Some push bunions into the uterus, others mutilate their stomachs or ingest acid, determined to abort at all costs. Faced with these women, international NGOs are tackling the issue of abortion, often overshadowed by the urgency of a conflict or an epidemic.
“I will never forget this young woman to whom I said no for an abortion, she was in panic. I never knew what happened to her,” Nadia (not her real name) tells AFP, who wants to keep quiet about the country where she works because abortion is illegal there.
Other members of humanitarian organizations tell, in Paris or by telephone, of having seen lives shattered by an unwanted pregnancy, sometimes with tragic outcomes.
“There are teenage girls who want to continue their studies, women who have been raped, others who thought they were menopausal or who already have four children and do not want another pregnancy. The profiles are different, but the purpose is the same” and so are the complications (infections, hemorrhages, infertility, etc.), underlines Clémence Chbat, midwife at Médecins sans frontières (MSF).
One in four pregnancies ends in induced abortion, according to the World Health Organization (WHO).
“When we do not provide the service, women arrive with hemorrhages”, sometimes due to “barbaric” curettages carried out by matrons or clandestine clinics, explains Ms Chbat, who recalls that unmedical abortion is one of the main causes of maternal death and “the only one that can be avoided”.
However, “in all humanitarian contexts, for States and for donors [de fonds], the issue of abortion is a very neglected aspect, more than gender-based violence,” according to Tanit Iglesias Zayas, of Action Against Hunger (ACF). “It’s a reality that has been denied for a long time,” according to her.
“There has been an awareness of these issues” for around fifteen years, says Marie Lussier of Médecins du Monde (MDM). This is the case for health NGOs like his or Solthis which displays a similar line. But also for NGOs like ACF, which fights against poverty and takes the issue of sexual and reproductive rights as a vector for reducing inequalities.
At the same time, tensions around access to abortion in the United States, Italy or Africa with the sometimes complicated application of the Maputo protocol – which obliges state parties to eliminate discrimination at the respect for women – serve as a reminder that the right to abortion “is not a given”, underlines Isabelle Defourny, president of MSF.
Under the radar
The conviction in March in Poland of the co-founder of the organization Abortion Dream Team for providing abortion pills to a pregnant woman illustrated the risks to which NGOs, local and international, are exposed.
“For years this was done, sometimes confidentially,” says Isabelle Defourny. Then in 2017, MSF launched a “task force” to go into the field to discuss with the teams “with the objective of making these safe abortions accessible”.
Several of the humanitarian workers interviewed describe gray areas, discreet practices and often tacit tolerance from the authorities.
There is this woman who uses a grandson’s vaccine as an excuse to consult for an abortion. This other who, at over 60, makes an appointment with a gynecologist for an abortion, on behalf of her daughter-in-law.
“There is personal conscience, professional conscience, and there is what the law says, it weighs on conscience, we are touching on something which is illegal and we work closely with the local authorities. So we are not positioning ourselves as an NGO, but just as a medical gown,” says Nadia.
When it cannot directly provide access to abortion, it directs people to other safe structures.
“The fear of what comes next” is also present for humanitarian workers who may be on fixed-term contracts in small territories “where everyone knows each other” and where there is the risk of being labeled “pro-abortion”, says -She.
The NGOs interviewed say they organize internal awareness training to break down reluctance.
The ambition is for Médecins du Monde to integrate abortion into its basic care kit in 2025, “based on WHO recommendations”.
Abortion “only represents around 20% of our projects and it has not yet been put into practice,” estimates Isabelle Defourny of Médecins sans frontières. “How can we make abortion accessible on a much broader basis? “, especially in emergency situations in large tents where confidentiality is not always possible? “It’s not a question that has been decided,” she said.