Over the last 30 years, 59 countries have relaxed abortion restrictions. This includes 18 countries that have overturned complete bans on abortion. In stark contrast, with Roe v. Wade overturned, the U.S. joins the ranks of only three other countries to have restricted access in that time: Poland, El Salvador and Nicaragua.
So, while the news from the U.S. is cause for alarm, it also reminds us of how far we’ve come, and why we cannot turn back the clock in countries that have liberalized abortion. The following stories of abortion providers in Cambodia, Ethiopia and Nepal of life before their countries legalized abortion show the U.S. how restricting abortion rights can endanger women’s lives.
Across the country, women still lack bodily autonomy and the rights they need to make independent decisions about their bodies.
Lila started working for MSI just as abortion was legalized in Nepal in 2002. Born in Sindhupalchowk, a rural region to the north of Kathmandu, Lila knows all too well about the barriers that women and girls in remote areas face accessing sexual and reproductive health services.
Before abortion was liberalized in Nepal in 2002, 20 percent of its maternal deaths were attributable to unsafe abortion, one of the highest in the region. Thanks to commitments from the government and the tireless work of abortion providers like Manju, this has now dropped by a staggering 72 percent.
“The services we provide now are very different from when I first started as a midwife,” she said. “Before abortion was legalised in Nepal, I often saw clients coming in with severe pelvic bleeding, including women who had visited traditional providers to access abortion.”
She added: “Sometimes clients came into the clinic after being advised by traditional providers to use a four-centimeter long ‘medicinal stick’ that was inserted in their vaginas. It was so distressing to see women going through that situation every day and for women to have to hide their pregnancies as it was illegal to have an abortion.”
And while a lot of progress has been made in Nepal, approximately 44 percent of women, especially those living in rural areas, still do not know that abortion has been legally available for 20 years.
“Not all barriers to access have been removed,” said Manju, another MSI abortion provider in Nepal. “Across the country, women still lack bodily autonomy and the rights they need to make independent decisions about their bodies.”
“Although there are still cultural barriers that prevent women from accessing abortions in Nepal, women are much more aware of their rights and the methods of abortion available,” she added, referencing how providers are now able to help women terminate unwanted pregnancies at home.
As the pandemic hit Nepal, this progress might have been threatened. Since the start of the pandemic, MSI Nepal has worked closely with the government to deliver medical abortion at home, protecting women’s access to choice at a critical time. Outreach teams have crossed mountains and valleys to reach women in the most rural and remote parts of the country, overcoming some of the barriers they face in accessing services.
“The situation is completely different now. Women across the country can access safe abortion services, and since the start of the pandemic, we’ve been able to support women to access medical abortion services at home,” said Lila.
Although more progress needs to be made to remove the barriers that women still face, Manju said that “the challenges are nothing in comparison to the satisfaction and smiles we see from our clients. It makes our work worth it!”
She added: “Abortion is not just a service, it’s a women’s rights issue and is essential health care. I feel very proud to serve women and help to save their lives.”
The methods women used at the time to try and terminate an unwanted pregnancy were desperate. By the time these women came to health facilities, many were already in a very critical situation. We were able to save a few, but many more died.
When restrictions on abortion block women from receiving safe care, many turn to dangerous unsafe methods—putting their lives and health at risk. But the reverse is also true: When restrictions are removed and women can access safe care, lives are saved.
Before Ethiopia liberalised its abortion laws in 2005 to help tackle the country’s high maternal mortality rates, unsafe abortion contributed to nearly a third of all maternal deaths in the country. “The law was very strict, but as in many contexts, the risks did not deter women and abortion rates remained high,” Abebe Shibru, MSI Ethiopia’s country director said.
“In an average week, around two or three women died in clinics across the country. At that time, it was normal to see half of the delivery and gynaecology rooms in Ethiopia filled with women who needed immediate medical assistance.” Other hospital beds were reserved for women who had become septic.
Shibru has worked for over 20 years in sexual and reproductive health and saw firsthand the deadly effects of restrictive abortion policies in Ethiopia before the law changed. With no legal routes to access an abortion, women were faced with dangerous alternatives that could cause infections, and lifelong disabilities, and were in some cases fatal.
“The methods women used at the time to try and terminate an unwanted pregnancy were desperate. Ranging from traditional remedies including tree roots and herbs, women would also insert harmful objects like catheters and metallic tools inside of them to try and end their pregnancy, causing uterine perforation and organ injury. By the time these women came to health facilities, many were already in a very critical situation. We were able to save a few, but many more died.”
Since 2005, Ethiopia has changed its laws and made huge strides in making safe abortion accessible for women in the country. Recent studies have shown that maternal mortality due to unsafe abortion has dropped sharply from a third to 1%.
Abebe added: “The change in abortion laws in Ethiopia has helped us to serve more women with safe and effective high-quality care. The rooms and the beds once reserved for post-abortion care are now used to help women to access safe abortion and a range of sexual and reproductive health services.”
However, this important progress is fragile. Anti-choice activists in Africa continue to push for restrictions, which could drive more women back to unsafe methods. Having seen the progress Ethiopia has made in tackling maternal mortality and expanding women’s reproductive rights, Abebe issued a stark warning about how a reversal of Roe v. Wade would send shockwaves across the continent.
“If Roe v. Wade is reversed it would be a victory for anti-choice groups who finance the opposition in Africa and a catastrophe for us. It could influence policy makers and mean that in Africa we will keep seeing women dying. Whatever we have gained could be lost.”
The most crucial thing about the law was that it decreased the rate of maternal mortality.
MSI midwife Sophornnary has seen firsthand that legalization of abortion saves women’s lives. As department director of a referral hospital in Kampong Chang in eastern Cambodia, she, remembers that before abortion was legal, trained midwives sometimes performed the service anyway, but secretly. They took the risk because they knew that women determined to end a pregnancy will always find someone willing to help. Sometimes with deadly consequences.
Before legalization, restrictions on abortion meant that few midwives had proper training on abortion care. The homemade methods used by traditional health care providers were crude and often unsafe, risking women’s lives in the process. “The death rate from unsafe abortion was high, she said, but so too were abortion rates,” highlighting the fact that restrictive abortion policies have never been shown to reduce the demand. “Many women ended up with heavy bleeding, and there were some who couldn’t be saved.”
Since the legalization of abortion in Cambodia, Sophornnary has worked with local authorities, health centers and referral hospitals to raise awareness for safe abortion services and contraceptive methods to prevent unintended pregnancies. She now sees about 10 women per month who want to terminate their pregnancies, many who travel from nearby provinces to access the quality care offered in her hospital.
“The most crucial thing about the law was that it decreased the rate of maternal mortality,” she said. Maternal mortality has dropped dramatically in the 30 years since Cambodia legalized abortion. Down from 432 to 170 maternal deaths per 100,000 live births.
What Sophornnary has witnessed in Cambodia is not unique. It’s supported by data from other countries. Worldwide, abortion-related deaths are higher in countries where abortion laws are more restrictive than in countries with less restrictive laws. Laws making abortion more accessible are often combined with increases in comprehensive sexuality education and access to modern, reliable contraception-all of which are needed to keep maternal mortality rates headed downward.
Even though abortion has been legal in Cambodia for so long, stigma still surrounds it. Sophornnary hears of people criticizing the women who come to her for help. She is concerned that those who oppose abortion in her country will find strength from U.S. abortion politics. She worries that the progress that has been made in education and access to contraception and safe abortion could be jeopardized. She fears that restrictions could return.
She told us: “Years ago, before abortion was legal, a woman came to me seeking my help after she’d had an unsafe abortion and couldn’t stop the bleeding. I had to tell her to go to the hospital because I wasn’t able to help her.” The woman died trying to get help. Sophornnary added: “The memory of that woman haunts me to this day.”
Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.