Maria de Bruyn of Ipas analyses “the good and the bad on women’s rights” at the 2012 AIDS conference, in an article on Reality Check. While the meet focused on the rights of HIV-positive women to become mothers, it failed to address safe abortions as a reproductive right for women who may opt out of parenthood. The author notes, “While the section on women and the law addresses violence against women, property and inheritance rights, coerced and forced sterilization and abortion, it does not address criminalization of abortion and denial of safe abortion.” (Read another article on the same topic by Maria de Bruyns)
In the recent years, studies have revealed that the AIDS stigma often drives governments and care providers to push abortions on pregnant women living with AIDS. This is a problem inherent with the programmes, which continue to focus on PPTCT or Prevention of Parent to Child Transmission among pregnant HIV positive women, thus effectively making invisible the option to have an abortion. While this right has to be recognized and forced abortions condemned, the right to safe terminations cannot be overlooked. In short, an international convention that deals with the reproductive needs of a woman, has to address the woman’s right to choose the outcome of her pregnancy: be it parenthood, or termination.
Women living with HIV, just like other women, are likely to experience unwanted pregnancies. In fact, studies show a high correlation between poverty, vulnerability to HIV infections, and poor access to reproductive health services, including family planning. In addition to the lack of access to contraception, women might have unwanted pregnancies because of contraceptive failure, or sexual abuse.
While it is true that HIV positive women should not be denied the right to motherhood, the high number of unsafe abortions among women with HIV infections shows that safe abortions need to be comprehensively addressed along with safe motherhood. WHO studies show that out of 49 million abortions every year for HIV positive women, 19 million are unsafe. Ninety-five percent of these occur in developing countries across Africa, Asia, South and Latin America. Unsafe terminations are particularly high in countries where abortion is criminalized, and poverty is rampant. This echoes the findings of the Guttmacher Institute: legal restrictions do not decrease the number of abortions; rather, they increase the rates of unsafe abortion.
Unfortunately, because of their compromised immune system, women with HIV infections are at a higher risk for complications following an unsafe abortion, specifically from infections. In 2008, the International Community of Women Living with AIDS demanded better access to information, and to good services with trained providers.
It is also necessary to recognize the advantages of abortion pills in these cases. Medical abortions are non-invasive, and therefore do not require hospitalization. Also, these pills can be taken at home in private, as long as care providers have ruled out any complications in the pregnancy. Unfortunately, a study carried out by ASAP partners in Nepal and India shows that care-providers do not always recognize the advantages of medical abortions. But the study also showed that caregivers do not discriminate against these women because of their HIV positive status, and are likely to provide surgical treatment in countries where abortions are legalized. However, these women are likely to need high doses of antibiotics during post-surgical care, because of their HIV infections. This can be avoided with medical abortions.
It is also important not to ignore the value of second and late trimester abortions for women who might discover their HIV positive status late in their pregnancies. Several of them might want to terminate the pregnancy, but might be unable to do so because of restrictions against abortions after 12 weeks. Studies have shown that women are likely to carry their child to term if they have access to anti-retro viral therapy, which can stop transmission from mother to child. If not, these women are likely to seek abortion, and resort to unsafe options if proper care is restricted or unavailable.
Women with HIV infections are also in need of other reproductive health care services, including access to contraception to prevent unwanted pregnancies. Women who have had abortions to prevent unwanted pregnancies should be informed about the entire range of contraceptives, and asked to choose from them.
There are many unmet needs among men and women living with HIV, and while it is important to actively address the need for women with HIV infections to have autonomy over their bodies, and have the right to continue with their pregnancies, it is equally important to discuss safe abortions for all women who might need them, irrespective of the access to anti-retro viral therapy, and neonatal care. It is especially important to recognize the right of all such women to both medical and surgical care, and to allow them to choose the option most suitable for them.