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Edited by Axel I Mundigo and Cynthia Indriso, London and New York, Zed Books, 1999, 498 pages, UK £49.95, US $69.95.
Induced abortion is one of the oldest methods used to end a pregnancy and has been practised in almost all societies. It is clear to social scientists that pregnancy as a social condition is different from pregnancy as a physical condition, but this is not always taken into account by other disciplines. Reasons for abortion are multifaceted and complex, and to understand these it is important to look at more than just the biological aspects of terminating a pregnancy.
According to World Health Organisation (WHO) reports, 40 to 60 million abortions currently take place in the world every year. Despite large costs and efforts to prevent these, policies to introduce safer alternatives have been ineffective. There are indications that the number of induced abortions is actually increasing, particularly in the developing world. The majority of operations are performed illegally, often leading to complications and deaths of women. The costs in terms of human suffering are incalculable.
Abortion in the Developing World was funded by the WHO to discover why, in spite of the serious risks involved, women still resort to abortion even in those countries where adequate family planning services provide contraceptive facilities. The book also aims to understand how abortion and contraception behaviour are related. It provides a cross-cultural forum for women to explain the motivations behind their decisions. As the editors put it: “abortion issues have been the subject of intensive debate among men: legal scholars, moralists, men of religion and politicians. The voices of women have been drowned in this loud debate despite the fact that it is women whose bodies, psyche, health and life are directly concerned”. Gaining knowledge of women's views and needs is of course paramount, however these should be understood in their fuller social and cultural context, ie the degree of involvement of men and the wider kin network in decision making should be taken into consideraton. Only three of the case studies include men, and it is interesting to see that in these, women either echoed men's decisions or had consulted closely with them.
Several important common issues emerge from the studies: legalising abortions has reduced the health risks, but has not reduced their total number; the relationship between abortion and contraception continues to be poorly understood; abortion is not only the resort of unmarried women, the poor, and young adolescents girls, a considerable number of married women also use it as a means of regulating fertility. The specific problems of increasing adolescent pregnancy are given a chapter of their own. Most importantly, it emerges that the decision about how to handle an unwanted pregnancy is not taken lightly by women and there is an “agonising moral and ethical dilemma that women face in deciding how to handle an unwanted pregnancy”. The service providers, especially those working illegally, also describe the major moral and ethical dilemma they face when confronted by the abject misery and the bleak future awaiting women who seek abortion if they do not receive help. The book explores these dilemmas, and questions whether abortion should be viewed/treated as a health matter, or as one of ideology (moral, religious, etc).
Abortion in the Developing World is commendable in it's in-depth, cross-cultural treatment of the subject (it takes case studies from 16 different countries) and its strong policy recommendations. However, coverage of the conservative Muslim Middle East and North Africa is needed to complement the abundant studies from conservative Catholic countries. Various fundamentalist Muslim countries (for example Yemen, Iran, Saudi Arabia) have interpreted Islam differently for the purposes of population and abortion policies, and studies from these countries would have given a more comprehensive perspective on the range of abortion issues in the developing world.
The book concludes that “women are not passive agents in their reproductive destiny”, and that in the absence of adequate services they use whatever strategies and resources are available, and are prepared to risk their lives to gain control of their fertility. It provides a deep insight into why women seek abortion. Overall, the book is a welcome and valuable addition to the field.