The project has examined policies, discourses and practices related to fertility control and abortion among adolescents in Ethiopia, Tanzania and Zambia. As deeply embedded in religious and socio-cultural norms about sexuality, reproduction and gender relations, fertility control and abortion are controversial issues. Despite unsafe abortion being one of the easiest preventable causes of maternal mortality, restrictive abortion laws continue to prevent women from accessing safe termination of pregnancy. In the absence of safe alternatives, more than 20 million girls and women undergo unsafe abortion every year and risk premature death and illness. The figures are particularly alarming in sub-Saharan Africa.
The project has consisted of three interlinked research components:
In the first part we have investigated the relationship between the abortion law and girls and womens access to safe abortion services by comparing the law texts, policies, health services and public opinion in the three countries.
In the second part we have focused on how national discourse on fertility control and abortion are played out in the mass media, religious organizations and court rooms. An important question has been how this relates to national policy and community ideas and morality on sexuality, motherhood and the status of the fetus.
Key results from these parts show that there is an unclear association between the status of the law and access to safe abortion procedures. The abortion law have been classified as liberal in Zambia, semi-liberal in Ethiopia and restrictive in Tanzania, but our research indicates a paradoxical relationship between national abortion laws, abortion policy and womens actual access to safe abortion services.
The Zambian abortion law permitting safe abortion on broad social and medical grounds, is challenged by the demand for three signatures by medical doctors. In Ethiopia, the abortion law is placed under the Penal Code, but specifies a number of exceptions making abortion in principle highly accessible, particularly for underage girls. In both countries, knowledge about the law is poorly disseminated. In Tanzania, the effects of the highly restrictive abortion law seems to be modified by a pragmatic attitude to both provider induced- and self-induced medication abortion and limited prosecution of abortion- seekers and providers. A strong public voices arguing for the need to protect womens health and rights in pregnancy termination play an important role in this context.
Another factor between law and access is the increasing availability of misoprostol, a drug used for medical abortion that can be purchased off label in all three countries. Access to misoprostol, makes it possible to circumvent both the law and gatekeepers in the health system. At the same time it reduces the risk associated with a clandestine abortion. Hence, restrictive abortion laws may in a longer term perspective become less relevant in determining access to medical abortion procedures.
The third part has focused on access to fertility control and tensions between social norms and individual practice. It has examined how adolescent girls move between socio-cultural and religious norms, peer expectations and their own need to prevent or terminate unwanted pregnancy. Using a gender perspective, we have investigated the role of boys and men and the expectations to their involvement in pregnancy prevention.
Key results point to lack of access to fertility control, safe abortion services and sexual and reproductive health information for adolescents. A study from Zambia shows that there are huge problems in implementing the national curricula of comprehensive sexual education due to resistance among teachers and lack of acceptability in the local community. A series of five edutainment films, co-produced with students in secondary school in north west Ethiopia address existing gaps in knowledge about sexual and reproductive health and rights and prevailing gender norms that put girls at particular risk.
A case study of young men and gender identity in rural Ethiopia, indicates that despite persistent gender inequality, there is a growing tendency of negotiations and shared responsibility for fertility control among young unmarried couples. But, as identified both in this study, and in a study among Ethiopian university students, premarital pregnancy is experienced as a major crises where girls who end up carrying the baby to term pay a huge cost in terms of education, family relations and life prospects. Thus unwanted adolescent pregnancy continues to be a major cause of maternal complications and social suffering.
The project is anchored in long-term research-collaboration between leading institutions in Tanzania, Ethiopia, Zambia and Norway.
The platform built through the project forms a basis for further collaboration with research institutions, policy makers and other relevant stakeholders within the field.
The results of this project constitute an important part of the accumulation of operational evidence about fertility control and safe abortion policy and implementation. It contributes to improved reproductive health for girls and young women, and averted deaths related to teenage pregnancy and unsafe abortion through:
Improved knowledge among policy makers, health workers and the community at large on the abortion law and the conditions on which abortion is permitted:
Improved commitment and routines among health workers achieved through training and efficient dissemination of the safe abortion guidelines
Improved access to safe fertility control services among girls and young women
The comparative perspective facilitates exchange of evidence of what works across countries and enhances the long-term impacts.
The project examines global and national policy discourses surrounding fertility control and abortion, and local practices and moralities related to these issues among adolescents in Ethiopia, Tanzania and Zambia. Fertility control and safe abortion demonstrate the controversies over sexual and reproductive health policies and the gendered socio-cultural and religious norms impeding progress on girls and womens rights. Unsafe abortion, which is tightly linked to restrictive abortion laws and lack of access to contraception and safe abortion services, is a problem of enormous scale. With 20 million cases yearly it caters for a high proportion of the continued high maternal death- and morbidity rates globally.
The project consists of three interlinked components; Component A explores the main normative messages underpinning global policies and the campaigns of global civil society actors in the field of fertility control and safe abortion, and how these global normative messages are reflected in national policies. Component B investigates how national public discourse surrounding fertility control and abortion in media, religious organizations and court rooms intersect with national policy and with grassroots discourse on sexuality, motherhood and the status of the foetus. Component C explores how adolescent girls manoeuvre between moral obligations embedded in socio-cultural and religious norms, restrictions/liberalisation in their countrys abortion law, and their own needs for fertility control. It also identifies how masculinities play out in the reproductive arena in general and on abortion in particular.
Our contention is that the gendered socio-cultural dynamics, which sexual and reproductive health policies enter into, play out differently in the three countries. Diverging laws, policies and differing access to fertility control and safe abortion services make this an interesting case for comparison with relevance beyond the study contexts.