Visual Media, Journal Articles, and Other Publications

19 February 2016


Film: 24 weeks, a late abortion drama, brings Berlinale to tears

15 February 2016

German late abortion drama brings Berlinale to tears
Julia Jentsch and Bjarn Mädel in 24 Weeks. Photo: DPA

“24 Weeks", a drama about a couple struggling to decide whether to have a late-term abortion, moved the audience to tears at its Berlin film festival premiere.

The film by Anne Zohra Berrached, 33, tackles a thorny issue in a country in which, according to the producers, more than 90% of parents terminate pregnancies in which the fetus is severely disabled. The subject, however, is rarely discussed.

The picture is set in east Germany, and tells the story of a cabaret performer and her manager husband who already have one child and learn she is pregnant with a second… The film presents a society in which religion hardly plays a role but where the abuses under Adolf Hitler, in which 300,000 ill and disabled people were systematically murdered by the Nazis, loom large.

Tags: Germany, second trimester abortion, fetal anomaly


Video: Can Faith and Freedom Co-exist?

Catholics for Choice
(English, 11 min)

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The debate over religious freedom will continue to be a key issue in the United States and Europe. Religious lobbies are pressuring policymakers for exemptions or for permission to impose their views on the rest of society. Catholics for Choice co-convened a forum at the European Parliament to discuss the real meaning of religious freedom with members of the European Parliament, journalists and civil society leaders.

The video was produced by Catholics for Choice on behalf of the Global Interfaith and Secular Alliance to answer pressing questions about religious freedom, secularism and extremism.

Tags: USA, Europe, religious freedom, secularism


Poster: How to think about the fetus

Joyce Arthur, Executive Director, Abortion Rights Coalition of Canada

This was a poster presentation at the 3rd International Congress on Women's Health and Unsafe Abortion, Bangkok, 26-29 January 2016. Below are two sections of the poster.

The whole poster can be accessed at:

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Tags: reproductive rights, status of fetus
European Parliament

Draft report: The situation of women refugees and asylum seekers in the European Union

16 November 2015
Hon. Mary Honeyball, UK MEP/

The European Parliament Committee on Women's Rights and Gender Equality has adopted a report authored by the Hon. Mary Honeyball, UK MEP which highlights that women and girls fleeing conflicts and war face various forms of gender-based violence in their journey towards a hosting country, as well as multiple discrimination. It says:

“Historically, international conventions and national asylum policies have tended to overlook the specific position of female asylum seekers and the gendered nature of refugee situations. Asylum systems have largely been seen through the lens of male experience. Despite the creation of the Common European Asylum System (CEAS), law, policy and practice in member states continues to vary significantly and there is a noticeable gap in the protection given to women seeking asylum in the EU.

“Accurate statistics on the demographic diversity of refugees trying to reach Europe are, by their nature, difficult to generate. However, all contemporary research suggests that more single men reach the EU to seek international protection than women and children. This is largely a result of the gendered barriers to accessing protection that women face throughout their journeys. Traditional unequal divisions of labour mean women are often left behind to care for children and elderly family members. Many lack the independence - both financial and administrative - to leave their country of origin in the first place.

“The increasing numbers of women who do flee are vulnerable at all stages of their journeys; in countries of origin, transit and destination. As well as being a key driver behind women’s decisions to flee, gender-based violence is a common feature throughout journeys to and within the EU.”

General recommendations:
1. Believes that, to improve the security and safety of women refugees, safe and legal routes to the EU must be made available for those fleeing conflict and persecution; believes that legislation and policies relating to irregular migration should never prevent access to EU asylum procedures;
2. Reiterates its call for all Member States to sign and ratify the Council of Europe Convention on preventing and combating violence against women (Istanbul Convention);
3. Expresses its deep concern at reports that women and children are engaging in survival sex to pay smugglers to continue their journey to seek asylum in the EU.

Specific needs:
Women have specific needs in screening and interview processes and standards continue to vary significantly across member states. To address this, as a minimum, member states should:
  • guarantee and publicise the right to request a female interviewer and interpreter

  • deliver comprehensive and mandatory training for interviewers and interpreters on sexual violence, trauma and memory

  • provide trauma counselling for women who have experienced gender-based harm

  • provide information about the asylum process, rights and entitlements specific to women seeking asylum

  • provide childcare during screening and asylum interviews

  • inform women of their right to make an independent application for asylum

The report was adopted by 18 votes in favour and 10 against, with 0 abstentions and will go to the European Parliament plenary to be voted upon.

Tags: Europe, sexual violence, rights of women refugees/asylum seekers


Psychosocial factors and pre-abortion psychological health: the significance of stigma

JR Steinberg, JM Tschann, D Furgerson, CC Harper

Social Science & Medicine 2016;150:67-75. DOI: 10.1016/j.socscimed.2015.12.007
Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted.

The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma.

Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion.

This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological stress.

Tags: USA, pre-abortion mental health, abortion stigma


The incidence of abortion in Nigeria

Akinrinola Bankole, Isaac F Adewole, Rubina Hussain, Olutosin Awolude, Susheela Singh, Joshua O Akinyemi

International Perspectives on Sexual and Reproductive Health 2015;41(4):170-81. DOI: 10.1363/4117015

Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. A widely used, indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and post-abortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria.

An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15-49. 56% of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed.

Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and post-abortion care services (as permitted by law) may help reduce maternal morbidity and mortality. 

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Tags: Nigeria, unsafe abortions


Taking women’s rights seriously: using human rights to require state implementation of domestic abortion laws in African countries with reference to Uganda

Charles G Ngwena

Journal of African Law 60.1(Feb 2016):110-40's_Rights_Seriously_Using_Human_Rights_to_Require_State_Implementation_of_Domestic_Abortion_Laws_in_African_Countries_with_Reference_to_Uganda

This article is constructed around the premise that women's rights to safe abortion give rise to obligations that the state has a positive duty to implement. Using Uganda as a case study, it frames failure by a state to implement its abortion laws in ways that render the rights tangible and accessible to women as a violation of human rights. The article develops a normative human rights framework for imposing on a state the obligation to take positive steps to implement abortion laws that the state, itself, has adopted. The framework does not depend on requiring the state first to reform its substantive laws or broaden the grounds for abortion. Rather, it focuses on the implementation of existing domestic laws. The article draws its remedial juridical responses partly from conceptions of women-centred rights to procedural justice, equality and health, and partly from jurisprudence developed in recent years by United Nations treaty-monitoring bodies and the European Court of Human Rights.

The full text of this article is available from the printed journal, or online here through subscribing libraries.

Tags: Uganda, abortion law and policy


Pharmacy workers’ knowledge and provision of medication for termination of pregnancy in Kenya

Kate Reiss, Katharine Footman, Vitalis Akora, Wilson Liambila, Thoai D Ngo, et al

Journal of Family Planning & Reproductive Health Care February 2016, DOI:10.1136/jfprhc-2013-100821

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To assess pharmacy workers’ knowledge and provision of abortion information and methods in Kenya. In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion services they provide. We also used mystery clients, who made 401 visits to pharmacies to collect first-hand information on abortion practices.

The majority (87.5%) of pharmacy workers had heard of misoprostol but only 39.2% had heard of mifepristone. We found that pharmacy workers had limited knowledge of correct medical abortion regimens, side effects and complications and the legal status of abortion drugs. 49.8% of pharmacy workers reported providing abortion information to clients and 4.3% reported providing abortion methods. 75.2% of pharmacies referred mystery clients to another provider, though 64.2% of pharmacies advised mystery clients to continue with their pregnancy. Pharmacy workers reported that they were experiencing demand for abortion services from clients. 13.7% had received abortion training; 45.5% wanted more information or training on abortion services.

Pharmacy workers are important providers of information and referrals for women seeking abortion, however their medical abortion knowledge is limited. Training pharmacy workers on medical abortion may improve the quality of information provided and access to safe abortion.

Tags: Kenya, medical abortion pills, pharmacy workers


A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital

Sahar J Hassan, Laura Wick, Jocelyn DeJong

Women and Birth 2015;28(4):e148-56. DOI: 10.1016/j.wombi.2015.08.008

Little is known about the burden and patterns of maternal morbidity during childbirth, particularly in the Middle East Region. Investigating the patterns of maternal morbidity can be useful in guiding improvement in the quality of maternal services, and informing policy debates on women's health. To examine the incidence, types and patterns of management of severe and non-severe maternal morbidities of Palestinian women during pregnancy, labour, delivery and up to seven days post-partum in one Palestinian hospital.

A prospective hospital-based study was conducted for a 3-month period in 2011-2012, reviewing hospital records for all pregnant women (1,583) admitted to the governmental hospital in Ramallah, Palestine. Of all pregnant women included in this analysis (1.558), 419 (26.9%) women experienced one or more maternal morbidities and 15 (0.96%) women survived a life-threatening complication (near miss). Of all women who suffered morbidities, 69 (16.5%) had vaginal deliveries, 61 (14.6%) had caesarean sections, 179 (42.7%) had abortions/miscarriage, and 110 (26.3%) experienced complications during pregnancy or the post-partum. Haemorrhage during pregnancy, birth or post-partum was the most common morbidity. Of those who gave birth, women who gave birth by caesarean sections were three times more likely to suffer from morbidities than those who had vaginal delivery.

Of those who experienced morbidities, 69 (16.5%) women had vaginal delivery, 61 (14.6%) had caesarean sections, 179 (42.7%) had abortions, and 110 (26.3%) were pregnant or in their post-partum period. Abortion/miscarriage-related haemorrhage was the most common complication documented for women with morbidities. The curettage procedure was utilized for 22 women.

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In Palestine, abortion is illegal by law and is not accepted by the Islamic society for religious reasons except to save the mother’s life, which increases the burden of maternal morbidity related to abortion on the health system. Moreover, in cases of unwanted pregnancies, women seek abortions either in private clinics or use traditional methods at home which may result in abortion-related haemorrhage and ultimately women with such cases show up at the hospital complaining of haemorrhage. The most common forms of management were medical methods followed by curettage, which are unsafe practices as complications are 2–3 times higher than vacuum aspiration method and more costly. Providers must be trained on evidence-based practices and safe abortion care.

The burden of maternal morbidity for Palestinian women between the ages of 16 and 48 is high. In Palestine, maternal morbidity can be prevented by promoting a rational use of caesarean section, avoiding unnecessary medicalization, reducing unwanted pregnancies and updating practices of providers related to abortion/miscarriage care…

Tags: Palestine, unsafe abortions, maternal morbidity, post-abortion care

Assessment of safe and unsafe abortion among Palestinian women in Hebron Governorate in the Southern West Bank, Palestine

Ayesha AlRifai, Palestinian Family Planning and Protection Association, January 2015

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PFPPA reproductive health services project, Palestine

This assessment employed a descriptive cross-sectional mixed-method approach to address the question of abortion with particular emphasis on unsafe abortion in the southern West Bank. In the quantitative part of the study, women attending the PFPPA clinics and service delivery points at four urban and rural sites were targeted with a questionnaire. Using purposive non-random sampling method, a total of 541 participants was chosen from women who had at least one abortion experience during their lifetime and were service users at the said facilities.

At the qualitative part of the study various stakeholders were interviewed using different interviewing format. Two focus group interviews were conducted; the first was with health and social work professionals selected from MOH and NGOs while the second was with the PFPPA staff solely. At the macro policy and strategic levels, expert opinion was solicited through a small group interview with selected stakeholders being senior service providers, managers, policy makers or planners in the areas of; healthcare, human rights, law and social work. A total of 21 professionals and experts participated in this qualitative study component.

The study sheds some light and provided insights on abortion experience spontaneous and induced; safe and unsafe as well as pertinent reproductive health aspects such as age of marriage, age at first childbirth, and family planning methods use and none-use. It evidently showed that abortion is not a rare experience for Palestinian women in Hebron- Southern West Bank. The overall percent of women who experienced abortion at least once in their lifetime was more than 70 % of the total. Around 49% of the participants confidants told them they too underwent the same experience. Of the total; around half were married, more than 40% had their first pregnancy and 28% had their first childbirth, all at18 years of age or less.

Family planning methods utilization pattern and reasons for none-use indicate that women still endure the major burden and responsibility for family planning… In more than 40% of those who did not use a family planning method, the husbands’ unwillingness to use a method or let the wife use one is the reason for the non-use… Among those who reported having gone through abortion, two thirds (66.3%) had more than one abortion; 11.3% had it induced and 60.5% had it spontaneous.

Around 50% of the aborted women received treatment for incomplete abortion which ranked first in the participants service utilization of post-abortion care. In addition, sever vaginal bleeding was the complication endured by most (52.2%). Furthermore, more than two thirds (67.6%) of the conducted abortions were clandestine covertly done with the prior knowledge of nobody except the woman herself.

A total of 46% of the aborted women articulated having experienced negative feelings of sin, guilt, regret and self blame implied in killing their own babies when they were asked about how they felt after abortion. About obstacle encountered in relation to abortion the most reoccurring obstacles women reported were: compelled home abortions due to the presence of military checkpoints. Continuous bleeding, absence of any form of support, lack of awareness about abortion altogether, prolonged hospitalization days until full recovery from post-abortion complications, fear from psychological effects, financial difficulties in relation to covering pertinent expenses and strike in hospitals. Surprisingly, none of them mentioned anything related to abortion service availability as per se although abortion is not a service on offer as was agreed by all.

Beyond the participants themselves, 48.98% (n=265) said a female relative or friend confided to them about a personal experience of abortion, induced by 81.1% (n=215), also indicating how common abortion is here….

Tags: Palestine, unsafe abortions, post-abortion complications


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