When the world’s policymakers moved their focus from mass family planning programmes to the sexual and reproductive health (SRH) needs and rights of individuals in the early 1990s, attention turned to men. Men began to be included in SRH programming not only as individuals with their own SRH needs but also as actors who influence women’s SRH outcomes. In the quarter-century since then, policymakers have attempted to tackle significant global SRH challenges – HIV, unskilled care for pregnancy and childbirth, early pregnancy, female genital cutting to name a few – in all of which recognising that a woman’s risk of morbidity and mortality is – to a greater or lesser extent – bound-up with what her sexual partner, husband, boyfriend, father, uncle is doing. However, one of the leading – and most easily addressed – causes of maternal morbidity and mortality hasn’t seen much focus on men at all.
Unsafe abortion is a massive public health challenge. It accounts for around 13% of maternal deaths around the world, but in the regions where it’s most common – low- and middle-income countries in Africa and Asia – it accounts for around a third of all maternal deaths (WHO, 2018).
Some interventions for addressing the problem are apparently obvious: making safe abortion legal and having adequate healthcare facilities licensed to provide abortion services in the areas people need them for instance. But in some countries like Zambia, South Africa, Cambodia, Nepal with these structures in place, policy makers and researchers have struggled to identify why some women receive safe abortions and others don’t.
Take the example of Zambia. Here the question is understanding what influences women’s pathway to either safe and legal abortion in one of 75+ licensed Government facilities, or unsafe abortion outside of the legal system. Our research suggests at least one answer must be to consider the influence of men.
We spoke to women who came to a large urban hospital for either safe abortion services or for post-abortion care following an unsafe abortion. We wanted to know how they had ended up in the study hospital. We didn’t ask them about the men in their lives particularly, but men’s roles formed a significant part of their stories.