The paradox of access
Although high rates of unsafe abortion are – broadly speaking – linked to restrictive abortion laws, the country cases demonstrate that there is an unclear and at times paradoxical association between the status of the law and actual access to safe abortion procedures. The complexity of the relationship between abortion laws, policy and access cannot, however, be fully grasped without recognising how abortion is fundamentally embedded in social, religious and health-system contexts.
Globally, three different discourses dominate the debate on abortion: a human rights discourse, a public health discourse and a religious/moral discourse. In Ethiopia, Zambia and Tanzania the discourse on safe abortion as a ‘human right’ is largely absent while the discourses on safe abortion as a ‘public health’ issue and as a ‘moral transgression’ are competing for prominence. Below we take a look at how these normative discourses are played out and their importance for actual outcomes in the three country contexts.
The official governmental discourse on abortion in Ethiopia is based in public health. Rooted in mortality and morbidity figures related to unsafe abortion, the public health discourse on safe abortion gains legitimacy through the aim of reducing abortion-related death rates, and protecting girls and women from the adverse health consequences of unsafe abortions (1). The changes in the earlier, more restrictive abortion law were fought through in an alliance between civil society actors and the Federal Ministry of Health, promoting safe abortion as a public health measure to reduce maternal mortality.
Different religious groups, particularly the Ethiopian Orthodox Christian Church to which the majority of the population belong, challenge the public health argument and retain the position that abortion is a religious offence and morally wrong. The increasing availability of safe abortion services thus to some extent remains silenced, the law is not widely known and high numbers of young women continue to resort to unsafe procedures (12).
The case of Zambia, possibly more than the other two countries, highlights the importance of the religious-moral dimensions of abortion. Zambia has declared itself a Christian nation, the Catholic Church is powerful and the independent churches – including the Pentecostal church – are increasingly visible in the discourse on abortion, promoting a pro-life agenda that constructs abortion as a sin and a religious offence. A new bill of rights has recently proposed an amendment to the constitution with vast implications for abortion-seeking women stating that: ‘The right to life begins at conception’ (17).
The ontology of human life and personhood lies at the core of this, as well as of other major abortion controversies. Within the Christian discourse, politicisation and diverse interpretations of the point at which human life begins is particularly pertinent (18). In Zambia, this discourse has opened up for a renewed political dispute over abortion that may curb recent public health efforts to simplify access to safe abortion services in the country.
In Tanzania, where Islam and Christianity are practised by approximately equal proportions of the population, the discourse on abortion as a sin and as a moral transgression predominates at official level. Although the media regularly raises the problem of unsafe abortion-related complications and deaths among young girls, the public health argument is not officially endorsed. Despite the public condemnation there seems to be room for considerable pragmatism, particularly when it comes to the increasing availability and accessibility of misoprostol (19).