Part 3 - Participatory Sessions

In-Depth, Participatory Discussion Sessions in Small Groups (15-25)
on Advocacy for Safe Abortion in Policy and Practice in Africa

Building on the more academic part of the conference, these sessions will prioritize the sharing of knowledge, experience, and strategies in advocacy for safe abortion in Africa, around the following main themes:

1. Decriminalization of abortion: whether, to what extent, and how

Sessions will explore feasible and strategic ways of responding to the criminal law on abortion, the extent to which abortion might be removed from the criminal law so as to be treated as a bona fide health service for women, or whether it is necessary to continue to work within the confines of existing law in a limited way, given the national climate.

2. How medical abortion pills are changing everything (or should be)

Sessions will pool knowledge on whether access to medical abortion pills has become possible in different countries and country settings (e.g. urban vs rural) , and discuss how to address the fact that they are being used with very differing levels of success, depending on whether women have correct information and access to post-abortion care or not.

3. Understanding the basis of the opposition to abortion today and how to address it

The anti-abortion movement is highly influential in many countries, often seeking to assert religious control over state policy, and working from local level to the United Nations. In some cases, they claim abortion is "foreign" and "against traditional culture" when in fact the aim is to keep women pregnant and maintain patriarchal control over women's lives.

Some specific issues to cover that have arisen in the region in recent years include:

i) plans to decriminalize abortion in line with the Maputo Protocol, under the aegis of the African Commission for Human and Peoples' Rights;

ii) the reasons why some efforts to reform the law on abortion have succeeded (e.g. in Ethiopia, Mozambique) while others which were on the cusp of succeeding have stalled (e.g. Sierra Leone, Malawi) and still others have not moved at all or gone backwards (e.g. Kenya);

iii) the role of resistance to change and respect for senior anti-abortion figures – the dominance of male religious and traditional leaders invoking tradition and cultural values to oppose law reform and the widespread belief that abortion is bad, even though so many women have abortions;

iv) the weakness of public health systems, the lack of training for providing abortion care at primary level, and the lack of involvement in fostering change on the part of many health professionals and policymakers; and

v) poor adherence to human rights standards in relation to women's needs, especially pregnant women's right to life and health whether a pregnancy is wanted or not.

As regards medical abortion, although self-use of medical abortion pills is happening in most legally restricted settings, it is still occurring less in Africa than in other regions. Pills (most often misoprostol only) may be obtained from pharmacies and drug sellers, but their quality is uncertain and information on how to use them is greatly lacking. Private providers cater for women who can pay. And in Kenya, Malawi, Morocco and Nigeria, for some women at least, there are safe abortion information hotlines to contact. Research from Madagascar, Burkina Faso and Benin, about to be published, shows how problematic the experience of self-use of pills has been in some of the poorest countries, however, and other evidence shows that large numbers of women still have access only to unsafe invasive methods, with continuing high rates of maternal morbidity and mortality.

Tunisia and Ethiopia are examples of success both in law reform and provision of medical abortion by mid-level providers. But in most countries in Africa, evidence that midwives, nurses, community health workers and other primary care providers, including trained pharmacy workers, can safely provide MVA and/or medical abortion at primary and community level is not widely known and is not being implemented.

This picture raises profoundly legal and policy issues as well as public health and health services issues for African countries. We will be asking participants to share evidence and experience from their own countries and discuss how they believe change can happen in these areas.

Those interested in participating are asked to share suggestions for specific topics under the main themes to help us develop a final agenda.