Saving Women Life

SAVING
WOMENS
LIVES
The Health Impact of Unsafe Abortion
Safe
Motherhood
The Health Impact of Unsafe Abortion
Prepared by Elizabeth Westley, Family Care International, in collaboration with the Safe Motherhood
Inter-Agency Group (IAG). The IAG, active from 1987-2003, included the following members:
UNFPA, the World Health Organization, the World Bank, International Planned Parenthood Federation,
the Population Council, the International Federation of Gynecology and Obstetrics, the International
Confederation of Midwives, the Safe Motherhood Network of Nepal, and the Regional Prevention
of Maternal Mortality Network (Africa). Family Care International serves as the secretariat. In 2004
the IAG merged into the Partnership for Safe Motherhood and Newborn Health (PSMNH), which
endorses this report.
For the members of the IAG and the PSMNH, the principles and policies of each agency are governed
by the relevant decisions of each agencys governing body. Each agency implements the interventions
described in this document in accordance with these principles and policies and within the scope
of its mandate.
Family Care International, Inc. 2005
Design by Green Communication Design, Montreal Canada
SAVING
WOMENS
LIVES
The Health Impact of Unsafe Abortions The Health Impact of Unsafe Abortion
REPORT OF A CONFERENCE HELD IN KUALA LUMPUR, MALAYSIA
29 September 2 October, 2003

INTRODUCTION: UNSAFE ABORTION AS A THREAT TO SAFE MOTHERHOOD 2
OPENING CEREMONY 5
PLENARY SESSIONS 6
The Context: Unsafe abortion globally and regionally 6
The legal and policy framework: Laws, policies, and regulations 9
in the provision of care
Preventing unwanted pregnancy 15
Postabortion care: Addressing complications of unsafe abortion 19
Expanding access to safe services, where not against the law 23
Quality of care: The critical elements 28
CONCLUSION: ACTING NOW TO SAVE WOMENS LIVES 32
ANNEX 1: CONFERENCE PARTICIPANTS 33
ANNEX 2: CONFERENCE AGENDA 44
Table of Contents

Sri Lanka
In 1962 I was working as a doctor in a small
hospital in rural Sri Lanka. One morning, one of
the clerical staff working in this institute came to
see me with the following story:
My wife and I have a two-year-old daughter.
My wife had to go through a very difficult time
during her pregnancy and childbirth. After the
delivery the doctors who attended my wife advised
us not to have another child for at least four
years. Unfortunately she is pregnant again. Could
you do something to get rid of the pregnancy?
The abortion laws of Sri Lanka are very strict,
and abortion is only permitted to save the life
of the mother; I explained this to the husband.
However, I assured him that if he brought his
wife to hospital, I could go through the records
of the first pregnancy, assure her a safe passage
through her pregnancy and refer her, when
appropriate, to a consultant.
I did not hear from the couple till a few weeks later,
when I got an urgent call from the female ward.
I rushed to the ward to see this young mother was
seriously ill, and one glance at her was sufficient to
confirm the diagnosis of tetanus. She had sought
the assistance of an unqualified practitioner
to have an abortion done and this was the result.
She was dispatched to the nearest big hospital,
but needless to say she died. A two-year-old baby
was left motherless.
Story provided by Dr. Ranjit Atapattu, Chairperson,
Special Advisory Council to the Minister of Health, Sri Lanka
1
S AVI NG WOME N S L I VE S : T HE HE AL T H I MPACT OF UNS AF E ABORT I ON 2
INTRODUCTION: UNSAFE ABORTION AS
A THREAT TO SAFE MOTHERHOOD
S
afe motherhood requires that all women receive the
care they need to be safe and healthy throughout
pregnancy and childbirth. Safe motherhood strategies,
therefore, must include all interventions necessary to
prevent the death, disability, or illness of a pregnant
woman. Unsafe abortion is
among the top five causes
of pregnancy-related death
in the developing world,
killing at least 68,000 women
per year. Although unsafe
abortion is the most easily
preventable cause of maternal
death and disability, it has
not yet been widely inte-
grated into safe motherhood programmes. This
is beginning to change in some countries, but more
concerted efforts are needed to strengthen linkages
and promote a comprehensive approach to addressing
all the major causes of maternal mortality
and morbidity.
As with other aspects of safe motherhood
programmes, addressing unsafe abortion
effectively requires a comprehensive
approach to womens health and rights,
and the involvement of a wide range of
stakeholders, including government, non-
governmental organisations (NGOs), health
providers, communities, international agen-
cies and donors. It is important to ensure
that unsafe abortion is included in national
and international discussions about womens
health. This report describes one effort to
promote such a discussion: a conference at
which delegates discussed how countries in
Asia and around the world have addressed
the challenge of unsafe abortion, and what
has been learned from their experiences.
The toll of unsafe abortion
While there is a high global prevalence of abortion-
related complications, abortion is not an inherently
dangerous procedure. On the contrary, when performed
in sanitary conditions by skilled providers, abortion is
a very safe medical procedure much safer than child-
birth, for instance.
Complications are most often
the result of unsafe abortion,
defined by WHO as a pro-
cedure for terminating an
unwanted pregnancy, either
by persons lacking the necessary
skills, or in an environment
lacking the minimal medical
standards, or both.
1
And for
most women in the developing
world (outside of China), where restrictive laws limit
access to safe abortions, the procedure is often conducted
in unsafe conditions.
1
World Health Organization (WHO). The Prevention and Management of Unsafe Abortion. Geneva, 1992.
THE CRITICAL ROLE OF GENDER INEQUITY
Senator Mechai Viravaidya of Thailand described how womens
low social status is a significant contributor to their risk of
sufferingeven dyingfrom unsafe abortion:
Limited access to education restricts womens access
to health information, their opportunities for earning
a living, and their capacity for self-sufficiency.
Vulnerability to sexual coercion and other forms of
sexual violence directly contributes to unwanted pregnan-
cies and hence to abortion-related deaths and injuries.
Limited decision-making capacity and lack of access
to resources results in womens inability to negotiate
sexual activity, and lack of access to family planning
information and supplies.
Unsafe abortion is defined as a procedure
for terminating an unwanted pregnancy,
either by persons lacking the necessary
skills, or in an environment lacking the
minimal medical standards, or both.
World Health Organization
3
I nt r o d uc t i o n
It is estimated that between 10% and 50% of women
who undergo unsafe abortions need medical care
for complications.
2
Besides death, possible complications
include infection, haemorrhage, and injury to internal
organs, and can lead to long-term health problems
such as chronic pain, pelvic inflammatory disease,
and infertility. These health problems can result in
lowered productivity both inside and outside the home
and an inability to care for children, as well as have
an adverse effect on sexual relations.
In addition to its negative health impact, unsafe
abortion also carries significant financial costs. Costs
for women and their families include fees for services,
medicine, and supplies; transportation expenses; and
lost income from missing work. Unsafe abortion also
places a substantial burden on health care systems.
In many countries, women with incomplete abortion
account for half of gynaecological admissions at hospitals,
and treatment has traditionally required several days of
hospital stay, significant staff
time, blood transfusion, and
general anaesthesia.
International response
As part of its strategy to
address unsafe abortion
in the context of safe motherhood, the Safe Motherhood
Inter-Agency Group (IAG) held a three-day meeting
in Kuala Lumpur, Malaysia from September 29 to
October 2. Asia was chosen as the venue for the confer-
ence as it provides a diversity of experience as shown
in Table 1 (p. 4), which presents demographic and abor-
tion-related data for the eleven priority countries.
The objectives of the conference were to:
Highlight unsafe abortion as a major public health
problem within the context of safe motherhood and
womens health;
Illustrate the context in which unsafe abortions
occur, including why women have unsafe abortions,
what makes abortions unsafe, and the consequences
for maternal mortality and morbidity; and
Foster the development of strategies to address
the problem of unsafe abortion.
Almost 130 participants attended the conference,
representing Ministries of Health; parliamentarians;
health service providers; professional associations;
womens groups, legal associations, and other NGOs;
and donors. Delegations from eleven Asia-Pacific coun-
tries were invited and had the opportunity to work
together to develop strategies specific to their countries.
The list of participants can be found as Annex 1.
Following the opening ceremony and keynote address,
the conference was divided into five sessions, covering:
A. The legal and policy framework: laws, policies,
and regulations related to abortion
B. Preventing unwanted pregnancy
C. Postabortion care: addressing complications
of unsafe abortion
D. Expanding access to safe services, where not
against the law
E. Elements of high-quality care
Let us always remember that concern for those
38,000 women who die in Asia each yearis our mission.
Dr. Raj Karim, Regional Director of the IPPF East and
South-East Asia and Oceania Regional Office
2
Safe Motherhood Inter-Agency Group. Safe Motherhood Fact Sheet: Unsafe Abortion. New York, 1998.

*I: to save the womans life
II: I and to preserve physical health
III: I, II and to preserve mental health
IV: I, II, III and socio-economic grounds
V: without restriction as to reason
3
Population Reference Bureau. 2003 World Population Data Sheet. Washington, DC. 2003.
4
World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems. Geneva. 2003.
5
Ross, John, John Stover and Amy Willard. Profiles for Family Planning and Reproductive Health Programs: 116 Countries. The Futures Group International. 1999.
6
Center for Reproductive Rights. The Worlds Abortion Laws 2003. New York, 2003.
Each session included an overview presentation followed
by case studies. For each of the five panel session
topics, working groups then developed recommendations
for reducing maternal death and disability from
unsafe abortion. The conference agenda can be found as
Annex 2.
Country Population
3
(in millions)
MMR
4
Abortion rate
5
(per 1000 women aged 15-49)
Legal status of abortion
6
*
Bangladesh 146.7 600 12 I
Cambodia 12.6 590 49 V
India 1,068.6 440 24 IV
Indonesia 220.5 470 35 I
Malaysia 25.1 39 38 III
Nepal 25.2 830 21 V
Pakistan 149.1 200 25 II
Papua New Guinea 5.5 390 N/A III
Sri Lanka 19.3 60 8 I
Thailand 63.1 44 13 II
Vietnam 80.8 95 57 V
Table 1: Demographic and abortion-related data for participating countries

OPENING CEREMONY
P
articipants were welcomed to Kuala Lumpur and
to the conference by Dr. Raj Karim, Conference
Chair and Regional Director of International Planned
Parenthood Federations East & South-East Asia and
Oceania Regional Office. In the opening session of the
conference, Dr. Siti Hasmah, the wife of the then Prime
Minister of Malaysia, forthrightly addressed the com-
plexities and difficulties of addressing unsafe abortion,
which she characterized as probably the most heated
and controversial issue in health and well being of
women today. As a physician herself, she noted that
healthcare providers have seen the suffering caused by
unsafe abortion, and have to be realistic and pragmatic
as to how best we can overcome this problem, which
causes untold suffering, misery, and pain.
Petra ten Hoope-Bender, then Secretary General of the
International Confederation of Midwives and Co-Chair
of the IAG, related how the IAGa partnership of inter-
national and national agencies
7
was established to reduce
maternal mortality and morbidity in developing countries
and to realize the goals of the global Safe Motherhood
Initiative.
8
In 2001, following the development of ten
Safe Motherhood Action Messages, one of which high-
lights the need to prevent unwanted pregnancy and
address unsafe abortion, the IAG began focussing on
unsafe abortion as a priority safe motherhood issue.
While unsafe abortion remains a controversial and chal-
lenging issue worldwide, recognition of the importance
of the problem and willingness to address it have grown
substantially since the International Conference on
Population and Development (ICPD) in 1994 and ICPD+5
in 1999. And, thanks to the growth in research and
pilot efforts on unsafe abortion, there is a substantial
body of information and significant lessons learned
about clinical and programmatic issues that can be
shared internationally. The critical need now is to take
programmes to scale, and to provide guidance, support,
and encouragement to national governments in doing so.
Challenges that have reduced the effectiveness of efforts to address unsafe abortion, described in the opening
session by Dr. Khama Rogo (World Bank and co-chair of the IAG):
A vertical approach to programming has fragmented maternal and reproductive health services,
which must be integrated in order to achieve optimal impact.
Donor restrictions on funding related to abortion have had a significant chilling effect on developing
country governments and on local and international NGOs.
Poor documentation of abortion-related mortality and morbidity obscures the evidence that
abortion causes death and disability to countless women worldwide.
Service delivery barriers, including those caused by provider attitudes, impede a response to unsafe
abortion at the health facility level.
The politics of abortion are often highly polarised and frequently overlook the needs of women.
7
IAG members include: the World Health Organization (WHO), the World Bank, International Planned Parenthood Federation (IPPF), the Population Council, the United Nations
Population Fund (UNFPA), International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives (ICM), Safe Motherhood Network of Nepal,
and the Regional Prevention of Maternal Mortality Network (Africa). Family Care International serves as the secretariat.
8
The Safe Motherhood Initiative was launched at a global conference in Nairobi in 1987.
Op e ni ng Ce r e mo ny
5
PLENARY SESSIONS
The Context: Unsafe abortion globally
and regionally
To provide the audience with a clear and detailed pic-
ture of what we know about the prevalence of unsafe
abortion, Dr. Iqbal Shah of WHO reviewed the most
recent statistics, with a focus on the situation in Asia.
Of the 46 million abortions that take place each year
worldwide, 20 million are considered unsafe, resulting
in roughly 70,000 deaths and hundreds of thousands
of disabilities. Almost all (95%) unsafe abortions occur
in developing countries, as shown in Figure 1.
Asia has the largest total number of unsafe abortions
(roughly 10 million), and the highest number of
deaths from unsafe abortions (34,000 per year);
Latin America has the highest rate of unsafe

abortion (26 per 1000 women aged 1449); and
Africa has the highest death rate from abortion
(680 per 100,000 abortions).
Dr. Shah also explained that within Asia, the different
sub-regions have quite different rates of abortion,
as shown in Figure 2 (opposite):
12
10
8
6
4
2
0
Figure 1: Estimated incidence of unsafe abortions by region, in millions
Asia Africa Latin America Europe Oceania
and the Caraibbean
E
s
t
i
m
a
t
e
d

n
u
m
b
e
r

o
f

u
n
s
a
f
e

a
b
o
r
t
i
o
n
s

i
n

m
i
l
l
i
o
n
s
Western 0.5
South-eastern 2.7
4.2
South-central 7.2
3.7
0.5
0.03
Source: Ahman, Elisabeth and Iqbal Shah. Unsafe abortion: Worldwide estimates for 2000.
Reproductive Health Matters. Volume 10, Number 19. May 2002.
7
P l e na r y S e s s i o ns
WHO data overturned some commonly held mispercep-
tions about women who have abortions. Dr. Shah and
colleagues conducted an analysis which showed that
women across the age span experience abortion.
Echoing this point, Senator Mechai Viravaidya of
Thailand stated in his Keynote Address that, For too
long we have thought that women faced with unwanted
pregnancies are primarily adolescents or unmarried
women. We know, however, that most women who
seek abortion are married women, trying to limit their
family size or space births because of economic
difficulties or other reasons.
Dr. Shah further noted that the burden of abortion
complications is not borne evenly across the social,
economic, and demographic spectrum. Analyses from
Nigeria, South-East Asia, and Latin America have
shown that the safety of abortion services varies greatly
according to a womans location and income: whether
she is poor and rural, or urban and of higher social
and economic status. Women falling in this latter category
are significantly more likely to use physicians, while poor
rural women are more likely to use untrained or unskilled
providers, and thus to suffer abortion complications.
Senator Mechai finished by noting that reducing the
toll of deaths and injuries from unsafe abortion is both
possible and feasible, if political will is mobilised
around womens health and empowerment. Let us take
concrete steps and work together in partnership, he
urged, so that women and their families no longer
have to suffer as a result of a pregnancy that is
unplanned and unwanted.
25
20
15
10
5
0
All Asia South Centre South East West
13
22
21
12
Figure 2: Number of abortions per 1,000 women aged 1544
(Asian sub-regions), 2000
Source: I. Shah, 2003

KL was a 16-year-old high school girl from a coastal village
some 100 km from the capital. She got pregnant from
an older man who took her out one night when she
was attending a school netball competition in Port Moresby
during the semester break. Her family became aware of
her pregnancy in the New Year when she was about
6 months gestation; consequently she was not allowed to go
back to school.
She was brought to the antenatal clinic at Port Moresby General
Hospital by her aunt when she was some seven months. She was not
feeling well and told the midwives in the clinic that she 'had a sore
on her vulva'. On examination she had a fever, an offensive vaginal
discharge and a necrotic looking large ulcer on her left labia.
She was admitted to the ward and received antibiotics and antimalarials.
She seemed to improve and was allowed to go home to complete her
medicines; the doctors and nurses did not know about the attempt
at abortion at this time.
KL was brought back to the hospital two days later very ill; she had a high
fever and was not fully conscious. At this time the attending doctor specifically
inquired about any interference with the pregnancy and was told by the aunt
that family members had attempted to terminate the pregnancy in the village.
She was found unconscious early the next morning in the toilet where she had
delivered a stillborn 1.3Kg foetus; she died shortly afterwards.
[Research has shown that more than 50% of girls in PNG report that their first sexual
experience is associated with some degree of coercion.]
Story provided by Dr. Glen Mola, University of Papua New Guinea
Papua New Guinea
KLs story
9
The legal and policy framework: Laws, policies,
and regulations in the provision of care
The issue of unsafe abortion, unlike other causes of
maternal death and disability, clearly carries significant
political and at times religious weight. Perhaps no other
health issue has been subject to such stringent regulation
and such intense debate. Dr. Khama Rogo pointed out
that, while there are many reasons for the failure
of safe motherhood programmes to address unsafe
abortion, politics is a major factorand advocacy
is an important tool for addressing this problem.
Laws and Policies: Overview
Overview presenter Kathy Hall-Martinez
(then Director of the International Legal
Program at the Center for Reproductive
Rights) reviewed the legal and policy
frameworks around abortion. Safe mother-
hood is closely linked to several basic
human rights, including the fundamental
right to life, as well as the rights to high-
quality health care, non-discrimination,
and reproductive self-determination.
9
A number of important international
policies and commitments acknowledge
these rights. In addition to the explicit
statements on the need to address
unsafe abortion at ICPD and ICPD+5
(see box), other international legally
binding human rights instruments,
such as the Convention on the Elimination of All Forms
of Discrimination against Women, support all womens
fundamental right to experience pregnancy safely.
At the national level, laws and policies are an important
tool for assuring the provision of quality services,
whether for safe abortion, postabortion care, or family
planning. Hall-Martinez described the legal situation
globally and in Asia specifically. Table 2 summarises
the legal status of abortion in South-East Asia, which
ranges from permissible on limited grounds in some
countries to available without restrictions in others.
All Governments and relevant inter-governmental and non-
governmental organisations are urged to strengthen their
commitment to womens health, to deal with the health impact
of unsafe abortion as a major public health concern and to
reduce the recourse to abortion through expanded and
improved family planning services. Prevention of unwanted
pregnancies must always be given the highest priority and
every attempt should be made to eliminate the need for
abortion. Women who have unwanted pregnancies should have
ready access to reliable information and compassionate coun-
selling. Any measures or changes related to abortion within
the health system can only be determined at the national or local
level according to the national legislative process...
ICPD Programme of Action, paragraph 8.25, 1994
9
Center for Reproductive Rights. Surviving Pregnancy and Childbirth: An International Human Right. August 19, 2003. www.reproductiverights.org
Limited Legal Grounds for Abortion
(threat to womans life)
Bangladesh, Indonesia, Papua New Guinea,
Philippines, Sri Lanka
Several Legal Grounds for Abortion
Physical Health Only Pakistan, Thailand
Plus Mental Health Malaysia
Plus Socio-economic India, Japan
Abortion Permitted Without Restriction Cambodia, Nepal, Vietnam
Table 2: Abortion Laws in Asia

Laws, however, do not always coincide with the avail-
ability of abortion. Abortion may not be available in
a country where it is legally permitted, and vice versa,
depending on:
whether criminal sanctions are enforced;
the ambiguities in interpretation of the law; or
policy and regulatory barriers (such as a dearth
of protocols and standards of care, mandatory coun-
selling and waiting periods, restrictions on medical
facilities and personnel, and a lack of clear informa-
tion on the law).
For example, a woman in a country that allows abortion
might not be able to obtain one legally because of
policies that prohibit certain health facilities from
providing the service. Alternatively, a country that
technically outlaws abortion may turn a blind eye
on illegal abortions, which enables women to terminate
their pregnancies without legal repercussions. In other
cases, women have even been
wrongfully imprisoned after
having spontaneous abortions.
Even where abortion laws are
the least permissive, according to
Hall-Martinez, it is critical to discuss
unsafe abortion, address the cultural
mores that stigmatize women who
have had abortions, and avoid over-
interpreting abortion-related laws
by imposing more restrictions
than the law actually requires.
Myths that hinder womens ability to access abortion
(see box p. 11) should be addressed, and postabortion care
should always be offered, regardless of the legal status
of abortion.
When the abortion procedure is made legal where it
was previously prohibited, it can be carried out by
trained providers and regulated by the government.
Case studies from Nepal and Turkey, both of which
have liberalised their abortion laws, illustrated how
unsafe abortion can be prevented through liberalising
restrictions on safe abortion services.
Turkey: Intersectoral collaboration yields legal change
Sare Mhokur (Hacettepe University Medical School)
presented the experience of Turkey following liberalisa-
tion of the abortion law in 1983. She described a
combination of factors which contributed to the law
reform, including leadership by the Ministry of Health,
supportive and compelling research, advocacy, and
intersectoral communication.
In the 1970s and early 1980s Turkey had highly restric-
tive legislation on abortion. Several studies were carried
out during this time period, documenting the high
prevalence of abortion and the adverse outcomes of
illegally induced abortion. The Ministry of Health and
NGOs organised a number of advocacy meetings;
participants included parliamentarians, policy-makers,
scientists, religious leaders, and others. The issue was
also discussed on a number of television programmes.
This issue has resulted in huge political, state,
religious, legal, cultural, social, professional,
ethical, and moral divides in and across countries
and groups, and has even resulted in international
sanctions for funding of health and
related programmes for women.
Dr. Siti Hasmah, physician and wife of
the then Prime Minister of Malaysia
in circumstances where abortion is not

against the law, health systems should
train and equip health-service providers
and should take other measures to ensure
that such abortion is safe and accessible.
Additional measure should be taken to
safeguard womens health.
ICPD+5, paragraph 63.iii, 1999
11
The Ministry of Health then submitted a population
law to parliament. The proposed law was broad in
scope and included issues such as authorisation of non-
physicians to insert IUDs and strengthening collaboration
related to family planning services, as well as provi-
sions to legalise abortion up to 10 weeks and to license
trained general practitioners in pregnancy termination.
After long and heated discussion both for and against
the proposed law in parliament, the Population Planning
Law of 1983 was passed.
Since the passage of the new law, maternal
mortality due to unsafe abortion has
almost disappeared, and the burden of
unsafe abortion on the health care system
has greatly decreased. Abortion rates ini-
tially increased, but then began to decrease
after 1990. IUD usage doubled, and the
prevalence of modern contraceptives in
general increased.
Nepal: The critical role of
public education
In Nepal, which has one of the highest
maternal mortality ratios in the world, the
laws relating to abortion changed much
more recently. Dr. Laxmi Raj Pathak and
Mr. Anand Tamang presented a case study
describing the actions that led to legal
change in 2002, and outlined challenges
that Nepal is still facing in implementing
the law.
Until 2002, Nepalese laws did not allow
abortion under any circumstances, and
women who were thought to have sought
an abortion were often imprisoned. As in
Turkey, initial research showed high levels
of unsafe abortions, resulting in a sizable burden of
injury and death among Nepali women. For instance,
54% of admissions to gynaecology wards were for
unsafe abortion. At the same time, fully 20% of incar-
cerated women had been convicted of abortion
or infanticide.
MYTHS about abortion laws, policies, and regulations hinder
efforts to make abortion safer for women around the world.
Hall-Martinez described several of these myths:
MYTH 1: If abortion is illegal, its incidence will be lower.
Abortion incidence is related to how successfully couples
can prevent unwanted pregnancies and meet their desired
family size; abortion restrictions seem to have little or
no influence.
MYTH 2: Where abortion is legal there is low abortion-
related mortality and morbidity.
In several countries where abortion is legally permitted,
availability is low and rates of abortion-related mortality
and morbidity are high.
MYTH 3: Abortion is either legal or illegal, with no
exceptions or mitigating factors.
In almost every country, abortion is allowed in some
circumstances, usually to save the life of the woman.
MYTH 4: Abortion will no longer occur if women have
access to family planning.
Even if all the demand for family planning was met
and all couples used their method perfectly, unintended
pregnancies would still occur and there would still be
some demand for abortion.
In 1996 the Centre for Research on Environment,
Health and Population Activities (CREHPA) conducted
public opinion polls and found a majority in favour
of legalised abortion. The media covered these results
extensively. CREHPA initiated a programme in 1999
to educate the public about unsafe abortion and to advo-
cate for change, focussing primarily on parliamentarians,
political parties, journalists,
womens groups, NGOs,
lawyers, and policy
makers/administrators.
In March 2002, members of
Parliament overwhelmingly
approved legislation to permit
abortion on demand up to
12 weeks.
10
This bill became
an Act by Royal Assent in
September 2002, marking a historic achievement for
the reproductive health and rights of Nepals women.
The combination of research and advocacy was critical
to making this change.
The challenge for Nepal now is to publicise and imple-
ment the new law nationwide. The Department of
Health Services has formed an Abortion Task Force
to plan and implement the steps to move from legal-
isation to action. The law has been translated into
service directives, which now require the creation
and dissemination of service delivery standards,
standardised training, and information dissemination
and monitoring.
Under a two-year implementation plan, both institutions
and individual providers will go through a certifica-
tion procedure to be recognised as abortion providers;
officials will be informed of the new law and proce-
dures; and logistical and supply issues will be
addressed. In addition, women imprisoned for abortion
must be released and reunited with their families.
The information and media
activities are just as impor-
tant for implementing the
new law as they were for
drawing attention to the
need to change the previous
law. A survey conducted in
November 2002 found that
only 22% of urban adults
were aware of the new law.
In response, NGOs, womens groups, and volunteers are
now being harnessed to inform women of their rights.
Law enforcement will need to monitor untrained
providers or quacks as well as get rich quick
schemes exploiting womens desire for safe abortion
services. Certainly, many obstacles must be overcome
before women in Nepal will be able to exercise their
newly gained right to safe abortion services, but the
importance of this change to their health and well-being
cannot be underestimated. Mr. Tamang concluded that
persistent advocacy efforts combined with evidence-
based research proved highly effective.
Women and girls will stop dying in preg-
nancy and childbirth when governments
actionsnot simply their rhetoricreflect
a respect for and a commitment to
womens fundamental human rights.
Center for Reproductive Rights, 2003
10
The law also permitted abortion up to 18 weeks in the case of rape or incest, and at any gestational age in cases of foetal deformity, disability, or risk to the womans life.
While not all attempts to liberalise restrictions on abor-
tion services are successful (Sri Lanka is an example of
a country where such efforts were defeated, and in
some countries laws have been made more restrictive),
a number of countries are liberalising their laws
(according to Hall-Martinez, 12 countries have done so
since 1994). The evidence is that such legal changes
results in fewer deaths and disability. The data from
Turkey and other countries also show that over time,
abortion rates often drop after safe abortion and family
planning services are made more available.
Lessons Learned
Almost all Asian countries have laws that allow abor-
tion for broad social or economic reasons, on health
grounds, or in certain circumstances such as cases of
rape or incest. The interpretation and implementation
of these laws and policies can vary widely within and
across countries, however, and a range of other factors
can also contribute to whether women can access the
range of appropriate services. For example, beliefs and
attitudes influence how policies are interpreted, which
can enhance or restrict availability of family planning,
postabortion care, and safe abortion services. Ensuring
that existing laws are properly implemented is a first
step towards reducing the incidence of unsafe abortion,
and is discussed further in Section D.
13
I do not know the whereabouts of my husband and had been living
with my parents for some time. It was late at night in my parents home when I had a
miscarriage. I was four months pregnant and I had been bleeding for around nine days.
I could not afford medical treatment.
I could also not afford to ease my heavy workload, which I suspect
contributed to my miscarriage.
The neighbours helped dispose of the foetus. Five days after my miscarriage, the police came
and arrested me. They asked me if I induced the abortion.
They beat me and I became unconscious. I was taken to a hospital for medical treatment where
I spent 15 days. I was then taken to court and was locked up.
I received no medical examination.
Before being transferred to the Central Jail for medical treatment, I was asked
to sign a document stating that the case may continue in my absence. I later learned that I
signed an agreement to accept whatever decision was issued by the court.
I never went to school and could not know what I signed. The court handed down
a decision sentencing me to life imprisonment.
At the time of the conference, 20-year-old Kamala was serving a life sentence at the
Dilli Bazaar Khor prison. She had been forced into an arranged marriage and has
a two-year-old son.
Story provided by the Center for Reproductive Rights,
Abortion in Nepal: Women Imprisoned.
Nepal
Kamalas Story
Thailand
Tidas story
I already have a family. We had our first child a year after getting married.
I wanted to get a permanent sterilisation because my husband and
I agreed to have only one child. Both of us dont have much education.
We are just wage workers and dont make much money. If we have
more than one, it will be impossible for us and the kids to
have better lives.
When giving birth to my first kid, I told the doctor to tie my tubes.
But the doctor refused. He said I would have to wait until after a second
pregnancy. After the birth of our first child, we moved to my husbands
home village in a Northern province. By then, I was taking pills regularly
as recommended by the doctor. One day I ran out of pills. I went to the
villages Health Service Station. I was told no contraceptive pills were available.
In the meantime, my husband and I were very careful during sex as we were
using a withdrawal method.
A few months afterwards, my husbands grandma passed away. We both moved
back to my parents house. I was so glad. The Health Service Station here had
contraceptive pills for sale. My husband and I needed not to worry anymore. But, our
nightmare materialised. After the first week of getting back, I noticed my periods
were late. I went back to the Station and had a pregnancy test. The test was positive.
My husband and I became so stressed out. Its not simply that when you have a husband
you can have many children any time. I thought about having an abortion even though
I have a husband and did not get loose with anyone.
For me, I needed an abortion because my first child was just one year old. My husband and
I just got jobs. Our income combined was a little over 3,000 Baht. The formula for my baby
cost us over 1,000 Baht each month. We also had to contribute to my parents household
expenses each month. We had no saving. How could I afford the delivery fee and the formulas
for the second child? Moreover, I would not be able to work until the first child reached school
age because my mom could not take care of two young children at the same time.
I keep asking why. Why did this have to happen to me? Why were there no contraceptive pills available
at my husbands villages Health Service Station? Why didnt the doctor agree to tie my tubes when
I was giving birth to my first child?
Story provided by the Population Council, Bangkok Office, through the Reproductive Health Research and Advocacy Project.
I nt r o d uc t i o n P l e na r y S e s s i o ns
15
Preventing unwanted pregnancy
A primary approach to preventing abortion-related
deaths and injuries is to reduce the numbers of unplanned
or unwanted pregnancies. There are approximately
75 million unwanted pregnancies each year; every
minute, about 190 women confront an unwanted or
unplanned pregnancy. Over half of these pregnancies
end in abortion, with the majority of unsafe abortions
taking place in developing countries. The most common
reasons for unwanted pregnancy are contraceptive
failure and non-use of contraception, frequently due
to a lack of access or awareness. Despite the dramatic
increase in contraceptive use worldwide over the last
40 years, approximately 350 million couples still do
not have access to family planning services and
methods. Young and unmarried women, in particular,
face difficulties in accessing contraceptive methods.
Unequal gender roles contribute to the problem by
limiting womens control over contraceptive and other
reproductive choices. In addition, sexual assault and
rape can lead to unwanted pregnancy.
Family planning (including emergency contraception)
11
plays a key role in preventing unwanted pregnancy
and improving womens health. However, even with
widespread access to family planning, unwanted preg-
nancies would still occur. Global estimates project that
contraceptive failure leads to over 26 million accidental
pregnancies annually.
12
Dr. Pramilla Senanayake, former Assistant Secretary
General of the International Planned Parenthood
Federation, discussed the role of family planning
and emergency contraception in preventing unwanted
pregnancies in her overview presentation, pointing
out that there are three ways for women to avoid
unwanted pregnancy: abstinence, family planning,
and abortion.
Family planning
As fertility preferences have shifted over the past half
a century, couples in many parts of the world want
fewer children and have tried to limit the size of their
families. Comprehensive, high-quality family planning
services that respond to individual preferences and
provide access to a broad range of contraceptive options
help people to meet their fertility preferences. Research
from Chile, Bangladesh, and more recently, the former
Soviet Union has shown that where such services are
available, couples will use them and both fertility rates
and abortion rates will fall. For instance, in Kazakhstan,
the abortion rate decreased by about 50% between 1991
and 1998, while the use of contraceptive methods
increased by about the same magnitude, when services
were improved. In Chile, rates of treatment of abortion
complications dropped as contraceptive use rose, fol-
lowing the introduction of family planning in 1964.
Studies in Matlab, Bangladesh, showed that improving
family planning services lowered abortion rates.
Yet numerous barriers still remain. Despite the fact
that the multiple benefits of family planning are widely
known, between 120 150 million women who want
to space or limit their pregnancies are still without
the means to do so effectively, and 350 million couples
lack information about contraception and access to
a range of services. Young people are particularly
underserved, affected by barriers of cost, stigma,
and lack of information. Poor and marginalised people,
and those who are HIV-positive, also struggle to access
family planning services.
In response to these challenges, a project in India
is focussing on reaching some of the countrys poorest
and most isolated families with high quality reproduc-
tive health services, including family planning.
11
See page 16 for information on emergency contraception.
12
Op. cit., World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems.

Nita Jha (Medical Director, Janani) presented a case study
describing the innovative efforts of the Janani social
marketing project to improve reproductive health services,
with a special emphasis on family planning, in three
states with high fertility and low contraceptive prevalence.
Janani works with the private sector, primarily small
pharmacies and general stores providing non-clinical
family planning methods, which are located mostly in
urban areas, and rural medical practitioners, who pro-
vide 85% of all non-hospital health care in rural areas.
The two approaches ensure that both rural and urban
clients are reached.
The mostly male rural medical practitioners have the
opportunity to join a network of reproductive health
service providers, on the condition that they invite
a woman (usually their wife), to join the practise.
They receive intensive training, after which their centre
can provide a variety of reproductive health services,
as well as some income-generating non-health services
such as birth and marriage registration, and applica-
tion of bridal makeup; this compensates for the fact
that family planning services by themselves offer
very low profits.
A referral network of doctors supports the rural health
providers. The doctors provide clinical family planning
services such as IUD insertion and male and female
sterilisation, as well as safe abortion services, at prices
considerably lower than those charged by the existing
private sector. There are currently 45,000 shops,
21,000 rural health clinics, and 500 doctor-staffed
clinics working together within the Janani system.
These service delivery sites are backed up by an IEC
campaign that uses radio, television, and newspaper
to reach communities. To train the doctors participating
in the network, a training centre was established; this
centre now serves as many clients as all 116 government
hospitals in the state of Bihar.
Low literacy and low levels of female autonomy present
continuing challenges as Janani works to expand
reproductive choice. Nevertheless, data has shown that
in two of the intervention states, Bihar and Madhya
Pradesh, contraceptive prevalence has risen since the
project started (from 19.7 to 22.4% in Bihar, and from
38.3 to 42.3% in Madhya Pradesh, according to National
Family Health Surveys undertaken in 199192 and
199899). This sustainable, private-sector model of
delivering family planning services may prove to be
an effective way to reach poor and rural people with
urgently needed services.
Emergency contraception
Emergency contraception (EC) refers to several family
planning methods that can be used to prevent pregnancy
after unprotected sex or if a contraceptive method fails.
The most common methods of EC are variations of oral
contraceptives or insertion of an intrauterine device
(IUD), and they are typically administered within three
to five days after an act of unprotected sex or contra-
ceptive failure. The World Health Organization has
stated that if EC were easily available, millions of
unwanted pregnancies and abortions could be avoided.
For example, in the United States, close to half (43%)
of the decline in abortion between 1994 and 2000 can
be attributed to the use of the emergency contraception.
13
However, EC remains generally under-utilised, misun-
derstood, and unknown to clients and service providers.
Research from Kenya, Mexico, Ghana, and the US reveals
that service providers rarely mention the method to
their clients, and few women have accurate knowledge
of EC. Around the world, countries have launched
successful information, education, and communication
projects to increase knowledge and awareness of EC.
There have also been efforts in some countries to improve
access by making EC available without a prescription;
over the counter status greatly reduces the barriers
to women accessing the regimen.
13
Jones RK, Darroch JE, and Henshaw SK, Contraceptive use among U.S. women having abortions in 20002001, Perspectives on Sexual and Reproductive Health, 2002, 34(6): 294301.

In his case study, Professor Harshalal R. Seneviratne
(Faculty of Medicine at the University of Colombo,
and Family Planning Association of Sri Lanka) cited
several innovative marketing approaches that were
employed to increase access to EC in Sri Lanka, where
numbers of unsafe abortions appear to be fairly high
and increasing. Through the efforts of the Family
Planning Association of Sri Lanka and the Consortium
for Emergency Contraception, a dedicated EC product
(that is, pills packaged and labelled specifically for
emergency contraceptive use) was introduced and
marketed through clinics, private health care providers,
and pharmacies. In 2003, roughly 4,600 EC pill packets
were sold each month, and a telephone hotline received
more than 75 calls a day from all over the country.
With abortion highly restricted in Sri Lanka (a 1995
proposal to change the law to allow abortion in cases
of rape or incest failed), ECs contribution to reducing
unwanted pregnancy is especially important.
Lessons Learned
Expanding accessibility to family planning services,
including EC, and improving quality of care can greatly
reduce the incidence of unwanted pregnancies. Over
time this can reduce the demand for abortion services
quite dramatically. In order to achieve this goal, repro-
ductive health programmes must strive to prevent
unwanted pregnancies by reaching more clients and
offering them high-quality services. Even a perfect
family planning programme, however, cannot eliminate
the need for safe abortion services.
17
Carmen and her husband Ronald lived in Bagong Barrio, a poor community
in one of the densely populated cities in Metro Manila. Their eldest child
was only 4 years old when Carmen, who had just recently given birth to
the second, found herself pregnant with the third. She sought the help
of a friend who had an experience in abortion. She was referred to a
traditional caregiver. Her pregnancy test was positive.
Carmen was the familys main breadwinner, selling flavoured ice shavings
at a market stall. Her children accompanied her to work everyday; eldest
child was already running errands such as buying ice and sugar. Mother
and eldest child worked while the newborn was put to sleep in a shelf
beneath their pushcart. All the while Ronald was busy with cockfighting.
After more than a week of rumination and of saving up money, Carmen
made up her mind. Her husband didnt know of her plan. The traditional
caregiver inserted the catheter up into Carmens womb and instructed
her to pull off the hose the moment she could no longer endure the
cramps that she would experience. She was already bleeding when she
left the traditional providers place.
Carmen removed the catheter but the pain became more intense.
She bled so heavily overnight that she almost used up two bagfuls of
clothing in place of sanitary napkins. The traditional provider was
summoned and directed her to have herself brought to the hospital if the
bleeding did not stop. But she refused to be hospitalised. She took a drug
from the caregiver to arrest the blood flow, and it slowed and became
like a normal period. But then the profuse bleeding resumed. Carmen was
sent to the hospital, where she passed out immediately after her arrival.
A D&C had already been performed on her when she regained consciousness
at 5 a.m. the next day. She stayed in the hospital for four days but had
a relapse after fetching pails of water for laundry. The bleeding returned,
this time in spurts, prompting her to be rushed again to the hospital.
She almost died once more.
Story provided by Likhaan, a Philippine NGO.
Philippines
Carmens story
19
Postabortion care: Addressing complications
of unsafe abortion
WHO estimates that almost 20 million unsafe abortions
occur each year, and a smaller but still high number
of spontaneous abortions also occurs. Whether abortion
is legal or not, all women experiencing complications
following either a spontaneous or induced abortion
should have access to comprehensive postabortion care
(PAC). PAC includes both treatment of abortion compli-
cations and provision of postabortion family planning
to prevent future unwanted pregnancies, as well as
other counselling and services that women may need.
While PAC has been widely accepted by the international
community following the International Conference
on Population and Development (Paragraph 8.25,
ICPD, 1994), its implementation on the ground
is not yet complete.
Postabortion care (PAC) is a strategy
for reducing mortality and morbidity
resulting from complications of
incomplete and unsafe abortions.
14
As described in an overview by
Dr. Enriquito Lu (JHPIEGO), the aim
of PAC is to improve the quality of
care received by women with
postabortion complications, and to
make services more accessible, more
humane, and more comprehensive.
Since its endorsement at ICPD in
1994, the availability of PAC services around the world
has expanded significantly and many successful pilot-
projects provide lessons and strategies for ensuring
womens access to PAC.
The original model for PAC included three elements:
1. Emergency treatment of complications following
induced or spontaneous abortion;
2. Provision of postabortion family planning
counselling and services; and
3. Linkages to other reproductive health services.
More recently, several agencies and individuals working
on PAC have proposed adjustments to the model.
For example, the Postabortion Care Consortium, a
group of agencies addressing unsafe abortion, has
expanded its PAC model to five elements, adding com-
ponents on community involvement and counselling
to move from a facility-based model to one that is
more public-health focussed.
Dr. Lu described several strategies for expanding access
to PAC, including advocacy, policy support, institution-
alisation of PAC services, and community and provider
partnerships. Advocacy can promote understanding of
the problem of unsafe and spontaneous abortion in a
community, define what PAC is and is not (which helps
reduce resistance to PAC caused by its association with
abortion), and ensure support from community leaders.
National policies and service guidelines should promote
access to PAC and answer questions about who can pro-
vide PAC services
at what level of
each health care
site. PAC can be
institutionalised
by organising
services to link
PAC treatment
with family plan-
ning services,
ensuring that the
necessary drugs and equipment are available (for instance,
through essential drugs lists), and training providers.
Although PAC has been widely endorsed and imple-
mented, some argue that it is not the most efficient
way to deal with the deaths and disabilities caused by
unsafe abortion. Provision of safe, accessible abortion
services, noted Dr. Beverly Winikoff (President, Gynuity
Health Projects) in her presentation, would greatly
reduce the need for postabortion treatment. She stated
that PAC training should emphasise improving provider
attitudes towards abortion and women who have
sought abortion, as well as include the latest medical
information on effective methods for clinical postabortion
care, such as misoprostol.
14
Incomplete abortion may result from either induced or spontaneous abortion.
In all cases, women should have access to
quality services for the management of com-
plications arising from abortion. Postabortion
counselling, education and family planning
services should be offered promptly, which
will also help avoid repeat abortions.
ICPD Programme of Action, paragraph 8.25, 1994

Efforts to improve emergency clinical treatment of
women with abortion complications have focussed on
the introduction of manual vacuum aspiration (MVA),
which has been shown to be safer, less costly, and as
effective as the traditionally used dilatation and curettage
(D&C). Numerous pilot projects have shown that MVA
can be performed safely by mid-level providers and at
lower level facilities, facilitating the decentralisation
of services and increasing access for women.
However, although MVA can dramatically expand
access to PAC, this treatment is still unavailable
to many women who live in rural areas where there
are few or no trained mid-level providers. For these
women and others, medical treatment with misoprostol
is being investigated. (See box on What is misoprostol?)
Both Dr. Lu and Dr. Winikoff noted that such medical
treatment has the advantage of being easy to deliver by
even minimally trained medical staff. It can be offered at
all levels of the health care system by a range of health
care providers. It is low-cost, has few side-effects, and
reduces the risk of sepsis and uterine perforation.
The effectiveness of misoprostol in treating abortion
complications is still being investigated; studies pub-
lished to date show a range of effectiveness, from 66%
to 95%. The data are limited, however, due to widely
differing study populations, protocols, and definitions
of success. Dr. Winikoff presented preliminary data
from new studies in Uganda and Vietnam showing
success rates over 95%, and indicating promise for PAC
treatment; these study populations are more reflective
of women suffering from unsafe abortion in developing
countries. Political and regulatory obstacles to the
widespread use of misoprostol for postabortion treatment
will need to be addressed, however.
Two case studies illustrated different approaches
to implementing PAC services. In Nepal, as described
by Dr. Bimala Lakhey (Maternity Hospital Thapathali,
Katmandu), the need for PAC was urgent before abor-
tion was legalised in 2002. Twenty-four percent of
maternal mortality nationally was ascribed to unsafe
abortion, and half of all maternal deaths in a major
maternity hospital were attributed to complications of
unsafe abortion. In this environment, PAC services were
introduced in 1995 with the assistance of a range of
international NGOs and donors at this major maternity
hospital. Thapathali became a national health training
centre for PAC in 1997, treating women with both MVA
and D&C. Records show that about two thirds of women
treated for postabortion complications accepted family
planning methods, usually pills, before discharge.
WHAT IS MISOPROSTOL?
Synthetic prostaglandin E1 analogue
Available in tablet form in many countries
Low-cost: 35-45 cents per tablet
Long shelf life (seven years) and very stable
Causes uterine contractions
Used for first and second trimester abortion,

treatment of foetal death or spontaneous
abortion, labour induction, prevention and
management of postpartum haemorrhage,
and pre-abortion cervical priming
Success rate for treating incomplete abortion

ranges from 66-97%
21
As PAC became more established, additional doctors
and nurses were trained, and staff from other hospitals
(and even from Indonesia) went to Thapathali to receive
training. PAC services were expanded to 34 sites
around the country, going far to meet demand but not
covering every district in Nepal. Evaluation of PAC
services showed that the smaller sites tended to be more
successful at providing PAC than larger sites, and
nurses (with the full support of physicians and hospital
management) were the most effective service providers.
Staff shortages and frequent staff transfers, coupled
with low awareness of services in the community, were
among the challenges to implementing PAC more fully.
In the meantime, abortion was legalised in Nepal
in 2002 (see Section A, p. 11), and policy-makers
and providers are now challenged with meeting the
demand for comprehensive abortion care, as described
by Dr. Laxmi Raj Pathak (Ministry of Health, Nepal) in his
earlier presentation. Thapathali Hospital is again taking
the lead, training senior doctors and standardising
services. Abortion care will need to be expanded country-
wide, but will meet the same challenges staffing,
community knowledge, lack of equipment and space
that have already been faced by PAC services.
In order to ensure that both comprehensive abortion
care and PAC are accessible to Nepali women, more
nurses should be trained, and training can be insti-
tutionalised within medical and nursing school
pre-service programmes. Only when these services
are properly established and widely available can
Nepals maternal mortality ratio, currently one
of the highest in the world, be reduced.
Similar lessons were learned in Kenya, where maternal
mortality is also high, and abortion is highly restricted.
Monica Oguttu (Project Director, Kenya Medical and
Educational Trust) described Kenyas experience in
instituting PAC training for private and public sector
midwives, noting, If poor, powerless womens lives
are to be saved in developing countries, midwives have
to be involved. PAC was introduced early in Kenya,
with MVA piloting starting in 1986. MVA was included
in the medical curriculum for doctors starting in 1992,
and by 1997 PAC was included in national reproductive
health guidelines. A PAC working group was formed to
share lessons learned, and the private sector started to
get involved in providing PAC services.
It became clear both that midwives could safely offer
PAC services, and that their role was essential in order
to meet the needs of Kenyan women countrywide.
There are only 5,300 doctors in Kenya, compared to
27,000 mid-level providers. Furthermore, midwives are
more likely to serve in rural and peri-urban areas, and
to work with low-income clients. Expansion of PAC in
Kenya, therefore, depended heavily on the involvement
of mid-level providers.
After a successful pilot project to train midwives
in PAC was carried out by PRIME in 1999, the govern-
ment agreed to move forward with wider training
of midwives. Several challenges were met during this
expansion phase, including problems with erratic
supply of contraceptive commodities and MVA equip-
ment, and the need to strengthen the involvement of
communities. At the time of the conference, 195 nurse
midwives had been trained in Kenya, and were suc-
cessfully providing PAC services. They were especially
successful at providing post-abortion family planning.
A third case study described the situation in Myanmar
(Khin Ohn Myint and Khin Than Sein, Ministry of
Health, Myanmar), where unsafe abortion causes up
to 60% of maternal deaths and the repeat abortion rate
has been found to range from 31% to 67%. Research
showed that women with abortion complications often
delayed seeking care, staff at lower levels were unable
to diagnose and manage abortion complications, and
referral systems were not functioning. Hospitals were
overwhelmed and lacked adequate supplies, drugs,
and staff trained in PAC. In this environment, PAC
was introduced at all health service levels in 28 town-
ships, emphasising prevention of abortions through
advocating birth spacing within communities, providing
comprehensive treatment of those abortion complica-
tions that do occur, and linking emergency care to birth
spacing to prevent future repeat abortion. At the time
of the Kuala Lumpur conference, data on the interven-
tion were still being collected.
Lessons Learned
As various conference participants noted, just as
addressing unsafe abortion has often been left out
of safe motherhood efforts, PAC programmes are often
implemented separately from other safe motherhood
programme efforts. This reflects a range of factors,
including donor restrictions on funding, and the fact
that women suffering from unsafe abortion are treated
in gynaecological, as opposed to obstetrical wards.
There are good reasons to integrate PAC with safe
motherhood programmes, however: often the same
people work on PAC and safe motherhood, at both
national and health facility levels; and delays in seeking
emergency obstetric care, whether following an unsafe
abortion or at the time of giving birth, could be
addressed through joint community awareness-raising
and mobilisation activities.
23
Expanding access to safe services,
where not against the law
Abortion is legal in almost all countries for at least
some indications. Even if the indications under which
abortion is allowed are restrictive, international agree-
ments, including ICPD+5, specify that safe services
should be provided to those women who meet the
legal criteria. However, legal and safe services are
often not available.
A number of factors limit access to safe, legal
abortion, including:
Health system barriers. In many cases, pervasive health
sector problems affect the availability and quality
of abortion services. These problems include: lack
of equipment and supplies, such as MVA kits, medi-
cines, and consumable supplies; limited supervision
capacity; and inadequate staffing at health facilities.
Inadequate training of health care personnel.
In order to expand access, health professionals must
be trained to provide safe abortion services. In many
countries, mid-level providers, such as nurses, mid-
wives, clinical officers, and physician assistants,
are much more numerous than doctors, particularly
at lower-level health facilities. These mid-level
providers are also more geographically dispersed,
making them more accessible to rural populations.
Experience from a number of countries has shown
that these providers can safely and effectively offer
abortion-related care, but in many places they lack
the training to do so.
Restrictive policies and regulations. Many abortion-
related policies create barriers that impede womens
ability to safely terminate their pregnancies. One
such example is the requirement of third party
authorisation or certification, such as hospital abortion
committees, spousal authorisation, or medical or police
certification of rape, in order to obtain a legal abortion.
Cost. Fees for abortion-related services are often
prohibitively high.
Negative attitudes. Societal attitudes and stigma
around abortion can greatly hinder efforts to
improve access to safe services.
In response to countries need for technical input and
guidance for overcoming these barriers and offering
safe abortion services, the World Health Organization
published Safe Abortion: Technical and Policy Guidance
for Health Systems in 2003. As explained in the newly
released publication, introduced by Paul Van Look (WHO),
there is considerable opportunity in most countries to:
1. review and promote wider understanding of the
relevant laws and policies;
2. design and implement comprehensive policies
to ensure access to services to the extent the law
provides for; and
3. identify and remove unnecessary regulatory
and administrative barriers to services.
For instance, in many countries where abortion is legal
in cases of rape or incest, stigma and lack of informa-
tion restrict womens ability to access services to which
they are legally entitled. Changes in policies, organisation
of services, and information can be made to ensure that
women can indeed access the services allowed under
the law. WHOs Safe Abortion: Technical and Policy
Guidance for Health Systems provides a comprehensive
reference for a wide range of health professionals,
inside and outside governments, who are working to
reduce maternal mortality and morbidity.
S AVI NG WOME N S L I VE S : T HE HE AL T H I MPACT OF UNS AF E ABORT I ON
Case studies from India and South Africa illustrated the
gap between legal and actual availability of abortion,
and a case study from Bangladesh described an assess-
ment of menstrual regulation services; strategies for
meeting the need for safe services are included. A case
study from Tunisia shows how the introduction of a
new technology medical (or medication) abortion
can expand access for women.
In India, as described by Sharad Iyengar
(Action Research and Training for Health,
Udaipur, India), a liberal abortion law has
not led to widespread access to safe abor-
tion services, due to restrictions on
providers and facilities. Abortion was
legalised as a public health measure in
1971, under the Medical Termination of
Pregnancy (MTP) Act. The law restricts
abortion services to government or
government-certified facilities, which
must be equipped to administer general
anaesthesia and must have the capacity
to perform emergency abdominal surgery.
Abortion providers are supposed to be
obstetrician-gynaecologists or specially
trained doctors.
However, it is believed that informal or clandestine
providers provide at least three-quarters of abortion
services in the country. These services are technically
illegal but are widely accepted by both society and
regulatory bodies. Even within government facilities,
there is a mismatch between which services meet the
regulatory requirements and which actually provide
services some sites that are equipped are not staffed
with certified doctors, and some certified doctors do
not work at properly equipped sites; even in cases
where both the staff and equipment are adequate,
some sites do not offer MTP services.
A number of factors influence the discourse on safe
abortion in India. A campaign against sex-selective
abortion has stigmatised abortion providers generally.
Abortion is also seen as a population control issue
rather than a reproductive right, and as such does not
garner widespread support. Finally, some donors do
not include abortion in their maternal health funding,
which contributes to the separation of abortion from
safe motherhood.
Since 2000, several legal and policy changes have been
introduced in order to improve access to abortion. For
instance, the National Population Policy of 2000 advo-
cates the use of MVA and medical methods, access to
abortion through primary health facilities, and recogni-
tion of the role of mid-level providers. In 2002 and
2003, changes were made to the MTP Act to make the
site certification process less cumbersome. A number
of barriers still exist, however: mid-level providers and
ayurvedic or homeopathic physicians still cannot be
certified as providers, even for medical methods;
mifepristone is only approved for use in women up
to seven weeks pregnant (seven weeks following the
last menstrual period, or LMP); and training is restric-
tive and inaccessible for many.
MEDICAL (OR MEDICATION) ABORTION
Medical methods of abortion have been shown to be safe and
effective, and have an important and growing role to play in
expanding access to safe services. The WHO Guidance states that
preferred regimens are the antiprogesterone mifepristone, followed
by administration of a prostaglandin (usually misoprostol).
Repeated doses of a vaginal prostaglandin are among the preferred
methods after 12 completed weeks since the last menstrual period.
A number of studies have shown the effectiveness and acceptability
of medical abortion in low-resource settings; however, the neces-
sary drugs are available in few developing countries.
24
25
Additionally, authorities are becoming more rigorous in
prosecuting and imprisoning non-certified abortion
providers, although Dr. Iyengar suggested that expanding
access to certified providers might be a more effective
way to put non-certified providers out of business.
The situation in India is a reminder that a number of
barriers can restrict womens access to safe abortion
services, even when abortion laws are quite liberal and
have been in place for over 30 years. Suggestions for
how to expand access to safe abortion services in India
included: broadening the role of mid-level providers,
incorporating abortion into pre-service training,
ensuring sensible access to newer medical abortion
technologies, and improving the quality of contracep-
tive counselling in both the private and public sectors.
South Africa has liberalised its laws much more
recently than India. In 1996, after the dissolution of
apartheid, the Choice on Termination of Pregnancy
Act was introduced. Makhosazana Xaba (Director, Ipas
South Africa) described how this new law has given
South African women of any age the right to access
abortion upon request up to 12 weeks LMP, with limita-
tions imposed from the 13
th
week onwards. In the first
trimester, services are provided by trained midwives;
this is an important provision in a country where
access to physicians is uneven.
Under the Act, an increasing number of facilities have
been designated to provide abortion services, and
providers have been trained, resulting in greater access
for women and a reported reduction in the severity
of complications due to unsafe abortion. A number
of challenges still remain, however, including negative
attitudes of health workers and managers, insufficient
trained personnel, long waiting times for services, a
lack of awareness of the law on the part of the public,
and negative societal attitudes. In addition, the Act
has faced legal challenges in the courts.
In response to these issues, a National Strategic Plan
for the Implementation of the Choice on Termination
of Pregnancy Act was developed, calling for a number
of steps to broaden access to abortion services,
including mainstreaming clinical training, supporting
providers on quality issues, and providing an enabling
environment (including for minors). These steps are
all directed towards realising the vision of the plan,
which states that every woman in South Africa should
have access to good quality termination of pregnancy
services when faced with unwanted pregnancy as well
as access to other reproductive health services.
A situation analysis from Bangladesh, presented
by Dipu Moni (independent consultant), showed that
a range of barriers prevent women from accessing
menstrual regulation (MR), even in a setting where
services are theoretically available. Moni reported on
an assessment carried out by Reproductive Health
Alliance, which showed that although services carried
out by trained providers are widely available, many
women are still unable to access MR for myriad reasons.
For instance, unofficial payments are required, unau-
thorised brokers mislead clients, and women receive
little post-procedure counselling, no pain control, and
minimal psychological support. Women also face barriers
of distance and transportation costs, and providers were
found to sometimes be judgemental and impose unnec-
essary preconditions for receiving treatment. Facilities
are substandard, especially with regard to privacy
and cleanliness, and sometimes lack adequate supplies
of essential commodities. In response to these issues,
the assessment team recommended a number of
improvements: addressing quality of care issues; strength-
ening training, supervision, and accountability; developing
culturally sensitive informational materials; and exploring
service fees as a form of sustainable financing.
A case study from Tunisia described how the introduction
of medical abortion, a new technology, can expand
access to high-quality abortion services. Tunisia has
abortion laws that are considerably more progressive
than those in most African or Islamic nations. Abortion
services have been available and free since 1973, and
maternal deaths due to abortion are now almost
unknown. Dr. Selma Hajri (ONFP or National Office
on Family and Population, Tunisia) recounted the recent
process of introducing medical abortion in Tunisia.
Three introductory trials of medical abortion were held
in 1998, 1999, and 2000. Through these studies a
Tunisian Protocol was developed, which simplified the
regimen developed in France by allowing women the
option of taking the misoprostol dose at home. In 2002,
medical abortion was introduced into 10 centres run by
ONFP; 28% of women elected to take the misoprostol at
home. Results were followed for the first three months
of service delivery and showed a success rate of 94%,
comparable to the rates found in earlier studies. Women
reported a high degree of satisfaction with the regimen.
Dr. Hajri concluded that training in counselling was
critical to the successful introduction of medical abor-
tion technology, at least as important as the medical
aspects of introducing the new method.
Lessons Learned
Laws that allow abortion are not in and of themselves
sufficient to guarantee that women will be able to
access safe abortion services; a number of barriers
including cost, poor policies, lack of trained providers,
and negative service provider attitudeskeep women
from accessing high quality services, even when laws
are favourable. New technologies, such as medical
(medication) abortion, can enhance access, as can other
efforts, described in WHOs Guidance on this topic.
Ple, a seventeen-year old girl, had just
started her first year in vocational school.
She had made a decision that has changed
her life completely. She was pregnant and
decided to terminate the pregnancy. She did
not realise the doctor from whom she sought
care did not have a professional licence.
During the procedure, her womb was damaged,
and she was also left with severe infection
of the ovaries. Ple had both the ovaries and
the womb removed, resulting in physical and
emotional suffering; she is far behind in school
and has to take hormones for the rest of her
life. And, she will not be able to have her own
children when she meets someone she wants
to share her life with.
Story provided by
Planned Parenthood Federation of America International, Asia
27
Thailand
Ples story
P
h
o
t
o
:

R
i
c
h
a
r
d

L
o
r
d
Quality of care: The critical elements
Quality of care is a key aspect of access to safe abor-
tion and postabortion care services. This session of the
conference afforded participants the chance to discuss
quality of care extensively. All service sites should
strive to improve quality of abortion and/or postabor-
tion care by focussing on the following elements:
Access to services. Access can be affected by
a number of factors, including distance, cost, confi-
dentiality, referral systems, and whether services are
offered on a 24-hour, seven-day-a-week basis.
Equipment, supplies, and drugs. This includes appro-

priate technology for performing abortion or for
treating abortion complications, for example making
MVA and medical abortion more widely available.
Technical competence. It is essential that all relevant
cadres of health care providers receive adequate
training in all aspects of abortion and postabortion
care. This training should be institutionalised into
pre-service training programmes/institutions, and
also provided through in-service training so that
services can be immediately improved.
Interactions between women and providers, including
counselling and information provision, should be
improved to address negative and judgemental provider
attitudes, ensure informed consent, and foster pro-
fessional responsibility in the provision of care.
Links to family planning and other reproductive

health services. As described above in the section
on PAC, whether women come for treatment of
postabortion complications or for elective induced
abortion, they should also be provided with informa-
tion and services on family planning and other
reproductive health services.
Presentations from India, Vietnam, and several Marie
Stopes affiliates in Asia demonstrate the importance
of high-quality services. Overview presenter
Dr. Bela Ganatra (Senior Research and Policy Advisor,
Ipas, Asia region) described a number of overarching
issues relating to quality of care for both abortion serv-
ices and postabortion care.
Quality of care has many components; technology is
a key area where quality is fairly quantifiable and has
been investigated. Research indicates clearly that
vacuum aspiration (either manual MVA, or electric
EVA) is preferable to dilation and curettage (D&C), and
it is recommended in WHOs publication Safe Abortion:
Technical and Policy Guidance for Health Systems.
However, recent studies in India, Ethiopia, Myanmar,
and Vietnam indicate that D&C is still being used
extensively (see Table 3, opposite) for both elective
abortion and PAC. Medical abortion, described in the
previous section, offers an additional choice to women,
and has some advantages; many women prefer it.
Dr. Ganatra noted that, beyond the actual technology
used to empty the uterus, a number of other clinical
issues may require improvement. Proper diagnosing
is essential in order to verify that the pregnancy is
intra-uterine, and dating the pregnancy aids in selecting
the appropriate method of termination to use. Equally
important are the diagnosis of complications, including
examination of aspirated tissue, and emergency man-
agement, including stabilisation. A critical area that
affects services hospital-wide is infection prevention,
which should protect both staff and patients and
includes implementing universal precautions (hand-
washing, use of protective barriers such as gloves and
gowns, safe disposal of waste products and sharps
such as needles, and proper handling and processing
of linens and instruments). Pain management, which
can range from verbal and behavioural support to
general anaesthesia, is another important quality issue.
Finally, links to other services are a critical aspect of
safe abortion and postabortion care. Women with abor-
tion complications may need contraception and
screening or treatment for reproductive tract infections,
HIV, and cervical cancer. They may also benefit from
links to non-medical services such as screening and
referral for domestic violence, and for social, legal
or economic difficulties. However, while on-site links
(such as provision of postabortion family planning
services) can increase accessibility for women, care
must be taken to ensure that these links do not become
28 S AVI NG WOME N S L I VE S : T HE HE AL T H I MPACT OF UNS AF E ABORT I ON

29
coercive. For example, no woman should be required to
accept a family planning method in order to receive
postabortion care.
Research among women seeking care indicates
that quality is defined by different women in different
ways, according to Dr. Ganatra, and it goes far beyond
the clinical issues mentioned above. For some women,
pain relief, medical safety, and adequate information
may be less important than confidentiality, affordability
of care, and a quick return home. All women are
understandably eager to avoid verbal abuse, coercion,
and monetary exploitation, all of which can accompany
abortion services in many settings. Unmarried, young,
or childless women can all face additional barriers,
including the disapproval of providers.
In a setting where abortion is heavily legally restricted,
women seeking abortion are particularly vulnerable
and it is hard to ensure quality and humane treatment.
Improving the legal and policy environment can con-
tribute immeasurably to improving the quality of
abortion care.
Dr. Ganatra gave a number of suggestions for improving
the quality of care received by women. Training can
become more competency- and skills-based, and can
put greater emphasis on counselling, values clarification,
ethics and legal aspects of abortion, and postabortion
care. Service delivery spaces can be reorganised to
provide greater privacy and improve the flow of clients.
Referral systems and networks can be improved, and
quality can be linked to monitoring and accountability.
If communities are involved in defining and monitoring
quality, and abortion is de-stigmatised, services will
respond with improved quality.
Country Year of Study PAC or Elective Abortion Percent using D&C
India (4 states) 199697 Elective 64%
Ethiopia 2000 PAC 94%
Myanmar 2003 PAC 100%
Vietnam 2000 Elective < 8 weeks
Elective 812 weeks
12%
70% (as main procedure
or check)
Table 3: Percentage of PAC and Abortion Procedures using D&C, selected countries
Both Vietnam and India provided examples of efforts to
improve the quality of abortion care, and case studies
on improving the quality of abortion-related services
were also provided from Marie Stopes partners in
Bangladesh, Pakistan, Nepal, and Sri Lanka.
From Vietnam, Dr. Phan Bich Thuy (Training and
Service Associate, Ipas Vietnam) described the
Comprehensive Abortion Care (CAC) project, which
addressed Vietnams high
rates of repeat abortion,
lack of counselling and
information, limited avail-
ability and variety of
contraceptives, and poor
infection prevention prac-
tices. Using a participatory
process, national standards
and guidelines for abortion
care were updated to be in
line with international
standards, and a cur-
riculum was developed. A
performance improvement
approach was taken to
strengthen service delivery
and encourage woman-
centred care; this included
a needs assessment to
identify problems, develop-
ment of action plans,
on-going internal and
external monitoring, and
finally a review of progress.
The project was implemented at two sites, both
of which are important training institutions linked to
medical schools. Providers worked together to identify
service delivery problems, such as long waiting times
for women seeking services. They addressed this
problem by scheduling appointments to redistribute
client load throughout the day, and by rearranging the
availability of the medical staff. A number of simple
innovations were made, including installing a light for
checking tissue, replacing metal instruments with
plastic ones, and packing sterilised instruments in sets,
making it easier for medical staff to quickly locate the
correct equipment. Changes were also made to the
physical plant: the waiting area was rearranged and
redecorated, and small, private rooms were established
for counselling. To provide more information to women
waiting for services, group counselling was instituted
for women in similar situations. Record-keeping was
also improved.
Monitoring found that this model was highly effective
and sustainable, and it has now been adopted by the
Ministry of Health. In addition to improving services
for women at the sites, the project fostered commitment
and ownership, as well as networking and exchange
among teaching facilities, the Ministry of Health,
NGOs and others.
Nepal
Prahlad Bhattarais story
"I am a teacher and a father of 3 children. While
I was out in a training, I got the information that my wife had been
admitted in hospital and was in serious condition. When I reached to
the hospital I found my wife screaming due to heavy bleeding.
Doctors were unable to save her life and she died during the treatment.
Later, I learned that my wife had gone to a private clinic in our vil-
lage because of stomach pain. The health assistant diagnosed
pregnancy as a reason for my wife's pain and recommended her for
abortion. He performed abortion after assuring safety. However,
through the medical report it was found that while performing abor-
tion, sharp equipment was used and that cut the uterus of my wife
and caused continuous bleeding. Its not only my wife who died of
unsafe abortion, I myself am aware of 67 innocent women who died
because of unsafe abortion.
Story provided by Forum for Women, Law and Development (www.fwld.org.np)

31
Leela Visaria (Gujarat Institute of Development Research)
reviewed the quality of abortion services in India.
She emphasised that although abortion has been legal
in India since 1971, little research has been conducted
on its quality. What research exists is typically small-
scale and cannot be generalised to the country as a
whole. Despite these limitations, a certain amount is
already known about access, pre-abortion care, abor-
tion procedures, postabortion care, and family planning
counselling for abortion clients. For instance, she
echoed Dr. Iyengars earlier statement that access is
limited in rural areas of India, partially due to restric-
tive requirements for facilities and providers. Women
generally know where to go for abortion services, and
for married women, little or no stigma is attached to
seeking abortion. For unmarried, divorced, and wid-
owed women, however, the stigma attached to abortion
is significant, and access to safe services is more limited.
Cost is also a barrier for many women.
Women generally report pre-abortion care to be accept-
able, as reported by Dr. Visaria, but their expectations
are low; often they are not treated with respect, and
facilities are not always clean or adequately equipped.
Abortion is generally conducted by dilation and curet-
tage (D&C), despite evidence that vacuum aspiration
is safer for women. Mid-level providers, such as mid-
wives, typically do not provide abortion care. In the
postabortion period, women receive little counselling
including for family planning, and generally do not
seek or receive follow-up care. Heavy workloads and
poverty mean they often are unable to rest as directed
after the procedure. Suggestions for improving quality
included promoting vacuum aspiration, increasing the
role of mid-level providers, and simplifying the regis-
tration requirements for both facilities and providers.
Studies were conducted to examine the quality of care
provided by Marie Stopes Internationals
15
partners in
Bangladesh, Pakistan, Nepal, and Sri Lanka. Dr. Reena
Yasmin (General Manager, Programme & Resource
Development, Marie Stopes Clinic Society, Bangladesh)
described some of the findings. For instance, research
conducted with clients at clinics in Bangladesh helped
define quality from the clients perspective often
quite different from clinical definitions of quality.
Women reported that short waiting times, adequate
attention and explanations from the provider, and
ability to receive multiple services in the same visit
were all important indicators of quality.
Lessons Learned
According to these session presentations, improvements
to quality of care can change the face of abortion and
postabortion services, even in situations where abortion
is highly restricted or not easily accessible. By making
care more comprehensive and client-centred, and by
using the technology that is most appropriate to low-
resource settings, providers and administrators have
the opportunity to reduce the incidence and severity
of abortion complications.
15
Marie Stopes International is a UK-based non-profit organisation that has established partners in a number of countries to provide reproductive health services.
CONCLUSION: ACTING NOW TO SAVE
WOMENS LIVES
I
n the closing address, Dr. Fred Sai (President, Ghana
Academy of Arts and Sciences) began by acknowl-
edging the value of this forum in which ideas and
strategies were exchanged, and encouragement and
support were fostered among stakeholders working
to address unsafe abortion worldwide. He also repeated
the case for integration of abortion and postabortion
care into safe motherhood programming, with the
following statement:
Dr. Sai then detailed what can be done in three separate
dimensions of public health to address this problem:
To prevent unsafe abortion at the service delivery level,
providers and administrators can:
Make prevention a priority.
Ensure that abortion is safe and accessible.
Introduce abortion and/or postabortion care to
pre-service and in-service provider training.
Ensure service sustainability.
Utilise appropriate and cost-effective technology.
Promote comprehensive, integrated, client-centred
and respectful services.
The legal and policy sphere will benefit from the
following changes:
Removal of barriers that prevent women from

obtaining services.
Expansion of the existing laws to allow more
circumstances under which women may legally
terminate a pregnancy.
Multi-sector partnerships to liberalise abortion laws.
In order to address the toll caused by unsafe abortion,
all conferees can:
Provide scientific and statistical evidence of the
rationale for addressing unsafe abortion.
Share true stories of individual womens experiences
with unsafe abortion.
Always emphasise respect for womens choices.
Dr. Sai concluded his address with a call to action:
It is impractical and short-sighted for
those who fund, design, and evaluate
programmes to separate abortion-related
care from the other core elements of
pregnancy-related care. Pregnancy
termination and other services should
be provided by the same health workers;
in the same facilities and wards; use
much of the same supplies and equipment;
and most of all, it is the same women who
need the care. These interventions must
be integrated. We shouldnt be thinking
of this as an isolated, stand-alone
programme, subject to political caprices.
Let us remember that we are not dealing

with a different population; we are
talking about ordinary women, our sisters,
daughters, and mothers, often rural, and
often illiterate. Unsafe abortion is usually
the result of gender-based inequities:
let us resolve to eradicate or reduce this
shameful situation. We cannot allow
this situation to continue; maternal mor-
tality will not be reduced, and the Safe
Motherhood Initiative cannot achieve its
goal, unless unsafe abortion is dealt with.
Anne x 1
Rashidah Abdullah
Director
Asian-Pacific Resource & Research Centre for Women (ARROW)
Ground Floor, Block G, Anjung Felda
Jalan Maktab
Kuala Lumpur 54000
Malaysia
Tel: +60 3 2692 9913
Fax: +60 3 2692 9958
E-mail: arrow@arrow.po.my
Marlene R. C. Abeyewardene
Sri Lanka College of Ob/Gyn
16, Cambridge Place
Colombo 7
Sri Lanka
Tel: +94 7413939, 2692074
Fax: +94 1464452
E-mail: swickrema@sltnet.lk, asokaabey@sltnet.lk
Halida Hanum Akhter
Managing Director
Health Promotion Limited (HPL)
House #310, Road #3
Baitul Aman Housing Society
Adabor, Shyamoli
Dhaka
Bangladesh
Tel: +880 2 914 3201
E-mail: hhakhter@dhaka.net
Y.A. Bhg Dato Seri Utama Dr Siti Hasmah bte Hj Mohd Ali
Wife of Prime Minister, Malaysia
Pejabat Perdana Menteri Malaysia
Perdana Putra
Pusat Pentadbiran Kerajaan Persekutuan
62502 Putrajaya
Malaysia
Tel: +60 3 8888 8000
Fax: +60 3 8888 3444
Mymoon Alias
Deputy Director
Family Health Development Division
Ministry of Health
Bahagian Pembangunan Kesihatan Keluarga
KKM, Blok B, Komplek Pejabat Kesihatan
Jalan Cenderasari
Kuala Lumpur 50590
Malaysia
Tel: +60 3 269 46601
Fax: +60 3 269 46510
E-mail: mymoon_kkm@hotmail.com
Rachel Koshy
(on behalf of Narimah Alwin)
Family Health Division, Ministry of Health
Bahagian Pembangunan Kesihatan Keluarga
KKM, Blok B, Komplek Pejabat Kesihatan
Jalan Cenderasari
Kuala Lumpur 50590
Malaysia
Tel: +60 26946601 ext. 235
Fax: +60 26966510
E-mail: rachelkphilip@hotmail.com
Jennifer Amery
Senior Health Adviser Asia Directorate
Department for International Development
1 Palace Street
London SW1E 5HE
United Kingdom
Tel: +44 20 7023 0311
Fax: +44 20 7023 0284
E-mail: j-amery@dfid.co.uk
Kulenthran Arumugam
Department of Obstetrics and Gynaecology
University of Malaya Medical Centre
Kuala Lumpur 50603
Malaysia
Tel: +60 3 79502462
Fax: +60 3 9551741
E-mail: a_kulenthran@hotmail.com, ogsm@po.jaring.my
Ranjit Atapattu
Chairperson
Special Advisory Council to Minister of Health
23A, Mihindu Mawata
Tangalla 82200
Sri Lanka
Tel: +94 47 40371
Fax: +94 47 40413
E-mail: ranjita@sri.lanka.net
Marge Berer
Editor
Reproductive Health Matters
444 Highgate Studios
53/79 Highgate Road
London NW5 1TL
United Kingdom
Tel: +44 20 7267 6567
Fax: +44 20 7267 2551
E-mail: rhmjournal@compuserve.com
A N N E X 1 : Conf er ence Par t i ci pant s
33
A. B. Bhuiyan
President
Obstetrics and Gyneacology Society of Bangladesh
House #42, Road # 4A
Dhanmondi R/A
Dhaka 1205
Bangladesh
Tel: +880 2 861 8879
Fax: +880 2 861 8879
E-mail: ogsb@agni.com
Mohsina Bilgrami
Managing Director
Marie Stopes Society
21-C, Commercial Area DHA-II
Karachi 75500
Pakistan
Tel: +92 21 588 9876/ 111538538
Fax: +92 21 538 9128
E-mail: Mohsina.Bilgrami@msspk.org, marie.stopes@msspk.org
Nongluk Boonthai
Reproductive Health Division
Department of Health
Ministry of Public Health
Nonthaburi 11000
Thailand
Tel: +66 2 590 4265
Fax: +66 2 590 4163
E-mail: nonglukb@health.moph.go.th
Diane Bushley
CATALYST Consortium
1201 Connecticut Ave., NW, Suite 500
Washington DC 20036
USA
Tel: +1 202 775 1977
Fax: +1 202 775 1988
E-mail: dbushley@rhcatalyst.org
Charnchao Chaiyanukij
Director-General
Rights and Liberties Protection Department, Ministry of Justice
Software park building 15 Floor
Changwattana Rd.
Nonthaburi 11120
Thailand
Tel: +66 2 502 8186
Fax: +66 2 502 8195
Kamheang Chaturachinda
The Royal Thai College of Obstetricians and Gynaecologists
RTCOG, 8
th
Floor, Soi Soonvijal
New Petchaburi Rd.
Bangkok 10310
Thailand
Tel: +66 2 716 5723
Fax: +66 2 716 5720, 66 2 716 5720
E-mail: rakcu@mahidol.ac.th, gumhang@hotmail.com,
pr_rtcog@rtcog.or.th
Tan Vuoch Chheng
National Maternal & Child Health Center
NMCHC French Street
Samgkat Sras Chak
Phnom Penh
Cambodia
Tel: +855 23 724257
Ping Chutema
Director
Clinical Service of RHAC and
RHAC Coordinator with MOH
#6, Street 150
Sangkat Veal Vong Khan 7 Makara
Phnom Penh
Cambodia
Tel: +855 23 883 027
Fax: +855 23 885 093
E-mail: chutema@rhac.org.kh
Dula de Silva
P.O. Box 780
26, Bauddhaloka Mawatha
Colombo 7
Sri Lanka
Tel: +94 0777489807
Fax: +94 12502845
E-mail: dula@whosrilanka.org
Vincent de Wit
Asian Development Bank
Philippines Country Office
6 ADB Avenue, Mandaluyong City
0401 Metro Manila
Philippines
Tel: +63 2 683 1000
Fax: +63 2 683 1030
E-mail: vdewit@adb.org
Thrse Delvaux
Institute of Tropical Medicine
STD/HIV Research and Intervention Unit
155 Nationalestraat
2000 Antwerp
Belgium
Tel: +32 3 247 6295
Fax: +32 3 247 6532
E-mail: tdelvaux@itg.be
Madhu Dixit Devkota
Safe Motherhood Network, Nepal
Institute of Medicine, Tribhuvan University
GPO Box No. 3711
Kathmandu
Nepal
Tel: +977 1 424860
Fax: +977 1 240058
E-mail: devkota@healthnet.org.np
Eden R. Divinagracia
Executive Director
Phillipine NGO Council on Population, Health & Welfare, Inc.
(PNGOC)
San Luis St.
Pasay City 1300
Philippines
Tel: +63 2 834 5007
Fax: +63 2 834 5008
E-mail: info@pngoc.com, erdivinagracia@pngoc.com
Jane Edmondson
Department for International Development (DFID)
1 Palace Street
London SW1 5HE
United Kingdom
Tel: +44 20 7023 0740
Fax: +44 20 7023 0917
E-mail: j-edmondson@lshtm.ac.uk
Lindsay Edouard
Senior Reproductive Health Advisor
United Nations Population Fund
220 East 42
nd
Street
New York NY 10017
USA
Tel: +1 212 297 5241
E-mail: edouard@unfpa.org
Fariyal Fikree
Program Associate
Population Council
One Dag Hammarskjold Plaza, 9
th
Floor
New York NY 10017
USA
Tel: +1 212 339 0605
Fax: +1 212 755 6052
E-mail: ffikree@popcouncil.org
Bela Ganatra
Senior Research and Policy Advisor (Asia)
Ipas
D/4 322 Clover Gardens
4 Naylor Road
Pune Maharashtra 411001
India
Tel: +91 20 6123065
Fax: +91 20 6123065, 91 11 5166 1711
E-mail: bganatra@vsnl.net
Aparajita Gogoi
National Coordinator
White Ribbon Alliance of India
Secretariat CEDPA, 50M, Shantipath
Gate No.3, Nitimarg
Chanakyapuri
New Delhi 110021
India
Tel: +91 11 24672154, 26886813
Fax: +91 11 26885850
E-mail: aparajitagogoi@vsnl.net
Lorelei Goodyear
Senior Program Officer, Reproductive Health
PATH
1455 NW Leary Way
Seattle WA 98107
USA
Tel: +1 206 285 3500
Fax: +1 206 285 6619
E-mail: lgoodyear@path.org
Daniel Grossman
Program Associate
Population Council Mexico
Panzacola No. 62, Int. 102
Colonial Villa Coyoacan
CP 04000 D.F.
Mexico
Tel: +52 55 5999 8659
Fax: +52 55 5554 1226
E-mail: dgrossman@popcouncil.org.mx
Selma Hajri
Office National de la Famille et de la Population (NOFP)
7 Rue de la Mosqu
Marsa Plage 2070
Tunis
Tunisia
Tel: +216 71 748 371, 71 728 530
Fax: +216 71 354 967
E-mail: selmahajri@graffiti.net
Jafar Ahmad Hakim
Director (MCH-Services) and Line Director (ESP)
Directorate of Family Planning
Population Bhavan
Azimpur
Dhaka 1205
Bangladesh
Tel: +880 9111665, 8625984
Fax: +880 28124575
Katherine Hall-Martinez
Director, International Legal Program
Center for Reproductive Rights
120 Wall Street
14
th
Floor
New York NY 10005
USA
Tel: +1 917 637 3600
Fax: +1 917 637 3666
E-mail: Khall-martinez@reprorights.org
Mahroo Hamayoun
Director General (Technical)
Ministry of Population Welfare
Jamil Mohsin Mansion
Civic Center, Near GPO
Islamabad 44000
Pakistan
Tel: +92 51 9201804
Fax: +92 51 9201293, 9204879
E-mail: mahroo_hamayoun@hotmail.com
Anne x 1
35
Marianne Haslegrave
Director
Commonwealth Medical Trust
BMA House
Tavistock Square
London WC1H 9JP
United Kingdom
Tel: +44 20 7272 8492
Fax: +44 20 7272 1663
E-mail: marianne@commat.org
Danielle Hassoun
Center for Training in Reproductive Health Technologies
11 Rue Severo
Paris 75014
France
Tel: +33 1 43 79 87 17
Fax: +33 1 43 71 95 07
E-mail: d.hassoun@wanadoo.fr
Sri Hermiyanti
Director of Family Health
Ministry of Health/Indonesia
Jalan H.R. Rasuna Said
Blok X-5, Kav 4-9
Kuningan
Jakarta 12950
Indonesia
Tel: 62-21-529-63053
Fax: 62-21-520-3871
To Minh Huong
Vice Director
Hanoi Obstetrics and Gynecology Hospital
Lathanh Road
Ba Dinh District
Hanoi
Viet Nam
Tel: +84 4 8343 285
Fax: +84 4 7753 481
E-mail: bvpshn@fpt.vn
Nguyen Thi Mai Huong
Director
Center for Community Health Research & Development (CCRD)
C2/72B Ngo Thong Phong
Ton Duc Thang Street
Hanoi
Viet Nam
Tel: +84 4 7321686
Fax: +84 4 7323116
E-mail: maihuong.ccrd@hn.vnn.vn
Nasreen Huq
Country Director
Action Aid Bangladesh (AAB)
House No. 32, Road 43
Gulshan
Dhaka 1212
Bangladesh
Tel: +880 2 881 5991
Fax: +880 2 881 5087
E-mail: silsilla@agni.com, nphuq@hotmail.com,
nasreen@actionaid-bd.org
Julia Hussein
Immpact, Scientific Co-ordination Leader
Dugald Baird Centre for Research on Women's Health
Aberdeen Maternity Hospital
Cornhill Road
Aberdeen, Scotland AB25 2ZL
United Kingdom
Tel: +44 1224 554 474
Fax: +44 1224 553 708
E-mail: j.hussein@abdn.ac.uk
Q. Monir Islam
Director
Family and Community Health
Regional Office for South-East Asia
I P Estate, Ring Road
New Delhi 1 10 002
India
Tel: +91 11 2337 0804 ext. 2621
Fax: +91 11 337 0197, 11 337 9507
E-mail: islamm@WHOSEA.ORG
Md. Nurul Islam
Project Director
Urban Primary Health Care Project (UPHCP)
Flat 2 / 502, Eastern Orchid
8 Circuit House Road
Dhaka 1000
Bangladesh
Tel: +880 2 966 7791
Fax: +880 2 966 7792, 2 955 9616
E-mail: pduphcp@bangla.net
Sharad Iyengar
Secretary
Action Research and Training for Health (ARTH)
39 Fatehpura
Udaipur 313004
India
Tel: +91 294 2451033
Fax: +91 294 2451033
E-mail: arthsoc@sancharnet.in
Sadiqua N. Jafarey
National Committee for Maternal Health &
Ziauddin Medical University
F. 71, Block '4' Clifton
Karachi 75600
Pakistan
Tel: +92 21 536 1594
Fax: +92 21 586 2940
E-mail: snjaf@wtmeca.net
C. Anoma Jayathilaka
Family Health Bureau
Ministry of Health
231 De Sarem Place
Colombo 10
Sri Lanka
Tel: +94 1 2699332, 1 2696677
Fax: +94 1 2691605
E-mail: jayaadse@sltnet.lk, jayathilakaca@yahoo.com
Ravindran Jegasothy
Head and Senior Consultant O&G
Malaysian Medical Association
Seremban Hospital
376, Jalan Bukit Rajah
Seremban Negeri Sembilan 70300
Malaysia
Tel: +60 6 7604211
Fax: +60 6 7645107
E-mail: jravi@tm.net.my
Nita Jha
Janani
Reshmi Complex
P&T Colony
Kidwaipuri
Patna Bihar 800001
India
Tel: +91 0612 2537564, 2537645
Fax: +91 0612 537291
E-mail: nitajha@hotmail.com, nita@janani.org
Sya Dunita Kamaruddin
International Planned Parenthood Federation, East and South East
Asia and Oceania Regional Office (IPPF ESEAOR)
246 Jalan Ampang
Kuala Lumpur 50450
Malaysia
Tel: +60 3 4256 6122
Fax: +60 3 4256 6386
E-mail: sdkamaruddin@ippfeseaor.org
Koum Kanal
Director
National Center for Maternal Child Health
#5, Street France
Sankat Sras Chak
District Phnom Daun Penh
Phnom Penh
Cambodia
Tel: +855 023724257
E-mail: koumkanal@camnet.com.kh
Rehana Kariapper
Senior Program Officer, RH
Shirkat Gah
68 Tipu Block
New Garden Town
Lahore, Punjab 54624
Pakistan
Tel: +92 42 5838815, 5836554
Fax: +92 42 5860185
E-mail: rehana@sgah.org.pk
Raj Karim
Regional Director
International Planned Parenthood Federation, East
and South East Asia and Oceania Regional Office (IPPF ESEAOR)
246 Lorong Enau, Off Jalan Ampang
Kuala Lumpur 50450
Malaysia
Tel: +60 3 425 66 122/246/308
Fax: +60 3 4256 66 386
E-mail: rkarim@ippfeseaor.org
Lady Carol Kidu
Ministry for Welfare and Social Development
PO Box 7354
Boroko
Port Moresby NCD
Papua New Guinea
Tel: +675 325 0120
Fax: +675 325 0118
E-mail: dkidu@global.net.pg, ministrycsd@datec.net.pg
Marie Klingberg
Karolinska Institute IHCAR
Asgatan 81B
Falun 79170
Sweden
Tel: +46 707174414
E-mail: marie.klingberg@phs.ki.se
Bimala Lakhey
Director
Maternity Hospital Thapathali
5307 Prasuti Griha Thapathali
Kathmandu 5307
Nepal
Tel: +977 1 4260405
Fax: +977 1 4260274
E-mail: maternity@mail.com.np
Andr Lalonde
Executive Vice President/SOGC
The Society of Obstetricians and Gynaecologists of Canada
780 Promenade Echo Drive
Ottawa ON K1S 5R7
Canada
Tel: +1 613 730 4192
Fax: +1 613 521 4314
E-mail: alalonde@sogc.com
Anne x 1
37
Christina Larsson
Sida
DESO/Health Division
Sveavagen 20
Stockholm SE 105 25
Sweden
Tel: +46 8 698 5072
Fax: +46 8 698 5647
E-mail: christina.larsson@sida.se
Ricky Lu
Senior Reproductive Health Advisor
JHPIEGO/ MNH
TIFA Building 5
th
floor Suite 501
Jalan Kuningan Barat Kav 26
Jakarta 12710
Indonesia
Tel: +62 21 52522174 ex 156
Fax: +62 21 522 9271
E-mail: rlu@jhpiego.net
Milton S W Lum
International Federation of Gynecology and Obstetrics (FIGO)
Assunta Hospital, Jalan Templer
Petaling Jaya 46990
Malaysia
Tel: +60 3 7782 3433
Fax: +60 3 7784 1749
E-mail: mswlum@hotmail.com
Yvonne MacPherson
International Projects Manager
International Family Health
First Floor Cityside House
40 Adler Street
London E1 1EE
United Kingdom
Tel: +44 20 7247 9944 ext. 234
Fax: +44 20 7247 9224
E-mail: ymacpherson@ifh.org.uk
Liz Maguire
President and CEO
Ipas
300 Market Street
Suite 200
Chapel Hill NC 27516
USA
Tel: +1 919 967 7052
Fax: +1 919 929 0258
E-mail: maguirel@ipas.org
Beena Mahat
Program Manager
Safe Motherhood Network of Nepal
P O Box 1172
Kathmandu
Nepal
Tel: +977 1 535597, 1 547250
E-mail: beenamahat@hotmail.com, smnnepal@wlink.com.np
Tran Thi Phuong Mai
Deputy Director of MCH & FP Dept.
Ministry of Health
138 Giang Vo Street
Ba Dinh District
Hanoi
Viet Nam
Tel: +84 4 464060
Fax: +84 4 8236926
E-mail: mahaky@hn.vnn.vn
Dileep Mavalankar
Senior Management Advisor
Columbia University (AMDD)
Public Systems Group
India Institute of Management
Vastrapur
Ahmedabad 380015
India
Tel: +91 79 6324944
Fax: +91 79 6306896
E-mail: dileep@iimahd.ernet.in
Sare Mhokur
Hacettepe University, Medical School
Public Health Department
Ankara
Turkey
Tel: +90 0535 2760977
E-mail: sare.m@superonline.com
Glen Mola
University of Papua New Guinea
Box 1421
Boroko NCD
Papua New Guinea
Tel: +675 3248310
Fax: +675 3258212
E-mail: glenmola@dg.com.pg
Dipu Moni
101/B, Road 4, Banani
Dhaka 1213
Bangladesh
Tel: +880 2 9888058, 0171538653
Fax: +880 2 8812871
E-mail: tnawaz@bol-online.com
Suneeta Mukherjee
UNFPA Representative
IDB Bhaban (15
th
floor)
Sher-e-Banglanagar
Dhaka 1207
Bangladesh
Tel: +880 2 8111061, 2 8110836
Fax: +880 2 9131236
E-mail: smukherjee@unfpa-bangladesh.org
39
Anne x 1
Khin Ohn Myint
Township Health Nurse
Township Health Department
Naung Cho Shan State
27, Pyidaungsu Yeiktha Road
Dagon
Yangon 11191
Myanmar
Tel: +95 1210618
Fax: +95 1210652
Kamalben Naik
Honorary Consultant
CHETNA
Lilavatiben Lalbhais Bungalow, Civil Camp Road, Shahibaug
Ahmedabad, Gujarat 380004
India
Tel: +91 79 2866695
Fax: +91-79 2866513
Email: chetna@icenet.net
Amulya Ratna Nanda
Population Foundation of India
B-28 Qutab Institutional Area
Tara Crescent
New Delhi 110 016
India
Tel: +91 11 26867080, 11 26867081, 11 26867083
Fax: +91 11 26852766
E-mail: popfound@sify.com
Nguyen Thi Nhu Ngoc
Vice Director
Hung Vuong OBGYN Hospital
128 Hung Vuong Street
Q5 Ho Chi Minh Ville
Viet Nam
Tel: +84 8 955 2228
Fax: +84 8 857 4365
E-mail: ngockiet@hcm.vnn.vn
Frederick Nunes
14907 Running Ridge Lane
Silver Spring, MD 20906-1954
Tel: +1 301 598 6251
E-mail: ydelph@aol.com
Monica Atieno Oguttu
Project Director
Kisumu Medical and Educational Trust (KMET)
P.O. Box 6805
Tom Mboya Estate, next to Josana Academy
Kisumu
Kenya
Tel: +254 35 22148
Fax: +254 35 41305
E-mail: moguttu@africaonline.co.ke
Mahlon Paiva
Division of Obstetric and Gynecology
Port Moresby General Hospital
FMB PO Boroko NCD
Papua New Guinea
Tel: +675 3248310
Fax: +675 3250342
E-mail: mpaiva@datec.net.pg
Laxmi Raj Pathak
Director
Department of Health Services, Ministry of Health,
His Majesty's Government of Nepal
Department of Health Services
Teku
Kathmandu
Nepal
Tel: +977 1 261436, 1 261712
Fax: +977 1 262468, 1 262896, 1 262238
E-mail: lrp@ntc.net.np
Gordon Perkin
Senior Fellow
The Bill & Melinda Gates Foundation
PO Box 23350
1551 East Lake Avenue East
Seattle WA 98102
USA
Tel: +1 206 709 3101
Fax: +1 206 709 3170
E-mail: gordon@gatesfoundation.org
Hitelai Polume-Kiele
Government Justice
PO Box 591 WAIGANI
National Capital District
Waigani NCD
Papua New Guinea
Tel: +675 301 2925
E-mail: hitelai@netscape.net
Jennifer Potts
Planned Parenthood Federation of America International
434 West 33
rd
Street
New York NY 10001
USA
Tel: +1 212 261 4356
Fax: +1 212 247 6274
E-mail: Jennifer.Potts@ppfa.org
Sapana Pradhan-Malla
Advocate and President of FWLD
Forum for Women, Law and Development (FWLD)
P.O. Box 2923
Kathmandu
Nepal
Tel: +977 1 4242683, 4266415
Fax: +977 1 4240627
E-mail: fwld@andolan.wlink.com.np
M. Prakasamma
Director
Academy for Nursing Studies
F-1, Shirdi Apartments
Rajbhavan
Somajiguda
Hyderabad A.P. 500 082
India
Tel: +91 40 23411924
Fax: +91 40 56611635
E-mail: dirans@hd2.dot.net.in
Nina Puri
President
Family Planning Association of India
Bajaj Bhaban, Nariman Point
Mumbai Maharashtra 400021
India
Tel: +91 22 22029080
Fax: +91 11 26840644
E-mail: fpaind@ndf.vsnl.net.in, fpai@giasbm01.vsnl.net.in
Pinky Singh Rana
Rural Women's Development and Unity Centre
Post Box 13205
Kathmandu
Nepal
Tel: +977 1 535597, 547250
Fax: +977 1 549755
E-mail: samanata@wlink.com.np
Shafia Rashid
Safe Motherhood Program Officer
Family Care International
588 Broadway
Suite 503
New York NY 10012
USA
Tel: +1 212 941 5300
Fax: +1 212 941 5563
E-mail: srashid@familycareintl.org
Naghma Rehan
Director Research
Pakistan Medical Research Council
Fatima Jinnah Medical College
32 / G, Gulberg -III
Lahore 56400
Pakistan
Tel: +92 42 6373509, 6373785
Fax: +92 42 6375309
E-mail: rehan@wol.net.pk, nrehan@yahoo.com
Khama O. Rogo
Lead Health Specialist
The World Bank
1818 H Street, NW
Room J8-099
Washington DC 20433
USA
Tel: +1 202 473 6117
Fax: +1 202 477 6391
E-mail: krogo@worldbank.org
Natalia Rudiak
Safe Motherhood Program Assistant
588 Broadway
Suite 503
New York NY 10012
USA
Tel: +1 212 941 5300
Fax: +1 212 941 5563
E-mail: nrudiak@familycareintl.org
Fred Sai
P. O. Box 9983
K.I.A. Accra
Ghana
Tel: +233 21 774 404
Fax: +233 21 773 309
E-mail: fredsai@ug.edu.gh
Joycelyn Salgado
Linangan ng Kababaihan, Inc. (Likhaan)
92 Times Street, West Triangle Homes
Quezon City 1104
Philippines
Tel: +63 2 926 6230
Fax: +63 2 411 3151
E-mail: office@likhaan.org
Khin Than Sein
District Health Director
Thaton District Hospital
27, Pyidaungsu Yeiktha Road
Yangon 11191
Myanmar
Tel: +95 1210618
Fax: +95 1210652
E-mail: ihdmoh@mptmail.net.mm
Pramilla Senanayake
4/8, Hyde Park Residencies
79, Hyde Park Corner
Colombo 2, Sri Lanka
Tel: +94 1 2665460
Fax: +94 1 2665461
E-mail: pramilla@dsl.pipex.com
Harshalal Rukka Seneviratne
Professor of Obstetrics and Gynaecology
Faculty of Medicine, Colombo University
No. 32 First Chapel Lane
Colombo 06
Sri Lanka
Tel: +94 1 682102
Fax: +94 1 595198
E-mail: sagala@eureka.lk
Sona Sethi
Regional Director, Asia
Planned Parenthood Federation of America International,
Asia and Pacific Regional Office
37 Petchburi Road, Soi 15
Bangkok 10400
Thailand
Tel: +66 2 254 8954
Fax: +66 2 254 8956
E-mail: sona.sethi@ppfa.org
Iqbal Shah
Department of Reproductive Health and Research (RHR)
CH-1211 Geneva 27
Switzerland
Tel: +41 22 791 3332
Fax: +41 22 791 4171
E-mail: shahi@who.int
Khadijah Shamsuddin
Faculty of Medicine,
Universiti Kebangsaan Malaysia
Dept. of Community Health
Jalan Yacob Latiff
Bandar Tun Razak, Cheras
Kuala Lumpur 56000
Malaysia
Tel: +60 3 91702529
Fax: +60 3 91737825
E-mail: khadijah@mail.hukm.ukm.my
Jill Sheffield
President
588 Broadway, Suite 503
New York NY 10012
USA
Tel: +1 212 941 5300
Fax: +1 212 941 5563
E-mail: jsheffield@familycareintl.org
Shirish Sheth
President
International Federation of Gynecology and Obstetrics (FIGO)
70 Wimpole Street
London W1M 7DE
United Kingdom
Tel: +44 20 7224 3270
Fax: +44 20 7935 0736
E-mail: figo@figo.org
Rashidah Shuib
Associate Professor
Kelantan Family Planning Association
and Women's Health Development Unit
School of Medical Sciences
Universiti Sains Malaysia
Kubang, Kerian Kelantan
Malaysia
Tel: +60 9 766 4090
Fax: +60 9 765 3370
E-mail: rashidah@kb.usm.my
Mustika Sofyan
Indonesian Midwives Association
Jl. Johar Baru V/D13
Jakarta 10560
Indonesia
Tel: +62 21 4247789, 21 4244214
Fax: +62 21 4244214
E-mail: ppibi@cbn.net.id
Soeur Sophal
Ministry of Health
Group 32
Mitapheat District
Sihanoukville
Cambodia
Tel: +855 23 720 967
Fax: +855 23 720 967
E-mail: anong@bigpond.com.kh, soeursophal@yahoo.com
Ann Starrs
Executive Vice President
New York NY 10012
USA
Tel: +1 212 941 5300
Fax: +1 212 941 5563
E-mail: astarrs@familycareintl.org
Zarfiel Tafal
Executive Director
Indonesian Planned Parenthood Association
JL. Hang Jebat III / F.3
Jakarta Selatan DK1 12120
Indonesia
Tel: +62 21 7225681, 21 7394123
Fax: +62 21 7394088, 21 7253172
E-mail: mztafal@indo.net, ippa@pkbi.or.id
Anand Tamang
Director
Center for Research on Environment Health
and Population Activities (CREHPA)
Ekantakuna, Jawalakhel
P.O. Box: 9626
Kathmandu
Nepal
Tel: +977 1 530344
Fax: +977 1 530341
E-mail: anand@crehpa.wlink.com.np
Anne x 1
41
S AVI NG WOME N S L I VE S : T HE HE AL T H I MPACT OF UNS AF E ABORT I ON
Petra ten Hoope-Bender
Secretary General
International Confederation of Midwives
Eisenhowerlaan 138
2517 KN Den Haag
Netherlands
Tel: +31 70 3060520
Fax: +31 70 3555651
E-mail: p.tenhoope@internationalmidwives.org
Seang Tharith
Vice Dean of Faculty of Medicine
University of Health Science
#57, Street 306
Boeng Keng Kang I
Chamkar Morn District
Phnom Penh
Cambodia
Tel: +855 12892176
Fax: +855 23218569
E-mail: 012892176@mobitel.com.kh
Phan Bich Thuy
Training and Service Associate
Ipas Vietnam
Room 203 Toserco Bldg.
Van Phuc Compound
#2 Nui Truc
Hanoi
Viet Nam
Tel: +84 4 72 60548
Fax: +84 4 72 60549
E-mail: thuypb@fpt.vn
Hoang Thi Diem Tuyet
OB & GYN Sonographist
The Family Planning Department
Tudu Hospital
26 Phan Van Tri - Binh thanh
Ho Chi Minh City District 1
Viet Nam
Tel: +84 8 839 5117
Fax: +84 8 839 6832
E-mail: main: khhgdtudu@hcm.vnn.vn
Stewart Tyson
Deputy Head of Health
Department for International Development (DFID)
Policy Division
1 Palace Street
London SW1W 5HE
United Kingdom
Tel: +44 207 023 0961
Fax: +44 207 023 0428
E-mail: s-tyson@dfid.gov.uk
Huwaidiyah Pitsuwan Useng
Democrat Party
67 Settasini
Samsem
BKK/Thailand
Thailand
Fax: +66 2 945 3746
E-mail: huwaidiyah@yahoo.com
Budi Utomo
Director
Population Council, South East Asia, Indonesia Office
Menara Dea Building, 3
rd
Floor, No. 303
JI Mega Kuningan Barat Kav. E 4.3, No. 1
Jakarta 12950
Indonesia
Tel: +62 21 576 1011/2
Fax: +62 21 576 1013
E-mail: butomo@cbn.net.id, pcjkt@cbn.net.id
Paul Van Look
Director, Special Programme of Research
20 Avenue Appia
CH 1211 Geneva 27
Switzerland
Tel: +41 22 791 3380/3372
Fax: +41 22 791 4171
E-mail: vanlookp@who.int
Ouk Vong Vathiny
Executive Director
Reproductive Health Association of Cambodia (RHAC)
#6, Street 150 Sangkat Veal Vong
7 Makara District
PO Box 905
Phnom Penh
Cambodia
Tel: +855 23 982 120
Fax: +855 23 885 093
E-mail: vathiny@rhac.org.kh, rhac@rhac.org
Mechai Viravaidya
Chairman
Population and Community Development Association (PDA)
6 Sukhumvit Soi 12
Bangkok 10110
Thailand
Tel: +66 2 2294611 Ext. 331
Fax: +66 2 2294632
E-mail: mechai@pda.or.th
Leela Visaria
Coordinator
Health Watch
Gujarat Institute of Development Research
Near Gota Char Rasta, Gota
Ahmedabad 380 060
India
Tel: +91 79 3742366
Fax: +91 79 3742365
E-mail: visaria@vsnl.com
42
Elizabeth Westley
Communications Officer
New York NY 10012
USA
Tel: +1 212 941 5300
Fax: +1 212 941 5563
E-mail: ewestley@familycareintl.org
Ninuk Widyantoro
Chair
Women's Health Foundation
Ji Empu Sendok No. 2B Kebayoran Baru
Jakarta 12110
Indonesia
Tel: +62 21 573 4602
Fax: +62 21 573 4602
E-mail: ykesehatanperempuan@yahoo.com, ninukw@hotmail.com
Gulardi Wignjosastro
Faculty of Medicine University of Indonesia
JL Salemba Raya No 6
Jakarta Pusat 13040
Indonesia
Tel: +62 21 3918721
Fax: +62 21 3915041
E-mail: gulardihw@hotmail.com
Dhara Wijayatilake
Secretary
Ministry of Justice, Law Reform and National Integration
Superior Courts Complex
Colombo 12
Sri Lanka
Tel: +94 1 2449959, 1 2323979
Fax: +94 1 2445447
E-mail: secmoj@sri.lanka.net
Beverly Winikoff
President
Gynuity Health Projects
15 East 26th St., Suite 1609
New York NY 10010
USA
Tel: +1 212 448 1230
Fax: +1 212 448 1260
E-mail: bwinikoff@gynuity.org
Khosi Xaba
Country Director
Ipas South Africa
PO Box 1079
Auckland Park 2006
South Africa
Tel: +27 11 482 2569
Fax: +27 11 482 4718
E-mail: makhosazanax@ipas.org.za
Reena Yasmin
General Manager, Programme & Resource Development
Marie Stopes Clinic Society (MSCS)
House 6/2 Block-F
Lalmatia
Dhaka 1207
Bangladesh
Tel: +880 2 9121208, 9129022
Fax: +880 2 8117673
E-mail: mscs5@citechco.net
Ng Kok Ying
Head of Department of Obstetrics & Gynecology, Maternity Hospital
Kuala Lumpur
Jalan Pahang
Kuala Lumpur 50586
Malaysia
Tel: +60 3 2692 1044
Fax: +60 3 2694 8980
E-mail: kok_ying@tm.net.my
Shahida Zaidi
President
Asia Oceania Federation of Obstetrics and Gynecology (AOFOG)
140 R, Block 2
P.E.C.H.S.
Karachi 75400
Pakistan
Tel: +92 21 4551445, 4552129
Fax: +92 21 4312525
E-mail: zaidis@cyber.net.pk
Catharina Ztterstrm
IHCAR
Sesammottagning, Karolinska Sjukhuset
Stockholm S-171 70
Sweden
Tel: +46 8 51772285
Fax: +46 8 51775575
E-mail: catharina.zatterstrom@ks.se
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MONDAY, 29 SEPTEMBER 2003
9:00 am - 3:00 pm Conference Registration
6:00 pm Opening Reception
TUESDAY, 30 SEPTEMBER 2003
9:00 am -10:30 am Opening Ceremony
Welcome
Raj Karim, IPPF East and Southeast Asia and Oceania Region, Conference Chair
Address from Government of Malaysia
Y.A. Bhg. Dato Seri Utama
Dr. Siti Hasmah bte. Mohd. Ali, wife of Prime Minister
Welcome on behalf of IAG Co-Chairs
Petra ten Hoope-Bender, International Confederation of Midwives/The Netherlands
Setting the Scene
Unsafe Abortion in the Context of Safe Motherhood: Khama Rogo, World Bank/USA
10:30 am - 11:15 am Coffee/Tea
Press Conference (selected participants/speakers only)
11:15 am -12:15 pm Keynote Address
A Call to Action to Save Women's Lives: Senator Mechai Viravaidya, Thailand
Plenary Presentation
Unsafe Abortion in the Asia Context: Iqbal Shah, WHO/Switzerland
12:15 pm - 1:30 pm LUNCH
1:30 pm - 3:00 pm Panel Session I
A. The legal & policy framework: laws, policies, and regulations in the provision of care
Session Chair:
Milton Lum, Assunta Hospital, Malaysia
Overview Presenter:
Kathy Hall-Martinez, Center for Reproductive Rights, USA
Case Studies:
Nepal: Laxmi Raj Pathak, Ministry of Health and Anand Tamang, Center for Research
on Environment Health and Population Activities (CREHPA)
Turkey: Ayse Akin, Hacettepe University Medical School
A N N E X 2 : Conf er ence Agenda
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45
TUESDAY, 30 SEPTEMBER 2003 (Continued)
3:00 pm - 3:30 pm Coffee/Tea
3:30 pm - 5:00 pm Panel Session I (continued)
B. Preventing unwanted pregnancy
(family planning, emergency contraception, post-abortion counselling)
Session Chair:
Halida Akhter, Health Promotion Limited, Bangladesh
Overview Presenter:
Pramilla Senanayake, IPPF/United Kingdom
Case Studies:
Sri Lanka: Harsha Seneviratne, Family Planning Association
India: Nita Jha, Janani Project
7:00 pm Marketplace:
Informal gathering with materials, crafts, and food
WEDNESDAY, 1 OCTOBER 2003
9:00 am -10:30 am Panel Session I (continued)
C. Post-abortion care: Addressing complications of unsafe abortion
Session Chair:
Andr Lalonde, Society of Obstetricians and Gynaecologists of Canada
Overview Presenter:
Ricky Lu, MNH/JHPIEGO, Indonesia (Presenter)
Beverly Winikoff, Gynuity Health Projects, USA (Discussant)
Case Studies:
Nepal: Bimala Lakhey, Maternity Hospital, Kathmandu
Kenya: Monica Oguttu, Kisumu Medical & Educational Trust
Myanmar: Khin Ohn Mint, Ministry of Health
11:00 am - 1:00 pm Working Groups Session I
1:00 pm - 2:00 pm LUNCH
2:00 pm - 3:00 pm Working Groups Session I:
Report Back (plenary)
WEDNESDAY, 1 OCTOBER 2003 (Continued)
3:00 pm - 5:00 pm Panel Session II
D. Expanding access to safe services, where not against the law
Session Chair:
Elizabeth Maguire, Ipas/USA
Overview Presenter:
Paul Van Look, WHO/Switzerland
Case Studies:
India: Sharad Iyengar, Action Research and Training for Health
Tunisia: Nabiha Gueddana, National Office of Family and Population
Bangladesh: Dipu Moni, Independent Consultant
South Africa: Khosi Xaba, Ipas/South Africa
5:30 pm - 6:30 pm Meet the Experts:
Poster Session and Reception
THURSDAY, 2 OCTOBER 2003
9:00 am -10:30 am Panel Session II (continued)
E. Quality of care: elements of high-quality care
Session Chair:
Shirish Sheth, FIGO/United Kingdom
Overview Presenter:
Bela Ganatra, Ipas/India
Case Studies:
Viet Nam: Phan Bich Thuy, Ipas/Viet Nam
Reena Yasmin, Marie Stopes International/Asia
India: Leela Visaria, Gujurat Institute of Development Research
11:00 am - 1:00 pm Working Groups Session II
1:00 pm - 2:30 pm LUNCH
Country Working Groups
2:30 pm - 3:30 pm Working Groups Session II:
Report Back (plenary)
3:30 pm - 4:00 pm Panel Session:
Wrap-Up and Look Ahead
Fred Sai, Ghana Academy of Arts and Sciences
Y.B. Dato Chua Jui Meng, Minister of Health, Malaysia
4:00 pm - 4:30 pm Closing Ceremony
For further information, please contact the secretariat,
Partnership for Safe Motherhood and Newborn Health:
c/o World Health Organization
Room X-023
1211 Geneva 27 Switzerland
Tel. +41 22 791 3309
Fax: +41 22 791 4171
Email: info@safemotherhood.org
Web site: www.safemotherhood.org

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SAVING

Latin America has the highest rate of unsafe

in circumstances where abortion is not

S AVI NG WOME N S L I VE S : T HE HE AL T H I MPACT OF UNS AF E ABORT I ON 20

Synthetic prostaglandin E1 analogue

Available in tablet form in many countries

Low-cost: 35-45 cents per tablet

Long shelf life (seven years) and very stable

Causes uterine contractions

Used for first and second trimester abortion,

Success rate for treating incomplete abortion

Equipment, supplies, and drugs. This includes appro-

Links to family planning and other reproductive

Removal of barriers that prevent women from

Let us remember that we are not dealing

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