Why Abortion is becoming more available and safer around the world

March 18, 2020

     By Duncan Green     

If you were to buy just one issue of The Economist a year, the edition just before International Women’s Day is usually a good bet. Even though it seldom mentions IWD directly, the issue usually sneaks in some fascinating gender-based pieces (eg this 2017 article on gender budgeting).

This year it ran pieces on femicide in Latin America; sexism and coronavirus in China and a review of two books on women and work (sorry if these are gated). But the big report this year was a global survey on abortion. Some highlights (and some important caveats from Oxfam’s in house gurus at the end):

‘Behind the headlines, abortion is becoming more widely available in most of the world. Between 2000 and 2017 some 27 countries made it easier for women to get abortions. Only Nicaragua made it harder. In the past two years Cyprus, the Republic of Ireland, Northern Ireland and North Macedonia have all loosened restrictions. Since last April, South Korea and Thailand’s constitutional courts have ruled that banning abortion is unconstitutional. Argentina will probably legalise it soon, though Colombia’s top court refused to do so on March 3rd. And in countries where ending a pregnancy is still illegal or tightly restricted, do-it-yourself abortions, which once involved back-alley butchery or wire coat-hangers, are becoming safer.

Reynosa, a city on Mexico’s border with America, is controlled by drug cartels and patrolled by heavily armed state police, their bulletproof vests bristling with spare magazines. The streets are lined with pharmacies which are visited regularly by Americans. Maria (not her real name), a pharmacist, says she sells the “abortion pill” to at least one “gringo” every day.

Misoprostol, the drug in question, is a stomach-ulcer drug which can also be used to cause abortions. It is tightly regulated in America. In Mexico, where abortion is mostly illegal, pharmacies stock it next to cough drops and painkillers. The generic version costs 990 pesos ($50). Some 15 miles away in McAllen in Texas, a state that is dogged in its efforts to stop women getting abortions, the region’s sole surviving abortion clinic charges $700 for treatment that includes the same drug. Some who cannot afford that take their chances with Reynosa’s guns and gangs. Others who dare not cross the Rio Grande buy misoprostol on the black market in America, where they risk getting fakes. Even if the medication is genuine, it is less effective without a second drug, mifepristone, which is much harder to get.

Now there is a third option. Last year Isis, an unemployed 20-year-old from Fort Worth in Texas, got an abortion. She consulted online a doctor in Austria who works for Aid Access, a non-profit that helps women who cannot otherwise get abortions. She paid the group $90. A pharmacy in India sent her seven pills. Isis never had to leave her home. Such abortions are increasingly available—even in countries where ending a pregnancy is illegal.

Bans and restrictions seem to do little to cut the number of abortions. In countries where it is mostly illegal, 37 in 1,000 women have an abortion each year compared with 34 in countries where it is widely available, estimates the Guttmacher Institute, a pro-choice research group. Abortion rates in America have declined steadily since the late 1980s, with no significant difference between states that have introduced new limits and those that have not.

Better access to contraception, by contrast, does make abortions rarer. Every year nearly half of pregnancies worldwide are unintended. That share has been falling for years, mostly thanks to the increased availability of effective contraceptives. In 1969 only 4% of women in the least-developed countries who wanted modern contraception got it; by 2019 that figure was 59%. In much of the rich world it is nearly 90%.

Brazilian women first discovered misoprostol could be used to terminate pregnancies in the 1980s. Women across Latin America told each other about “the pill that makes your period come back”, first in person and later through hotlines and online.

Since then the shift from surgical abortions to medical ones has been dramatic; in the Nordic countries over 90% of abortions are now drug-induced, in India 80% and in America a third. When taken with mifepristone, misoprostol ends 97% of pregnancies in the first ten weeks without complications. More women are seeking abortions earlier in their pregnancies. That is largely because of cheap at-home pregnancy tests, says Jasbir Ahluwalia, a doctor at the McAllen clinic: “The 98 cents test at Walmart has given women such power.” In most rich countries over two-thirds of terminations are carried out before nine weeks and 90% before 13 weeks.

Statistics on how many women take abortion pills without medical care are understandably patchy. Still less is known about how they fared. But a study in 2016 by Abigail Aiken of the University of Texas at Austin of 1,000 women in Ireland who managed their own abortions with the help of Women on Web, a non-profit which provides online advice and prescribes pills by post, found that 95% ended their pregnancies without any surgical intervention. Just 3% received medical help such as a blood transfusion or antibiotics. The organisation gets around 150,000 requests for help each year, many coming from Brazil, Poland, Thailand and (until abortion was legalised) Northern Ireland. Requests shoot up whenever the website is translated into a new language, says Rebecca Gomperts, the group’s founder.

The impact on women who live in countries where abortion is illegal is most dramatic. Backstreet abortions used to result in perforated uteruses and life-threatening infections and haemorrhages. Some still do. But globally such complications have become rarer. Since 1990 the number of women dying as a result of botched abortions—most of them illegal—has dropped by 42%, from 108 per 100,000 abortions (1990-94) to 63 (2010-14).’

And here’s the all-important caveats, from Fenella Porter, 0xfam’s Co- Director, Women’s Rights and Gender Justice:  

‘I’m concerned about the framing of this.

Of course it is a positive thing that women have more access to abortion, and that they are able to self-administer where there are more repressive conditions. But this can’t distract us from the more fundamental issue that safe and accessible abortion (whether surgical or medical) should be freely available to all women because it is their right.

At times, the article seems to be falling into a trap – saying that if women are getting access to abortion pills, then we don’t need to worry so much if they are doing so under safe conditions, or if they are getting this access because they are empowered to do so within society.

There has been a huge roll back in women’s reproductive rights (including the global gag rule), so although the data in here suggests that in terms of just getting access to abortion pills the numbers are looking better, in fact the situation is increasingly worrying. Having access to an abortion pill is not in any way a counter balance to the need for women to be empowered to have bodily autonomy and the right to control their own fertility.

March 18, 2020
Duncan Green