Unsafe abortion claims the lives of thousands of women every year. Globally, it is the women in Sub-Saharan Africa who face the highest risk of death and injury from abortion-related complications (Ahman & Shah 2011, p.123). Current global and national efforts to reduce incidences of unsafe abortion are ineffective in the rural Ghanaian community where this research was undertaken. This anthropological examination of key aspects of contemporary local social practice and the norms and customs which underpin it, demonstrates the necessity for many local women to utilise a dangerous plant to facilitate potentially fatal self-induced abortions as their primary means of resisting culturally-defined fertility patterns. This thesis is broadly structured around anthropologists’ Scheper-Hughes’ and Lock’s (1987, p.6) concept of three intersectional bodily perspectives: the phenomenological individual body-self, the social body and the body as an artefact of political control. The reader is offered insight from each of these perspectives into the social practice of unsafe abortion in the lives of rural Ghanaian women. I argue that unsafe abortion can be seen as a kind of social struggle against the local economic mode of production. The thesis provides an analysis of the position of many women within local relations of production from a neo-Marxist perspective which has been modified by concepts of class and exploitation particular to pre-industrialist societies. The modifications are taken from the theoretical positions of French anthropologists Terray (1975), Meillassoux (1972) and P.P Rey (1975). In addition, following the work of critical medical anthropologist Scheper-Hughes (1993), the thesis demonstrates the ways in which medical discourses and policy output about family planning and reproductive health which are produced and reproduced at the level of the national body politic, obscure more deeply embedded powerful ideologies and social praxis about female sexuality and reproduction which is produced and reproduced at the level of the social body within the context of popular interpretations of tradition and customary law. Ultimately, I argue that current Programmes of Action aimed at reducing incidences of unsafe abortion fail to address patterns of gender violence and patriarchal control by medicalising some village women’s social suffering.

The study was motivated by studies which have revealed that teenage pregnancy, maternal mortality and unsafe abortion are high in Lesotho. The purpose of the study was to examine whether or not lack of access to emergency contraception as one of the essential forms of contraception could be the reason for the aforementioned health challenges facing adolescent girls in Lesotho. The study was a desktop review with content analysis of documents applicable to the health of adolescents and those relating to access to family planning services for adolescent girls. The woman question was used as a tool for ascertaining whether the health rights of adolescent girls are fulfilled by Lesotho. The legal framework relevant to access to emergency contraception was also scrutinised to ascertain whether they are compliant with human rights treaties ratified by Lesotho. The study is also a comparative analysis of Lesotho's policy frame with South Africa. From the analysis of the literature review, the study uncovered how religious, cultural practices and some areas of the laws relevant to access to emergency contraception for adolescents were not responsive to the female adolescent question, thereby perpetuating infringement of various human rights belonging to adolescent girls. The study also revealed that lack of political will and poor coordination and monitoring of policies, budgetary deficiencies and shortages in human resources are some of the factors inhibiting adolescent's realisation of their full access to family planning services. The study made recommendations which the Government of Lesotho could use to change the current state of access of adolescent girls to emergency contraception. / tm2017 / Centre for Human Rights / LLM / Unrestricted

This study aimed to explore perceptions and experiences concerning sexuality, contraceptives, unwanted pregnancy and unsafe abortion among young people in Kisumu, Kenya. The design of the study was inductive with a qualitative approach using personal in-depth interviews. Eight participants (four female and four male) were asked to describe their perceptions and experience concerning sexuality, contraceptives, unwanted pregnancies and unsafe abortion. The result showed that culture and norms, misconceptions and gender based power in sexuality are factors that impact Sexual Reproductive Health among young people in Kisumu today. Unwanted pregnancy was described as a shame, a burden and a destroyed life which lead to many unsafely induced abortions. The findings indicate that youth interventions are important, such as engaging young men in unwanted pregnancy and thus unsafe abortions and to empower young women.

Background: Restrictions on induced abortion varies widely across the globe and so does the rate of induced abortion and maternal mortality (MM). Safe abortions – done by trained providers in hygienic settings and early medical abortions carry fewer health risks and reduce maternal mortality rates (MMR). However, nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year. Aim: The aim was to explore national and regional patterns of abortion laws, the abortions percentages and the maternal mortality rates (MMR), to see if patterns could be distinguished and how they differentiate to each other. Method: With a shape-file containing polygons representing the world’s countries, and the computer program ArcMap, was used to gather and join data. Result: The result showed that many African countries has a restrictive abortion law, and they also have a high MMR. In the Nordic countries they have a liberalized abortion law and they have low MMR. Another finding is that a restricted abortion law does not correspond to a low percentage of abortions. This is clearly demonstrated in South America, where they have a high abortion percentage, and extremely restricted abortion laws. Conclusion: This result revealed patterns showing that countries with restricted abortion laws, does not contribute to a low MMR, and restricted abortion law does not decrease the percentage of abortions.

Philosophiae Doctor - PhD / The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.

Background: Restrictions on induced abortion varies widely across the globe and so does the rate of induced abortion and maternal mortality (MM). Safe abortions – done by trained providers in hygienic settings and early medical abortions carry fewer health risks and reduce maternal mortality rates (MMR). However, nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year. Aim: The aim was to explore national and regional patterns of abortion laws, the abortions percentages and the maternal mortality rates (MMR), to see if patterns could be distinguished and how they differentiate to each other. Method: With a shape-file containing polygons representing the world’s countries, and the computer program ArcMap, was used to gather and join data. Result: The result showed that many African countries has a restrictive abortion law, and they also have a high MMR. In the Nordic countries they have a liberalized abortion law and they have low MMR. Another finding is that a restricted abortion law does not correspond to a low percentage of abortions. This is clearly demonstrated in South America, where they have a high abortion percentage, and extremely restricted abortion laws. Conclusion: This result revealed patterns showing that countries with restricted abortion laws, does not contribute to a low MMR, and restricted abortion law does not decrease the percentage of abortions.

Unsafe abortion is a worldwide reproductive health issue and a contributing factor of high numbers of maternal death in the developing world. Many international conferences and assemblies acknowledge the issue and urge governments to take action. Abortion is a phenomenon surrounded by strong opinions, many times regulated by restrictive laws as well as socio-ethical, religious and cultural norms. Factors often active in making abortion a clandestine procedure which take place under unsafe conditions.The Philippines have one of the most restrictive laws on abortion in the world, but it does not diminish the occurrence of abortion in the country. There is unmet need for family planning that in turn makes way for unwanted pregnancies ending in unsafe abortion. Attempts in congress aiming at providing universal reproductive health service are being opposed and the issue of abortion is surrounded by its criminal ban and a great social stigma. The Roman Catholic Church is very present in the Philippine society and also offers a powerful voice against abortion and equally rejects modern contraception.This study look into how the issue of abortion – under its criminal ban – is being dealt with and if there are any actors/groups/organisations of social work, within the reproductive health sector or women’s organisations acting upon this, making abortion an issue and a part of their work. It asks if there is any advocacy for abortion in the Philippines and any interventions for the women concerned. If so, how is abortion spoken about and understood and how is that notion put into action? Groups are identified as either anti-abortion or pro-abortion, two discourses addressing abortion as a public health issue in fundamentally different ways.There are groups that might not be public about their opinion being pro-abortion, as they do not wish to get on the wrong side of the general opinion or negatively affect their reputation. Some pro-abortion groups are found acting against the law by providing safe abortions for these women. Trough social constructivist glasses this study look at the structure surrounding abortion in the Philippines, analysing how these discourses are being reconstructed and transferred under different postulations as anti-abortion or pro-abortion.

Cette thèse aborde dans la première partie une revue panoramique des controverses historico-juridiques autour de l’avortement dans le monde, suivi par une analyse du contexte socioculturel des attitudes et des pratiques liées aux rapports sociaux de sexe, aux grossesses non désirées et à l’avortement non sécurisé. Enfin, nous examinons les articulations entre la médecine traditionnelle, coloniale et moderne au Gabon. Tout cela nous amène à notre étude sur les barrières à l’accès aux soins modernes chez les femmes en situation d’urgence médicale.L’objectif de cette thèse doctorale est d’élaborer et d’appliquer, dans sa deuxième partie, une méthodologie pour étudier le réseau des acteurs impliqués dans les pratiques liées aux avortements afin de mieux comprendre les résistances aux changements socio-cliniques et juridiques. Quel est le système de soins formel et informel chez les prestataires médicaux de soins en matière d'avortement et quels sont les obstacles que les praticiens et les femmes doivent franchir pour fournir (les praticiens) et obtenir (les femmes) ce service ? Spécifiquement une investigation des interactions sociales et institutionnelles en milieu hospitalier de Lambaréné et dans les zones rurales environnantes a été réalisée. Elle nous a conduit à déceler différentes barrières extra médicales et intra médicales à l’accès aux soins d’urgence suite aux complications des avortements non sécurisés. Ainsi, nous nous sommes concentrés, d’une part, sur les discours des professionnels de la santé, leurs pratiques et les contextes de soins ; et d’autre part, nous avons privilégié les récits des femmes sur les stratégies à interrompre les grossesses avec ou sans l'aide médicale et sur leurs stratégies d’accès aux soins modernes malgré les obstacles.Les résultats obtenus à partir des entretiens, après l’analyse de contenus, montrent qu’en pratique, il existe d'importantes barrières à l'accès aux soins d’urgences. Ces difficultés débutent dans leur environnement social avec la recherche des produits abortifs et les premiers traitements (automédication, aller en pharmacie ou chez le tradithérapeute). En cas de complications aggravées, les obstacles extra médicaux s’amplifient avec la distance géographique, les problèmes de transport et des moyens financiers. Par ailleurs, une fois ces obstacles plus ou moins franchis, les femmes doivent encore affronter les obstacles intra médicaux dans la prise en charge des urgences. Fournir un accès aux services d’avortement sans risque pour les Gabonaises est l’un des grands défis auquel nous devons faire face actuellement. Cette thèse contribue à dénoncer tout haut ce qui se passe de manière informelle dans la société gabonaise. Les femmes vivent des situations tragiques. / This dissertation begins with a broad overview of juridical and historical controversies surrounding abortion in the world followed by an analysis of attitudes and practices in diverse socio-cultural contexts linked to gender relations, unwanted pregnancy and unsafe abortion. We then examine articulations between traditional, colonial and modern medicine in Gabon. That panorama brings us to our study of the obstacles women with medical emergencies face in accessing modern health care.The objective of this doctoral research is to elaborate and apply a methodology for studying the network of actors involved in practices connected to abortion in order to better understand resistance to socio-clinical and juridical change. What is the formal and informal health care system of medical providers in matters related to abortion and what are the obstacles that providers and women must transverse to offer (providers) and obtain (women) this service? Specifically, an investigation of social and institutional interactions was conducted in urban hospital settings and in surrounding rural areas. That led us to detect different extra-medical and intra-medical barriers to emergency care access following unsafe abortion complications. In this way, we focused, on one side, upon the discourse, practices and medical contexts of health professionals while, on the other side, privileging the accounts women recited of their strategies for terminating pregnancies with or without medical help and for accessing modern care despite the obstacles.Content analysis of interviews revealed major barriers to emergency care access. Those difficulties start in the social environment with the search for abortion products and for initial treatments (self-medication and visits to the pharmacy or to traditional practitioners). In cases of advanced complications, extra-medical obstacles intensify with greater geographic distance, transportation problems and insufficient financial means. Moreover, once those obstacles are more or less overcome, women must then confront intra-medical obstacles within emergency care hospital units. Providing access to safe abortion for Gabonese women in current times is one of the great challenges we must confront. This dissertation contributes to a loud vocal denunciation of informal happenings in the society of Gabon. Women live tragic circumstances.