Christine Akoth is a Kenyan midwife, and she leads the maternity services in MSF primary health centres in Jamtoli and Hakimpara, Cox’s Bazar, Bangladesh. The Rohingya women prefer to give birth in their homes. Traditional practices in the community, lack of trust in healthcare providers, combined with exclusion from healthcare in Myanmar contribute to deliveries at home. MSF health promotion teams work with traditional birth attendants, and community and religious leaders to encourage expectant mothers to give birth in health facilities where they can be assisted by medical professionals. MSF in Cox’s Bazar assists deliveries, and provides antenatal and postnatal care, family planning services, menstrual regulation (Bangladesh term for safe abortion care), mental health care, and medical and psychosocial support for survivors of sexual violence. © Anthony Kwan/MSF

Safe Abortion

Unsafe abortions are a major problem in many parts of the world. Without proper healthcare or sanitary conditions, abortions can be fatal. Performed by unqualified personnel and/or in unhygienic environments, unsafe abortions can cause life-threatening complications in girls and women. These can include severe bleeding, infections and peritonitis (a swelling of the stomach).

Almost every maternal death and disability caused by unsafe abortions can be prevented.

Since 2004, Doctors Without Borders/Médecins Sans Frontières (MSF) has provided access to voluntary safe abortions for women around the world, with the objective of reducing maternal mortality and suffering. In 2018, MSF treated over 24,000 women and girls with abortion-related concerns and complications, many of which resulted from unsafe attempts to terminate pregnancy. 

We also provided safe abortion care to over 11,000 women and girls who requested termination of pregnancy. 


Abortion around the world

The vast majority of unsafe abortions take place in developing countries. 

In developed regions, it is estimated that 30 women die for every 100,000 unsafe abortions. That number rises to 220 deaths per 100,000 unsafe abortions in developing regions and 520 deaths per 100,000 unsafe abortions in sub-Saharan Africa.

African women have the highest chance of dying from an unsafe abortion. While the continent accounts for 29 percent of all unsafe abortions, it sees 62 percent of unsafe abortion-related deaths. 

In many societies, there are strong social standards and prejudices linked to abortion, including a certain degree of reluctance to practice, or even talk about it.

We take these social considerations into account, reaching a balance between personal opinion and professional responsibility.

In countries with particularly strict rules on abortion, we work with international volunteers who assume the responsibility for carrying out procedures.

Abortion law

We balance local attitudes and abortion law by focusing on the respect for and safety of the women involved.

We also endeavour to communicate clearly about the issue in areas where we work, explaining our medical mission and our arguments and justifications for providing this type of care to women who request it.

Confidentiality and communication

Our abortions are 100 percent voluntary and we provide confidentiality to all our patients.

Global gag rule

The Mexico City Policy, also known as the Global Gag Rule (GGR), will prevent midwives all over the world from providing these vital services.

The GGR is a United States government executive order prohibiting non-governmental organizations (NGOs) that receive U.S. government funding from providing or discussing with patients the option of safe termination of pregnancy.

While the U.S. has not allowed government funding for most abortion services overseas since the 1973 Helms Amendment, this executive order further restricts women’s ability to receive complete reproductive care by withholding all funding if abortion is even mentioned during patient consultations.

That means no patient counselling, no public education, and no referrals related to safe abortion services.