This course will provide you with an overview of the most important health challenges facing the world today. You will gain insight into how challenges have changed over time, we will discuss the likely determinants of such changes and examine future projections. Successful international strategies and programs promoting human health will be highlighted and global health governance structures will be mapped and the role of the key actors explored.
7.4: Abortion Stigma (T Gammeltoft)
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From the course by University of Copenhagen
An Introduction to Global Health
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From the lesson
Maternal and Child Health
This fourth module deals with maternal and child health. The first focus will be on the important, and at times controversial, topic of sexual and reproductive health and rights, often shortened to SRHR. This is followed by a short lesson focussed on child health.
Meet the Instructors
Flemming KonradsenProfessor, Director
Copenhagen School of Global Health
[MUSIC]
Hi, my name is Tine Gammeltoft.
And I'm a professor at the Department of Anthropology here at the University of
Copenhagen.
My talk today focuses on abortion stigma.
I will start out by saying a few words about abortion as a global health problem,
and then move on to talk about abortion stigma.
Induced abortion is one of the most contested and
controversial issues in this field.
Around the world, opposition to abortion is often fierce.
And practically all government authorities try to regulate and
control women's access to abortion in some way.
Abortion opponents argue different things.
Some claim that the life of a fetus equals that of a person already born,
therefore abortion is murder.
Others argue that abortions are harmful to women's' mental health,
causing lifelong trauma.
And others, again, are of the opinion that such vital decisions
should not be placed in the hands of individual women, but
should lie with the couple or the family at large.
In most countries, abortion battles are ongoing, abortion rights advocates trying
to secure women's access to abortion, abortion critics trying to restrict it.
In Vietnam, for instance, abortion has been legal and easily available for
half a century.
And abortion has been officially framed as a question of women's rights.
A new draft law in populations set forth this year,
however, proposes to restrict women's access to abortion.
Under the law,
a woman having an abortion must sign a pledge with agreement from her husband or
parents, and abortions will only be permitted under certain conditions.
Other countries, such as El Salvador, Nicaragua, and Poland, have
also recently increased their restrictions on women's access to abortion.
From a women's health and rights perspective, such moves are problematic.
Let's take the rights perspective first.
At the International Conference on Population and Development, the ICPD,
that was held in Cairo in 1994, induced
abortion was among the issues that it was most difficult to reach consensus on.
And as at present,
no international agreement to consider abortion as a human right.
Nevertheless, women's health advocates insist that abortion is a human right,
reasoning that if the right to life and
the right to health are human rights, then abortion is every woman's human right.
While there's still controversy around abortion rights,
there's complete consensus that unsafe abortion is a major public health problem.
This was recognized by all government delegations at the ICPD.
The WHO considers the elimination of unsafe abortion as
one of the top five priorities in the field of sexual and reproductive health.
The WHO defines unsafe abortion as a procedure for terminating a pregnancy that
is performed by an individual lacking the necessary skills, or
in an environment that does not conform to minimal medical standards, or both.
Worldwide, approximately half of all abortions are unsafe.
And the proportion of unsafe abortions has increased over the past decade.
In Africa, nearly all abortions are unsafe.
More than 97% of all abortions are unsafe abortions.
In Latin America, the figure is 95%.
Overall, 98% of all unsafe abortions take place in the developing world.
Interestingly, restrictive abortion laws are not associated with lower
abortion rates.
In Western Europe, for instance, where abortion is generally legal,
the abortion rate is only 12 per 1,000 women.
Whereas in Africa, where abortion is generally illegal,
the abortion rate is 29 per 1,000 women.
Evidence clearly shows that abortions do not disappear by being criminalized.
To reduce abortion rates, what is needed is better family planning services, and
a strengthening of women's abilities to control their own fertility.
The consequences of unsafe abortions for women's health and lives are far ranging.
First, unsafe abortions kill women.
The WHO estimates that 13% of all maternal deaths are due to unsafe abortion.
In 2008,
it was estimated that 47,000 women died as a direct consequence of such abortions.
Unsafe abortion also cause serious health problems among women
in the developing world.
According to a recent article published in The Lancet, an estimated 8.5 million
women annually need medical attention, due to complications from unsafe abortion.
And 3 million of these women do not receive the care that they need.
Of every five women who have an unsafe abortion,
at least one suffers a reproductive tract infection as a result.
And unsafe abortions may also cause infertility.
Adolescent girls suffer the most from complications of unsafe abortions.
In 2008, more than 40% of all unsafe abortions in
developing countries were in young women aged 15 to 24 years.
This suffering could have been prevented.
Existing research shows that when abortions are performed under safe
conditions, they pose hardly any risks to women's physical or mental health.
Since abortions, in themselves, are not harmful to women's health,
some scholars and activists now argue a major problem that must be addressed is
the stigma that is attached to induced abortion in many settings.
The term stigma was coined by the sociologist Erving Goffman
in 1963 to describe a situation where an individual's
identity is changed to a tainted, discounted one.
People who become associated with a stigmatized condition
are labelled in a negative way.
And they pass from a so-called normal to a so-called discredited social status,
often internalizing this spoiled identity themselves.
The stigmatized person is disqualified from full social acceptance,
experiencing negative treatment, social exclusion, and condemnation.
Practices of stigmatization occur in all societies.
People who are particularly often stigmatized include the disabled,
the mentally ill, and people living with HIV.
Stigma contributes to the construction of divisions between us and
them, confirming the normalcy of some people by devaluing others.
Stigmatization, in other words, relates closely to questions of power of
inequality, as some people have the power to stigmatize others, while others do not.
In an article published in the journal Culture,
Health & Sexuality in 2009, Anu Kumar, Leila Hessini, and
Ellen Mitchell applied Goffman's concept of stigma to the field of abortion.
To explain why women continue to experience abortion-relatied illness and
death, they argue, we must pay more attention to abortion stigma.
Kumar, Hessini, and Mitchell proposed this definition of abortion stigma.
A negative attribute ascribed to women who seek to terminate a pregnancy that
marks them, internally or externally, as inferior to ideals of womanhood.
Across the world,
existing research shows women who seek abortions tend to be negatively labelled.
They are stigmatized in governments, since experiencing moral condemnation and
social ostracism.
To explain the dynamics of this stigmatization, Kumar, Heissini, and
Mitchell argue we must place abortions in the context of dominant ideas
about womanhood, motherhood, and sexuality.
In many cultures, women who obtain abortions are challenging dominant ideas
about the essential nature of women.
Such ideas hold that female sexuality is solely for procreation, and
that motherhood is a woman's duty.
An abortion, therefore, is an assertion of women's moral autonomy that is
perceived as deeply troubling and threatening.
And to scientists, respond by stigmatizing both the women who challenge the moral
order in this way, and also of the health providers who perform the abortions.
Abortion is, in other words, not just a health issue.
It's also an ideological battle over the meanings of womanhood, motherhood, and
sexuality.
The problem is that when abortions are stigmatized,
they are often surrounded by secrecy, silence, and shame.
Women tend to keep abortion experiences to themselves, and
it becomes more difficult to address the health problems that
are associated with unsafe abortions, and to advocate for abortion rights.
If we want to enhance women's health and insist on women's rights,
therefore, a good place to start is by addressing abortion stigma.
Thank you.
[MUSIC]
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