Abortion Policies and Health Outcomes in Latin America: What Are the Relevant Lessons for Africa?

Both Latin America and sub-Saharan Africa have high abortion rates (generally above 30/1,000 women aged 15-44) despite overwhelmingly restrictive moral, legal, and social sanctions.  Although data are limited, enough is known to examine how Latin American countries are making progress in negotiating the challenges posed by abortion and compare it with the situation in sub-Saharan Africa. This allows identification of relevant lessons for improving health and social outcomes in much of Africa.

Several decades ago, many Latin American countries had economic levels seen in many African nations today. They have since achieved better contraceptive practice and social outcomes, and are now witnessing declining rates of abortion, unsafe procedures, and related deaths.  In contrast, Africa accounts for over half the world’s unsafe abortion-related deaths and abortion rates will increase unless unmet needs are more strongly addressed. We explore several promising steps for ameliorating present and future dilemmas. 

We review how abortion policies have been changed recently in Colombia, Mexico City and Uruguay, their implementation and effects.  Also, we investigate the effects of improved contraceptive practice and the social diffusion of simple innovations (including emergency contraception and misoprostol) across much of Latin America to reduce abortion.

These interventions are being sustained in the absence of legal change and strong social movements, and could potentially be implemented to strengthen the performance of African health systems.  This could help overcome scarce resources and confusion about how to deal with abortion, as well as reduce inequalities in health and health care.  We stress the importance of strengthening the evidence base, research-policy connections, health systems, and issue networks to articulate reproductive and human rights, health rationales, and to exploit policy windows.  Such a coordinated strategic incremental approach may secure social change, bolder policy reform, and better outcomes in this deeply controversial policy arena.