between contraception and abortion, issues B-Chap 1.indd 11 07/02/2006 13:31:35 specifically related to adolescents and unsafe abortion, the increasing spread of medical abortion in the region, and the quality of postabortion care practices. The paper proposes a number of areas for further research to better understand unsafe abortion in the region, including investigative research into abortion ideologies and public attitudes towards abortion and the determinants of induced abortion. Abortion is provided without restriction throughout Eastern Europe and Central Asia, with the exception of Poland, where the provision of abortion is extremely restricted. Levels of abortion in this region are among the highest in the world (for example, there are 68 abortions per 1000 women in the Russian Federation). Horga’s article presents data on abortion levels in the region, assesses explanations for the high levels of abortion, including the unmet need for family planning, and examines the consequences of abortion. The determinants of unsafe abortion in Eastern Europe remain poorly understood; some women seek out illegal abortions even though abortions are legal and are provided free of charge. Horga provides strategies for decreasing the number of unwanted pregnancies and the subsequent demand for abortion in the region and identifies obstacles to their implementation. Among other constraints, few Eastern European countries have implemented sex education programmes so it is likely that young women beginning their sexual lives will continue to depend on abortion to control their fertility as their mothers did under the former regimes. It is also likely that economic incentives for providers are behind the continued emphasis on abortions rather than contraception, suggesting that alternative economic incentives should be explored for health care providers. Until unsafe abortion is eliminated, women and public health systems will continue to suffer the consequences of abortions performed under unsafe conditions. Unfortunately, safe motherhood programmes generally do not address the causes and consequences of unsafe abortion. Consequently, as the other causes of maternal mortality decrease, deaths from complications of abortion increase as a proportion of all deaths. A 13-year retrospective study of the Safe Motherhood Initiative in Ghana (18) found that as the relative contributions of other causes of maternal mortality decreased, complications of abortion increased significantly. It is hoped that the contributions in this book will contribute to reducing unsafe abortion by identifying priority areas for research and action. These recommendations are listed in the final chapter and provide both a stimulus and blueprint for action. Abortion, human rights and the International Conference on Population and Development (ICPD) Rebecca J. Cook 1 ABSTRACT This paper explores ways in which human rights have been and could be applied to reduce the causes and harmful consequences of unsafe abortion to women and their families. It addresses abortion as a major public health concern, as was urged at the 1994 International Conference on Population and Development, held in Cairo (Egypt). It analyses how the right to be free from inhuman and degrading treatment, and the rights to equal protection of the law, to liberty and security of the person, to health, and to non-discrimination on grounds of sex and race are being applied to reduce unsafe abortion. It suggests that it is necessary to conduct a human rights needs assessment that identifies how laws, policies or practices facilitate or inhibit the availability of and access to services at the clinical and health system levels, and that addresses underlying inhibiting social or economic conditions. Where laws, policies or practices directly or indirectly obstruct the availability of or access to family planning services or, where women find them necessary, to abortion services, they need to be reformed to comply with human rights principles. 1 Faculty of Law, University of Toronto, Toronto, Ontario M5S 2C5, Canada. Website : www.law-lib.utoronto.ca/diana 2 Book ch.02.qxd 11.2.2005 10:36 Page 15 Introduction The focus of this paper is to address the ways human rights have been and can be applied to reduce the causes and consequences of unsafe abortion. The framework draws on the International Conference on Population and Development (ICPD), which was held in Cairo (Egypt) in 1994. The Conference and the resulting Programme of Action (1) went beyond traditional identification of the problem and controversy of abortion, and lifted it out of the rhetoric that contrasts women’s rights to autonomy with fetal rights to life. Taking into account the reality of frequent abortions in the many communities where legal and safe services are not available and the conflicting views on morality, the Conference proposed the development of policies directed at making abortion considerably less frequent, and considerably more safe for women who choose it. In short, it proposed that unsafe abortion be addressed as a public health concern. The explicit resolution for governments pledging themselves to the Cairo Programme of Action was: to strengthen their commitment to women’s health to deal with the health impact of