be illegal or legal only under certain circumstances, but the procedure has been de-criminalized. For example, if a woman were to obtain an abortion under a circumstance that is not clearly defined by law (for example, for socio-economic reasons in a country that does not have this exception), there is no legal punishment for her action or in other words she would not be sent to jail for her actions. Canada is the only country in the world where no abortion legislation exists. In 1988, the Supreme Court of Canada struck down the law that criminalized abortion, declaring the law to be

Ibid.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

unconstitutional because it infringed upon a woman’s right to “life, liberty, and the security of the person”.4 The laws of many countries specify the process a woman must follow in order to obtain a legal abortion. This can include mandatory waiting times, parental or spousal consent laws, stipulations on who can perform the abortion, gestational limitations, and whether or not the service is paid for by the state. In France, for example, abortions are available under any circumstance. However, abortions are only allowed up until 12 weeks’ gestation and only after a 7-day waiting period. Additionally, pre-abortion counselling is obligatory in France, but only for minors under 18, even though they do not need parental consent for abortions.5 In Turkey, a married woman must obtain her husband’s authorization prior to obtaining an abortion; however, a single woman is not required to have her partner’s consent.6 For young women and youth, accessing abortion services is considerably more complicated. In many countries, even those with “liberal” abortion laws, there are age restrictions, mandatory reporting to parents and the reluctance to take young women’s requests for abortion seriously. Many women who become pregnant at an early age are scared that if they visit a doctor or ask about abortion services, their parents will find out. This fear can cause young women to resort to unsafe abortions under unsanitary conditions and/or with unskilled practitioners. This chapter will examine what types of abortion laws exist, and where young pro-choice activists can advocate for change. The various laws and clauses examined can highlight effective advocacy points for youth activists, with the ultimate goal being to have abortion laws free from any restriction that impedes a woman in accessing safe abortion care. Background Recently, there have been many articles from the medical and international development communities describing how illegal and unsafe abortions affect women’s health and longevity. By making abortion illegal, governments are endangering the lives of a significant portion of their population, not to mention ignoring the long-term effect of women’s death and disability from unsafe abortions on the population at large. In their 2006 “Sexual and Reproductive 4

Canadians for Choice website, “Historical Background,” (Retrieved January 2006), http://www.canadiansforchoice.ca/historicalbackground.html. Pinter, B., et al., “Accessibility and Availability of Abortion in Six European Countries”, The European Journal of Contraception and Reproductive Health Care (10.1: March 2005), 54. 6 Ibid., 56. 5

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Health Series”, The Lancet medical journal described unsafe abortion as “the preventable pandemic”.7 One article estimated that 19–20 million unsafe abortions take place every year, with 97% taking place in developing countries.8 The authors also estimated that 68,000 women die every year from unsafe abortions (which translates into roughly 8 every hour), while many more are injured during unsafe or illegal abortions.9 However, it should be pointed out that illegal abortion does not automatically mean unsafe abortion. In some countries, women who are in a position to pay more for the procedure can have access to safe abortion care. It is largely women who cannot afford to pay for the services that suffer the effects of unsafe illegal abortions. Many countries around the world have laws on abortion that date back to colonial rule. Many nations that were colonized tend to maintain the colonial laws that made abortion illegal. Today, most countries with liberal abortion laws are in North America, Western and Eastern Europe, and parts of Asia. However, there are exceptions, such as South Africa, which has safe abortion available without restriction, and Poland, which only allows abortion to preserve a woman’s physical health. In the latter case, women cannot even be sure that they can obtain such legal abortions. For example, Polish physicians refused to give one woman a legal abortion even though carrying her pregnancy to term worsened her deteriorating eyesight; she finally had to take her case to the European Court of Human Rights to obtain compensation.10 One of the most hazardous obstacles facing women today is restricted access to safe abortion care. In many countries where abortion is free from numerous legal restrictions, the lack of access prevents many women from obtaining safe abortions. In Canada, for example, there is no federal law against abortion and there are no limits on terminations according to the gestational time of the foetus; nevertheless, health care is managed provincially and many local governments restrict access to abortion by not funding these services in hospitals. Furthermore, in areas that are remote or rural, women often do not have a choice about where to go for medical help. This means that if an antichoice doctor is servicing the area, women could be intimidated into unwanted pregnancies or into having unsafe and clandestine abortions that could cost them their health or lives. The impediments to accessing abortion services and how it affects young women will be covered in Chapter 2. 7

Grimes, D., et al., “Unsafe abortion: the preventable pandemic.” The Lancet (Nov 2006), 1. Ibid. Ibid. 10 Center for Reproductive Rights, “CENTER FOR REPRODUCTIVE RIGHTS APPLAUDS LANDMARK ABORTION DECISION BY EUROPEAN COURT OF HUMAN RIGHTS”, Press Release (March 20, 2007), http://cmiskp.echr.coe.int/tkp197/view.asp?action=html&documentId=814538&portal=hbkm&source=externalbydocnumber&table=F 69A27FD8FB86142BF01C1166DEA398649. Federation for Women & Family Planning, Poland, Polish Repro news (2:21, March 20, 2007), http://Hwww.federa.org.plH. 8 9

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Definitions of Restrictive Laws The introduction of this chapter mentioned that abortion laws could be classified into 7 – sometimes overlapping - general categories. Below we will examine each one in detail. I. Completely Illegal or Only Allowed to Save a Woman’s Life Throughout the world, the most common exception to laws that penalize abortion is when an abortion is permitted to save a pregnant woman’s life. Some countries may explicitly state what they consider to be life-threatening situations, but in general it is left up to the physician(s) performing or approving the abortion to make that decision. The only countries that do not have any exceptions to their abortion laws are: Chile, Malta, El Salvador, and most In the countries with this type of abortion law or recently, Nicaragua.11 restriction, it is extremely difficult to obtain a safe abortion. Physicians are often unwilling to perform abortions even if it is medically necessary. This is also the most dangerous type of law as it forces women into unsafe situations. In countries where induced or elective abortions are punishable by law, many women turn to unsafe methods to end their pregnancies. Because these methods are often performed by untrained individuals, oftentimes in unhygienic conditions or with unsafe instruments or drugs, or because women self-induce abortions, women who have undergone unsafe procedures frequently end up seeking emergency care in hospitals or other health facilities. Here they can be reported for inducing an abortion and can be reported to authorities. This situation obviously discourages women from seeking appropriate medical attention and may lead to high numbers of maternal mortality or morbidity in some cases. However, in the case of Chile, although abortion is illegal, women rarely die due to the complications of unsafe abortions because of the high level of emergency medical care that they can access. Nevertheless, this is more of an exception than a rule. II. Preservation of a Woman’s Physical Health This indication for abortion permitted by law allows women to access safe abortion care when it is necessary to preserve their physical health. The term “physical health” is open to a variety of interpretations, with some countries having narrow definitions and a list of conditions that they consider to fall under this term, and other countries having no set definitions and thus allowing room for interpretation. In some countries, the term “health” is not specifically limited to physical health and may encompass mental health as well; in this case, abortion is allowed for any threat or risk of injury to the pregnant woman’s 11

Abortion Policies – A Global Review, op. cit.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

overall health. Although this exception to the term health is uncommon, it is a ground on which many women have challenged abortion laws. 12 III. Preservation of a Woman’s Mental Health In many countries, legal abortions may be obtained when pregnancy endangers a woman’s mental health. Definition of the term “mental health” varies from country to country, with most British Commonwealth countries including: emotional distress caused to existing children, and/or emotional distress caused to the pregnant woman as a result of her situation. This allows for abortions based on socio-economic grounds. As well, many countries that permit abortions on the grounds of mental health follow the ruling of the British Courts in Rex v. Bourne, which states that although a law may not specifically allow abortions for physical or mental health reasons, abortions performed for either reason are considered lawful.13 IV. Unwanted Pregnancy Resulting from Rape or Incest This indication for legal abortion allows women to obtain safe abortion care when they have suffered rape or incest. This indication for abortion permitted by law is very common throughout the world; some countries name rape and incest specifically in their laws, while others only mention “criminal offence” in the law, thus allowing abortions to be sought under other circumstances such as statutory rape. However, some countries require that a woman first contact the police to bring charges against the rapist in court before they are granted permission for an abortion. This requirement is extremely detrimental and discourages many women from trying to obtain legal abortions. In other cases, authorities place the burden of proof of rape or incest on the woman, or take a long time in filing the necessary documents, causing women to be unable to obtain abortions due to gestational time limitations.14 V. Foetal Impairment Some countries allow women to obtain legal abortions if there are foetal impairments. The term foetal impairment is open to interpretation and each country has its own list of what constitutes such impairment. In general, foetal impairment “refers to the existence of life-threatening or serious anatomical signs that will lead to either an impaired quality of life or at worst lethal anatomical malformations which renders the foetus unable to survive outside a pregnant woman’s body.” 15

12 13 14 15

Ibid. Ibid. Ibid. Wikipedia Online Encyclopedia, http://en.wikipedia.org/wiki/Foetal_impairment.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

VI. Economic or Social Reasons Legal permission to terminate a pregnancy for economic or social reasons varies greatly among countries that have this indication for abortion. Some countries specifically mention social or economic conditions that may qualify. For example, in Barbados, the abortion law specifies that in determining whether the continuation of the pregnancy would involve a risk of injury to the health of the woman, the medical practitioner must take into account the “pregnant woman’s social and economic environment, whether actual or foreseeable.” In New South Wales, Australia, reference is made to social or economic stresses. Other countries, such as Burundi and Ethiopia, do not permit abortions on social and/or economic grounds, but allow the reason to be taken into consideration when sentencing a woman who has obtained an abortion illegally. In the case of Ethiopia, there was a review of the country’s criminal code in 2005, which included a revision of its abortion legislation. In this revision there was inclusion of abortion permitted for minors who are physically or psychologically unprepared to raise a child.16 Most countries that have laws that take social and economic grounds into consideration allow for very liberal interpretations of the law, and in practice are very similar to countries where abortions are available on request.17 VII. Availability upon Request: Abortion Permitted on all Grounds Countries with laws that permit abortion upon request do not ask the woman to qualify her decision. In these countries, women must only find a physician that is willing to perform the abortion. Some countries, such as Albania, France and Belgium, require the woman to state that she is in a situation of crisis or distress. However, in many countries with the most liberal abortion laws, gestational time limits are imposed, often making abortion available only in the first trimester. After this time, a woman must present a “valid” reason for terminating her pregnancy.18 Even if a country has laws and policies that allow abortion under any circumstance, this does not mean that the government will take the responsibility to ensure that safe abortion care is accessible or available. In other instances countries allow for regulations that restrict access to abortion care by applying some of the conditions explored below. How Do These Restrictions Impact Youth? All of the situations described above are situations in which abortion is permitted by law. However, young and adolescent women may have more difficulties in

16 17 18

Ipas website (Retrieved April 25, 2007), http://www.ipas.org/english/press_room/2005/releases/06072005.asp. Abortion Policies – A Global Review, op. cit. Ibid.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

accessing legal abortions because of added stipulations regarding consent, mandatory reporting to parents, cost and other restrictions. Consent Laws Abortion consent laws require that women be of a certain age in order to give consent to an abortion. Consent conditions, which vary from country to country and even within regions of the same country, mean that women under 18 or 16 are seen as unable to make an individual choice and must consult their parents or guardians when seeking an abortion. As we will see in Chapter 3 on abortion and human rights, there are many international treaties that govern sexual and reproductive health. In terms of adolescents’ ability to make their own decisions, the United Nation’s Convention on the Rights of the Child addresses young people under the age of 18, and it distinguishes that while parents have the right to make decisions in regards to their children’s welfare, parental rights should be balanced with the evolving decision-making capacities of the child.19 This means that although parents have rights over their children, their decisions should not take precedence over the decision of a minor who is capable of making it. Therefore if a young woman has taken the decision to seek an abortion free from coercion, then her decision supersedes the wishes of her parents. Mandatory Reporting to Parents In keeping with consent laws, mandatory reporting to parents implies that women under a certain age must fully inform their parents of their pregnancy and their decision to obtain an abortion. In some cases, parents must be present when a young woman or adolescent obtains an abortion. Waiting Periods Although not specific to young women, some countries have mandatory waiting periods from the moment a woman requests an abortion to the moment it is performed. In some countries it can be 24 hours, while in others it can be as long as 5 days or a full week. This waiting time is proposed as a way to give a woman time to think over her decision. However, in reality, it means that women may have to travel more than once to access abortion services, and must spend more time and money that they may not necessarily have. Women who live in rural areas generally have to travel to urban centres to find a healthcare provider willing and/or able to perform the procedure. By imposing a waiting time, this may incur greater costs, and if they hope to undergo the abortion without having a partner or family know, it may raise the risk of 19

Ahumada, C. and Kowalski-Morton, S., A Youth Activist’s Guide to Sexual and Reproductive Rights (2005), 11.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

discovery. Often, waiting periods are not necessarily about allowing a woman the time to “think over” a decision, but rather to give her the chance to “repent” and change her mind, or to keep her from accessing services.20 Payment In some countries, where abortion is legal, services are covered by the state. This is usually in the case of countries that have state sponsored health-care systems. However, in many countries, government support for safe abortion care, even if abortion is legal, is non-existent and women are required to cover the cost of care themselves. Payment restrictions mean that poor women, often young or adolescent women with little personal income or economic means, are unable to pay for needed services. For example, it may be difficult for young women, who are not covered by health care, to earn income and pay for abortion care while going to school or working in the home. Location and Lack of Providers Many countries also restrict who can perform an abortion and in which type of facility it can be performed. For example, in The Netherlands, general practitioners are able to perform safe abortions in separate clinics. In contrast, other countries specify that only doctors specifically trained in abortion care can perform the procedure, or that abortion services can only be obtained in hospitals or operating rooms. While health facilities must guarantee adequate and appropriate equipment and spaces, unnecessary facility requirements are also sometimes imposed. Conclusion Women around the world are faced with many barriers and restrictions when they try to access safe abortion care. In most cases these barriers are built into the laws of a county. For young women, abortion laws often not only define the age at which they can access services but may also demand that they inform their parents of their decision. Young people already have hindered access to sexual and reproductive health services, and when facing unwanted pregnancies, the restrictions imposed on women due to their age may make it impossible for them to access safe services, even if abortion may be legal in their country. It is crucial that laws take into consideration that young women have the capacity to make informed decisions. Two-tiered laws, which restrict access on 20 Center for Reproductive Rights, Crafting an Abortion Law that Respects Women’s Rights: Issues to Consider, Briefing Paper (August 2004).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

the basis of age, are specifically discriminatory to young women. Other, more general restrictions tend to impede young women’s access to safe abortion care, because they face more economic barriers than older women. Abortion laws can make abortion illegal with specific exceptions, or legal under certain circumstances. When a country criminalizes abortion, the need for women to access safe abortion care is not acknowledged. The need for abortion services does not disappear once a country decides to make abortion totally illegal. Instead, it places women in desperate situations where they may risk their lives by undergoing unsafe abortions. Universal access to safe abortion care should be a right enjoyed by all women, regardless of their age, ethnicity, or circumstance. Advocacy Tips: What Can I Do?

•

Find out about the law concerning abortion in your country. For which indications is it illegal or legal? Are there any restrictions? If you feel that the law in your country impedes a young woman’s ability to access abortion services, start researching ways in which to influence a progressive change in the law.

•

Research a case in your country where a woman has been denied an abortion. Has she been denied her rights, even though abortion is legal in certain circumstances in your country?

•

Research a case in your country where a woman has successfully challenged the abortion law in order to obtain a safe abortion. How can you use this case to change the law? Can you use this case to start lobbying decision- and policy-makers for a change in the law? Find out if there are any groups working to challenge the abortion laws in your country and get involved!

•

Join an abortion advocacy group. Usually there are groups of women who are trying to mount a challenge to restrictive abortion laws.

•

One organization that supports the autonomy of women over their own bodies and supports women’s reproductive rights is Ipas. They can provide you with advocacy resources (documents, statistics) and information about the training of providers and advocates, etc. Similar organizations include the International Planned Parenthood Federation

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

(IPPF), local family-planning clinics and associations, feminist groups, and the United Nations Population Fund (UNFPA) offices. To get more information you may want to consult the following websites: Ipas - http://www.ipas.org/ IPPF – http://ippf.org/ UNFPA - http://www.unfpa.org/ WHRnet - http://www.whrnet.org/

•

Contact your country’s Ministry of Health. Inform them that you think that unsafe abortion is a serious threat to women’s life and that it is a public-health concern that must be taken seriously.

•

Contact your local government representative. Tell him or her that you think that your government should do more for women’s reproductive rights and that they should take the initiative to legalize abortion or strip away any restrictions that impede access to safe abortion care.

•

If your country has progressive or liberal abortion laws, research how this change happened. See if this process of change can be used to change laws in other countries that restrict abortion.

•

Start your own reproductive rights group. Using this guide, invite other young people or youth allies to a discussion on abortion and talk about the myths and challenges surrounding abortion. Discuss the abortion laws in your country and how they are hurting or supporting women’s health. Find ways for your group to get involved in pro-choice and equality movements: you could attend workshops relevant to the issue, research and write fact sheets about regional obstacles or initiatives, start a consciousness-raising group, or broaden your mission and ask other organizations that work in the field of sexual and reproductive rights to join you in discussing crosscutting issues (such as LGBTQ, gender, and social violence issues).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

CHAPTER 2

Access to Safe Abortion Care By Tanya Baker, Canada/Trinidad and Tobago

Introduction Decriminalization and legalization of safe induced abortion is an important aspect of abortion advocacy. However, often the legal status of abortion may mean little for protecting women’s health or supporting their human rights. In fact, the legal environment does not necessarily affect the incidence of abortion, but rather how a woman will end an unwanted pregnancy or how safe the procedure will be.21 Since abortion is a medical procedure, it is part of a country’s broader health system, which may already have significant barriers for women who want to access health services. In many countries where abortion laws are liberal, such as India, safe abortion services are still not readily accessible.22 Safe abortion, which involves a trained and properly equipped health-care provider under sanitary conditions, is one of the safest medical procedures.23 The provision of safe abortion care (SAC) is an essential medical treatment for any health system, not only to induce an abortion when the law permits, but also to treat complications from unsafe or spontaneous abortions. Spontaneous abortions, also known as miscarriages, are a common occurrence ending approximately 15% of all pregnancies; induced abortions end roughly another 22% of all pregnancies.24 In order to reduce the mortality rate of young women due to unsafe abortion and improve their lives, health systems must be able to effectively manage SAC, which comprises three elements:25 1. 2. 3.

Safe induced abortion for all indications permitted by law Treatment of abortion-related complications Provision of post abortion contraception.

Unsafe Abortion: An Overview Abortion has been present throughout history, sometimes as the only means of fertility control; accordingly, many providers and techniques have emerged over 21

Rao, K. A. and Faundes, A., “Access to safe abortion within the limits of the law.” Best Practice & Research Clinical Obstetrics & Gynaecology (2006). 22 Duggal, R. and Ramachandran, V., “The abortion assessment project-India: Key findings and recommendations”. Reproductive Health Matters, (2004). 23 World Health Organization (WHO), Safe abortion: Technical and policy guidelines for health systems, 2003. 24 Rogo, K., “Improving technologies to reduce abortion-related morbidity and mortality.” International Journal of Gynecology & Obstetrics (2004). 25 Healy, J., et al., “Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services”, International Journal of Gynecology & Obstetrics (2006).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

the years. The World Health Organization (WHO) defines unsafe abortion as “a procedure for terminating an unintended pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both”.26 The procedure is associated with high rates of poor health outcomes, including death, and a significant strain on over-burdened health systems. Unsafe abortion primarily imperils women in developing countries. Conversely, legal abortion in industrialized countries has minimal hazardous outcomes or complications, and almost no risk of death.27 The statistics are disturbing28: • 19–20 million unsafe abortions take place annually all over the world. • About 68,000 women die every year due to unsafe abortion, representing 13% of all maternal deaths; many more are permanently injured. • Although rates according to age vary by region, generally young women, between 15 and 25 years, are disproportionately affected by unsafe abortion. • In many countries, 50% of the hospital obstetric/gynecological budget is allocated to the treatment of unsafe abortion. Figure 2.0 Global and regional estimates of number of unsafe abortions and of mortality due to unsafe abortion, around the year 200029

World Health Organization (WHO), 207. Grimes, 204. World Health Organization, “Unsafe abortion: Global and regional estimates of incidence of unsafe abortion and associate mortality in 2000”, (2004). 29 Ibid. 8. Note: Figures may not exactly add up to totals because of rounding; * Japan, Australia and New Zealand have been excluded from the regional estimates, but are included in the total for developed countries; ° no estimates are shown for regions where the incidence is negligible. 27 28

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

It is important to be familiar with some public health concepts, such as mortality and morbidity, in order to understand the impact of unsafe abortion on women’s health. I. Mortality A death due to an unsafe abortion is categorized as a maternal death. Maternal deaths are recorded or deduced to give a number of deaths in a given area, using the term maternal mortality. The exact definition from the International Classification of Diseases defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”30 Although this definition may be helpful for epidemiologists who monitor health trends and statistics, the 42-day mark is actually arbitrary and the associations with using the term ‘maternal’ have far-reaching implications.31 In the social sphere, maternal is associated with motherhood, not specifically pregnancy. Many women, especially young women, seeking a termination of pregnancy do not wish to be associated with the term or concept of motherhood at the time. Rather they choose not to be a mother, to be a mother at a later date, or to be a healthier mother to her current children; in any case, they are women with their own agency separate from being a mother. Furthermore, when deaths due to unsafe abortions are grouped within a broader category of maternal mortality, the underlying cause of the death is not readily apparent, making the social, legal and political implications easier to ignore. Consequently, we recommend using the more scientifically accurate terms: • • • •

Death due to unsafe abortion Unsafe abortion mortality Pregnancy-related death Pregnancy-related mortality

Improving maternal health by reducing maternal mortality is Goal 5 of the Millennium Development Goals, which were agreed upon by all UN (United Nations) Member State leaders in 2000.32 Reducing the number of unsafe abortions is inherent in this Goal; however, measuring abortion-related deaths is difficult. In general, pregnancy-related mortality is difficult to measure due to lack of vital registration systems and many deaths occurring outside of hospitals. 30

World Health Organization (1992), 208. World Health Organization, “Maternal mortality: The measurement challenge”, (2001), https://www.who.int/reproductivehealth/publications/maternal_mortality_2000/challenge.html. 32 United Nations Millennium Development Goals, www.un.org/millenniumgoals/goals.html. 31

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Abortion-related mortality is further undercounted due to its illegal and clandestine nature, which promotes powerful disincentives for reporting. Thus, decriminalizing abortion is an important step towards providing safe pre- and postabortion care. II. Morbidity Morbidity is the term used to designate illness, side effects and poor health outcomes that do not lead to death but that can be life-long and much more common. The risk factors for unsafe abortion mortality and morbidity are the same, associated with an unskilled provider or an unclean/unequipped environment. There are high rates of complications with unsafe abortions, with an estimated 20–50% of women undergoing unsafe abortions requiring hospitalization post procedure.33 The complications associated with unsafe abortion that can lead to long-term poor health include: • • • • •

Uterine perforation and haemorrhage (profuse bleeding) Anaemia (low iron); malaria or HIV infection can worsen the effects of the bleeding Sepsis (infection throughout the whole body) Peritonitis (infection of the uterus/abdomen) Trauma (to vagina, cervix, uterus and abdominal organs).

It is very difficult to determine the rates of unsafe abortion morbidity; however, while an estimated 68, 000 women die yearly from unsafe abortion, millions more are significantly, and oftentimes permanently, debilitated34. These complications must be treated in a health centre with trained personnel, which can take significant health system resources. Young women are at increased risk for developing complications. They tend to undergo an abortion later in pregnancy, for various reasons including lack of finances, social networks and support, information and understanding of the health implications; abortions done after the first trimester (12 weeks of gestation) are considered more difficult and have higher rates of complications. In addition, young women tend to seek treatment for complications later, citing stigma and discrimination and lack of funds, transportation and understanding of when to seek help. Accordingly, young women have unique needs with respect to unsafe abortion.

33 34

Grimes, D.A.,et al., 204. Grimes, D.A., et al., 2.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Young Women and Unsafe Abortion It is important to understand the prevalent ages of women seeking unsafe abortions in order to target interventions and provide effective postabortion care. The age distribution varies widely over regions. In Africa, almost 60% of unsafe abortions are in women under the age of 25, while in Asia it is 30%.35 Figure 2.1, a World Health Organization (WHO) graph, highlights the regional distribution, but generally unsafe abortion continues to be a young women’s issue. Figure 2.1 Per cent of all unsafe abortions, by age group36

Latin America and the Caribbean

Asia

Africa

Developing countries 0%

20%

15-19 20-24 25-49

40%

60%

80%

100%

The Public-Health Perspective It is widely held that many women are dying and disabled due to an understood and preventable cause - unsafe abortion. People working in public health analyze the incidence, risks and causes of death and disability in a population with the primary aim of preventing such an occurrence. However, it should be recognized that abortion will never be entirely prevented because contraceptives are not 100% effective and sexual violence and coercion continue to exist; abortion will still be necessary and provision of SAC should always be accessible. 35

Shah, Iqbal and Elisabeth Åhman, "Age Patterns of Unsafe Abortion in Developing Country Regions", Reproductive Health Matters 12, (No. 24, 2004), 206. 36 World Health Organization website (Retrieved January 21, 2007), http://www.who.int/reproductivehealth/unsafe_abortion/index.html.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

The primary prevention strategy for unsafe abortion is to reduce the number of unwanted pregnancies, primarily through the provision of legal, safe and accessible abortion and the provision of contraception. Broader programs that aim at increasing knowledge and information, such as sexuality education or reducing sexual violence and coercion, also contribute to the primary prevention strategy. Secondly, treatment of the complications that arise from an unsafe abortion must be made available. This is included in the provision of SAC under the limits of the law. Finally, those women who have long-term disabilities associated with unsafe abortion must be treated and cared for. Postabortion care services should also include contraception counseling in order to prevent future unwanted pregnancies, especially in adolescents and young women. All three levels of public health approaches are necessary to address some of the issues associated with unsafe abortion. Access to Care There • • •

are 3 primary dimensions of access to health care: Availability Affordability Acceptability

The following conditions are needed to ensure the availability of SAC for young women: I. Health-care Providers Health-care workers must be able to provide care to young women seeking SAC in a non-judgmental, youth-friendly manner. Furthermore, they must be able to diagnose pregnancy and effectively determine the gestational age of the foetus, which informs them about the methods of abortion which can be safely used. Health-care providers should be trained in surgical and medical (pharmaceutical) methods for inducing an abortion, including treating or referring complications that can arise, primarily haemorrhage and infection. Postabortion provision of contraception and counselling is an important component of SAC, which ideally would be conducted by a peer counsellor or someone trained in the sensitivities of young women’s lives. Midlevel providers such as nurses and midwives have been shown to safely conduct first-trimester abortions (up to 12 weeks’ gestation); however, second-trimester abortions require a specially trained physician.37 37

WHO, 2003.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

II. Equipped Facilities Health-care facilities must meet sanitary standards and be sufficiently and sustainably equipped with necessary medical/surgical supplies (see Fig. 2.2 for methods of abortion): Figure 2.2 Methods of Abortion38

Pharmaceuticals for medical abortion: • Mifepristone – an anti-progesterone agent. Progesterone is a hormone that is needed to keep a pregnancy viable; if mifepristone is used, the continuity of the pregnancy will be interrupted. •

Misoprostol – a prostaglandin analogue, this enhances uterine contractions and helps expel the products of conception. This drug can also be used to treat excessive bleeding from the uterus (haemorrhage).

WHO, Safe Abortion: Technical and Policy Guidance for Health Systems (2003).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Equipment: • Vacuum aspiration - this involves evacuation of the contents of the uterus through a plastic or metal cannula attached to a vacuum source. It can be managed electrically (Electric Vacuum Aspiration EVA) or manually (Manual Vacuum Aspiration- MVA). •

Dilatation and evacuation (D&E) - this involves dilating the cervix with mechanical (laminara) or pharmacological agents (mainly misoprostol) and then using an electric vacuum aspirator and other instruments to evacuate the contents. Dilating the cervix adequately can require 2 hours to one day. This should only be used in the second trimester by a specially trained provider.

•

Dilatation and curettage (D&C) – this involves dilating the cervix and using a sharp metal curette to scrape the uterus. This carries significantly more risk of complications due to infection and haemorrhage than a vacuum aspirator and is no longer recommended in the first trimester.

Postabortion care: • Antibiotics - used to treat bacterial infections, including some sexually transmitted infections. Routine use post-procedure is recommended; however, an abortion should not be denied if antibiotics are unavailable. •

Contraceptives - used for post-abortion care, can include short- or long-term contraceptives.

Pain management: • Pain management should be available but is not mandatory for early abortions. Options include oral painkillers and local anaesthetic (numbing) around the cervix. General anaesthesia (being put to sleep) is not generally recommended but can be considered under special circumstances such as an abortion following rape. Pain management also includes emotional and verbal support throughout and following the procedure. Other resources: • Ultrasound (optional) - this technology projects sound waves onto a computer screen to give a picture of the contents of the uterus. This is a helpful tool to determine the gestation of the pregnancy or whether all uterine contents have been effectively removed. 21

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Ultrasound technology should be available in a centre that offers comprehensive SAC. It is recommended that there be a minimum of 5 facilities per population of 500,000 that offer SAC, one of which can offer more comprehensive SAC (see text boxes below).39 Functions of Basic SAC services

Functions of Comprehensive SAC services

Available during regular outpatient hours: • Perform induced abortion for uterine size < 12 weeks for all legal indications • Provide postabortion contraception

Perform all basic SAC functions

Available 24h per day, 7 days per week • Administer essential antibiotics • Administer intravenous replacement fluids • Administer oxytocics • Perform removal of retained products for uterine size < 12 weeks • Provide postabortion contraception

Available during regular outpatient hours • Perform induced abortion for uterine size > 12 weeks, for all legal indications Available 24h per day, 7 days per week: • Perform removal of retained products for uterine size > 12 weeks • Perform blood transfusion • Perform laparotomy

Roads and Transportation Since complications from an abortion can arise suddenly and constitute a medical emergency, the length of time required to reach a facility that provides SAC is crucial. Also, delays in accessing SAC can postpone procedures to a later gestation, increasing the risk of complications. UNICEF defines access to health services as the “percentage of the population that can reach appropriate local health services by the local means of transport in no more than one hour”.40 Effectively distributing the centres that provide SAC and improving roads and transportation will help improve access to services. Knowledge and Information Young women must be aware of when and how to access safe abortion services when needed; this includes an understanding of: • 39

what an abortion is;

Healy,J., et. al., “Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services”, International Journal of Gynecology & Obstetrics (95.2, November 2006), 200. 40 UNICEF, 1996.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

• • • • • • •

who conducts it; when it is allowed under the law; when is the safest time to obtain an abortion; what are the indications to seek treatment from complications arising from an abortion; where are the facilities that provide SAC located; what are the times of operation; what are the costs associated, etc.

This information needs to be provided in a clear, comprehensible, friendly manner that is readily distributed to, and accessible to young people. Health-care providers must also be aware of their national laws governing legal indications for inducing an abortion and the consent laws pertaining to minors or spouses. If parental involvement is required, they should inform young women about exceptions, such as judicial bypass procedures, and how these exceptions can be obtained. Patients must be informed and supported to provide SAC to the full extent permitted by law.

Symptoms that could indicate complications resulting from unsafe abortions: • • • • • • •

Bleeding that lasts longer than 2 weeks Fever, chills, weakness, nausea, vomiting, muscle aches Tenderness when pressure is applied to the abdomen Abdominal pain Cramping, backaches Prolonged or heavy bleeding Foul-smelling discharge from the vagina Delay in the return of menstruation for more than 6 weeks

When young women want to undergo an • abortion outside the law there is little information regarding the safety and training of illegal abortion providers. Furthermore, such services often cost a significant amount, and the young women and provider may live in fear of being caught and penalized. Affordability of Safe Abortion Care Cost of Services SAC costs money, which often requires the woman to pay for some or all of such care. Unsafe abortion is firmly rooted in deep social and economic inequalities.41 In countries where abortion is severely restricted, wealthy women may still be able to pay for SAC while poor women may have to use an untrained provider and/or unhygienic conditions. Governments must be held accountable to their

Gasman, N., et al., “Abortion, social inequity, and women's health: Obstetrician-gynecologists as agents of change”, International Journal of Gynecology & Obstetrics (94.3, September 2006), 310-316.

Freedom of Choice: A Youth Activistâ&#x20AC;&#x2122;s Guide to Safe Abortion Advocacy

citizens for essential medical procedures such as SAC, and in efforts to reduce maternal mortality and improve womenâ&#x20AC;&#x2122;s health. Young women are even less likely to be able to afford safe abortion services due to their restricted economic and social independence. Alternative payment/financial schemes must be developed to ensure that costs for services or transportation to the health centre are not the leading barrier to accessing SAC. Social health insurance, community-based health insurance, donor-funded non-governmental organization services and vouchers can all play a role in reducing barriers associated with cost. Commodities/Supplies SAC requires a sustainable supply of medical commodities including pharmaceuticals and equipment. In 2005, WHO added mifepristone and misoprostol to the essential medicines list, which advises governments on which drugs doctors should have available. As a result, these medicines along with antibiotics, painkillers and contraceptives should be readily and cheaply available within a national health system. Safe abortion equipment is also a necessity; the safest and most economical for all settings is the Manual Vacuum Aspirator (MVA). Some MVA equipment can be sterilized and reused, depending on manufacturing and local regulations. Acceptability of Safe Abortion Care Even when SAC is available and affordable, young women still may not access such services due to a perceived or real mistrust of the care provided42. SAC may not adequately address the underlying issues associated with the need to seek such care, including sexual violence, coercion or the need for sexual and reproductive health counselling. Some health-care providers discriminate against unmarried sexually active young women, while others may not respect the requirement of privacy and confidentiality. Policies and training must also incorporate non-discriminatory, youth-friendly services as part of a comprehensive sexual and reproductive health package. Quality of care is also an important factor. Many health systems and health-care professionals are working beyond capacity, which diminishes the quality and consequently, the acceptability of such care. More resources must be added to strengthen health systems and increase the number of health-care providers. In addition, the training that medical providers receive is primarily focused on physiology and treatments; there is little focus on the gendered and human 42

World Bank, 2003.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

rights aspects of the care that they provide. Consequently, it can be more difficult to build capacity on the social issues associated with abortion in traditional or rigid hierarchal institutions. Additionally, social and cultural norms can pose a barrier to acceptability of receiving SAC. More efforts should be made to discuss issues surrounding abortion with communities and governments. Conclusion Improving access to health services is difficult and complex with a number of actors and a significant amount of resources required. The barriers to providing SAC to young women are further compounded by the controversies and social stigma associated with such an issue. In many countries there are currently a number of health-sector reforms that are reviewing how to improve and strengthen health systems, where to allocate finite resources and which care packages are considered essential. Accordingly, it is an important time to advocate for the inclusion of comprehensive SAC into the health-sector reforms of your country. This can be done by teaming up with health-care professionals, health-care policy-makers, women’s health activists, community leaders and young people.

Advocacy Tips: What Can I Do? These advocacy points, actions and messages are specifically designed to help you advocate to professionals, policy makers or activists in the areas outlined below. However, in order to build stronger advocacy messages, it is an excellent idea to build partnerships with professionals or other advocates working specifically in these fields. ► Health-care Professionals Work with local professional health associations such as the obstetrics/gynaecology association or midwifery association to advocate for: • • •

Adequate training of health-care workers to provide SAC Sustainable and dependable medications and equipment for the provision of SAC Mifepristone and misoprostol should be included on the national essential medicines list 25

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

• •

Postabortion contraceptives should be readily available and offered Further training of health-care workers providing SAC in providing nonjudgmental, youth-friendly services, counselling and comprehensive care (including violence and STI prevention), gender and human rights Expansion of health-care providers’ knowledge and understanding of the laws and policies regulating provision of SAC and limits of using the conscientious objection clause (which is not applicable when the women’s life is at risk) Increase statistics and research on the incidence and complications related to unsafe and safe abortion, disaggregated by age Have real stories of women on hand. It is important to put a face to the numbers. Develop qualitative research as a powerful advocacy tool.

•

• •

► Health-Sector Reformists Develop an understanding of the health-sector reforms that are taking place in your country; many of these reforms began in the 1990s with loans or grants from the World Bank. Further review of national health-sector reforms should include civil society consultation. Possible advocacy points include: • • • • •

Include SAC as part of an essential service package for every country as a means to reduce women’s mortality and improve women’s health Include SAC as an indicator for access to emergency obstetric care Design affordable payment schemes for essential services, including contraceptives and SAC Special attention should be given to marginalized groups, especially young women Strengthen broader health systems to improve regulations and quality of provision of health care.

► Health-Policy Makers Health-policy makers in governments, hospitals, or large organizations have the ability to make and change policies related to the provision of SAC. • • •

Remove policies related to parental/spousal consent for a safe abortion Remove mandatory waiting periods and conscientious objection clauses for the provision of a safe abortion Promote comprehensive sexual and reproductive health care policies related to safe abortion services (i.e. referrals for counselling, STI testing, contraceptives).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

► Community Leaders Social and cultural stigmatization related to abortion is significant and must be addressed through dialogue within a community. • Engage community leaders, teachers and young people in a discussion about young women’s health and abortion • Highlight indications where abortion is permitted under law • Inform young women of locations where they can receive good quality SAC • Advocate for comprehensive sexuality education. ► Legal Framework – Lobbyists/ Human Rights Lawyers • Have available legislation, guidelines, technical norms or/and regulations of any sexual and reproductive issue that highlight specific responsibilities of the health sector to caring for the sexual and reproductive health of women and young people, specifically related to abortion and postabortion care. • Analyze the political environment to see the possibility of legislation change; this need not involve complete decriminalization but might move towards incremental change or changing policies to allow for abortion in certain circumstances.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

CHAPTER 3

Abortion and Human Rights By Joana Chagas, Brazil

Introduction Today, one of the biggest challenges facing the women’s rights agenda is gaining recognition of abortion as women’s right. This chapter will focus on how the human rights language in international treaties and consensus documents can be interpreted and used in advocacy for the recognition of women’s right to abortion. Furthermore, this chapter will introduce you to the main international human rights treaties and consensus documents and it will offer you an interpretation of how specific human rights relate to women’s right to abortion. Although this chapter will only focus on human rights treaties and consensus documents adopted under the United Nations, it is worth mentioning that regional human rights treaties and consensus documents have important language on human rights, sexual and reproductive rights and the right to abortion, and they sometimes have more progressive language than the UN documents.43 Lastly, although much of the interpretation of how specific human rights relate to women’s right to abortion is derived from treaty monitoring bodies’ concluding and general recommendations/comments, it is not limited to them. Here you will find a more progressive interpretation of rights, that is, how we would like to see such rights interpreted, rather than how they have been interpreted so far. This is what advocacy is for! The Right to Abortion is a Young Woman’s Right Human rights advocacy means actively participating in decision-making spaces in order to influence policies and legislation so that they embrace human rights. Thus, it is fundamental that we know what ‘human rights’ means to us. Specifically, if we want to defend ‘abortion as a young woman’s right’, we need to have clear reasons, arguments and concepts.

The Youth Coalition expects to expand this guide in the future to include regional systems for the protection of human rights. In the meantime, please check our website for updates: http://www.youthcoalition.org/.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Human rights are universal rights to which Some Basic Definitions every person is entitled, simply because they are human. Women’s human rights mean Respect: States must refrain from violating human rights that these same human rights also apply to women and cannot be denied to them on the Protect: States must prevent violations of basis of their sex. All human rights treaties human rights by third parties (individuals, include the principle of non-discrimination corporations, etc) based on sex; the Universal Declaration of Human Rights (UDHR), for example, affirmed Promote: States must take action to that “[e]veryone is entitled to all the rights realize human rights (policies, laws, and freedoms set forth in this Declaration, services, campaigns, etc) without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”44 Similarly, both the International Covenant on Civil and Political Rights (ICCPR)45 and the International Covenant on Economic, Social and Cultural Rights (ICESCR)46 reaffirmed this principle.47 The equality that is formally recognized in legislation is called ‘formal equality’. However, the non-discrimination-based-on-sex principle, despite its importance, has not been able to prevent violations of women’s human rights. When we advocate for women’s human rights, we advocate for the recognition of the equality of women and men: that all the rights set forth in all human rights treaties must be respected, protected and promoted without discrimination of any kind, including discrimination based on sex. The term ‘of any kind’, can also be interpreted as including age-based discrimination, which is particularly important for young people’s sexual and reproductive rights. Women’s rights, on the other hand, are rights that specifically pertain to human beings of the female sex who suffer discrimination due to the fact that they are female. So, when we advocate for women’s rights, we advocate for the recognition of the difference between women and men. Some examples of women’s rights violations are harmful traditional or cultural practices such as female genital mutilation/cutting, child marriage, female infanticide, and violence against women. Abortion is a women’s right, since pregnancies only take place in women’s bodies; it is therefore only women who have the right to choose to continue or interrupt a pregnancy.

Universal Declarations on Human Rights (from now on, UDHR), article 2, http://www.unhchr.ch/udhr/. International Covenant on Civil and Political Rights (from now on, ICCPR), article 2, http://www.ohchr.org/english/law/ccpr.htm. International Covenant on Economic, Social and Cultural Rights (from now on, ICESCR), article 2, http://www.ohchr.org/english/law/cescr.htm. 47 For a comprehensive account of how human rights instruments address equality and discrimination, see Charlesworth, H. and Chinkin, C., The Boundaries of International Law: A Feminist Analysis (Manchester: Manchester University Press, 2000); and COOK R. (ed.), Human Rights of Women: National and International Perspectives (University of Pennsylvania Press, 1994). 45 46

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Likewise, the right to abortion is a young woman’s right. All human rights must be respected, protected and promoted without discrimination of any kind, including that based on sex and age. Young women’s rights to safe legal abortion is of particular importance given that evidence shows young women represent almost half of the total number of women who go through unsafe abortion procedures due to unwanted pregnancies (see data from the World Health Organization in Fig. 3.1). Figure 3.1 Per cent of all unsafe abortions, by age group

Latin America and the Caribbean

Asia

Africa

Developing countries 0%

15-19 20-24 25-49

20%

40%

60%

80%

100%

In addition, there are more obstacles for young women seeking safe abortion services than for women of other ages (parental consent requirements, lack of resources for private services, discrimination when accessing health services, lack of recognition as decision-makers over their own bodies, etc.). Laws that require parental consent for an abortion procedure and non-accessible, nonaffordable and non-youth-friendly health-care services constitute examples of discrimination against young women. The History of Abortion in the Human Rights Agenda At the UN – or international – level, abortion has not yet been explicitly recognized as a right.49 Nevertheless, the UN has recognized a set of human 48

World Health Organization website (Retrieved January 21, 2007), http://www.who.int/reproductivehealth/unsafe_abortion/index.html. 49 At the regional level, however, more progressive language has been adopted. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa call on states to “take all appropriate measures”, to “protect the reproductive rights

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

rights that can be interpreted to protect women’s right to abortion. Each of these rights will be analyzed in the last section of this chapter. Before that, let’s briefly see how they came to be. Although some human rights principles can be traced back to ancient times, the understanding we have of them today dates back to the adoption of the Universal Declaration of Human Rights (UDHR), in 1948. The UDHR emphasizes that everyone, men and women, is equally entitled to the rights set forth in its text, including: • • • • • • • •

right to life, liberty and security of person; right to non-discrimination; right to freedom of thought, conscience and religion; right to seek, receive and impart information; right to education; right to health; right to scientific advancement and its benefits; and right not to be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

As a non-binding declaration, the UDHR does not have the weight of international law and lacks a mechanism for enforcement. In order to make the human rights expressed in the UDHR binding and, therefore, enforceable, the United Nations Member States drafted two covenants. In 1966, the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR) were adopted, entering into force ten years later. Together, the UDHR, the ICCPR and the ICESCR and their protocols form the International Bill of Human Rights.50 Although these documents expressly affirm the principle of non-discrimination based on sex, violations to women’s rights, and more specifically to young women’s rights, have continued to be widespread. For this reason, in 1979 the United Nations General Assembly adopted the Convention for the Elimination of All Forms of Discrimination Against Women (CEDAW)51, which entered into force in 1981.52

of women by authorizing medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus”, http://www1.umn.edu/humanrts/africa/protocolwomen2003.html. 50 International Bill of Human Rights, http://www.ohchr.org/english/about/publications/docs/fs2.htm. 51 Convention on the Elimination of All Forms of Discrimination Against Women (from now on, CEDAW), http://www.un.org/womenwatch/daw/cedaw/cedaw.htm. 52 For a short history of CEDAW, see http://www.un.org/womenwatch/daw/cedaw/history.htm.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Also known as the Women’s Convention, CEDAW introduces the idea that women, because of their sex, suffer specific forms of Declarations are collective consensus statements on discrimination and violence that principles that do not have the status of law. States violate their human rights. The that sign them, however, express an intention to Convention calls on States honor their recommendations and these consensus parties to modify or abolish statements can serve as sources of legal discriminatory customs and interpretation for international law with the passage of practices carried out by time. government agencies, organizations, enterprises or Charters, Conventions, Covenants, Pacts, individuals; to revoke legislation Protocols, or Treaties are all different names for and penal codes that international agreements that become legally binding discriminate against women; to when States ratify them. ensure that women have access to family planning education and services; to decide the number and spacing of their children and to have access to the information and means to do so. In 1989, the General Assembly adopted the Convention on the Rights of the Child (CRC)53, recognizing various children’s rights, including the right to life; the freedom to seek, receive and impart information of all kinds; the children’s right to education; and the children’s right to the highest attainable standard of health. This treaty entered into force in 1990. The ICCPR, IESCR, CEDAW and CRC are the most important international human rights treaties that contain human rights provisions that can support young women’s right to abortion. However, three other Conventions can also provide protection under specific situations: the Convention for the Elimination of All Forms of Racial Discrimination (CERD)54, the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment (CAT)55, and the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (ICRMW)56. The most recent international human rights treaty, the Convention on the Rights of Persons with Disabilities, is likely to enter into force in 2007; it, too, calls on States parties to “provide persons with disabilities with the same range, quality and standard of free or affordable health care and

Convention on the Rights of the Child (from now on, CRC), http://www.unhchr.ch/html/menu3/b/k2crc.htm. Convention for the Elimination of All Forms of Racial Discrimination, http://www.ohchr.org/english/law/cerd.htm. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment, http://www.ohchr.org/english/law/cat.htm. 56 Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, http://www.ohchr.org/english/law/cmw.htm. 54 55

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”57 The Covenants and Conventions are human rights treaties, that is, they have the value of international law, and countries that sign and ratify these documents are bound to observe their provisions. But there are other documents that identify key issues and define strategies to be taken in order to advance human rights. These consensus statements include plans, programmes or platforms for actions, which are the result of the negotiations and consensus-building processes during world conferences sponsored by the United Nations. As mentioned before, these consensus statements are not legally binding, but they impose moral obligations on governments and provide guidelines for the interpretation of already recognized human rights. The most important consensus statements regarding sexual and reproductive rights are: ► The International Conference on Population and Development (ICPD) Programme of Action (PoA)58 was adopted in 1994 at a UN-sponsored international meeting of States in Cairo, Egypt. The PoA defines reproductive rights as “Rest[ing] on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.”59 Importantly, the document recognizes that reproductive rights are not just for adults, but that they are fundamental for the well being of adolescents and youth as well.60 The ICPD PoA emphasizes that reproductive health services should be designed to serve the needs of adolescent women61, safeguarding their right to privacy, confidentiality, respect and informed consent.62 Furthermore, it affirms that in circumstances in which abortion is not against the law, such abortion should be safe and that in all cases, women should have access to quality services for complications arising from abortion.63 57

Convention on the Rights of Persons with Disabilities, article 25(a), http://www.ohchr.org/english/law/disabilitiesconvention.htm#II. 58 International Conference on Population and Development (ICPD) Plan of Action, http://www.unfpa.org/icpd/icpd_poa.htm. 59 Ibid., paragraph 7.3 60 Ahumada, C. and Kowalski-Morton, S., 2. 61 ICPD, supra note 17, paragraph 7.7. 62 Ibid., paragraph 7.45. 63 Ibid., paragraph 8.25.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

► The Fourth World Conference on Women Platform for Action (PFA)64 was adopted in 1995 at a UN-sponsored international meeting of States in Beijing, China. The PFA called on States to "consider reviewing laws containing punitive measures against women who have undergone illegal abortions."65 As well, it demanded that States "understand and better address the determinants and consequences of unsafe abortion."66 ► In 1999, when the United Nations General Assembly convened a special session to review and evaluate the implementation of the ICPD PoA, they adopted the report ICPD +5: Key actions for the further implementation of the Programme of Action.67 This document called on States to “deal with the health impact of unsafe abortion as a major public-health concern and to reduce the recourse to abortion through expanded and improved family planning services”68 and stated that “[c]ountries should ... remove legal, regulatory and social barriers to reproductive health information and care for adolescents69. In addition, it stated that States should “train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible”,70 in circumstances where abortion is not against the law. ► In 2000, a UN meeting entitled “Women 2000 – gender equality, development and peace for the twenty-first century”71 was convened to review and evaluate the implementation of the Beijing Platform for Action. The political declaration and a consensus outcome document entitled Further actions and initiatives to implement the Beijing Declaration and Platform for Action (Beijing +5)72 reaffirmed the previous commitments to women’s sexual and reproductive rights. Abortion and Human Rights: Interpreting Rights Abortion has not yet been explicitly recognized as women’s right at the United Nations. However, as shown in the previous section, the international human rights framework has developed a rich language of fundamental rights and freedoms that can be interpreted to protect women’s right to abortion. 64

Fourth World Conference on Women (FWCW) Platform for Action, http://www.un.org/womenwatch/daw/beijing/index.html. Ibid, paragraph 106(k). Ibid, paragraph 109(i). 67 Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development, 8 November 1999, http://www.unfpa.org/icpd/icpd5.htm. 68 Ibid, paragraph 63 (i). 69 Ibid, paragraph 73(f). 70 Ibid, paragraph 63(iii). 71 To find out more about the Beijing+5 process, see http://www.un.org/womenwatch/daw/followup/beijing+5.htm. 72 Further actions and initiatives to implement the Beijing Declaration and Platform for Action (Beijing +5), http://www.un.org/womenwatch/daw/followup/ress233e.pdf. 65 66

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Moreover, treaty-monitoring bodies (TMBs)73 – committees that oversee Statesparties compliance with international human rights commitments – have addressed abortion in their recommendations to various governments. This section will give you some arguments that reflect and expand such recommendations. a) Right to life “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his [or her] life.” ICCPR, article 6(1)

“States Parties recognize that every child has the inherent right to life.” CRC, article 6(1)

• •

• • •

Forcing a woman to undergo a life-threatening pregnancy is a violation to her right to life; Forcing a woman to undergo an unwanted pregnancy can severely affect her mental health; in cases where the pregnancy is a result of rape and/or incest, or when the foetus has a fatal abnormality, it may even drive her to suicide, constituting a violation to her right to life; A lack of safe abortion care services may force a pregnant woman to seek unsafe procedures that may put her life under high risk; Denying or delaying post-abortion care to a woman who presents with complications resulting from a miscarriage or an unsafe abortion violates her right to life; The burden of child-bearing and -rearing can restrict a woman’s access to education, employment, and other opportunities for personal development, thus, violating her right to life, if we understand ‘life’ in an unrestrictive manner, as the ability of a person to have conditions to enjoy life (livelihood).

The right to life is the claim most used by opposition against women’s right to choose whether or not to have an abortion. There is a huge debate around the concept of life and when it begins: from fertilization to conception to birth. While the opposition argues that the foetus has a right to life, we argue that the woman’s right to life takes precedence. A foetus cannot be considered a person and it cannot be more important than the life and rights of the woman.

For more information on treaty monitoring bodies, see http://www.unhchr.ch/html/menu2/convmech.htm.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

b) Right to liberty and security of person “Everyone has the right to liberty and security of person ... No one shall be deprived of his liberty except on such grounds and in accordance with such procedure as are established by law.” ICCPR, article 9(1) • • • •

•

A woman is only free if she can control her own body; Forcing a woman to undergo an unwanted pregnancy is a violation of her bodily integrity, that is, forcing her to experience something she does not want to experience; Prohibitive legislation on abortion is a State’s arbitrary intrusion in a woman’s body and unnecessary to protect public health; When a woman does not seek health-care services because she fears her confidentiality will not be respected, or she will be reported to parents, husband/partner, or the police, a violation of her right to liberty and security of person occurs; Pressuring or forcing a woman to undergo an abortion (for example, because she is HIV-positive or of a certain ethnic/racial group) is a violation of her right to liberty.

c) Right to privacy “No one shall be subjected to arbitrary or unlawful interference with his [or her] privacy, family, home or correspondence, nor to unlawful attacks on his [or her] honour and reputation.” ICCPR, article 17(1) “No child shall be subjected to arbitrary or unlawful interference with his or her privacy.” CRC, article 16(1) • • • •

Decisions a woman makes about her body are private and individual and must not be subjected to interference or coercion from parents, husband/partner, or the State; Policies and legislation that require parental or spousal authorization for abortion violates women’s right to privacy; Policies and legislation that require health-care services providers to report abortion cases to law enforcement agencies violate women’s right to privacy and the doctors’ duty to observe physician-patient confidentiality; A woman’s right to privacy entitles her to have access to confidential health services.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

d) Rights to freedom of thought, conscience and religion “Everyone shall have the right to freedom of thought, conscience and religion.” ICCPR, article 18(1) “Everyone shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of his [or her] choice.” ICCPR, article 19(2) • • • •

A woman must not be forced to comply with laws based on religious beliefs or faith that are not her own; The separation of religion and the State is fundamental for the respect of human rights in general, and sexual and reproductive rights in particular, especially regarding pregnancy and abortion care services; Forcing a woman to carry a pregnancy against her will infringes upon her freedom of conscience; Health-care services providers who refuse to offer abortion care services permitted by law for religious reasons violate women’s rights when they do not refer women promptly to facilities nearby where they can obtain these services.

The opposition is increasingly using the right to freedom of thought, conscience, and religion to deny women’s access to abortion care services, advocating for observance of “conscientious objection” clauses for health-care services providers. We argue that this right has a limit; freedom of conscience cannot justify a refusal to provide health-care services, including abortion, especially when it represents a risk to the life and well being of the woman. In addition, the right to conscientious objection applies only to individual persons and not to institutions such as hospitals and clinics and States are required to ensure that women have reasonable access to all legal medical procedures.74 e) Right to health “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” ICESCR, article 12(1)

Cook, Rebecca and Dickens, B. M., “The scope and limits of conscientious objection”, International Journal of Gynecology and Obstetrics, (71, 2000), 71-77.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

“States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning” CEDAW, article 12(1) “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.” CRC, article 24(1) • • • • • •

States that deny women’s access to safe abortion care services are violating their right to health, not only physical, but also mental health; Unsafe abortions can have devastating effects on a woman’s health, leading to both short-term and long-term side effects (e.g. infertility) and, in some cases, death; Too early pregnancies and lack of birth spacing can pose risks to women’s health, particularly adolescent girls; A lack of youth-friendly reproductive health services is a barrier for young women’s access to such services, and a violation to their right to health; A lack of access to contraceptives that enable women to regulate their fertility is a violation to their right to health; A lack of confidentiality, requirements for authorization of parents or husband/partner to undergo abortion, (high) services fees, denial of care services based on conscientious objection of health-care services providers are examples of factors that may deter women from seeking advice or treatment, violating their right to health.

f) Right to education and information “The States Parties to the present Covenant recognize the right of everyone to education.” ICESCR, article 13(1) “States Parties shall take all appropriate measures to ... ensure... [a]ccess to specific educational information to help to ensure the health and well-being of families, including information and advice on family planning.” CEDAW, article 10(h) “The States Parties recognize the right of the child to education.” CRC, article 28(1) 38

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

•

• •

Access to high-quality, medically-correct, evidence-based education and information is fundamental for women to make informed choices about pregnancy and abortion; offering inaccurate non-scientific information based on religious beliefs violates women’s right to education and information; A lack of youth-friendly reproductive health information is a violation to young women’s right to information; When health-care services providers withhold information from women about indications for which abortion is permitted by law they are violating their right to information.

g) Right to enjoy the benefits of scientific progress “The States Parties to the present Covenant recognize the right of everyone... [t]o enjoy the benefits of scientific progress and its applications.” ICESCR, article 15(1)(b) •

•

Denying women access to medication abortion drugs such as misoprostol, mifepristone and RU 486, and to vacuum aspiration methods, that is, abortion methods that are safer than outdated methods (such as dilatation and curettage) is a violation of women’s right to enjoy the benefits of scientific progress; Withholding from women evidence-based information regarding abortion is a violation of their right to enjoy the benefits of scientific progress.

h) Right to non-discrimination “The term "discrimination against women" shall mean any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women ... of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field.” CEDAW, article 1 “States Parties ... undertake ... [t]o take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices which constitute discrimination against women.” CEDAW, article 2 “States Parties shall take all appropriate measures ... ”To modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based 39

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women.” CEDAW, article 5(a) • •

•

Laws that have the effect or purpose of preventing a woman from exercising any of her human rights are discriminatory against women; Laws that deny young women access to abortion services and care and that criminalize and penalize women for undergoing abortions are forms of discrimination against women, since abortion is a health service that only women need; such laws also discriminate because they take away from women the autonomy to make responsible decisions about their bodies and their lives; Laws that restrict access to abortion, such as laws that limit abortion indications, require parental or spouse/partner consent, mandatory counselling, waiting periods, conscience clauses, have the effect of preventing women from exercising their right to health; Denial of abortion and post-abortion care services to a woman based on age, race, ethnicity, HIV status, or any other trait is a violation of her right to non-discrimination.

i) Right to decide the number and the spacing of one’s children “States Parties shall take all appropriate measures to ... ensure ... [t]he same right freely to choose a spouse and to enter into marriage only with their free and full consent;” CEDAW, article 16(b) • • •

• •

A woman’s body is her body; she is the one to make the decision whether or not to have an abortion; Decisions a woman makes about her body are private and individual and must not suffer interference or coercion from parents, husband/partner, or the State; The burden of child-bearing and -rearing can restrict a woman’s access to education, employment, and other opportunities for personal development, thus, it is her decision only to determine the number and the spacing of her children; Mandatory counseling can undermine a woman’s autonomy to make a decision on whether or not to have an abortion; In many circumstances (economic, conflict, lack of access to contraceptives), abortion may be the only option a woman has to be able to control the number and spacing of her children.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

j) Right not to be subjected to torture or other cruel, inhuman, or degrading treatment or punishment “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” ICCPR, article 7 • • • •

Forcing a woman to undergo an unwanted pregnancy is subjecting her to torture, cruel, inhuman, degrading treatment and punishment; Forcing a woman to continue a pregnancy of a deformed foetus that will almost certainly die in uterus or shortly after birth is subjecting her to torture, cruel, inhuman, degrading treatment and punishment; Denying a young woman pain management in connection with abortion care services violates her right to be free from torture, cruel, inhuman, degrading treatment and punishment; Denying or delaying young women treatment for incomplete abortion is subjecting them to torture, cruel, inhuman, degrading treatment and punishment.

Conclusion Throughout this chapter, we have developed a framework of analysis to recognize women’s right to abortion under the existing international human rights framework. Human rights provide advocates with a powerful, universal language based on respect and concern for the dignity of every human being, regardless of sex or age. However, the language of human rights is not static; it constantly evolves as societies evolve. For this reason, it is important that young advocates participate in the discussion and definition of such rights, in order to achieve more comprehensive recognition and protection of young women’s rights, including the right to abortion.

Freedom of Choice: A Youth Activistâ&#x20AC;&#x2122;s Guide to Safe Abortion Advocacy

Advocacy Tips: UN Documents The following is a list of useful and important UN documents you can find online: Universal Declarations on Human Rights http://www.unhchr.ch/udhr/ http://www.ohchr.org/english/about/publications/docs/fs2.htm International Covenant on Civil and Political Rights http://www.ohchr.org/english/law/ccpr.htm http://www.ohchr.org/english/countries/ratification/4.htm International Covenant on Economic, Social and Cultural Rights http://www.ohchr.org/english/law/cescr.htm http://www.ohchr.org/english/countries/ratification/3.htm Convention for the Elimination of All Forms of Racial Discrimination http://www.ohchr.org/english/law/cerd.htm Convention on the Elimination of All Forms of Discrimination Against Women http://www.un.org/womenwatch/daw/cedaw/cedaw.htm http://www.un.org/womenwatch/daw/cedaw/history.htm Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment http://www.ohchr.org/english/law/cat.htm Convention on the Rights of the Child http://www.unhchr.ch/html/menu3/b/k2crc.htm Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families http://www.ohchr.org/english/law/cmw.htm Convention on the Rights of Persons with Disabilities http://www.ohchr.org/english/law/disabilities-convention.htm#II International Conference on Population and Development (ICPD) Plan of Action http://www.unfpa.org/icpd/icpd_poa.htm Fourth World Conference on Women (FWCW) Platform for Action http://www.un.org/womenwatch/daw/beijing/index.html

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development http://www.unfpa.org/icpd/icpd5.htm Other documents of use: Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa http://www1.umn.edu/humanrts/africa/protocol-women2003.html World Health Organization: Preventing unsafe abortion http://www.who.int/reproductive-health/unsafe_abortion/index.html

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Mass Media, Abortion and

CHAPTER 4

Sexual and Reproductive Rights By María Eugenia Miranda, Argentina & Nadia Ribadeneira González, Ecuador

Introduction This chapter contains a brief review of how the mass media is related to advocacy campaigns. We will examine the influence and power of the mass media, how the mass media can be used to strengthen advocacy campaigns, how to deal with the opposition, and how to build and transmit effective messages. Mass Media The term and the concept of “mass media” appeared at the beginning of the 20th century as a consequence of the rapid increase of industry and the development of the nation state. The mass media appeared as a solution to the requirement that people be more quickly and effectively informed of major changes occurring throughout the world. Mass media refers specifically to that section of the media focused on reaching a very large audience such as the population of a nation state. Among the mass media we include radio, TV, newspapers, and today, the Internet, as means to reach a large group of people. In the 21st century (also known as the “Communications Era”), the mass media has played an important role and has held enormous power to change society. The media can contribute to changing peoples’ mindsets and lives, and it can affect their interactions with and within society and the environment. The way we act, the food we eat, the music we listen to and the clothes we wear are all influenced by the mass media. Furthermore, the Internet now provides us with the means to immediately and freely connect with others at any distance. Amid today’s rapid and impressive advances in technology, it is easy to understand why communication has such an important place in our lives, and it is also essential to know that methods of communication are changing.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Strategic Communication: The Art of Persuasion A key element of strategic communication is to understand your audience with the purpose being to motivate a target audience to support your cause. The biggest challenge of strategic communication is the ability to put yourself in your audience’s shoes and see how they will benefit from supporting your cause. It’s important to think about the potential risks and rewards that your target audience will face by joining forces with you.75

Strategic Communication is any planned communication activity that seeks to achieve one of the following communication goals: Persuade, Motivate or Move to Action. CEDPA, Gender, Reproductive Health and Advocacy - A Trainers Manual

Before implementing an advocacy campaign, it is important to do an audience analysis. This means that you must define your target policy audience (figuring out the target group that you want to persuade). For this you will need to consider the following questions: • • • •

Are you familiar with the audience group? Is the audience familiar with you or with your network/organization? Is the audience well informed about the issue? Is the audience strongly supportive, neutral, or strongly opposed to the issue?

To answer these questions, it can be extremely helpful to create a Power Map. Creating a Power Map In order to identify your audience and the potential influences on your advocacy campaign, it can be helpful to create a Power Map, which includes a complete analysis of your allies, opponents and target audience. Power mapping is an exercise that will help you to identify key actors in civil society and the government; it can help map the positive or negative influence that civil society may have on the decision-making process in relation to your campaign. In order to build a good Power Map, you should follow five basic steps: 1.

Identify the influencing actors

75 Centre for Development and Population Activities (CEDPA), Gender, Reproductive Health and Advocacy: A Trainer’s Manual (Washington: CEDPA, 2000), http://www.cedpa.org/files/738_file_grad_english_all.pdf.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Think of all the individuals, organizations, government agencies or projects, institutions, private-sector companies, etc that may influence or be involved with your advocacy campaign, no matter their point of view. They might be fellow activists, like-minded organizations, opposing organizations, lobbyists, civil society, public institutions, etc. 2. Classify the actors (allies, opponents, target audience) Once you have identified all of the individuals or organizations that may affect your campaign, try to organize them into three categories: Allies

Opponents

Target Audience

Actors who are like-minded; already advocate for your issue; or are willing to join your campaign.

Actors who are opposed to your issue; are engaged in advocacy work that contradicts your campaign; or actively challenge all work related to your issue.

The target audience may vary depending upon the issues of your campaign. However, it could be made-up of actors who are neutral on the issue; uninformed or unfamiliar with the issue; whose stance on the issue you may not know; or are able to influence the decision-making process (in regards to your issue).

3. Prioritize key allies and opponents After classifying the actors, assess your “Allies” category. Prioritize the allies you think will be most strategic or helpful to your campaign. Once finished, assess your “Opponents” category. Prioritize the opponents you think will pose the greatest challenge to your advocacy campaign. 4. Determine your target audience Of the actors you have identified as your “Target Audience”, try to narrow the list to those most relevant to your advocacy campaign. For example, if your campaign is focused on youth issues, you may want to concentrate on the target audience members who are young people or youth-oriented organizations, agencies, companies, etc. 5. Understand your allies, opponents and target audience Research and get to know your key allies and find out how you can build partnerships with them, share research and information, or collaborate on projects. Likewise, study up on your opponents, and find out why and what they oppose. The better you know your opponents’ arguments, the better prepared you will be to defend your campaign (these arguments will be addressed later in the chapter). Lastly, get to know your target audience. Find out how much they 46

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

know about the issues, where they stand on those issues, and what position they may be in to effect change. Understanding your target audience will be key in knowing how and where to deliver effective messages. Now that you have created your Power Map, you will have a clearer picture of the scenario you are facing. The information you have organized will help you to create an effective strategy, as you can now clearly take into account the help that you may receive from allies, the obstacles you may face, and the target audience on whom you should focus your energies. The Strategic Communication Model76 It is of the utmost importance for an effective advocacy campaign to be strategic in communicating its objectives, key messages, and goals. CEDPA’s training manual series, “Gender, Reproductive Health and Advocacy”, describes a good Strategic Communication Model as one that accomplishes the following77: 1. 2. 3. 4.

Inform: create a big impact, transmit clear and real objectives about what you want to accomplish, how, and why. Motivate: make the audience relate emotionally to the issue. Persuade: move the audience to adopt a desired position on the issue. Move to Action: encourage the audience to take action.

Consider the following example: EXAMPLE: Following the Strategic Communication Model Goal: Legalize abortion in cases of pregnancy as a consequence of rape in Paraguay Target audience: Parliamentarians 1.

Inform: Available data suggests that in some countries nearly one in four women may experience sexual violence by an intimate partner and up to one third of adolescent girls report their first sexual experience as being unwanted. There are multiple factors influencing the risk of rape, such as poverty and age. The most common places where sexual assaults occur are at home and at educational institutions, with the perpetrator being known to the woman (father, stepfather, other male family member, teacher or neighbour). Other sources suggest that 25% of the women who have been raped will find themselves pregnant. In this context, Paraguay should remove punishments for women who seek abortions from the penal code when the pregnancy is a result of rape. Forcing women to carry pregnancies that are a result of rape is a violation of women’s reproductive freedom. ► Continued on next page

76 77

The Strategic Communication Model was developed by CEDPA consultant Thomas C. Leonhardt. CEDPA, 182-194.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

► Continued from previous page

Motivate: Women constitute half of humanity. Women are friends, sisters, mothers, partners, colleagues, workers, students, and professionals. Women have the right to live with dignity. Sexual violence is one of the many discriminatory actions against women. As a result of these acts, women face many negative situations in their physical, mental and sexual health. Forced pregnancy is one of these. Abortion must be legalized in order to ensure that, at the very least women’s human rights are not further violated, such as the right to decide when, how and with whom to have children.

Persuade: Legal abortion for pregnancies as a result of rape must be available to every woman. The government and society must respect women’s decisions; especially when abortion is one of the key solutions needed to remedy damage that occurs because of a human rights violation. It is necessary to defend women’s right to decide about their own reproduction and to defend their right to have legal, affordable, secure and comprehensive abortion services when they are facing forced pregnancy.

Move to action: Parliamentarians have the responsibility to legislate in favour of meeting people’s needs. In this specific case, since sexual violence and unwanted pregnancy are a common situation in women’s lives, it is imperative to modify laws in order to ensure women’s access to the full enjoyment of their human rights.

This example achieves all of the elements laid out in the Strategic Communication Model. The message informs the audience that the author believes that in Paraguay, punishments should be removed from the penal code for women who seek abortions when a pregnancy is the result of rape. The message motivates the audience by discussing women and the related issue in a manner that is emotionally evocative. The message persuades its audience by discussing the issue in the context of human rights violations. Lastly, the message moves the audience to act by reminding Parliamentarians of their responsibility to women’s rights. Each level of the Strategic Communication Model is important, but a successful advocacy campaign addresses them all.78

Ibid., 183.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Advocacy Tips: What Can I Do? Developing an Advocacy Campaign This section will cover some helpful tools and tips for a safe abortion care advocacy campaign. Here, you will find some useful exercises on how to deal with the opposition, how to speak with a politician, how to deal with the mass media, and more. Message Development Characteristics of an effective message: • Simple • Concise • Appropriate language • Consistent • Clear Remember, an effective message has 5 important elements to produce a measurable impact: • Content: what is the central concept of the message? • Language: is the language appropriate to your target audience? • Message: is the message credible? • Format (communication channel): what’s the best way to reach your target audience? • Time and place: when and where you will deliver your advocacy message? EXAMPLE: Effective Messages Goal: Legalize abortion for pregnancy as a result of rape/sexual assault in Paraguay Target audience: Public opinion Message: In Paraguay, one-third of the adolescent girls report their first sexual experience was a result of sexual assault. 25% of these adolescents will face unplanned pregnancies because of these acts. Stop violence against adolescents! Legalized abortion can save adolescents’ lives. Format: Posters Time and Place: Hang posters in the streets when discussions are taking place at the parliament about modifying the abortion law.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

If your message is simple, precise, concise and direct, the central idea will be better understood and help move opinions in your favour. Media, SRR and Abortion: Understanding the Problem It’s unfortunate that sexual and reproductive rights (SRR) are not immune to the power of the media and its influence over public opinion. For example, in Ecuador, it is largely conservative and anti-choice factions who control the media, and they have put together a large and expensive marketing campaign to sway public opinion against emergency contraception. Contrary to scientific and medical evidence, they stated that emergency contraception pills were an agent that induces abortion. They were so successful in this campaign that the government declared emergency contraceptive methods to be illegal and prohibited their sale. This decision was undoubtedly influenced by the media campaign, which incorrectly included pictures of mutilated foetuses and babies. Although feminist groups attempted to figure out ways to fight the inaccurate and misleading campaign, it had an enormous impact on public opinion, and consequently on the rights of women in Ecuador. The media (and subsequent public opinions) have a massive influence on what society believes to be true, moral, or safe. Accordingly, it is important for us as progressive, pro-choice advocates to also use them to defend our rights and oppose anti-choice rhetoric. However, be cautious. The mass media can be our worst enemy depending on how they report our issues and portray our advocacy campaigns. Mass Media Strategy: Reinforcing the Arguments In order to conduct an effective advocacy campaign, we need to consider the media and the opposition when strategizing. The table below shows the basics when it comes to working with the media during an advocacy campaign:79 Topic

Statistics and public opinion

Priority

Tools for discourse analysis

Objectives Analyze the public-opinion discourses in your country regarding matters of abortion: • Basic elements to elaborate and to identify in opinion polls • Presentation and analysis of opinion polls related to abortion (pro- and anti-choice) • Review of the media’s history when covering abortion issues

Table taken from Manual de jóvenes activistas en el tema de Aborto, authored by Ipas, Decidir, and Balance, (Promoción para el Desarrollo de la Juventud: México, unpublished, 2007).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Media and sexuality

Media

Tools for mapping power

Tools for action

Identify the principal actors and stakeholders and their positions regarding abortion: • Determine how the media works • Identify media, programs and spaces used by/available to pro-choice and anti-choice activists • Analyze the media arguments related to abortion and SRR Give practical tools to use the media in our favour: • Media strategies • Media messages • Press conferences • Radio interviews • TV interviews • Press releases

One of the main obstacles to decriminalizing abortion in many countries is opposition from religious institutions and conservative groups. However, even in countries where the majority of the population is Catholic, polls show that citizens believe women should have the right to decide whether or not to have an abortion and that abortion should be legally available and a right guaranteed by their country’s constitution. For example, in Mexico, Gallup polls done in 1992, 1993 and 1994 demonstrate that the majority of Mexicans believe that abortion should be available to all women80. Furthermore, in April 2007, Mexican women living in Mexico City won the right to access abortion care in the first 12 weeks of pregnancy despite strong opposition from the Catholic Church and other conservative groups.81 In the United States, which has many rich, powerful and influential conservative Christian groups, an Associated Press-NBC poll showed that 77% of respondents agreed that abortion “should be left to the woman and her doctor”, and showed that support for abortion rights cuts across political, age, religious, income, education, race and sex differences.82 The case of each country is different, of course, and in many countries, the polls may show that people are opposed to the legalization of abortion. In countries where this is true, it is important to create an effective campaign in order to sensitize civil society and key actors to the importance of legalizing abortion. However, there are countries where even the word ‘abortion’ is completely banned from the media, schools, and other sectors. In these cases, the task of 80

Ipas, Decidir, and Balance, Manual de Jóvenes Activistas en el tema de Aborto, (Promoción para el Desarrollo de la Juventud: México, not yet published, 2007). Sanchez, Maria Luisa, “Mexico City Makes Abortion Rights History in Latin America”, RH Reality Health Website, (Retrieved May 29, 2007), http://www.rhrealitycheck.org/blog/2007/05/24/mexico-city-makes-abortion-rights-history-in-latin-america. 82 Ibid. 81

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

sensitizing may be more challenging, thus it may be better to start with workshops to sensitize key actors or potential allies. In this case, it can be effective to focus on the harmful effects of unsafe abortions. The Anti-Choice Movement: Knowing your Opponents Many of the anti-choice groups and organizations have a great deal of influence over the mass media, and they take advantage of this relationship. They have been working in this field for many years, and they know very well who their allies are. They have lobbied and built strong relationships with key media figures in order to ensure that their messages are always forefront in the debate. These groups have invested a lot of money and effort in creating an effective network of media allies in radio, newspaper, television and the Internet. Many times, they tend to disseminate false information, statistics and data, and they usually have a very prepared and articulated discourse against the legalization of abortion. If you are invited to a radio or TV program where an anti-choice individual will also be present, you need to be well prepared to answer all of their questions, arguments and even attacks. This chart will help you to deal with crucial issues: Anti-choice arguments

Your answers and clarifications

Human life begins at conception. Therefore, abortion is the murder of a person.

Personhood at conception is a religious belief, not a biological fact. Even religious authorities disagree among themselves about when personhood begins.

Those who support the right to choose a safe, legal abortion are “proabortion”.

We follow the reproductive justice framework. We support the right of all women to affordable and voluntary contraception; to become pregnant, carry, and bear children in a context free of violence and environmental toxins; and to safe, non-judgmental abortion services83.

I believe that abortion is morally wrong, so I’m obligated to work to make abortion illegal and unavailable.

Many people who are personally opposed to abortion for religious or moral reasons try to impose their values by civil law on everyone. If you don’t like abortion, you can still respect the right of choice for all women.

The foetus is in no real sense part of the mother, but is a separate distinct human being.

The foetus is totally dependent on the woman’s body for its life support and is physically attached to her by the placenta and umbilical cord. The health of the foetus is directly related to the health of the pregnant woman. Only at birth are they separated.

L. Hessini, et. al., “Abortion matters to reproductive justice”, Reproductive Justice Briefing Book: A Primer on Reproductive Justice and Social Change, (Ipas), 40-41.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

The right of the unborn to live supersedes any right of a woman to “control her own body”.

A woman is a person and therefore a human being who deserves to fully exercise her human rights.

Abortion should not be permitted for rape because it’s wrong to punish a child for the sin of the father. Besides, pregnancy rarely happens from rape. Women can get immediate medical treatment to prevent pregnancy.

Forcing a woman to bear a rapist’s child may further traumatize the victim of a violent crime. Among 5.4% to 25% of rape victims become pregnant and many women do not have access to emergency contraception to prevent a pregnancy due to rape. Due to gender biases in our societies, many rapes are not reported immediately or at all. We believe in reproductive freedom, and rape is a human rights violation based on gender discrimination and violence; pregnancy resulting from rape should not be forced on a woman.

When a woman had sex, she had her fun, now let her pay for it. If you have sex, you should expect to get pregnant and pay the consequences.

This vindictive, self-righteous attitude stems from a belief that sex is bad and must be punished. Motherhood should never be punishment for having sex. Forcing a child to be born to punish a woman is the ultimate form of child abuse. Instead, we should promote a healthy and positive sexual culture, based on a gender-sensitive and human rights perspective, with specific attention paid to sexuality education.

Teenagers have forgotten how to say “no”. Making contraceptives and abortion available only encourages them to have sex.

The increase in teenage sex has complex societal causes, including sexually oriented TV, movies and advertising. In addition, not all sex is consensual, and many girls are forced into it. Birth control and abortion don’t cause sex, but reality dictates that they be available to prevent teens from becoming parents. When an adolescent is dealing with sexual intercourse, she or he needs comprehensive and understandable information on which to base decisions and take care of themselves and their partners.

Minors should have their parents’ consent before having abortions, and wives should have their husbands’ consent.

The right of privacy must allow young women to be free of governmental interference in decisions about childbearing. Young girls who bear children are considered adult enough to make decisions for their children; they are also adult enough to make decisions for themselves. In addition, some teen pregnancies are the result of incest and should not require consent from an abuser. A wife should not require her husband’s consent to terminate a pregnancy; not only will she physically bear the child and be directly affected by the pregnancy, women and young women are autonomous individuals capable of making decisions regarding their own bodies and sexuality.

Adoption is the best choice, not abortion. There are alternatives to abortion. Abortion is never the best solution.

A woman should be able to decide this for herself. Some single women do choose childbirth followed by adoption; many more choose single parenthood. In some cultural situations, giving up a baby for adoption may be virtually impossible (for example a woman with other children or a married woman).

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Most unwanted pregnancies become wanted children. Women make big mistakes having abortions, and they regret it later.

Unwanted babies may be abused, neglected and/or battered or even killed by unloving or immature parents. Many women make mistakes in having babies they don’t want or can’t love or care for. Some women may regret having an abortion, but this should not be a reason to deny choice to all women.

Abortion causes psychological damage to women. They suffer guilt feelings all their lives.

Many studies have concluded that abortion is not associated with a detectable increase in the incidence of mental illness. Some women experience depression and guilt feelings, but a higher percentage of new mothers suffer post-partum depression. That some women experience guilt is not a reason to make abortion illegal for all. The ways in which women face an abortion and its psychological implications are very much related to their social and cultural environments, their networks, their access to abortion-care services and the social support they receive during the whole process (preduring- post).

Typical TV talk shows are not the best places to have mature and fruitful discussions with anti-choice representatives. These groups often bring pictures and photos of third-trimester foetuses, bloody abortions, and foetuses in garbage cans that create a sense of fear and disgust, and leave a lasting impression on the TV audience. Anti-choice groups also use words such as ‘baby’, ‘kill’ and ‘murder’ to associate negative feelings and thoughts with abortion. All of these tactics are cleverly designed to evoke emotions of revulsion against abortion and sympathy for the foetus. You should be cautious when you receive an invitation to participate in these kinds of programs, as sometimes it can be difficult to present your point of view without being interrupted or attacked with pictures or false arguments from the anti-choice groups. If you decide to participate, prepare your speech in advance and bring current statistics with concrete sources and personal stories of triumph. If the anti-choice representatives bring statistics, ask them for the source, as they could be using incorrect or wrong data on purpose. Also, consider bringing photos or pictures that represent the actual size and composition of an early gestational embryo or foetus to put the falsehoods of the anti-choice activists into perspective. Conclusion If we use the mass media in our favour, it can be tremendously helpful to advancing our campaign issues and messages. If we choose not to take full advantage of the mass media, we risk missing out on a valuable resource, or 54

Freedom of Choice: A Youth Activistâ&#x20AC;&#x2122;s Guide to Safe Abortion Advocacy

worse yet, the misinterpretation of our issues. Simply be cautious, and develop a strong mass media strategy that addresses all areas of the media that you can think of: interviews, press bulletins, publicity and public relations, flyers, website, etc. Make certain that your strategy also includes strong objectives, a list of responsibilities for all of the individuals involved, a reasonable timeline, and way to evaluate your work and progress. Remember, mass media strategies are different for every advocacy campaign! It is not necessary to have a lot of money, having clear and agreed upon objectives, committed people and lots of energy is enough!

Freedom of Choice: A Youth Activistâ&#x20AC;&#x2122;s Guide to Safe Abortion Advocacy

CONCLUSION The objectives of this guide were to give readers an overview of the distinct, yet intersecting dimensions of advocacy for safe abortion care services from a youth perspective. Whether your audiences are policy makers, health care providers, human rights advocates, youth activists, or the media, this guide can help shape your advocacy campaign. The background information and the practical advocacy tips can help you develop strong, clear and influential messages that can be tailored specifically and relevantly to your own country and context. The main points are as follows: Abortion Laws When looking at changing the laws in your country regarding abortion, it is important to begin with a clear understanding under which circumstances abortion is available if at all. If you live in a country where abortion is a punishable crime or restricted to certain circumstances, your goal could be to decriminalize abortion, as well as the variety of circumstances under which women can access services regardless of reason. If you live in a country where abortion is legal, then improving access to safe abortion services may be your goal. For example removing payment requirements for services could be something that you advocate for, or changing age of consent laws, as both restrictions are barriers for many young women. Access to Safe Abortion Care Safe abortion care (SAC) services must be present within health systems whether abortion is legal or not. This is due to the need to treat the complications associated with spontaneous abortions (miscarriages) and unsafe abortions, as well as providing safe and legal abortions. Thus advocacy should entail how to ensure quality SAC is accessible to young women, through adequate and comprehensive design and funding models of health systems, training of health care providers, and education of young women, among other areas. Human Rights Human rights provide advocates with a powerful, universal language based on respect and concern for the dignity of every human being, regardless of sex or age. However, the language of human right is not static; it evolves as societies evolve. It is important, thus, that young people, advocates and activists 56

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

participate in the discussion and definition of such rights, in order to achieve more comprehensive recognition and protection of young women’s rights, including the right to abortion. Mass Media and Communication It is important to understand the history and evolution of today’s mass media, and how it is related to advocacy campaigns. The mass media continues to demonstrate enormous influence over society, and regularly contributes to changing peoples’ mindsets and lives. The power and utility of the mass media are not to be underestimated, and it can be an indispensable tool for dealing with the opposition and strengthening advocacy campaigns. We hope this guide is practical and useful, and will enable young activists and those working with youth issues to more effectively advocate for safe abortion care. Please feel free to contact the Youth Coalition for Sexual and Reproductive Rights (YCSRR) for further information or enquiries related to this publication.

We appreciate your feedback! Please send your comments about this publication to outreach@youthcoalition.org

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

BIBLIOGRAPHY Chapter 1 – Governing Abortion Ahumada, Claudia and Kowalski-Morton, Shannon. Youth Activists’ Guide to Sexual and Reproductive Rights. Ottawa: The Youth Coalition, 2005, <http://www.youthcoalition.org/DEV/mambo2/images/stories/SRRGUIDE/srr%20guide%20final%20 version.pdf>. Center for Reproductive Rights. Crafting an Abortion Law that Respects Women’s Rights: Issues to Consider, Briefing Paper, August 2004. Center For Reproductive Rights, “The World’s Abortion Laws: Categories of Abortion Laws from Most to Least Restrictive”, Poster, 2005. Canadians for Choice. “Historical Background.” Canadians For Choice website. Retrieved January 2006 <http://www.canadiansforchoice.ca/historicalbackground.html>. “Foetal Impairment.” Wikipedia Online Encyclopedia, Retrieved January 2006 <http://en.wikipedia.org/wiki/Foetal_impairment>. Ipas. Ipas website, Retrieved April 25, 2007 <http://www.ipas.org/english/press_room/2005/releases/06072005.asp>. Grimes, D., Benson, J., Singh S., Romero M., Ganatra, B., Okonofua F., Shah I. “Unsafe abortion: the preventable pandemic.” The Lancet. Sexual and Reproductive Health 4. (Nov 2006): p 1. Pinter, B., Aubeny, E., Bartfari, G., Loeber, O., Ozalp, S., and Webb A., “Accessibility and Availability of Abortion in Six European Countries”, The European Journal of Contraception and Reproductive Health Care. 10.1 (March 2005): p 54. United Nations Population Division, Department of Economic and Social Affairs. Abortion Policies – A Global Review, Explanatory Notes. United Nations Publications, 2001.

Chapter 2 - Access to Safe Abortion Care Duggal, R., and Ramachandran, V. “The abortion assessment project-India: Key findings and recommendations”. Reproductive Health Matters. 12:24, Supplement 1 (November 2004): 122-129. Gasman, N., Blandon, M. M., & Crane, B. B. “Abortion, social inequity, and women's health: Obstetrician-gynecologists as agents of change”. International Journal of Gynecology & Obstetrics. 94.3 (September 2006): 310-316. Grimes, D., Benson, J., Singh S., Romero M., Ganatra, B., Okonofua, F., and Shah, I., “Unsafe abortion: the preventable pandemic.” The Lancet. Sexual and Reproductive Health 4 (November 2006): 1. <http://cdrwww.who.int/reproductive-health/publications/articles/article4.pdf>.

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Healy, J., Otsea, K., and Benson, J. “Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services”. International Journal of Gynecology & Obstetrics. 95.2 (November 2006): 209-220. Rao, K. A. and Faundes, A. “Access to safe abortion within the limits of the law.” Best Practice & Research Clinical Obstetrics & Gynaecology 20.3 (June 2006): 421-432. Rogo, K. “Improving technologies to reduce abortion-related morbidity and mortality.” International Journal of Gynecology & Obstetrics. 85, Supplement 1 (June 2004): S73-S82. Shah, Iqbal and Elisabeth Åhman. "Age Patterns of Unsafe Abortion in Developing Country Regions." Reproductive Health Matters 12. No. 24 (2004). UNICEF. “Definitions - state of the world's children 1996.” 1996. Retrieved January 22, 2007. <http://www.unicef.org/sowc96/define.htm>. World Health Organization (WHO). Safe abortion: Technical and policy guidelines for health systems. Geneva: World Health Organization, 2003. World Health Organization (WHO). “Unsafe abortion: Global and regional estimates of incidence of unsafe abortion and associate mortality in 2000.” Fourth Edition. Geneva, 2004. World Bank. “Adolescent health at a glance.” 2003. Retrieved April 28, 2006 <http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EX TPHAAG/0,,contentMDK:20583778~menuPK:64229809~pagePK:64229817~piPK:64229743~theSite PK:672263,00.html>.

Chapter 3 – Abortion and Human Rights Africa (Maputo), Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (2003). <http://www1.umn.edu/humanrts/africa/protocol-women2003.html>. Ahumada, Claudia and Kowalski-Morton, Shannon. Youth Activists’ Guide for Sexual and Reproductive Rights. Ottawa: The Youth Coalition, 2005, <http://www.youthcoalition.org/DEV/mambo2/images/stories/SRRGUIDE/srr%20guide%20final%20 version.pdf>. CAT, Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. <http://www.ohchr.org/english/law/cat.htm>. CERD, Convention for the Elimination of All Forms of Racial Discrimination. <http://www.ohchr.org/english/law/cerd.htm>. CEDAW, Convention on the Elimination of All Forms of Discrimination Against Women. <http://www.un.org/womenwatch/daw/cedaw/cedaw.htm> <http://www.un.org/womenwatch/daw/cedaw/history.htm>. Center for Reproductive Law and Policy, and University of Toronto International Programme on Reproductive and Sexual Health Law. Bringing Rights to Bear: An Analysis of the Work of UN Treaty Monitoring Bodies on Reproductive and Sexual Rights. 2002.

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CESCR, International Covenant on Economic, Social and Cultural Rights. <http://www.ohchr.org/english/law/cescr.htm> <http://www.ohchr.org/english/countries/ratification/3.htm>. Charlesworth, Hillary and Chinkin, Christine. The Boundaries of International Law: A Feminist Analysis. Manchester: Manchester University Press, 2000. CMW, Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families. <http://www.ohchr.org/english/law/cmw.htm>. Committee on the Rights of Persons with Disabilities, Convention on the Rights of Persons with Disabilities. <http://www.ohchr.org/english/law/disabilities-convention.htm#II> Cook, Rebecca. (Ed.) Human Rights of Women: National and International Perspectives. University of Pennyslvania Press, 1994. Cook, Rebecca and Dickens, B. M. “The scope and limits of conscientious objection.” International Journal of Gynecology and Obstetrics, 71 (2000): 71-77. CRC, Convention on the Rights of the Child. <http://www.unhchr.ch/html/menu3/b/k2crc.htm>. De Bruyn, Maria. “Human rights, unwanted pregnancy and abortion-related care. Reference information and illustrative cases.” Chapel Hill: Ipas, 2003 <http://www.ipas.org/publications/en/HRIGHTS_E02_en.pdf>. HRC, International Covenant on Civil and Political Rights. <http://www.ohchr.org/english/law/ccpr.htm> <http://www.ohchr.org/english/countries/ratification/4.htm>. Human Rights Watch. “International Human Rights Law and Abortion in Latin America”. 2005. UNDAW, Fourth World Conference on Women (FWCW) Platform for Action. <http://www.un.org/womenwatch/daw/beijin/index.html>. UNDAW, Further actions and initiatives to implement the Beijing Declaration and Platform for Action. <http://www.un.org/womenwatch/daw/followup/beijing+5.htm> <http://www.un.org/womenwatch/daw/followup/ress233e.pdf>. UNFPA, International Conference on Population and Development (ICPD) Plan of Action. <http://www.unfpa.org/icpd/icpd_poa.htm> UNFPA, Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development. <http://www.unfpa.org/icpd/icpd5.htm>. United Nations, Universal Declarations on Human Rights. <http://www.unhchr.ch/udhr/> <http://www.ohchr.org/english/about/publications/docs/fs2.htm>. World Health Organization website. “Preventing unsafe abortion.” Retrieved January 21, 2007 <http://www.who.int/reproductive-health/unsafe_abortion/index.html>.

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

Chapter 4 – Mass Media, Abortion and Sexual and Reproductive Rights Advocates for Youth. Advocacy Kit: Adolescent Reproductive and Sexual Health. Washington, Advocates for Youth, 1995 <http://www.advocatesforyouth.org/publications/advocacykit.pdf>. Balance. Manual de formación de jóvenes activistas en el tema aborto. México: Balance, 2005. Centre for Development and Population Activities (CEDPA). Gender, Reproductive Health and Advocacy: A Trainer’s Manual. Washington: CEDPA, 2000 <http://www.cedpa.org/files/738_file_grad_english_all.pdf>. Cucurella Leonela, Mendizábal Iván. Comunicación en el Tercer Milenio. Quito-Ecuador: Abya-Yala, March 2001. Hessini, Leila, Hays, Lonna, Turner, Emily and Sarah Packer. “Abortion matters to reproductive justice.” Reproductive Justice Briefing Book: A Primer on Reproductive Justice and Social Change. Ipas, 40-41. Ipas, Decidir, and Balance. Manual de Jóvenes Activistas en el tema de Aborto. Promoción para el Desarrollo de la Juventud, México. Not yet published, 2007. Policy Project, The. Networking for Policy Change: An Advocacy Training Manual. Washington: POLICY, 1999 <http://www.policyproject.com/pubs/AdvocacyManual.cfm>. Sanchez, Maria Luisa. “Mexico City Makes Abortion Rights History in Latin America.” RH Reality Health Website. Retrieved May 29, 2007 <http://www.rhrealitycheck.org/blog/2007/05/24/mexicocity-makes-abortion-rights-history-in-latin-america>. Westchester Coalition for Legal Abortion. Choice Matters website. Retrieved January 2007 <http://www.choicematters.org/>. World Health Organization. World Report On Violence and Health. Geneva, 2002.

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ABOUT THE AUTHORS Tanya Baker, 26, is a certified Midwife and has a Bachelor of Science in Integrated Sciences combining life sciences and international health. She is the former Chair of the Global Outreach Students’ Association at the University of British Columbia, whose mandate is to improve the health of marginalized populations both locally and abroad. In addition, she is the Western Canada representative for the Student University Network for Social and International Health. Tanya is a strong believer that the enhancement of youth sexual rights and increased youth participation leads to the betterment of health and welfare of a population. Joana Chagas, 28, has been a member of the Youth Coalition since 2004, having participated at the Beijing+10 process, chaired the Millennium Development Goals Task Force, coordinated the publication "Learning to Speak MDGs", and participated in the organization of the International Youth Forum "Sexual Evolution of Development", where she co-facilitated the working group on HIV/AIDS. Currently, she is co-chair of the Human Rights Task Force, and member of the Abortion Task Force and the LGBTQ Task Force. For five years, Joana worked as Programme Assistant at the United Nations Development Fund for Women (UNIFEM) Regional Office for Brazil and the Southern Cone, where she was responsible for coordinating the planning, implementation and monitoring processes of UNIFEM's programme on human rights of women, as well as responding for young women leadership and political participation thematic areas. Joana graduated in International Relations at the University of Brasilia, and was awarded a Chevening Scholarship by the United Kingdom Foreign Commonwealth Office to undertake a MSc in Human Rights at the London School of Economics and Political Science, which she has just completed. Joana’s areas of interest are human rights of women, gender, sexuality and abortion. Maria Eugenia Miranda, 27, is a journalist and social communicator, an activist and trainer on sexual and reproductive rights and youth issues with considerable international advocacy experience. Based in Argentina, Maria Eugenia has a strong interest in youth and young women's issues. She was a founding member of the National Network of Adolescents for Sexual and Reproductive Health and Rights, created in 1999 and integrated by youth organizations from all over the country. She was also a founding member of the REDLAC and the Youth Coalition, where she still participates actively and is part of the organization’s Board of Directors. Furthermore, she is a former member of the Articulación de Mujeres Jóvenes Trabajando en América Latina y el Caribe por los Derechos Humanos y la Ciudadanía. Maria Eugenia has facilitated trainings on SRR, HR, gender and youth for young people at the national, regional and international level. She has participated in the

Freedom of Choice: A Youth Activist’s Guide to Safe Abortion Advocacy

United Nations ICPD+5, ICPD+10, MDG+5 and Beijing+5 processes as an advocate for young people's sexual and reproductive rights. She has also participated in many research and investigatory projects, written many articles, edited newsletters, and appeared on several radio programs. Currently, Maria Eugenia runs her own national NGO called Moverte, working for young people’s human rights, and is completing her Masters in Anthropology at FLACSO. Pamela Pizarro is the former Senior Communications and Outreach Officer for the Youth Coalition. Pamela joined the organization in 2004 after graduating from the University of Calgary with degrees in both Political Science and International Relations. Working with the Youth Coalition, Pamela attended and participated in many international conferences and meetings including the 49th Session on the Commission on the Status of Women (CSW), the 10th Annual International Woman and Health Meeting (IWHM), and the UNGASS Review on HIV/AIDS in May of 2006. In May 2005, Pamela helped organize the Youth Coalition’s International Youth Forum, which was held in Buenos Aires, Argentina, and in 2007, she coordinated 5 national abortion advocacy workshops held in Paraguay, Nigeria, Trinidad and Tobago, India and Ecuador. Nadia Ribadeneira González, 22, is in her 8th semester of the Communications program at the Universidad Internacional del Ecuador in Quito, Ecuador. Nadia is part of the feminist urban collective, Mujeres de Frente, who has been working in women's prisons in Quito for three years, giving workshops, publicly denouncing the abuses against female prisoners, and generating civic debates about the situation of prisoners in Ecuador. Nadia is also a founding member of several social justice initiatives: La Casa Feminista de Rosa (Rosa's Feminist House) is a social centre and a public space that defends the rights of women; the Coalición Ecuatoriana por la Despenaliación del Aborto (Ecuadorian Coalition for the Decriminalization of Abortion); and the regional organization, Jóvenes Ciudadanas, trabajando el América Latina y el Caribe por los Derechos Humanos y la Ciudadanía (Young Women Citizens, working in Latin America and the Caribbean for Human Rights and Citizenship). Nadia has been a member of the Youth Coalition since 2005, and she currently sits on its Board of Directors.