On September 20 2022, Action Canada for Population and Development held an NGO side event at the United Nations in Geneva while the 51st Human Rights Council Sessions were in place. The NGO side event titled “Sexual and Reproductive Health and Rights: A Conversation on Safe Abortion” was moderated by Sunita Kajur, the panelists were Bella Ganatra and Maria Luisa Peralta.
World Health Organisation’s recent “Abortion Care Guideline” was the starting point of discussion at the event, Bella Ganatra from the Department of Reproductive Health and Research at World Health Organisation, stating that this is the third comprehensive safe abortions guideline WHO has published since 2003 compiling recommendations for clinical care, service delivery care, and law and policy embedded in the human rights framework; commented that the most recent report is unique in the sense that it is conceptually framed to put the abortion seeker at the center of the discussion. Adding that the guideline recognizes that not one size fits all and that its recommendations on what type of care is to be provided, when and how and by whom may be adjusted as necessary depending on the context of the specific country; she has underlined that implementation must be within what is called an “enabling environment”, an enabling framework of law and policy supported by strong healthcare systems.
The second panelist Maria Luisa Peralta, recognizing that WHO’s sustained effort to gather and publish constantly updated information that is open source is a plus for democratization as it is for access to information and access to safe abortion; added that these guidelines are a great support for activists on the phone for safe abortions and primary healthcare providers who are not sure whether abortion through medicine is an initial option. She has also stated that self-medication abortions as opposed to surgical abortions are not yet completely trusted by people, and that there is an ongoing discussion within sexual and reproductive rights movements on whether self-medication abortions are a second-quality, second-rate option.
Bella Ganatra here has stated that the procedure of taking tablets is very safe and it is not a question of safety but rather a question of what is locally available and what is possible. “No option is second rate”, she said, “it is a matter of choice”. “Even when both options are available, in some cases and contexts women may prefer surgical abortions when in other cases they may prefer to self-manage their abortion.”
While some of the over fifty recommendations in the guideline can be actioned at the level of individual healthcare providers, some are on different levels of action such as legislation. Bella Ganatra, clarifying that the guidelines represent an ideal situation and that WHO does not expect countries to implement all recommendations in the guideline at once, stated “there is not one country on earth who can implement all of them at once, at the same time, there is no country in the world which cannot implement at least one of those recommendations”.
Maria Luisa Peralta added here that the role of civil society in this process is to reach as many women who require abortions as possible, who often feel vulnerable and isolated. Underlining that to access these guidelines one must have some knowledge on the subject, internet connection, a computer, one must be able to understand the technical vocabulary, she stated that it is the role of civil society to go further with the work and allow for this guideline to come alive. “There is a big distance between these huge international bodies and the women who benefit from abortion care”, she said, “and civil society is there to bridge this gap.”
She noted that in the context of Argentina, self-managed abortion has drastically changed the political discussion. When before, access to safe abortion was only possible through medical professionals; the introduction of medication abortion which is decentralized and can be managed in many ways has really changed the power balance. This change in power balance has been wonderful for autonomy, she commented, “self-managed abortions allow one the possibility to choose to whom one reveals their pregnancy and their abortion, which also allows then for greater dignity of person.”
Bella Ganatra, agreeing that self-managed abortions bring autonomy and self-determination, underlined that while self-managed abortions are undoubtedly very empowering, for an abortion to be “self-managed”, it must be a choice for the person to self-manage. When it is a choice taken out of desperation that one conducts their medication abortion themselves, because there are no other available options, then this would not constitute “self-management” under the guidelines. She added that moving forward, in order to guarantee safe abortion for all, we need a combination of being in the street protesting, advocacy work, and having a great network of alliances consisting of healtcare providers, academics who can support the work through research, and policymakers.
One question asked by the audience was in the area of third-party authorization when it comes to younger girls. Bella Ganatra stated that guidelines address this by recommending that they not be mandatory. Maria Luisa Peralta added that the youngest people requiring abortions, and people from the working class are the most vulnerable when it comes to being approached in a paternalistic way, that they are seen by society as unable to make their own decisions. “The same goes for people with disabilities”, she said, “society says they should not reproduce, or, that they are not fit to make the decision to terminate a pregnancy”. “We need to have information available in braille, in sign language, and make sure we tailor services to the particularly vulnerable.” It was also mentioned here that Covid-19 has accelerated the use of telemedicine, which can be very useful in the fulfillment of this aim. The importance of ensuring access to abortion with dignity for non-binary persons and trans men within the health systems was also underlined.
In closing, it was emphasized that it is essential to note that while access to self-managed care must be made more widespread, dignity, autonomy and respect for decision making is central to all abortion care. Instead of looking at self-managed care as the solution to stigma and bad healthcare, we need to keep look at the source of these ills, and to try and fight them at the source, especially since many countries criminalize women including for self-managed abortion care.
