by Srijani Mitra
The Right to Decide: Why Safe Abortion Is a Global Health Issue
There are few medical decisions over which the world exercises as much ownership as abortion. A pregnancy begins inside one person’s body, but almost immediately, that body can become a site of public argument. Governments legislate it. Religious institutions debate it. Families judge it. Strangers have opinions about it. And somewhere beneath all of these voices is the person who has to live with the decision.
On September 28, International Safe Abortion Day offers an opportunity to return the conversation to that person.
Abortion is often framed as a moral or political question, but before it becomes either of those things, it is a healthcare issue. According to the World Health Organization, abortion is a safe and common medical intervention when it is carried out using an appropriate method and with the necessary skills. Yet around 45% of abortions worldwide are unsafe. The consequences can include severe complications, disability and death. This is despite the fact that these outcomes are largely preventable.
The distinction between safe and unsafe abortion is therefore not simply a distinction between two procedures. It is a distinction between two worlds.
In one, a person can obtain accurate information, consult a trained healthcare provider, access appropriate medication or a procedure, receive follow-up care and return home without being treated as though she has committed a moral offense. In the other, she may encounter restrictive laws, financial barriers, stigma, misinformation, geographical isolation or a shortage of trained providers. She may delay seeking care because she is afraid. She may travel long distances. She may borrow money. She may turn to an unsafe provider because safe care is unavailable.
The pregnancy may be the same. The circumstances surrounding it are not.
This is why abortion access is inseparable from inequality. A right that can be exercised easily by someone with money, information and mobility can become almost theoretical for someone without them. Globally, the burden of unsafe abortion falls disproportionately on people living in poorer and underserved settings. WHO notes that more than half of unsafe abortions occur in Asia, particularly in South and Central Asia.
The language of choice can sometimes conceal this inequality. We speak about whether a person has the right to choose, but we do not always ask whether she has the resources necessary to make that choice safely.
Can she afford the consultation?
Can she travel to a provider?
Does she know which information is trustworthy?
Can she obtain the necessary medication?
Can she ask questions without being judged?
Can she return for care if she develops complications?
These are not abstract questions. They determine whether reproductive autonomy exists in practice.
Stigma makes the situation worse. Around the world, people seeking abortions can be subjected to shame, discrimination and moral judgment. Adolescents, unmarried women, people living in poverty, survivors of sexual violence and those living in humanitarian crisis may face additional barriers. A person who fears being judged may delay seeking healthcare, and a delay can turn an already difficult situation into a dangerous one.
Healthcare should not require a person to prove that she is a sufficiently sympathetic victim.
We are often more willing to accept abortion when we can attach a story of tragedy to it. We understand the pregnancy that threatens a woman’s life. We understand the pregnancy resulting from rape. We understand the woman who already has children and cannot afford another. But what about the person who simply does not want to become a parent?
Why should autonomy require an extraordinary justification?
Pregnancy changes a person’s body, health, finances, education, employment and future. Continuing a pregnancy is therefore not a consequence that can be discussed as though it exists outside the life of the person experiencing it. The right to reproductive autonomy must include both the freedom to become a parent and the freedom not to become one.
That does not mean that abortion is emotionally uncomplicated. It is not. People can experience relief, grief, certainty, uncertainty or several of these emotions at once. There is no single emotional narrative that can adequately describe every abortion.
But emotional complexity should not be confused with a justification for denying healthcare.
The global conversation also needs to recognize that safe abortion is connected to contraception, sexuality education and broader reproductive healthcare. Preventing unintended pregnancies through accessible contraception is important, but contraception cannot eliminate every unintended pregnancy. People experience contraceptive failure, sexual violence, changes in circumstances and pregnancies they are not prepared to continue. Recent global research shows that abortion remains an important component of reproductive agency alongside contraception.
The answer, therefore, cannot simply be to tell people to avoid pregnancy.
It has to be to ensure that when pregnancy occurs, people have access to the healthcare and information they need to make informed decisions about their lives.
This requires more than changing laws, although laws matter. It requires healthcare systems that are adequately funded and staffed. It requires trained providers. It requires accurate information. It requires confidentiality and respectful treatment. It requires post-abortion care. It requires removing unnecessary barriers that make safe care inaccessible to the people who need it most.
It also requires international solidarity.
In low and middle-income countries, the consequences of inadequate reproductive healthcare are particularly severe. Guttmacher estimates that millions of women in these countries experience unsafe abortions every year, while substantial resources are spent treating complications that could often have been prevented through access to safe abortion care.
This makes safe abortion not merely a question of individual freedom but of public health, gender equality and economic justice.
There is also something profoundly unequal about deciding that one person’s future deserves protection at the cost of another person’s present. The person who is already alive, already working, already caring for other children, already studying, already surviving violence or poverty, cannot be reduced to an abstract vessel for an argument about potential life.
A humane society does not need everyone to make the same reproductive choices.
It needs to ensure that people can make those choices safely.
International Safe Abortion Day should therefore be about more than defending a principle. It should be about examining the systems that determine who can actually exercise that principle. It should ask why safe healthcare remains inaccessible to millions. It should ask why misinformation travels faster than medical knowledge. It should ask why poverty, geography and stigma can determine whether a medical procedure is safe.
Most importantly, it should remind us that reproductive rights are not meaningful if they exist only on paper.
The ability to decide whether and when to have children is deeply connected to the ability to decide what kind of life one can build. Education, employment, financial independence, relationships and health are all shaped by reproductive choices. When people are denied control over those choices, their futures can become narrower before they have even had the opportunity to imagine them.
Safe abortion does not ask us to agree on what every person should do.
It asks us to agree that no one should have to risk their health or their life because safe healthcare was placed beyond their reach.
There will always be disagreement about abortion. There will be religious convictions, personal beliefs and political arguments. A pluralistic world has room for disagreement.
What it should not have room for is preventable death.
On September 28, the most important question is not whether we can make everyone agree about abortion. It is whether we can build a world in which every person, regardless of income, nationality or circumstance, can access accurate information, compassionate healthcare and the freedom to make decisions about their own body and future.
Because reproductive freedom is not the freedom to make the decision that everyone else considers right. It is the freedom to make the decision for yourself, and to remain worthy of care afterwards.