[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]
