Category: Global Health

Abortion debt: revolutionary acts and reclamations of care

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Photo credit: Melisa Slep

by Rishita Nandagiri and Lucía Berro Pizzarossa

Discussions about abortion tend to be dominated by considerations pertaining to medicine (e.g., “safety”) and law (e.g., “legality”). Medication abortion — misoprostol alone or in combination with mifepristone — has dramatically shifted these discussions. Brazilian women used misoprostol to self-manage their abortions in the 1980s, galvanizing Latin American and transnational feminist efforts to share knowledge and organize access to pills. In 2005, these medicines were added to the WHO’s Essential Medicines List. Self-managed abortion (SMA), which includes self-sourcing of abortion pills, self-diagnosis, and management of abortion processes and post-abortion care outside formal health systems, unsettles traditional understandings of what an abortion is, where and how it can (or should) occur, who a provider is, and what a “safe” abortion is. 

In April 2024, Polish activists from Abortion Without Borders (AWB) invoiced the Sejm (Polish parliament) €11.5 million ($12.4 million) for the financial costs and reproductive labor associated with  providing abortion access, resources, and care for Polish residents. AWB, an initiative by nine feminist organizations working across multiple countries, was founded in 2019 to provide information, support, and funding for abortion in Poland, either via pills or travel for in-clinic care abroad. Poland has some of the most restrictive abortion laws in Europe, which many describe as constituting a de facto ban on abortions. Ministry of Health statistics report Polish hospitals conducted only 161 abortions in 2022. In contrast, Polish non-governmental organizations estimate that, every year, 120,000-150,000 abortions are obtained via pills or procedurally. 

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Does History Matter?

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by Elena Caruso

While the exact definition of self-managed abortion remains blurred, it currently tends to refer to the end of a pregnancy through the autonomous administration of pills outside of a public health facility. The World Health Organization (WHO) recommends self-management for pregnancies under 12 weeks, using a combination of mifepristone and misoprostol (or misoprostol alone) and it includes both medications in its list of essential medicines. In its Abortion Care Guidelines, the WHO states that medication abortion has “revolutionized” access to abortion care, emphasizing the novelty of this method.  

While the origins of self-managed abortion with pills are not fully elucidated, it is generally accepted that this practice dates back to the second half of the 1980s in Brazil, when women discovered and disseminated the information that misoprostol (a medication legally available for the treatment of stomach and duodenal ulcers) could safely and effectively be used to prevent pregnancies. In the current debate on self-managed abortion, engagement with history is often limited to a few background sentences. This “ahistorical” approach can leave the impression that self-managed abortion lacks a significant and notable history. 

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The Global Challenge of Unhealthy Diets: Front-of-Package Labeling for America

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by Alice Bryk Silveira

The alarming rise in diabetes and obesity rates in the United States has placed significant strain on health care systems and poses a serious public health threat. Americans’ overconsumption of ultra-processed foods high in sugar, salt and unhealthy fats is a concerning contributor. Globally, poor nutrition from such dietary habits plays a major role in the global burden of chronic diseases. In response, many countries have implemented policies to reshape their food environments. A prominent strategy is front-of-package (FOP) labeling systems, designed to help consumers make more informed choices, encourage healthier lifestyles, and push food manufacturers to align with public health guidelines by reducing ingredients such as sugar and salt.

Despite international momentum and calls from public health experts, the United States remains behind. Since 2009, the U.S. government has discussed the potential adoption of a uniform FOP label, with Congress directing the Centers for Disease Control and Prevention and Institute of Medicine (IOM) to produce recommendations on the topic. No standardized system exists but the U.S. Food and Drug Administration (FDA) is expected to propose new rulemaking on front-of-package labeling in 2024.

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A full circle moment: legal risks to mifepristone and evidence for abortion with misoprostol alone

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Photo credit: Farrah Skeiky

by Patty Skuster and Heidi Moseson

Medication abortion did not begin with a clinical trial; it began at home as self-managed abortion, or abortion without supervision from a clinician. Decades before the 2000 U.S. Food and Drug Administration’s (FDA) approval of mifepristone for abortion, which is taken alongside misoprostol, feminists in Brazil found an opportunity to self-manage abortion with misoprostol, based on warning labels that cautioned about the risk of miscarriage if taken while pregnant. The genesis of abortion pills was therefore in self-managed abortion with misoprostol alone. 

Today, after several decades of clinical trials and heavy regulation of medication abortion, the practice of self-managed abortion with misoprostol-only is once again driving clinical practice. While medication abortion has been increasing in the U.S. since its introduction, major changes in recent years have dramatically increased usage. In 2021, the FDA relaxed enforcement of the requirement for in-person dispensing of mifepristone. This revolutionary change allowed the pills to be sent by mail for the first time, making them much more accessible. When, in 2022, the Supreme Court eviscerated the federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, the resulting abortion clinic closures led to even larger numbers of abortion seekers turning to medication abortion through telehealth and mailed medication from providers in supportive abortion states and clinicians outside the U.S. Combined, medication abortion now accounts for more than half of all abortions in the US. 

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Doctors as Advocates for Self-Managed Abortion and Reproductive Justice

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Photo credit: Martina Šalov

by Jessica Morris

The International Federation of Gynecology and Obstetrics (FIGO) is the world’s largest alliance of national professional societies of obstetricians and gynecologists. FIGO supports comprehensive, equitable, and accessible sexual and reproductive health (SRH) for everyone, recognizing that these are fundamental human rights and essential components needed to achieve global health goals. 

FIGO works through its technical committee and its programmatic arm to improve access to abortion across the globe. Over the last two decades, FIGO has been a global advocate and played an important role in encouraging progressive, evidence-based thinking on abortion with its 130+ national professional societies and other stakeholder groups. FIGO has worked to strengthen and support these societies in becoming national leaders on SRH and driving important improvements, including  legal and policy developments, service provision, increasing supportive attitudes, and raising awareness and challenging bias.

What is the role of doctors in the de-medicalization of abortion?

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When the right to abortion is more than a law: accompaniment and cultural transformations in the political activism of Argentina’s Socorristas en Red 

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by Julia Burton

English and Spanish versions/Versiones en inglés y español

In December 2020, the Argentinean Congress passed the Voluntary Interruption of Pregnancy Law, (27.610), which legalizes abortion up to and including the 14th week of gestation and, thereafter, in the case of rape or risk to the life or health of the pregnant person. Thus, Argentina became one of the countries that went from having a model of grounds-based legalization (only in the case of rape or risk to the pregnant person) to one that allows abortion on request in the first trimester, and became the second to legalize abortion in the Southern Cone (the first was Uruguay, in 2012). 

Feminist obstinacy and decades of struggle demanding the legalization and decriminalization of abortion added to the movement’s ability to establish alliances and influence existing legal frameworks, making possible the emergence of the “green tide” first and the legalization of abortion later. Within the broad trajectory of struggles for abortion rights, I will focus on Socorristas en Red. 

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Unseen Scars: The Devastating Impact of Corruption on Mental Health Systems in Low and Middle-Income Countries

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by Daniela Cepeda Cuadrado

There is a wealth of research demonstrating that corruption — the abuse of entrusted power for private gain — has contributed to weakening health systems and worsening public health globally. Corruption is associated with a higher infant mortality rate, the rise of antimicrobial resistance, and the diversion of key resources to invest in strengthening health systems. Corruption’s impact on health systems is well documented – that is if we see health systems only as the structures in place to cater to people’s physical health needs.

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Two Years On From A “Landmark” Abortion Decision in Kenya

Joelle Boxer Leave a comment

Two years ago, the Kenyan High Court in Malindi decided PAK and Salim Mohammed v. Attorney General et al., affirming that the constitutional right to abortion is “fundamental.”

Approximately 2,600 people lose their lives to unsafe abortion in Kenya each year, with an additional 21,000 people requiring hospitalization. While the Kenyan Constitution, adopted in 2010, allows for abortion when the pregnant person’s life or health is at risk under Article 26(4), the Kenyan Penal Code still criminalizes it—a legal grey area creating “ambiguity, confusion, and stigma.

This article will describe the PAK decision and analyze it in line with trends in transnational abortion law.

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Stethoscope on Ghana flag.

Dr. Eunice Brookman-Amissah: A Pioneer in Safe Abortion Law Reform

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By Joelle Boxer

Late last year, Dr. Eunice Brookman-Amissah won the Right Livelihood Award, also known as the “Alternative Nobel Prize,” for her pioneering efforts to improve safe abortion access in sub-Saharan Africa.

According to Dr. Brookman-Amissah, of the 36,000 deaths that occur globally due to unsafe abortion, almost 24,000 are in sub-Saharan Africa. “That was a totally unacceptable state of affairs,” she said, “given the fact that nobody, absolutely no woman has to die from a totally treatable and manageable cause.” Her advocacy work is credited with contributing to a 40% reduction in deaths from unsafe abortion in the region since 2000.

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View on Namche Bazar, Khumbu district, Himalayas, Nepal.

Intersectionality, Indigeneity, and Disability Climate Justice in Nepal

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By Pratima Gurung, Penelope J.S. Stein, and Michael Ashley Stein

The climate crisis disproportionately impacts marginalized populations experiencing multilayered   and intersecting oppression, such as Indigenous Peoples with disabilities. To achieve climate justice, it is imperative to understand how multiple layers of oppression — arising from forces that include ableism, colonialism, patriarchy, and capitalism — interact and cause distinctive forms of multiple and intersectional discrimination. Only by understanding these forces can we develop effective, inclusive climate solutions.

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