Working Together Towards Global Safe Abortion- 3rd IWAC

The conference is an international platform for global exchange, updates and sharing information on safe abortion as well as providing networking opportunities among committed health workers and SRHR safe abortion advocates. The theme of this congress was “Working together Towards Global Safe Abortion” recognizing that unsafe abortion still kills and disables thousands of women worldwide every day.   Highlights of the conference:

1. Conscientious objection: service providers should not deny the women access to abortion. (raised by Jon O’Brien and Dr. Choong from Malaysia).

2. Values clarification should be mainstreamed within medical education curriculum: To help future service providers understanding of the importance of women’s access to safe and legal abortion services and to enhance the quality service, non-judgmental service and maintaining privacy and confidentiality of clients.

3. “Trust Women”: The key to good medical abortion services (by Beverly Winikoff, Gynuity Health Projects.  

I came across the terminology “Conscientious Objection” during the refresher training organized for youth champions who had attended Youth Advocacy Institute organized by Asia Safe Abortion Partnership in 2014. Dr. sim-Poney Choong, Co-Chair, Reproductive Rights Advocacy Alliance Malaysia and a founder of Asia Safe Abortion Partnership said that it is a duty of a service provider to serve its client with non-judgmental attitude. He/she is not in the state of denial of service to its client because of his/her beliefs. If service providers do not perform abortion to a woman who needs, because it is against his/her beliefs then he/she is in wrong profession. Service providers before joining their profession as doctors or nurses take oath to serve every client. If they don’t, they are the reason for women seeking unsafe and illegal abortion resulting into complications and even death of women.

 Dr. Amar Jesani of the International Medical Journal of Ethics talked about abortion and how to handle ethical questions at Youth Advocacy Institute.

I agree that people come from different backgrounds and they have their own values and norms. However, when you serve nation as service provider on women’s health the important value is saving women’s lives rather objecting abortion service to them because it comes against own values. The best solution for this could be integrating Value Clarification Activities during the training for service providers on abortion. This helps to clear their values.

There was a presentation on trusting women by Beverly Winikoff- Gyunity Health Projects who talked about George Tiller, an American physician, an abortion provider and martyr for women’s right to choose. His motto was, ‘TRUST WOMEN’, an exhortation meant as moral and philosophical. It turns out that it is also very good policy and clinical advice. Her presentation spoke about medical abortion that has been made easier and more acceptable if women are included as major actors in the process and how many aspects of medical abortion treatment can be delegated directly to the woman with no loss of efficacy, safety or acceptability. Indeed, such a revamping of services seems to be more acceptable and preferable to many women.

An examination of what is required of medical abortion services using this lens raises the question of why the drugs are so often restricted to specialist services and to provision in clinics or hospitals only. Why shouldn’t medications for abortion be provided in pharmacies, like other safe and effective medicines? And why shouldn’t they be prescribed at the lowest level of the health care system that can use them effectively and safely- maybe by women themselves? This emphasized on trusting women and empowering them with information and self administrating the medical abortion pills.

Another interesting session was by Dr. Christian Fiala, MD, PhD Spezialist in Obstetrics and Gynaecology shouted asking question Why Is Abortion Illegal? What were the considerations and the intention of making it illegal in the first place? He, then clear the answer saying: monarchies, dictatorships and war leading countries wanted to increase their population and to have more soldiers. Care of children or women has never been a thought. It was only with democratic developments that people too, the freedom to vote for their political representatives and also wanted self-determination in the most intimate aspects of life: one’s sexuality and fertility. He also presented that respecting women implies to give the power to decide over all aspects of their reproductive choices. It also implies the duty for societies to rid of all remaining obstacles and patronizing restrictions.

Media Sensitization on Safe Abortion

Youth Champion Advocacy Network Nepal, YOUTHCANN had received a small grant from Asia Safe Abortion Partnership to organize various advocacy session on safe abortion to different groups like young people, service providers and media people. On the occasion of September 28, Global Day of Action for Access to Safe and Legal Abortion, YOUTHCANN organized half day sensitization program on safe abortion to media persons from print and radio.

Media is one of the most powerful instruments of communication. It plays a very constructive role in today’s world. As we know media plays an important role in increasing of public awareness and collect the views, information and attitudes toward certain issues. It presents the real stage of society. Without the media, people would be isolated, not only from the rest of the world, but also for the total formation of creditable world.

The media has got a vital role in molding positive perspective on abortion among people and spread positive message in the society to #BustTheMyths. But there is a myths on media

Myths: Most Media People Object the Abortion.

Facts: Media People are Often leading Advocates for Safe & Legal Abortion

Resource person Ms. Madhabi Bajracharya from Ipas shared that Ipas Nepal also closely works with media people and organize sensitization program for them regarding abortion. It has been observed that media people have their own values and they rarely accept abortion a woman’s right. Holding ones values on abortion might give rise to bias news and information which simultaneously lead to #abortionstigma and discrimination.

Likewise, one of the Youth Champions shared that she has been following various articles been published in newspaper and online news regarding abortion, the media always covers news on women deaths and complication due to abortion but they never specify where the deaths and complications are due to safe or unsafe abortion. There is difference between safe or unsafe abortion and reporting accordingly.

There was very good discussion among participants and facilitators. One of the media person asked what YOUTHCANN is doing to avoid abortion? Avoid Abortion…….. Well YOUTHCANN never promotes abortion. We are pro-choice and we respect informed choice and decision of every woman. We encourage young people to use modern contraceptive to prevent unwanted pregnancy which may lead to abortion. Even if Government has been giving more emphasis to contraceptive and it is free in almost all the health facilities, women do seek for abortion services. We encourage women and men to have safe and legal abortion which has less complication instead of unsafe traditional abortion which leads to death.

The participants were more curious to know about data on abortion and its failure rate. Also, they were keen to know the percentage of young women going for abortion. They perceive various myths on abortion like:

• Most of the young unmarried women undergo abortion.
• Abortion is a crime.
• Fetus has its right of survival
• Young people are using abortion as family planning.
• Repeated abortion is dangerous.
• Service providers do not want to perform abortion
• INGOs are promoting abortion.
• Abortion leads to infertility.
• Woman needs husband consent for abortion.
• Young people should not be given SRHR information and access to service.

All these Myths are cleared by the resource person Madhabi and Deepndra Khaniya. Deependra Khaniya is Managing Director of nation’s leading radio station Radio Audio which supports young people’s SRHR and on-air program on safe abortion. Deependra shared that his team receives more than 200 SMS daily from young people between 15 and 24 years which is mostly related to SRHR. Even if we do not allow young people to talk, listen and see SRHR stuffs they will definitely receive information from somewhere which might be incorrect and lead to unexpected situation. These days young people are more prone to social media and it is not always necessary they absorb only good information. Even we are helpless to block or stop the inaccurate information to reach our young people. Therefore, it is our job: media people’s job to clear our own values regarding abortion and provide reliable information to them.

Media should be sensitive when they write articles, news and on-air program on safe abortion. No woman undergoes abortion with her interest. It’s due to some reason and media should analysis those situation. One of youth champion shared that she had read an article which says, “Young girls in school uniform goes to abortion clinics and its increasing.” Well most of our government health facilities are Youth Friendly Service centres. It remains after school to reach most of the young people with information on SRHR. It’s government’s initiation. The YFS centres are in health institutes which provides safe abortion service as well. So, it would be discrimination to young school going girls if we publish on one sided information. May be she was there in health facilities for science project work or her regular meeting with community girls. This kind of bias information only hampers young girls and our country will never progress.

Youth Champion Prabina Sujakhu led value clarification exercise. Upon asking the statement: HIV infected woman should not give birth, most of the participants raise their hand in favor to the statement. The concern was if mother is infected she is not health enough to give birth to healthy baby. Some said infected mother gives birth to infected baby. Upon asking what if she knew pregnant. Most of the participants replied abortion is best option for her. But we facilitator shared its her right whether or not she wants to have her baby and knowing about safe procedure now we have in medicine which protect baby form HIV infection, the participants were forced to rethink.

Likewise, on asking whether husband’s consent is necessary for abortion most of the male participants were in favor to the statement stating mutual decision is the best which won’t lead to disturbance in family. Due to conflict in family, the marriage ends in divorce. But female participants shared that its woman’s body and she has her full right to decide about her pregnancy. There were argument between male and female participants on this statement.

Similarly, on asking abortion is killing fetus all most all the participants agreed upon address fetus as baby and life starts from conception. But the participants seem to be convinced when facilitator shared that there is not any study to show when life begins. Fetus depends on woman’s body as parasite. Life is only counted when it survives with its own.

At the end of the program, a video was shown “News Room Bahira”. The video talks about Sushila Jaisi’s death due to unsafe abortion. This video make the participant realized that even if there is availability of contraception for free of cost, abortion occurs. Abortion is always woman’s last decision. Use of contraception leads to prevent abortion.

The participants shared that this was the first time they had attended session on abortion. They realized bias information leads to #abortionstigma and discrimination. They also promised to contact YOUTHCANN for accurate information and resource materials on abortion as well as SRHR. In deed it was a fruitful orientation.