A guest post by Dr. Sim-Poey Choong. Dr. Sim-Poey Choong has led family planning services, is a safe abortion provider and works with HIV affected persons in Penang, Malaysia.

The International Conference on Population and Development or the ICPD, held in Cairo in 1994, is considered a landmark conference in expressing a global consensus on the relationship between women’s reproductive health and rights (RHR) and broader economic development.

This was seen as a revelation, although it was long self- evident since 1798, when Malthus propounded his warning on the exponential growth of populations in relation to the world’s limited resources, a frightening prospect before the advent of medical technology we now have.

Unfortunately, even as ICPD spelled out the general principles of ensuring women and families deciding on their family size etc.  it failed to openly identify the means to achieving such objectives; that is by  declaring that universal access to contraception and safe abortion as prerequisites to achieving these objectives.

Since then other international consensus statements such the ICPD+5 Program for Action in line with the MDG goals identified these unmet needs and highlighted the huge economic costs of ignoring these rights.

My personal experience as a safe abortion provider, having met thousands of women requesting for abortions over the last 25 years also reinforces my conviction that these women have thought through very carefully about their decision and are clearly acting responsibly to terminate an unplanned pregnancy with reasons ranging from ensuring the financial sustainability of the family, to continuing education etc.

In Asia, a comparison between the impressive economic progress of Thailand as compared to the Philippines over the last 25 years is a compelling example of poor reproductive rights in the latter leading to economic chaos, burdened by a population problem as well as huge healthcare costs in dealing with consequences of unsafe abortions.

In the ensuing debate on achieving these goals, contraception and safe abortion have been separated as two separate entities instead of recognizing both as being integral parts of reproductive healthcare, mainly because of the stigma attached to abortion. Clearly both these services are essential to prevent unwanted conceptions as well as to prevent unwanted pregnancies ending up as unwanted babies.

While universal access to contraception has made great headway and also has many champions , the issue of unsafe abortions continues to face obstacles. Despite the fact that 47,000 women die every year and thousands more suffer serious life- long complications from unsafe abortions, we still have political, religious and community leaders opposing moves to make universal access to safe abortion a priority in women’s healthcare services. That such opposition groups have developed strategic alliances and effective strategies is a worrying trend. The consensus document of the 47th CPD meeting in New York in April 2014 cannot be regarded as being progressive.

With the advent of new technology such as Manual Vacuum Aspiration as an outpatient procedure and Medical Abortion at home with pills, the costs for providing such services are a fraction of the economic costs of healthcare for abortion complications even without counting the enormous social costs on families losing a mother, often with young children to care for.

The medical fraternity itself bears a large measure of responsibility for not being united in supporting the principle of universal access as well as opposing the concept of task shifting for abortion services, despite the latter having a proven record of safety in many surveys.  The latter would make a dramatic improvement to greater access and lower costs of these services , especially in the developing countries of the world.

On a more optimistic note, the pro-choice community is also waking up to the threats we face in protecting women’s reproductive health and rights and we are now developing strategic alliances to counter these moves. The International Campaign for Women’s Right to Safe Abortion is one such recent global initiative. Meanwhile, we have to continuously monitor the situation closely to ensure that there shall be no backtracking on the consensus reached at the ICPD in Cairo in 1994 which in its principles includes the ‘right to be informed and (have) access to safe, effective, affordable and acceptable methods of family planning and any other methods for the regulation of her fertility that is not against the law.’

Arguments by anti-choice advocates to exclude safe abortion services in this context are clearly nonsense. Besides, Anand Grover, the UN special rapporteur on human rights has stated in his report to the human rights committee in 2012 that ‘laws criminalizing abortion should be regarded a violation of a woman’s human rights and should be removed.’

It is the obligation of the state to promote protect and fulfill the human rights of its citizens in a progressive manner and the way they can fulfill this obligation for the women is by ensuring laws that not only de-criminalize abortion but also ensure access to safe abortions and sensitive post abortion care and contraception. It is only when women can control their own fertility without any danger to their own lives that they can join in as productive members of society and not just reproductive.