EngenderHealth Recommits to Expanding Safe Abortion Globally 

EngenderHealth sees 2023 as a pivotal year for abortion rights and access, rife with significance, opportunities, and challenges. In Africa, African Union member states, activists, and other stakeholders are recognizing the 20^th anniversary of the Maputo Protocol and taking stock of countries’ progress in upholding commitments to promote women’s rights, including the right to safe abortion. In Latin America and the Caribbean, the Green Wave has successfully mobilized for expanded legal indications for abortion—part of an overwhelming trend in recent decades toward liberalization of abortion laws.  

And worldwide, increased access to medications for abortion, increased recognition of self-care as a safe and acceptable mechanism for increasing access, and growing momentum to ensure universal health coverage (UHC) combine to create a rapidly evolving environment with strong potential for overcoming current inequities in access to safe abortion. Yet, in a number of settings, including the United States, conservative backlash to women’s rights in general and sexual and reproductive rights in particular is dramatically reducing access to abortion care, with grave consequences for people’s lives, health, and rights. Strategies to support comprehensive abortion care must evolve with these complex times. 

EngenderHealth has a decades-long commitment to supporting national and local partners to increase access to comprehensive abortion care, and we recognize the vital engagement of many other global, regional, national, and local organizations in this critical work. We also understand that to have the greatest impact and to be the best partner we can be—especially amid myriad current challenges—we need to crystallize our approach to supporting safe abortion. It is in this context that we are proud to share our updated Strategy for expanding abortion rights, equity, and access for a gender-equal world.   

Background 

Access to safe abortion is essential to both human rights and public health. Unsafe abortion accounts for 16% of preventable maternal mortality worldwide, and multiple human rights conventions have affirmed that the right to health and the right to bodily autonomy bestow the right to a safe abortion. Safe abortion is healthcare and a human right.    

As has been well documented, the vast majority of countries have indications for legal abortion. However, many people live in countries (or states, in the US) where legal access is limited. For example, the Maputo Protocol explicitly recognizes abortion as a human right for certain circumstances, including when pregnancy results from sexual assault, rape, or incest; when there are life-threatening fetal anomalies; and when continuing the pregnancy endangers the woman’s mental and physical health or her life. Unfortunately, in many signatory countries, this right is not a reality, and actual national abortion guidelines—when they exist at all—do not adhere to the full indications outlined in the regional treaty.  

Even where laws are liberal, many implementation gaps still exist. Fortunately, there are a number of initiatives to reduce these gaps and increase access to comprehensive abortion care. For example, in Burkina Faso, EngenderHealth is leading the My Body, My Choices, My Rights campaign in partnership with the government and international and local partners to improve access to safe, high-quality abortion care. Using a rights-based approach, the program supports young women and adolescent girls, including those who are internally displaced, to exercise their agency and make decisions about their own health and wellbeing. 

Our Goal & Approaches 

EngenderHealth’s strategy to expand abortion rights, equity, and access builds on our broader global vision of a gender-equal world where all people achieve their sexual and reproductive health and rights. We believe that when women, girls, and other pregnant persons are empowered and engaged, when they live in supportive communities, when systems and institutions provide high-quality, gender-equitable sexual and reproductive health care, and when policies, laws, and processes are liberalized, then they will exercise their right to bodily autonomy. And, ultimately, women and girls will participate as full, equal members of society.  

Our strategy focuses on ensuring that all people, including those with the least access to sexual and reproductive health services, can realize their fundamental rights and obtain high-quality, affordable comprehensive abortion care, free from discrimination and stigma, within or near their communities, whether through a healthcare provider or using abortion pills on their own, when and where they want.  

How we do our work is as important as what we do. No matter the program, EngenderHealth uses approaches that are human rights-based and gender- and youth-transformative—that is, designed to empower individuals and redress systemic inequities that impede women’s, girls’, and young people’s ability to exercise their rights and participate as full members of society. And we build meaningful partnerships with youth-led and feminist organizations to transform communities by supporting current and future leaders, addressing gender biases in communities, and meeting the immediate needs of young people. We also have trusting relationships with ministries of health, and through these, we support the expansion of national technical standards and guidelines that are aligned to the latest global guidance, while helping governments strengthen people-centered, primary health care systems to deliver equitable maternal and reproductive health services, including comprehensive abortion care. 

And perhaps most critically, EngenderHealth’s commitment to reaching all people, no matter who they are or where they live, means that we design our programs with equity at the core from the start – to ensure that no one is left behind. In the case of abortion access, this means supporting programs that are by and for young people, who account for nearly one-third of all unsafe abortion-related deaths each year, and working with people with disabilities as well as those in crisis or humanitarian settings, to facilitate their access care. We also ensure that our work on gender-based violence is fully aligned with our work on abortion, so that women who are pregnant from sexual violence have all the health, social, and judicial services they need, including access to abortion. 

The Way Forward 

Political opposition to abortion rights is growing, alongside increasing attacks on comprehensive sexuality education and the rights of the LGBTQAI+ community. However, we have never had more tools and resources to ensure that abortion rights are upheld and services are available, acceptable, affordable, and high quality. Public support for abortion rights is high. Information and products for medication abortion are available. Global technical agencies like the World Health Organization have clear guidance for countries, health systems, healthcare providers, and people. Numerous human rights conventions acknowledge the right to abortion in a range of settings and for various populations. And, as advocates come together in Kigali, Rwanda next week for the Women Deliver Conference, global commitment to advancing reproductive rights remains.  

EngenderHealth will continue to counter misinformation, enhance service delivery, advocate for policy change, and we will do it with partners in the lead. Our role is to support women and young people, local organizations, state and national governments, and global stakeholders who are all working together to ensure that all people can make decisions about their own bodies and futures, and that everyone, everywhere can receive safe, affordable and unbiased abortion care.