Word Of The Month: Access
ac·cess n.
1. A means of approaching, entering, exiting, communicating with, or making use of: a store with easy access.
2. The ability or right to approach, enter, exit, communicate with, or make use of: has access to the restricted area; has access to classified material.
Those who work with safe abortion or other health services would be familiar with the AAAQ framework (called the Triple A Q framework). All health related facilities, goods and services must be available, accessible, acceptable, appropriate and of good quality (AAAQ). For more information on AAAQ and the importance of participation in a human rights framework, please refer to Helen Pott’s Participation and the right to the highest attainable standard of health (See PDF).
Access to safe abortion can be a common barrier irrespective of the legal status of abortion in that country. In fact, ASAP had a discussion on social media with some of its followers about this last year. You can read some interesting comments here.
In countries were abortion is legal, women or girls who need it may not be able to get the service. In other words, it could be available but not accessible. For example, public sector hospitals might not perform abortion unless the woman agrees to have an IUD inserted. Or they may simply turn her away if she is unmarried and worse, may make insensitive remarks and not keep her information in confidence. In some regions, the procedure may be available only in the private sector at a very high cost, creating a financial barrier to access. Alternatively, abortion may be offered by only one doctor in the area and the woman may not be able to find transport to get there without having to make public (even if only to the family) the information that she is going to get an abortion. That creates a confidentiality barrier for access.
In countries where it is illegal, it is often possible to find at least a few doctors willing to perform safe abortion, but they may not be accessible for the same reasons as stated above.
This is the crossroad where women and girls are forced to turn to unsafe services offered by informal or untrained providers, which may cross all the above mentioned barriers by being close to home, cheaper, discreet, with no coercion for contraception and no hassles about being unmarried. Women and girls who are seeking unsafe abortions by the thousands every year, are speaking with their actions — they want abortions that are cheaper, closer to home, non-judgmental, non-coercive and discreet in order for there to be no barriers to access!! When will safe abortion services cater to their needs in the same manner ?
Perhaps the tools are already available in the form of abortion pills, which have been around for over 20 years—medical abortion pills. But the strategies for utilization have not yet managed to cross all barriers. Here are some articles which document and explore these notions of access being critical to saving women’s lives:
Guttmacher: Access to Safe Abortion in the Developing World: Saving Lives While Advancing Rights
http://www.guttmacher.org/pubs/gpr/15/4/gpr150402.html
WHO: Unsafe abortion: the preventable pandemic
http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf
Amnesty: Indonesia Left Without Choice
WGNRR: The Denial, Witholding and Obstruction of Access to Reproductive Health Services, including Access to Safe and Legal Abortion, is Violence Against Women
