A focus on safe abortion in the 2030 Agenda for Sustainable Development

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An ambitious new global agenda begins in 2016, seeking to drive significant development for adolescents and young people over the next 15 years. The 2030 Agenda for Sustainable Development offers new global goals and renewed commitments from governments around the world to reduce maternal mortality; achieve universal access to sexual and reproductive health information, education, and services; ensure reproductive rights; and achieve gender equality as a matter of women’s and girls’ human rights.

Replacing the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) include 17 goals—such as to eradicate poverty, take urgent action on climate change, and promote health and gender equality—for global cooperation through 2030. The SDGs prioritize some of the biggest challenges facing adolescent girls and young women, including child marriage, gender-based violence and lack of access to sexual and reproductive health services. Unlike the MDGs that largely sidelined youth needs, the new agenda centers on and affirms the unique rights and needs of the more than 250 million adolescent girls and young women living in poverty today. The SDGs seek “to realize the human rights of all and to achieve gender equality and the empowerment of all women and girls.”

Youth and unsafe abortion

To meet several of the new SDG goals, policymakers, advocates, and governments must prioritize advancing the right to sexual and reproductive health services, including access to safe, legal abortion for all women—adolescent girls and young women in particular. Worldwide, 47,000 women die of unsafe abortions each year, and millions more suffer serious, often permanent injuries. Adolescent girls and young women are disproportionately affected. Because of the many barriers to safe abortion care, young women who decide to terminate a pregnancy often find no alternative than to resort to unsafe abortion—even in settings where abortion is legal. Social, economic, legal, and health-system barriers cause many young women to delay obtaining abortion care until later in pregnancy than adult women, and to delay seeking help for abortion-related complications. Of the approximately 22 million women who undergo unsafe abortions in the developing world each year, almost 50 percent are young women age 15–24.

Unsafe abortion is more common where adolescents and youth have an unmet need for contraception, where less effective contraceptive methods prevail, and in settings where abortion is criminalized. To reduce unintended pregnancy and unsafe abortion, governments must act urgentlyto advance comprehensive sexuality education, youth-friendly sexual and reproductive health services, and less restrictive abortion laws and policies.

New global goals:
Focus on women and girls

Gender equality and the importance of empowering women and girls are two important themes repeated throughout the 2030 Agenda for Sustainable Development. As with the MDGs, the new SDGs include a standalone goal on gender equality (Goal 5). In addition, a standalone goal on good health and well-being (Goal 3) was developed, which addresses sexual and reproductive health, among other health issues.

GOAL 3: Ensure healthy lives and promote wellbeing for all at all ages

TARGET 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

The 2030 target calls for a two-thirds reduction in maternal mortality, based on the latest estimate for the global maternal mortality ratio of 210 deaths per 100,000 live births. A report by the United Nations Secretary-General in 2013 highlighted unsafe abortion as a “leading cause of maternal deaths” and cautioned that “it is likely that the numbers of unsafe abortion will continue to increase unless women’s access to safe abortion and contraception—and support to empower women (including their freedom to decide whether and when to have a child)—areput in place and further strengthened.”

TARGET 3.7: By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Access to safe, legal abortion has been recognized by the global community as an essential intervention in a package of comprehensive sexual and reproductive health services that should be available to all women regardless of age, ethnicity, gender identity, geographic location, marital status, race, religion, socio-economic status or migration status. Youthfriendly abortion care services must account for the unique physical and emotional health needs of adolescent girls and young women, and address barriers to their ability to access care.

GOAL 5: Achieve gender equality and empower all women and girls

TARGET 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.

Achieving gender equality includes enacting laws and policies that allow access to safe and legal abortion, thereby recognizing women’s autonomy and capacity to make informed and independent decisions about their sexuality and reproduction. For adolescents and youth, access to safe and legal abortion is as important to their empowerment as equal access to education, employment, adequate food and housing.

Recommendations for policymakers and advocates

• Ensure adolescent girls and young women have access to effective contraception and safe, legal abortion care. Women who are poor, young, or in other vulnerable circumstances are at high risk for unsafe abortion, yet this is entirely preventable through access to contraception and safe abortion care—both essential and cost-effective components of any strategy to reduce maternal mortality and achieve target 3.1.
• Improve national systems to record maternal deaths and identify their causes—including unsafe abortion—to improve measurement of progress toward target 3.1 and identify priority interventions.
• Provide universal access to youthfriendly and nonjudgmental sexual and reproductive health services, including abortion care. Services must respect the rights to confidentiality, privacy and informed consent. In addition, adolescent girls and young women are disproportionately affected by sexual violence; interventions to achieve target 5.6 must therefore include services to prevent violence and provide care to those affected, including access to emergency contraception and safe abortion.
• Mandate comprehensive sexuality education, linked to integrated sexual and reproductive health services. Reaching all young people, particularly adolescent girls and young women—both in and out of school—with comprehensive sexuality education is key to preventing unwanted pregnancy, HIV and other STIs, and to meet target 3.7.
• Accelerate actions to repeal laws that make abortion a crime. In most countries, legalizing abortion is a precursor to planning for and delivering high-quality safe abortion services. It is no longer acceptable politically or morally for governments or international bodies to use arguments of culture or religion to avoid creating a supportive policy and legal framework for safe abortion that would lead to elimination of a major cause of maternal death and injury. To fulfill the 2030 agenda, governments and civil society must accelerate actions to repeal laws that criminalize women who seek abortion or who in other ways exercise their sexual and reproductive rights.