Today, September 28, is the Global Day of Action for Access to Safe and Legal Abortion. But is “safe and legal” enough?
Why in the 21st century do we still need a day of action? Who are abortions safe and legal for in today’s world, and who defines what is “safe” and what is “legal”? Are abortions accessible for people who have mobility or sight challenges, sex workers, or those with nonconforming sexual or gender identities? What about for adolescents who must seek parental notification, those who must pay the equivalent of their monthly wages for an abortion, and undocumented people trying to find an abortion provider in Texas?
Answering these questions requires going beyond the “safe and legal” frame to acknowledge the importance of transforming systems, structures, and services to meet the needs of all while also upholding individual autonomy and agency over health care. As members of our communities, health-care workers, and advocates, we must trust that those who can become pregnant know what’s best for them. And we must ensure they have the ability, access to resources, and power to pursue it.
To do that, we must destigmatize, decriminalize, and democratize abortion—here in the United States and worldwide.
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Abortion stigma occurs when people are labeled, dehumanized, or discriminated against due to their need for, or association with, abortion. Stigmatization marks individuals who have abortions and health-care professionals who provide them as different and undesirable. Stigma is discrimination, and it provokes different consequences for young people, people with disabilities, or individuals with nonconforming gender or sexual identities, among others. And stigma doesn’t just play out solely at the individual level but also structurally in the systems, structures, and discourses that govern reproductive health care.
Decriminalizing abortion is also immensely important. It’s a major step toward ensuring that all individuals can end their pregnancies without fear of shame, blame, or prosecution. Existing laws are not consistent with individuals’ needs and preferences. Laws and policies must be shaped by those whose rights they seek to uphold. They must also protect, respect, and fulfill women’s autonomy and human rights pertaining to self-administered abortion pills and their availability. In the context of the increased criminalization of women’s self-use of abortion pills, we must also strive to make sure self-use is legalized.
By democratizing access to information, drugs, and care, we can build deeper and more nuanced understanding of different people’s reproductive-health preferences based on their circumstances. All individuals should have access to confidential, accessible, and evidence-based information that is conveyed through familiar communication channels, formats, and languages. At the global level, The World Health Organization has issued guidelines that advance the roles of community health workers and individual women as agents of their own health care. Organizations and networks, such as Women on Web and Women Help Women, have set up hotlines for virtual counseling services and access to pills in settings where abortion is restricted. And, on the ground, community-based groups are recognizing the safety of decentralized care and self-induced abortion during early pregnancy. They are also creating different literacy tools for women to safely terminate an unwanted pregnancy, documenting where women prefer to go for information, and working closely with local groups to increase women’s access to abortion pills.
So today, September 28, we celebrate the millions of women every year who make a decision that is the right one for them, their families, and their communities. We celebrate the providers who are committed to truly providing patient-centered care regardless of age, sexual or gender orientation, marital status, reason for abortion, or ability to pay. We celebrate policymakers and activists who have worked tirelessly to overturn laws that criminalize and penalize women. And we celebrate donors and supporters who know that, with rising anti-woman and repressive politics and practices in so many countries and contexts, funding for progressive movements for social change has never been so important.
When abortions are not only safe and legal but when information, drug access, and medical services are truly informed by those who seek care, and when all peoples have access to care free from stigma, shame or restrictions, that’s when we’ll know we’ve achieved our vision.