When I was being interviewed to get my medical registration to practise as a doctor in Botswana, I was surprised to be given a stern warning: “There are only three circumstances when a patient may have an abortion: in cases of rape or incest, where there is a risk of life to the mother, or foetal abnormality, but only before 16 weeks.” I found it revealing that out of all the possible medical issues in Botswana, this was the one thing that was highlighted.

Botswana has restrictive abortion laws, but compared with many other countries they are pretty liberal. In many parts of the world, abortions are only allowed in extreme circumstances, if at all, and practicalities – for example, needing two police reports as proof of rape – often prove insurmountable barriers at the very time a woman needs the most sympathy and practical help.

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In developing countries, the maternal mortality rate is a staggering 239 per 100,000 women, with an estimated 303,000 women dying in 2015. One in 10 of all maternal deaths are caused by unsafe abortions; an estimated 20m unsafe abortions are performed every year.

We know that providing access to legal terminations would stop women dying, but this remains an issue that provokes huge debate. Women who can’t access them legally still have abortions, but they have to pay bankrupting sums, often risking their lives.

Backstreet abortions are usually done in an unclean and unsafe environment. If they don’t kill women, they often put them in hospital with horrific complications, leaving them infertile, facing major abdominal surgery and enormous medical bills.

The US has a ban on any of its funding being spent on terminations for women

A walk around any gynaecology ward in Africa reveals women with the horrifying complications that result from an unsafe abortion. These can from use of the right medications at the wrong doses in an unclean environment to toxic substances or foreign bodies inserted into the uterus to disrupt the pregnancy.

What is stopping women from accessing safe abortions? The first is restrictive laws in their own countries, which can extend to a ban. The UK has an important role to play here and should put pressure on countries that receive its aid to change these illiberal laws. Ludicrously, this problem is compounded by the fact that countries with the most restrictive abortion laws often have the poorest family planning provision.

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The second barrier is the tight regulation governing donor aid. The US has a ban on any of its funding being spent on terminations for women. The Helms amendment, a 43-year-old law, stipulates that abortions cannot be funded as a method of family planning. This means that no US foreign aid is spent on the provision of abortions or even advising or promoting abortion services for women. Recent headlines suggest that the US will not even allow its funds to be used to provide terminations for women who have been raped by Isis fighters.

The US spends large amounts of its money on family planning (pdf) and this should be applauded. But family planning and the safe provision of abortions go hand in hand. They are two key components of women’s reproductive rights.

There is a hugely damaging knock-on effect of this policy. The US prohibits all organisations in receipt of its funds from advising or providing abortion services. This means restrictions are also placed on donor aid from any other other countries that are also fellow funders in the same programmes. The only exception is where organisations can specifically segregate their funds in a way that isn’t usually practical.

This is not an issue of resources and funding, but a value judgment on what women may or may not do with their lives

We know that abortions, when performed legally, are cheap and safe. Yet the grim reality is that tens of thousands of women who die in the developing world each year from unsafe abortions do so because policymakers have decided their lives are not worth saving.

With changes in this policy, maternal mortality could be reduced for a low cost. The technology exists and is affordable. A misoprostol pill that induces an early stage abortion costs less than a dollar. This is not an issue of resources and funding, but a value judgment on what women may or may not do with their lives.

We will not reduce the world’s appalling rate of maternal mortality until we are clear about a woman’s right to choose. We have a key role in the UK to help US policymakers change this and ensure that donor aid is no longer subject to these counterproductive stipulations.

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The sustainable development goals including a commitment to reduce maternal mortality. All countries across the world must look at their legislation and customs to ensure that illiberal abortion laws are not preventing the most vulnerable women from getting the help they so desperately need.

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