Separating Myth From Reality

January 24, 2014

By Estelle M. Sidze, Associate Research Scientist, Beatrice W. Maina, Research Officer, and Joyce N. Mumah, Associate Research Scientist, APHRC

What does donor funding for abortion-related projects in Africa support?

Anti-abortion voices across Africa have always denounced what they perceive as the imposition of a foreign-driven abortion culture in the lives of people in Africa. In Kenya for instance, the promulgation, in 2010, of a new constitution that explicitly permits abortion (when, according to a trained health professional, there is need for emergency treatment; or the life and health of the mother is in danger.)[1]*) received criticism from certain quarters.  Particularly, there were claims that the Obama administration had spent over $23 million to persuade Kenyans vote for the new constitution to allow unlimited abortions.[2]

Available evidence indicates that about 6.3 million unsafe abortions occurred in African countries in 2008, representing one in two young women under age 25.[3] A recent report published by APHRC together with the Kenyan Ministry of Health and other partners shows that 465,000 induced abortions occurred in Kenya in 2012, with 120,000 of these women receiving care for moderate or severe complications in health facilities.[4] These alarming numbers remind us that urgent efforts are needed to provide universal access to family planning services (including information, counseling and range of methods) which could help prevent the inextricable consequences of unintended pregnancies.

Abortion laws in the continent vary immensely but are mostly restrictive. In a majority of African countries, abortion is only allowed to save the life of the mother. There are also few instances where abortion is allowed to preserve physical and mental health and on socio economic grounds. [5] For example, in Zambia, the law also permits abortion on socio-economic grounds while in Ethiopia, abortion is also allowed in cases of rape, incest or serious fetal impairment; or due to deficient physical or mental health. Similarly, in Cameroon, abortion is permitted to save a woman’s life, preserve physical and mental health or in case of rape or incest. In South Africa, a more liberal abortion law exists and varies by the gestational age of the pregnancy. Abortion is unconditionally permitted if the pregnancy is below 13 weeks old. Between 13 and 20 weeks, abortion is only permitted if the woman’s own physical or mental health is at stake; severe mental or physical fetal abnormalities; in cases of incest or rape; or for socio economic reasons. If the pregnancy is more than 20 weeks, abortion is permitted only if the woman’s or the fetus’ life is in danger or there are likely to be serious birth defects.

Debates on abortion (including proposals to legalize unrestricted abortion) continue in various African countries. [6] As a corollary, regional bodies such as the African Union have taken a stand on abortion by requesting member states to reduce the maternal mortality rate by taking adequate measures to provide effective access to reproductive health services including access to legal medical abortion to women. [7]

The pressure on many governments to liberalize the laws on abortion by civil society, advocacy organizations and researchers has been seen in some quarters as driven by Western donors who might lobby for an effective realization of women abortion rights (notably to decide whether to have an abortion or not). The Resources Flow Project data** offers a unique opportunity to gauge the extent to which donor assistance for population activities has funded abortion activities and to separate the myth from the reality. Statistics on significant projects funded by various international donors from 200 to 2011 that included a percentage of funds for abortion-related activities are presented in Table 1. These data indicate that donors have focused largely on PREVENTING CASES of induced abortions through the reduction of the numbers of unintended pregnancies. Because the burden of disease is high from these induced abortions, funding is also tilted towards POST-ABORTION CARE management and treatment services. Donor-funded projects have also covered the broader salient issues of reproductive health such as creating gender-appropriate, youth-friendly services; providing support to victims of gender based violence; integrating health services; improving medical practices (the use of Misoprostol in this case); developing facilities/providers’ capacity to provide good quality care; and informing public policy.  It could be argued that beneath these overarching strategies are mechanisms that encourage women to access safe abortion services. This argument however, will be speculative at best, for we cannot ascertain this premise based on the current data.

Far from driving a pro-abortion agenda therefore, donor funding has been geared towards preventing the root causes of unsafe abortion and especially a reduction in levels of unintended pregnancies. Regional expansion of these projects to include the West and Central African region (which appeared under deserved considering the beneficiary countries) is pertinent and necessary considering the magnitude of abortion in these regions***

 

 

Table 1. Funded projects with an abortion component, 2000-2011(donor data) 

Year Donor organization Type of activities implemented Beneficiary countries in Africa
2000 Bill & Melinda Gates Foundation Reduce unintended pregnancies, abortion and STIs Regional
United Nations Population Fund Post-abortion family planning Zimbabwe
Department for International Development  (DFID) Reduce unintended pregnancies, expand services for young people, develop facilities’ capacity to provide more effective and accurate abortion care services Ghana, South Africa, Zambia
International Projects Assistance Services (IPAS) Improve access to post-abortion care services Regional, Nigeria, Ethiopia
Rockefeller foundation Research Burkina Faso
The David and Lucile Packard foundation Improve access to post-abortion care services Regional, Nigeria
2001 Bill & Melinda Gates Foundation Reduce unintended pregnancies, abortion and STI Regional
MacArthur Foundation Study on abortion practices among rural communities Nigeria
Swedish International Development Cooperation Agency (SIDA) Not mentioned in the database Regional
World Bank Group Support for the Africa Alliance for women’s reproductive health and rights Regional
The David and Lucile Packard foundation Post-abortion care training, inform public policy on abortion, expand access to safe abortion care Nigeria
2002 JHPIEGO Corporation Post-abortion care-Misoprostol Kenya
McArthur Foundation Study on abortion practices among rural communities Nigeria
International Projects Assistance Services (IPAS) Promote women’s reproductive rights and expand access to safe abortion care Regional, Nigeria, Ethiopia, South Africa
The David and Lucile Packard foundation Inform public policy on abortion, support for post-abortion care training, expand access to safe abortion care Nigeria
Rockefeller Foundation Prevent unwanted pregnancies and unsafe abortion Kenya
World Bank Group Support for the Africa Alliance for women’s reproductive health and rights Regional
2003 Swedish International Development Cooperation Agency (SIDA) Support studies on post-abortion care Regional
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria, Ethiopia
Netherlands Ministry of Foreign Affairs Expand access to post-abortion care Ethiopia
McArthur Foundation Reproductive health care (program support) Nigeria
2004 Bill & Melinda Gates Foundation Reduce unintended pregnancies, abortion and STIs Regional
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria, Ethiopia
Netherlands Ministry of Foreign Affairs Expand access to post-abortion care Ethiopia
Swedish International Development Cooperation Agency (SIDA) Reduce unsafe abortion Regional
Pathfinder international Integrate behavior change communication and youth-friendly services for improving adolescents reproductive health Mozambique
2005 Pathfinder international Integrate behavior change communication and youth-friendly services for improving adolescents reproductive health Mozambique
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria, Ethiopia
International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, Ethiopia, Kenya, Nigeria, South Africa
2006 International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, Ethiopia, Kenya, Nigeria, South Africa
McArthur Foundation Expand access to post-abortion care Nigeria
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria, Ethiopia
Netherlands Ministry of Foreign Affairs Expand access to post-abortion care Ethiopia
Swedish International Development Cooperation Agency (SIDA) Support to IPAS regional activities Regional
Pathfinder international Integrate behavior change communication and youth-friendly services for improving adolescents reproductive health Mozambique
2007 International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, Ethiopia, Nigeria, South Africa, Mozambique, Ghana
Global Fund for Women Teenage pregnancy and unsafe abortion Kenya
Swedish International Development Cooperation Agency (SIDA) Support to IPAS regional activities Regional
Pathfinder international Integrate behavior change communication and youth-friendly services for improving adolescents reproductive health Mozambique
Netherlands Ministry of Foreign Affairs Expand access to post-abortion care Ethiopia
USAID Expand access to high quality family planning services to reduce unintended pregnancies Regional (over 15 countries)
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria
International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, Ethiopia, Nigeria, South Africa, Mozambique, Ghana
     2008 USAID Expand access to high quality family planning services to reduce unintended pregnancies Regional (over 15 countries)
The David and Lucile Packard foundation Increase the capacity of private sector to deliver post-abortion care, expand access to post-abortion care, support post-abortion care training Nigeria
Pathfinder international Expand access to post-abortion care Regional, Mozambique
Swedish International Development Cooperation Agency (SIDA) Support to IPAS regional activities Regional
World Population Foundation Support to victims of gender based violence South Africa
2009 World Population Foundation Support to victims of gender based violence South Africa
The David and Lucile Packard foundation Development of gender-appropriate youth-friendly services, expand  integrated family planning, post-abortion care, and management of STIs services, improve maternal health through prevention of unsafe abortion in secondary-level health care facilities, phase-out support to reduce impact of unsafe abortion and increase availability of post-abortion care Rwanda, Nigeria, Ethiopia, Angola
USAID Expand access to high quality family planning services to reduce unintended pregnancies Regional (over 15 countries)
International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, Ethiopia, Kenya, Nigeria, South Africa
Pathfinder international Expand access to post-abortion care, integrate post-abortion care with family planning counseling and STI screening Mozambique, Ethiopia, Ghana
Netherlands Ministry of Foreign Affairs Support to health policy formulation, promote and increase access to sexual and reproductive health services and rights, expanding access to post-abortion care, prevention and management of obstetric fistula, national survey on female  genital mutilation Mali,South Africa, Burkina, Mozambique, Tanzania, Ethiopia, Ghana, Zambia, Uganda, Zimbabwe
Swedish International Development Cooperation Agency (SIDA) Support for the formulation of health strategic plans, support to local civil society organization, health sector budget support, strengthen institutions’ capacity in regard to regulation, inspection, product assessment and quality control of medicines
2010 The David and Lucile Packard foundation Expand post-abortion care in Nigeria, register misoprostol for post-abortion care in Rwanda, improve youth-friendly services in Ethiopia, increase knowledge on abortion in rural communities in  Kenya Nigeria, Rwanda, Ethiopia, Kenya
MacArthur Foundation Increase access to post-abortion care services Nigeria
USAID Expand access to high quality family planning services to reduce unintended pregnancies Regional (over 15 countries)
International Projects Assistance Services (IPAS) Reduce deaths and injuries due to unsafe abortion and increase women’s ability to exercise their sexual rights Regional, South Africa, Ethiopia, Nigeria, Ghana
Pathfinder international Increase access to post-abortion care services, integrate post-abortion care with family planning, and STI screening, diagnosis and treatment Ethiopia, Angola, Mozambique
Rutgers WPF Support to victims of gender based violence South Africa
2011 Pathfinder international Technical support to ensure effectiveness of reproductive health programs, build sustainable models for safe abortion services (in South Africa and Ghana), increase access and use of reproductive health services for underserved groups Ghana, Uganda, South Africa, Nigeria, Mozambique
USAID Expand access to high quality family planning services to reduce unintended pregnancies Regional (over 15 countries)
Rutgers WPF Support to victims of gender based violence South Africa

 

Source: The UNFPA Resource Flows (RF) project database, donor data.

References:

[1] The Constitution of Kenya, revised Edition 2010, Chapter four, 26 (4)

* Up to that time, abortion was only permitted to protect a woman’s life.

[2] View in Article http://archive.lifenews.com/int1598.html

[3] Shah IH and Ahman E. Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women. Reproductive Health Matters 2012, 20(39): 169-173

[4] Incidence and complications of unsafe abortion in Kenya. Key findings of a national study.

[5] Grimes DA et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

[6] Brookman-Amissah E. and Banda Moyo J. Abortion law reform in sub-Saharan Africa: No turning back. Reproductive Health Matters 2004, 24(12): 227-234

[7] Resolution on the Health and Reproductive Rights of Women in Africa, Accra, Ghana, May 2007.

 

** The Resource Flows (RF) project monitors progress achieved by donors and developing countries in implementing the financial resource targets agreed upon at the International Conference on Population and Development in Cairo in 1994 and the Declaration of Commitment adopted at the United Nations Special Session on HIV/AIDS in 2001. The RF project collects data and subsequently reports on international population assistance and domestic expenditures for population activities in developing countries. The project started in 1997 as a joint collaboration between the United Nations Population Fund (UNFPA) and the Netherlands Interdisciplinary Demographic Institute (NIDI). Domestic data for sub-Saharan African countries are collected in collaboration with the African Population and Health Research Center (APHRC). The information is collected for every financial year on the sources and recipients of funding, type of projects funded and future funding commitments. Details are available at: http://www.resourceflows.org/.

*** The statistics indicate indeed that women in eastern Africa and Western Africa are more likely to have an unsafe abortion than are women in other African regions. See Grimes DA et al. Unsafe abortion: the preventable pandemic http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf

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