International Safe Abortion Day: September 28, 2022 By: Christina Davidson, MD The SMFM Patient Safety & Quality Committee invites you to join the World Health Organization, the International Campaign for Women’s Right to Safe Abortion, and September28.org in activities surrounding International Safe Abortion Day. This Day of Action for Access to Safe and Legal Abortion has its origin 2 decades ago in Latin America and the Caribbean, where women’s groups began mobilizing around September 28 to demand their governments decriminalize abortion, provide access to safe and affordable abortion services, and end stigma and discrimination towards women who choose to have an abortion. The date was chosen in commemoration of the abolition of slavery in Brazil, which is now remembered as the day of the “free womb.” In 2011, the Women’s Global Network for Reproductive Rights took September 28 to the global level in solidarity with the women’s movement in Latin America and in recognition of the fact that access to safe and legal abortion continues to be denied for too many women in too many countries. Eliminating unsafe abortion is one of the key components of the WHO global Reproductive Health Strategy. When individuals face barriers to obtaining quality abortion, they often resort to unsafe abortion. Global estimates from 2010–2014 demonstrate that 45% of all induced abortions are unsafe. Of all unsafe abortions, one third were performed under the least safe conditions, i.e., by untrained persons using dangerous and invasive methods. Developing regions bear the burden of 97% of all unsafe abortions. Each year, 4.7–13.2% of all maternal deaths can be attributed to unsafe abortion, often due to complications such as uterine perforation, hemorrhage, and infection. In developed regions, it is estimated that 30 women die per every 100,000 unsafe abortions. In developing regions, that number rises to 220 deaths per 100,000 unsafe abortions. Estimates from 2012 indicate that in developing regions alone, 7 million women per year were treated in hospital facilities for complications of unsafe abortion.    Evidence shows that restricting access to abortions does not reduce the number of abortions; however, it does affect whether the abortions are safe and dignified.   Unsafe abortion is not only an issue in developing countries. As states begin to enforce abortion bans and restrictions, the United States will certainly see an increase in maternal morbidity and mortality because safe abortion care will be inaccessible for certain patients. Early data from Texas indicate that abortion restrictions increase maternal morbidity in patients experiencing obstetric complications. A total abortion ban in the U.S. could result in an estimated 21% increase in all maternal deaths and a 33% increase in maternal deaths among Black individuals. Forced pregnancy for people at high risk of comorbidities could result in more high-risk pregnancies and increased risks of severe maternal morbidity and maternal mortality. The existing racial disparities in severe maternal morbidity and maternal mortality, together with higher rates of abortion among low-income people and people of color, mean that these groups are most impacted by decreased access to abortion. Furthermore, Black people are more likely to live in the U.S.  states that have the most restrictive abortion policies. Restrictions that create geographical, transportation, and financial barriers to abortion exacerbate racial inequities for those most at risk.  Multiple actions are needed at the legal, health system, and community levels so that everyone who needs abortion care has access to it. According to WHO, the three cornerstones of an enabling environment for quality comprehensive abortion care are: respect for human rights, including a supportive framework of law and policy; availability and accessibility of information; and a supportive, universally accessible, affordable, and well-functioning health system.  How can we as MFMs engage in ensuring safe access to abortion services? SMFM’s recent publication, Clinical Considerations for Management of Severe Complications When Abortion Care is Restricted, provides concrete suggestions for MFMs to assist in building partnerships, achieving consensus, and advocating at the institutional level to improve access to reproductive healthcare.   An interactive map by the Guttmacher Institute has detailed information about abortion access within each state of the USA.

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