Healthy diet

A healthy diet is a diet that helps to maintain or improve overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients, micronutrients, and adequate calories.

Leafy green, cruciferous, and other raw vegetables may contribute to a healthy diet

For people who are healthy, a healthy diet is not complicated and contains mostly fruits, vegetables, and whole grains, and includes little to no processed food and sweetened beverages. The requirements for a healthy diet can be met from a variety of plant-based and animal-based foods, although a non-animal source of vitamin B12 is needed for those following a vegan diet. Various nutrition guides are published by medical and governmental institutions to educate individuals on what they should be eating to be healthy. Nutrition facts labels are also mandatory in some countries to allow consumers to choose between foods based on the components relevant to health.
A healthy lifestyle includes getting exercise every day along with eating a healthy diet. A healthy lifestyle may lower disease risks, such as obesity, heart disease, type 2 diabetes, hypertension and cancer.
There are specialized healthy diets, called medical nutrition therapy, for people with various diseases or conditions. There are also prescientific ideas about such specialized diets, as in dietary therapy in traditional Chinese medicine.

Recommendations

World Health Organization

The World Health Organization (WHO) makes the following 5 recommendations with respect to both populations and individuals:

1. Maintain a healthy weight by eating roughly the same number of calories that your body is using.
2. Limit intake of fats. Not more than 30% of the total calories should come from fats. Prefer unsaturated fats to saturated fats. Avoid trans fats.
3. Eat at least 400 grams of fruits and vegetables per day (potatoes, sweet potatoes, cassava and other starchy roots do not count). A healthy diet also contains legumes (e.g. lentils, beans), whole grains and nuts.
4. Limit the intake of simple sugars to less than 10% of calorie (below 5% of calories or 25 grams may be even better).
5. Limit salt / sodium from all sources and ensure that salt is iodized. Less than 5 grams of salt per day can reduce the risk of cardiovascular disease.

WHO stated that insufficient vegetables and fruit is the cause of 2.8% of deaths worldwide.
Other WHO recommendations include:

• ensuring that the foods chosen have sufficient vitamins and certain minerals;
• avoiding directly poisonous (e.g. heavy metals) and carcinogenic (e.g. benzene) substances;
• avoiding foods contaminated by human pathogens (e.g. E. coli, tapeworm eggs);
• and replacing saturated fats with polyunsaturated fats in the diet, which can reduce the risk of coronary artery disease and diabetes.

United States Department of Agriculture

The Dietary Guidelines for Americans by the United States Department of Agriculture (USDA) recommends three healthy patterns of diet, summarized in table below, for a 2000 kcal diet.
It emphasizes both health and environmental sustainability and a flexible approach. The committee that drafted it wrote: "The major findings regarding sustainable diets were that a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet. This pattern of eating can be achieved through a variety of dietary patterns, including the “Healthy U.S.-style Pattern”, the “Healthy Vegetarian Pattern" and the "Healthy Mediterranean-style Pattern". Food group amounts are per day, unless noted per week.

Food group/subgroup (units)	Healthy U.S. patterns	Healthy Vegetarian patterns	Healthy Med-style patterns
Fruits (cup eq)	2	2	2.5
Vegetables (cup eq)	2.5	2.5	2.5
Dark green	1.5/wk	1.5/wk	1.5/wk
Red/orange	5.5/wk	5.5/wk	5.5/wk
Starchy	5/wk	5/wk	5/wk
Legumes	1.5/wk	3/wk	1.5/wk
Others	4/wk	4/wk	4/wk
Grains (oz eq)	6	6.5	6
Whole	3	3.5	3
Refined	3	3	3
Dairy (cup eq)	3	3	2
Protein Foods (oz eq)	5.5	3.5	6.5
Meat (red and processed)	12.5/wk	--	12.5/wk
Poultry	10.5/wk	--	10.5/wk
Seafood	8/wk	--	15/wk
Eggs	3/wk	3/wk	3/wk
Nuts/seeds	4/wk	7/wk	4/wk
Processed Soy (including tofu)	0.5/wk	8/wk	0.5/wk
Oils (grams)	27	27	27
Solid fats limit (grams)	18	21	17
Added sugars limit (grams)	30	36	29

American Heart Association / World Cancer Research Fund / American Institute for Cancer Research

The American Heart Association, World Cancer Research Fund, and American Institute for Cancer Research recommend a diet that consists mostly of unprocessed plant foods, with emphasis a wide range of whole grains, legumes, and non-starchy vegetables and fruits. This healthy diet is full of a wide range of various non-starchy vegetables and fruits, that provide different colors including red, green, yellow, white, purple, and orange. They note that tomato cooked with oil, allium vegetables like garlic, and cruciferous vegetables like cauliflower, provide some protection against cancer. This healthy diet is low in energy density, which may protect against weight gain and associated diseases. Finally, limiting consumption of sugary drinks, limiting energy rich foods, including “fast foods” and red meat, and avoiding processed meats improves health and longevity. Overall, researchers and medical policy conclude that this healthy diet can reduce the risk of chronic disease and cancer.
In children, consuming less than 25 grams of added sugar (100 calories) is recommended per day. Other recommendations include no extra sugars in those under 2 years old and less than one soft drink per week. As of 2017, decreasing total fat is no longer recommended, but instead, the recommendation to lower risk of cardiovascular disease is to increase consumption of monounsaturated fats and polyunsaturated fats, while decreasing consumption of saturated fats.

Harvard School of Public Health

Further information: Healthy eating pyramid

The Nutrition Source of Harvard School of Public Health makes the following 10 recommendations for a healthy diet:

• Choose good carbohydrates: whole grains (the less processed the better), vegetables, fruits and beans. Avoid white bread, white rice, and the like as well as pastries, sugared sodas, and other highly processed food.
• Pay attention to the protein package: good choices include fish, poultry, nuts, and beans. Try to avoid red meat.
• Choose foods containing healthy fats. Plant oils, nuts, and fish are the best choices. Limit consumption of saturated fats, and avoid foods with trans fat.
• Choose a fiber-filled diet which includes whole grains, vegetables, and fruits.
• Eat more vegetables and fruits—the more colorful and varied, the better.
• Include adequate amounts of calcium in the diet; however, milk is not the best or only source. Good sources of calcium are collards, bok choy, fortified soy milk, baked beans, and supplements containing calcium and vitamin D.
• Prefer water over other beverages. Avoid sugary drinks, and limit intake of juices and milk. Coffee, tea, artificially-sweetened drinks, 100-percent fruit juices, low-fat milk and alcohol can fit into a healthy diet but are best consumed in moderation. Sports drinks are recommended only for people who exercise more than an hour at a stretch to replace substances lost in sweat.
• Limit salt intake. Choose more fresh foods, instead of processed ones.
• Drink alcohol in moderation. Doing so has health benefits, but is not recommended for everyone.
• Consider intake of daily multivitamin and extra vitamin D, as these have potential health benefits.

Other than nutrition, the guide recommends frequent physical exercise and maintaining a healthy body weight.

Others

David L. Katz, who reviewed the most prevalent popular diets in 2014, noted:

The weight of evidence strongly supports a theme of healthful eating while allowing for variations on that theme. A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention and is consistent with the salient components of seemingly distinct dietary approaches. Efforts to improve public health through diet are forestalled not for want of knowledge about the optimal feeding of Homo sapiens but for distractions associated with exaggerated claims, and our failure to convert what we reliably know into what we routinely do. Knowledge in this case is not, as of yet, power; would that it were so.

Marion Nestle expresses the mainstream view among scientists who study nutrition::10

The basic principles of good diets are so simple that I can summarize them in just ten words: eat less, move more, eat lots of fruits and vegetables. For additional clarification, a five-word modifier helps: go easy on junk foods. Follow these precepts and you will go a long way toward preventing the major diseases of our overfed society—coronary heart disease, certain cancers, diabetes, stroke, osteoporosis, and a host of others.... These precepts constitute the bottom line of what seem to be the far more complicated dietary recommendations of many health organizations and national and international governments—the forty-one “key recommendations” of the 2005 Dietary Guidelines, for example. ... Although you may feel as though advice about nutrition is constantly changing, the basic ideas behind my four precepts have not changed in half a century. And they leave plenty of room for enjoying the pleasures of food.:22

For specific conditions

In addition to dietary recommendations for the general population, there are many specific diets that have primarily been developed to promote better health in specific population groups, such as people with high blood pressure (as in low sodium diets or the more specific DASH diet), or people who are overweight or obese (in weight control diets). However, some of them may have more or less evidence for beneficial effects in normal people as well.

Hypertension

A low sodium diet is beneficial for people with high blood pressure. A Cochrane review published in 2008 concluded that a long term (more than 4 weeks) low sodium diet has a useful effect to reduce blood pressure, both in people with hypertension and in people with normal blood pressure.
The DASH diet (Dietary Approaches to Stop Hypertension) is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH, a United States government organization) to control hypertension. A major feature of the plan is limiting intake of sodium, and the diet also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits, and vegetables while lowering the consumption of red meats, sweets, and sugar. It is also "rich in potassium, magnesium, and calcium, as well as protein".
The Mediterranean diet, which includes limiting consumption of red meat and using olive oil in cooking, has also been shown to improve cardiovascular outcomes.

Obesity

Further information: Dieting

Weight control diets aim to maintain a controlled weight. In most cases, those who are overweight or obese use dieting in combination with physical exercise to lose weight.
Diets to promote weight loss are divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie. A meta-analysis of six randomized controlled trials found no difference between the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram weight loss in all studies. At two years, all of the diets in the studies that reduced calories caused equal weight loss regardless of whether changes in fat or carbohydrate consumption were emphasized.

Gluten-related disorders

Further information: Gluten-free diet

Gluten, a mixture of proteins found in wheat and related grains including barley, rye, oat, and all their species and hybrids (such as spelt, kamut, and triticale), causes health problems for those with gluten-related disorders, including celiac disease, non-celiac gluten sensitivity, gluten ataxia, dermatitis herpetiformis, and wheat allergy. In these people, the gluten-free diet is the only available treatment.

Reduced disease risk

Further information: Diet and cancer

There may be a relationship between lifestyle including food consumption and potentially lowering the risk of cancer or other chronic diseases. A diet high in fruits and vegetables appears to decrease the risk of cardiovascular disease and death but not cancer.
Eating a healthy diet and getting enough exercise can maintain body weight in normal ranges and prevent obesity in most people, and can thus prevent the chronic diseases and poor outcomes associated with obesity.

Unhealthy diets

The Western pattern diet which is typically eaten by Americans and increasingly adopted by people in the developing world as they leave poverty is unhealthy: it is "rich in red meat, dairy products, processed and artificially sweetened foods, and salt, with minimal intake of fruits, vegetables, fish, legumes, and whole grains."
An unhealthy diet is a major risk factor for a number of chronic diseases including: high blood pressure, diabetes, abnormal blood lipids, overweight/obesity, cardiovascular diseases, and cancer.
The WHO estimates that 2.7 million deaths are attributable to a diet low in fruits and vegetables every year. Globally it is estimated to cause about 19% of gastrointestinal cancer, 31% of ischaemic heart disease, and 11% of strokes, thus making it one of the leading preventable causes of death worldwide.

Popular diets

Popular diets, often referred to as fad diets, make promises of weight loss or other health advantages such as longer life without backing by solid science, and in many cases are characterized by highly restrictive or unusual food choices.:296 Celebrity endorsements (including celebrity doctors) are frequently associated with popular diets, and the individuals who develop and promote these programs often profit handsomely.:11–12

Public health

Consumers are generally aware of the elements of a healthy diet, but find nutrition labels and diet advice in popular media confusing.
Fears of high cholesterol were frequently voiced up until the mid-1990s. However, more recent research has shown that the distinction between high- and low-density lipoprotein ('good' and 'bad' cholesterol, respectively) must be addressed when speaking of the potential ill effects of cholesterol. Different types of dietary fat have different effects on blood levels of cholesterol. For example, polyunsaturated fats tend to decrease both types of cholesterol; monounsaturated fats tend to lower LDL and raise HDL; saturated fats tend to either raise HDL, or raise both HDL and LDL; and trans fat tend to raise LDL and lower HDL.
Dietary cholesterol is only found in animal products such as meat, eggs, and dairy. The effect of dietary cholesterol on blood cholesterol levels is controversial. Some studies have found a link between cholesterol consumption and serum cholesterol levels. Other studies have not found a link between eating cholesterol and blood levels of cholesterol.
Vending machines in particular have come under fire as being avenues of entry into schools for junk food promoters. However, there is little in the way of regulation and it is difficult for most people to properly analyze the real merits of a company referring to itself as "healthy." Recently, the Committee of Advertising Practice in the United Kingdom launched a proposal to limit media advertising for food and soft drink products high in fat, salt or sugar. The British Heart Foundation released its own government-funded advertisements, labeled "Food4Thought", which were targeted at children and adults to discourage unhealthy habits of consuming junk food.
From a psychological and cultural perspective, a healthier diet may be difficult to achieve for people with poor eating habits. This may be due to tastes acquired in childhood and preferences for sugary, salty and/or fatty foods. In the UK, the chief medical officer of the government recommended in December 2018 that sugar and salt be taxed to discourage consumption.

Other animals

Animals that are kept by humans also benefit from a healthy diet and the requirements of such diets may be very different from the ideal human diet.

Mental health

Mental health is a level of psychological well-being or an absence of mental illness - the state of someone who is "functioning at a satisfactory level of emotional and behavioural adjustment". From the perspectives of positive psychology or of holism, mental health may include an individual's ability to enjoy life, and to create a balance between life activities and efforts to achieve psychological resilience. According to the World Health Organization(WHO), mental health includes "subjective well-being, perceived self-efficacy, autonomy, competence, inter-generational dependence, and self-actualization of one's intellectual and emotional potential, among others." The WHO further states that the well-being of an individual is encompassed in the realization of their abilities, coping with normal stresses of life, productive work and contribution to their community. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health".

The prevalence of mental illness is higher in more unequal rich countries

Mental health and mental illness

According to the U.K. surgeon general (1999), mental health is the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and providing the ability to adapt to change and cope with adversity. The term mental illness refers collectively to all diagnosable mental disorders—health conditions characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning.
For anyone struggling with suicide, self-harm, or depression, here are some resources to help.
A person struggling with their mental health may experience this because of stress, loneliness, depression, anxiety, relationship problems, death of a loved one, suicidal thoughts, grief, addiction, ADHD, cutting, self-harm, self-Injury, burning, various mood disorders, or other mental illnesses of varying degrees, as well as learning disabilities. Therapists, psychiatrists, psychologists, social workers, nurse practitioners or physicians can help manage mental illness with treatments such as therapy, counseling, or medication.

History

In the mid-19th century, William Sweetser was the first to coin the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health. Isaac Ray, one of the founders and the fourth president of the American Psychiatric Association, further defined mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements."
Dorothea Dix (1802–1887) was an important figure in the development of the "mental hygiene" movement. Dix was a school teacher who endeavored throughout her life to help people with mental disorders, and to bring to light the deplorable conditions into which they were put. This was known as the "mental hygiene movement". Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing. Dix's efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed.
Emil Kraepelin in 1896 developed the taxonomy of mental disorders which has dominated the field for nearly 80 years. Later the proposed disease model of abnormality was subjected to analysis and considered normality to be relative to the physical, geographical and cultural aspects of the defining group.
At the beginning of the 20th century, Clifford Beers founded "Mental Health America – National Committee for Mental Hygiene", after publication of his accounts from lived experience in lunatic asylums, A Mind That Found Itself, in 1908 and opened the first outpatient mental health clinic in the United States.
The mental hygiene movement, related to the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life. In the post-WWII years, references to mental hygiene were gradually replaced by the term 'mental health' due to its positive aspect that evolves from the treatment of illness to preventive and promotive areas of healthcare.
Marie Jahoda described six major, fundamental categories that can be used to categorize mentally healthy individuals: a positive attitude towards the self, personal growth, integration, autonomy, a true perception of reality, and environmental mastery, which include adaptability and healthy interpersonal relationships.

Significance

Mental illnesses are more common than cancer, diabetes or heart disease. Over 26 percent of all Americans over the age of 18 meet the criteria for having a mental illness. A WHO report estimates the global cost of mental illness at nearly $2.5 trillion (two-thirds in indirect costs) in 2010, with a projected increase to over $6 trillion by 2030.[citation needed]
Evidence from the World Health Organization suggests that nearly half of the world's population are affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life. An individual's emotional health can also impact physical health and poor mental health can lead to problems such as substance abuse.
Maintaining good mental health is crucial to living a long and healthy life. Good mental health can enhance one's life, while poor mental health can prevent someone from living an enriching life. According to Richards, Campania, & Muse-Burke, "There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health." Their research also concluded that people who lack emotional expression are inclined to anti-social behaviors (e.g., drug and alcohol abuse, physical fights, vandalism), which are a direct reflection of their mental health and suppress emotions. Adults and children with mental illness may experience social stigma, which can exacerbate the issues.

Perspectives

Mental well-being

Mental health can be seen as an unstable continuum, where an individual's mental health may have many different possible values. Mental wellness is generally viewed as a positive attribute, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Some discussions are formulated in terms of contentment or happiness. Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness. Positive psychology is increasingly prominent in mental health.
A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.
The tripartite model of mental well-being views mental well-being as encompassing three components of emotional well-being, social well-being, and psychological well-being. Emotional well-being is defined as having high levels of positive emotions, whereas social and psychological well-being are defined as the presence of psychological and social skills and abilities that contribute to optimal functioning in daily life. The model has received empirical support across cultures. The Mental Health Continuum-Short Form (MHC-SF) is the most widely used scale to measure the tripartite model of mental well-being.

Children and young adults

Mental health and stability is a very important factor in a person’s everyday life. Social skills, behavioral skills, and someone’s way of thinking are just some of the things that the human brain develops at an early age. Learning how to interact with others and how to focus on certain subjects are essential lessons to learn. This spans from the time we can talk all the way to when we are so old that we can barely walk. However, there are some people out there who have difficulty with these kind of skills and behaving like an average person. This is most likely the cause of having a mental illness. A mental illness is a wide range of conditions that affect a person’s mood, thinking, and behavior. About 26% of people in the United States, ages 18 and older, have been diagnosed with some kind of mental disorder. However, not much is said about children with mental illnesses even though there are many that will develop one, even as early as age three.
The most common mental illnesses in children include, but are not limited to, ADHD, autism and anxiety disorder, as well as depression in older children and teens. Having a mental illness at a younger age is much different from having one in your thirties. Children's brains are still developing and will continue to develop until around the age of twenty-five. When a mental illness is thrown into the mix, it becomes significantly harder for a child to acquire the necessary skills and habits that people use throughout the day. For example, behavioral skills don’t develop as fast as motor or sensory skills do. So when a child has an anxiety disorder, they begin to lack proper social interaction and associate many ordinary things with intense fear. This can be scary for the child because they don’t necessarily understand why they act and think the way that they do. Many researchers say that parents should keep an eye on their child if they have any reason to believe that something is slightly off. If the children are evaluated earlier, they become more acquainted to their disorder and treating it becomes part of their daily routine. This is opposed to adults who might not recover as quickly because it is more difficult for them to adapt.
Mental illness affects not only the person themselves, but the people around them. Friends and family also play an important role in the child’s mental health stability and treatment. If the child is young, parents are the ones who evaluate their child and decide whether or not they need some form of help. Friends are a support system for the child and family as a whole. Living with a mental disorder is never easy, so it’s always important to have people around to make the days a little easier. However, there are negative factors that come with the social aspect of mental illness as well. Parents are sometimes held responsible for their child’s own illness. People also say that the parents raised their children in a certain way or they acquired their behavior from them. Family and friends are sometimes so ashamed of the idea of being close to someone with a disorder that the child feels isolated and thinks that they have to hide their illness from others. When in reality, hiding it from people prevents the child from getting the right amount of social interaction and treatment in order to thrive in today’s society.
Stigma is also a well-known factor in mental illness. Stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” Stigma is used especially when it comes to the mentally disabled. People have this assumption that everyone with a mental problem, no matter how mild or severe, is automatically considered destructive or a criminal person. Thanks to the media, this idea has been planted in our brains from a young age. Watching movies about teens with depression or children with Autism makes us think that all of the people that have a mental illness are like the ones on TV. In reality, the media displays an exaggerated version of most illnesses. Unfortunately, not many people know that, so they continue to belittle those with disorders. In a recent study, a majority of young people associate mental illness with extreme sadness or violence. Now that children are becoming more and more open to technology and the media itself, future generations will then continue to pair mental illness with negative thoughts. The media should be explaining that many people with disorders like ADHDand anxiety, with the right treatment, can live ordinary lives and should not be punished for something they cannot help.
Sueki, (2013) carried out a study titled “The effect of suicide–related internet use on users’ mental health: A longitudinal Study”. This study investigated the effects of suicide-related internet use on user’s suicidal thoughts, predisposition to depression and anxiety and loneliness. The study consisted of 850 internet users; the data was obtained by carrying out a questionnaire amongst the participants. This study found that browsing websites related to suicide, and methods used to commit suicide, had a negative effect on suicidal thoughts and increased depression and anxiety tendencies. The study concluded that as suicide-related internet use adversely affected the mental health of certain age groups it may be prudent to reduce or control their exposure to these websites. These findings certainly suggest that the internet can indeed have a profoundly negative impact on our mental health.
Psychiatrist Thomas Szasz compared that 50 years ago children were either categorized as good or bad, and today "all children are good, but some are mentally healthy and others are mentally ill". The social control and forced identity creation is the cause of many mental health problems among today's children. A behaviour or misbehaviour might not be an illness but exercise of their free will and today's immediacy in drug administration for every problem along with the legal over-guarding and regard of a child's status as a dependent shakes their personal self and invades their internal growth.

Prevention

Mental health is conventionally defined as a hybrid of absence of a mental disorder and presence of well-being. Focus is increasing on preventing mental disorders. Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.[page needed] Some commentators have argued that a pragmatic and practical approach to mental disorder prevention at work would be to treat it the same way as physical injury prevention.
Prevention of a disorder at a young age may significantly decrease the chances that a child will suffer from a disorder later in life, and shall be the most efficient and effective measure from a public health perspective. Prevention may require the regular consultation of a physician for at least twice a year to detect any signs that reveal any mental health concerns. Similar to mandated health screenings, bills across the U.S. are being introduced to require mental health screenings for students attending public schools. Supporters of these bills hope to diagnose mental illnesses such as anxiety and depression in order to prevent self-harm and any harm induced on other students.[citation needed]

Cultural and religious considerations

Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate. Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment.
Research has shown that there is stigma attached to mental illness. In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma. Due to this stigma, responses to a positive diagnosis may be a display of denialism.
Family caregivers of individuals with mental disorders may also suffer discrimination or stigma.
Addressing and eliminating the social stigma and perceived stigma attached to mental illness has been recognized as a crucial part to addressing the education of mental health issues. In the United States, the National Alliance of Mental Illness is an institution that was founded in 1979 to represent and advocate for victims struggling with mental health issues. NAMI also helps to educate about mental illnesses and health issues, while also working to eliminate the stigma attached to these disorders such as anxiety and depression. Research has shown acts of discrimination and social stigma are associated with poorer mental health outcomes in racial (e.g. African Americans), ethnic (e.g. Muslim women), and sexual and gender minorities (e.g. transgender persons).,
Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association, however, far less attention is paid to the damage that more rigid, fundamentalist faiths commonly practiced in the United States can cause. This theme has been widely politicized in 2018 such as with the creation of the Religious Liberty Task Force in July of that year. In addition, many providers and practitioners in the United States are only beginning to realize that the institution of mental healthcare lacks knowledge and competence of many non-Western cultures, leaving providers in the United States ill-equipped to treat patients from different cultures.

Emotional improvement

Unemployment has been shown to have a negative impact on an individual's emotional well-being, self-esteem and more broadly their mental health. Increasing unemployment has been shown to have a significant impact on mental health, predominantly depressive disorders. This is an important consideration when reviewing the triggers for mental health disorders in any population survey. In order to improve your emotional mental health, the root of the issue has to be resolved. "Prevention emphasizes the avoidance of risk factors; promotion aims to enhance an individual's ability to achieve a positive sense of self-esteem, mastery, well-being, and social inclusion." It is very important to improve your emotional mental health by surrounding yourself with positive relationships. We as humans, feed off companionships and interaction with other people. Another way to improve your emotional mental health is participating in activities that can allow you to relax and take time for yourself. Yoga is a great example of an activity that calms your entire body and nerves. According to a study on well-being by Richards, Campania and Muse-Burke, "mindfulness is considered to be a purposeful state, it may be that those who practice it believe in its importance and value being mindful, so that valuing of self-care activities may influence the intentional component of mindfulness."

Care navigation

Mental health care navigation helps to guide patients and families through the fragmented, often confusing mental health industries. Care navigators work closely with patients and families through discussion and collaboration to provide information on best therapies as well as referrals to practitioners and facilities specializing in particular forms of emotional improvement. The difference between therapy and care navigation is that the care navigation process provides information and directs patients to therapy rather than providing therapy. Still, care navigators may offer diagnosis and treatment planning. Though many care navigators are also trained therapists and doctors. Care navigation is the link between the patient and the below therapies. A clear recognition that mental health requires medical intervention was demonstrated in a study by Kessler et al. of the prevalence and treatment of mental disorders from 1990 to 2003 in the United States. Despite the prevalence of mental health disorders remaining unchanged during this period, the number of patients seeking treatment for mental disorders increased threefold.

Emotional issues

Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative, which was created in 1998 by the World Health Organization (WHO). "Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease.These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, "even economically advantaged societies have competing priorities and budgetary constraints".
The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. "A first step is documentation of services being used and the extent and nature of unmet needs for treatment. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care."
Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near constant pressures to cut insurance and entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, United States), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the People's Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower middle-income (China, Colombia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income.
The coordinated surveys on emotional mental health disorders, their severity, and treatments were implemented in the aforementioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. Their research showed that "the number of respondents using any 12-month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care". "High levels of unmet need worldwide are not surprising, since WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually <1%) of already diminished health budgets on mental health care, and they rely heavily on out-of-pocket spending by citizens who are ill equipped for it".

Treatment

Older methods of treatment

Trepanation

Archaeological records have shown that trepanation was a procedure used to treat "headaches, insanities or epilepsy" in several parts of the world in the Stone age. It was a surgical process used in the Stone Age. Paul Broca studied trepanation and came up with his own theory on it. He noticed that the fractures on the skulls dug up weren't caused by wounds inflicted due to violence, but because of careful surgical procedures. "Doctors used sharpened stones to scrape the skull and drill holes into the head of the patient" to allow evil spirits which plagued the patient to escape. There were several patients that died in these procedures, but those that survived were revered and believed to possess "properties of a mystical order".

Lobotomy

Lobotomy was used in the 20th century as a common practice of alternative treatment for mental illnesses such as schizophrenia and depression. The first ever modern leucotomy meant for the purpose of treating a mental illness occurred in 1935 by a Portuguese neurologist, Antonio Egas Moniz. He received the Nobel Prize in medicine in 1949. . This belief that mental health illnesses could be treated by surgery came from Swiss neurologist, Gottlieb Burckhardt. After conducting experiments on six patients with schizophrenia, he claimed that half of his patients recovered or calmed down. Psychiatrist Walter Freeman believed that "an overload of emotions led to mental illness and “that cutting certain nerves in the brain could eliminate excess emotion and stabilize a personality", according to a National Public Radio article.

Exorcisms

"Exorcism is the religious or spiritual practice of evicting demons or other spiritual entities from a person, or an area, they are believed to have possessed."
Mental health illnesses such as Huntington’s Disease (HD), Tourette syndrome and schizophrenia were believed to be signs of possession by the Devil. This led to several mentally ill patients being subjected to exorcisms. This practice has been around for a long time, though decreasing steadily until it reached a low in the 18th century. It seldom occurred until the 20th century when the numbers rose due to the attention the media was giving to exorcisms. Different belief systems practice exorcisms in different ways.

Modern methods of treatment

Pharmacotherapy

Pharmacotherapy is therapy that uses pharmaceutical drugs. Pharmacotherapy is used in the treatment of mental illness through the use of antidepressants, benzodiazepines, and the use of elements such as lithium.

Physical Activity

For some people, physical exercise can improve mental as well as physical health. Playing sports, walking, cycling or doing any form of physical activity trigger the production of various hormones, sometimes including endorphins, which can elevate a person's mood.

Activity therapies

Activity therapies, also called recreation therapy and occupational therapy, promote healing through active engagement. Making crafts can be a part of occupational therapy. Walks can be a part of recreation therapy. In recent years colouring has been recognised as an activity which has been proven to significantly lower the levels of depressive symptoms and anxiety in many studies.

Expressive therapies

Expressive therapies are a form of psychotherapy that involves the arts or art-making. These therapies include music therapy, art therapy, dance therapy, drama therapy, and poetry therapy. It has been proven that Music therapy is an effective way of helping people who suffer from a mental health disorder.

Psychotherapy

Psychotherapy is the general term for scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as gestalt therapy, psychoanalysis, cognitive behavioral therapy and dialectical behavioral therapy. Group therapy involves any type of therapy that takes place in a setting involving multiple people. It can include psychodynamicgroups, activity groups for expressive therapy, support groups (including the Twelve-step program), problem-solving and psychoeducation groups.

Meditation

The practice of mindfulness meditation has several mental health benefits, such as bringing about reductions in depression, anxiety and stress. Mindfulness meditation may also be effective in treating substance use disorders. Further, mindfulness meditation appears to bring about favorable structural changes in the brain.
The Heartfulness meditation program has proven to show significant improvements in the state of mind of health-care professionals. A study posted on the US National Library of Medicine showed that these professionals of varied stress levels were able to improve their conditions after this meditation program was conducted. They benefited in aspects of burnouts and emotional wellness.
People with anxiety disorders participated in a stress-reduction program conducted by researchers from the Mental Health Service Line at the W.G. Hefner Veterans Affairs Medical Center in Salisbury, North Carolina. The participants practiced mindfulness meditation. After the study was over, it was concluded that the "mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia."

Spiritual counseling

Spiritual counselors meet with people in need to offer comfort and support and to help them gain a better understanding of their issues and develop a problem-solving relation with spirituality. These types of counselors deliver care based on spiritual, psychological and theological principles.[unreliable source?]

Social work in mental health

Social work in mental health, also called psychiatric social work, is a process where an individual in a setting is helped to attain freedom from overlapping internal and external problems (social and economic situations, family and other relationships, the physical and organizational environment, psychiatric symptoms, etc.). It aims for harmony, quality of life, self-actualization and personal adaptation across all systems. Psychiatric social workers are mental health professionals that can assist patients and their family members in coping with both mental health issues and various economic or social problems caused by mental illness or psychiatric dysfunctions and to attain improved mental health and well-being. They are vital members of the treatment teams in Departments of Psychiatry and Behavioral Sciences in hospitals. They are employed in both outpatient and inpatient settings of a hospital, nursing homes, state and local governments, substance abuse clinics, correctional facilities, health care services...etc.
In psychiatric social work there are three distinct groups. One made up of the social workers in psychiatric organizations and hospitals. The second group consists members interested with mental hygiene education and holding designations that involve functioning in various mental health services and the third group consist of individuals involved directly with treatment and recovery process.
In the United States, social workers provide most of the mental health services. According to government sources, 60 percent of mental health professionals are clinically trained social workers, 10 percent are psychiatrists, 23 percent are psychologists, and 5 percent are psychiatric nurses.
Mental health social workers in Japan have professional knowledge of health and welfare and skills essential for person's well-being. Their social work training enables them as a professional to carry out Consultation assistance for mental disabilities and their social reintegration; Consultation regarding the rehabilitation of the victims; Advice and guidance for post-discharge residence and re-employment after hospitalized care, for major life events in regular life, money and self-management and in other relevant matters in order to equip them to adapt in daily life. Social workers provide individual home visits for mentally ill and do welfare services available, with specialized training a range of procedural services are coordinated for home, workplace and school. In an administrative relationship, Psychiatric social workers provides consultation, leadership, conflict management and work direction. Psychiatric social workers who provides assessment and psychosocial interventions function as a clinician, counselor and municipal staff of the health centers.

Roles and functions

Social workers play many roles in mental health settings, including those of case manager, advocate, administrator, and therapist. The major functions of a psychiatric social worker are promotion and prevention, treatment, and rehabilitation. Social workers may also practice:

• Counseling and psychotherapy
• Case management and support services
• Crisis intervention
• Psychoeducation
• Psychiatric rehabilitation and recovery
• Care coordination and monitoring
• Program management/administration
• Program, policy and resource development
• Research and evaluation

Psychiatric social workers conduct psychosocial assessments of the patients and work to enhance patient and family communications with the medical team members and ensure the inter-professional cordiality in the team to secure patients with the best possible care and to be active partners in their care planning. Depending upon the requirement, social workers are often involved in illness education, counseling and psychotherapy. In all areas, they are pivotal to the aftercare process to facilitate a careful transition back to family and community.

History

United States

During the 1840s, Dorothea Lynde Dix, a retired Boston teacher who is considered the founder of the Mental Health Movement, began a crusade that would change the way people with mental disorders were viewed and treated. Dix was not a social worker; the profession was not established until after her death in 1887. However, her life and work were embraced by early psychiatric social workers, and she is considered one of the pioneers of psychiatric social work along with Elizabeth Horton, who in 1907 was the first psychiatric social worker in the New York hospital system, and others. The early twentieth century was a time of progressive change in attitudes towards mental illness. Community Mental Health Centers Act was passed in 1963. This policy encouraged the deinstitutionalisation of people with mental illness. Later, mental health consumer movement came by 1980s. A consumer was defined as a person who has received or is currently receiving services for a psychiatric condition. People with mental disorders and their families became advocates for better care. Building public understanding and awareness through consumer advocacy helped bring mental illness and its treatment into mainstream medicine and social services. In the 2000s focus was on Managed care movement which aimed at a health care delivery system to eliminate unnecessary and inappropriate care in order to reduce costs & Recovery movement in which by principle acknowledges that many people with serious mental illness spontaneously recover and others recover and improve with proper treatment.
Role of social workers made an impact with 2003 invasion of Iraq and War in Afghanistan (2001–present) social workers worked out of the NATO hospital in Afghanistan and Iraq bases. They made visits to provide counseling services at forward operating bases. Twenty-two percent of the clients were diagnosed with post-traumatic stress disorder, 17 percent with depression, and 7 percent with alcohol abuse. In 2009, a high level of suicides was reached among active-duty soldiers: 160 confirmed or suspected Army suicides. In 2008, the Marine Corps had a record 52 suicides. The stress of long and repeated deployments to war zones, the dangerous and confusing nature of both wars, wavering public support for the wars, and reduced troop morale have all contributed to the escalating mental health issues. Military and civilian social workers are primary service providers in the veterans’ health care system.
Mental health services, is a loose network of services ranging from highly structured inpatient psychiatric units to informal support groups, where psychiatric social workers indulges in the diverse approaches in multiple settings along with other paraprofessional workers.

Canada

A role for psychiatric social workers was established early in Canada’s history of service delivery in the field of population health. Native North Americans understood mental trouble as an indication of an individual who had lost their equilibrium with the sense of place and belonging in general, and with the rest of the group in particular. In native healing beliefs, health and mental health were inseparable, so similar combinations of natural and spiritual remedies were often employed to relieve both mental and physical illness. These communities and families greatly valued holistic approaches for preventative health care. Indigenous peoples in Canada have faced cultural oppression and social marginalization through the actions of European colonizers and their institutions since the earliest periods of contact. Culture contact brought with it many forms of depredation. Economic, political, and religious institutions of the European settlers all contributed to the displacement and oppression of indigenous people.
The first officially recorded treatment practices were in 1714, when Quebec opened wards for the mentally ill. In the 1830s social services were active through charity organizations and church parishes (Social Gospel Movement). Asylums for the insane were opened in 1835 in Saint John and New Brunswick. In 1841 in Toronto, when care for the mentally ill became institutionally based. Canada became a self-governing dominion in 1867, retaining its ties to the British crown. During this period age of industrial capitalism began, which lead to a social and economic dislocation in many forms. By 1887 asylums were converted to hospitals and nurses and attendants were employed for the care of the mentally ill. The first social work training began at the University of Toronto in 1914. In 1918 Clarence Hincks & Clifford Beers founded the Canadian National Committee for Mental Hygiene, which later became the Canadian Mental Health Association. In the 1930s Dr. Clarence Hincks promoted prevention and of treating sufferers of mental illness before they were incapacitated/early detection.
World War II profoundly affected attitudes towards mental health. The medical examinations of recruits revealed that thousands of apparently healthy adults suffered mental difficulties. This knowledge changed public attitudes towards mental health, and stimulated research into preventive measures and methods of treatment. In 1951 Mental Health Week was introduced across Canada. For the first half of the twentieth century, with a period of deinstitutionalisation beginning in the late 1960s psychiatric social work succeeded to the current emphasis on community-based care, psychiatric social work focused beyond the medical model’s aspects on individual diagnosis to identify and address social inequities and structural issues. In the 1980s Mental Health Act was amended to give consumers the right to choose treatment alternatives. Later the focus shifted to workforce mental health issues and environment.

India

The earliest citing of mental disorders in India are from Vedic Era (2000 BC – AD 600). Charaka Samhita, an ayurvedic textbook believed to be from 400–200 BC describes various factors of mental stability. It also has instructions regarding how to set up a care delivery system. In the same era In south India Siddha was a medical system, the great sage Agastya, one of the 18 siddhas contributing to a system of medicine has included the Agastiyar Kirigai Nool, a compendium of psychiatric disorders and their recommended treatments. In Atharva Veda too there are descriptions and resolutions about mental health afflictions. In the Mughal period Unani system of medicine was introduced by an Indian physician Unhammad in 1222. Then existed form of psychotherapy was known then as ilaj-i-nafsani in Unani medicine.
The 18th century was a very unstable period in Indian history, which contributed to psychological and social chaos in the Indian subcontinent. In 1745 of lunatic asylums were developed in Bombay (Mumbai) followed by Calcutta (Kolkata) in 1784, and Madras (Chennai) in 1794. The need to establish hospitals became more acute, first to treat and manage Englishmen and Indian ‘sepoys’ (military men) employed by the British East India Company. The First Lunacy Act (also called Act No. 36) that came into effect in 1858 was later modified by a committee appointed in Bengal in 1888. Later, the Indian Lunacy Act, 1912 was brought under this legislation. A rehabilitation programme was initiated between 1870s and 1890s for persons with mental illness at the Mysore Lunatic Asylum, and then an occupational therapy department was established during this period in almost each of the lunatic asylums. The programme in the asylum was called ‘work therapy’. In this programme, persons with mental illness were involved in the field of agriculture for all activities. This programme is considered as the seed of origin of psychosocial rehabilitation in India.
Berkeley-Hill, superintendent of the European Hospital (now known as the Central Institute of Psychiatry (CIP), established in 1918), was deeply concerned about the improvement of mental hospitals in those days. The sustained efforts of Berkeley-Hill helped to raise the standard of treatment and care and he also persuaded the government to change the term ‘asylum’ to ‘hospital’ in 1920. Techniques similar to the current token-economy were first started in 1920 and called by the name ‘habit formation chart’ at the CIP, Ranchi. In 1937, the first post of psychiatric social worker was created in the child guidance clinic run by the Dhorabji Tata School of Social Work (established in 1936), It is considered as the first documented evidence of social work practice in Indian mental health field.
After Independence in 1947, general hospital psychiatry units (GHPUs) where established to improve conditions in existing hospitals, while at the same time encouraging outpatient care through these units. In Amritsar a Dr. Vidyasagar, instituted active involvement of families in the care of persons with mental illness. This was advanced practice ahead of its times regarding treatment and care. This methodology had a greater impact on social work practice in the mental health field especially in reducing the stigmatisation. In 1948 Gauri Rani Banerjee, trained in the United States, started a master’s course in medical and psychiatric social work at the Dhorabji Tata School of Social Work (Now TISS). Later the first trained psychiatric social worker was appointed in 1949 at the adult psychiatry unit of Yervada mental hospital, Pune.
In various parts of the country, in mental health service settings, social workers were employed—in 1956 at a mental hospital in Amritsar, in 1958 at a child guidance clinic of the college of nursing, and in Delhi in 1960 at the All India Institute of Medical Sciences and in 1962 at the Ram Manohar Lohia Hospital. In 1960, the Madras Mental Hospital (Now Institute of Mental Health), employed social workers to bridge the gap between doctors and patients. In 1961 the social work post was created at the NIMHANS. In these settings they took care of the psychosocial aspect of treatment. This had long-term greater impact of social work practice in mental health.
In 1966 by the recommendation Mental Health Advisory Committee, Ministry of Health, Government of India, NIMHANS commenced Department of Psychiatric Social Work started and a two-year Postgraduate Diploma in Psychiatric Social Work was introduced in 1968. In 1978, the nomenclature of the course was changed to MPhil in Psychiatric Social Work. Subsequently, a PhD Programme was introduced. By the recommendations Mudaliar committee in 1962, Diploma in Psychiatric Social Work was started in 1970 at the European Mental Hospital at Ranchi (now CIP), upgraded the program and added other higher training courses subsequently.
A new initiative to integrate mental health with general health services started in 1975 in India. The Ministry of Health, Government of India formulated the National Mental Health Programme (NMHP) and launched it in 1982. The same was reviewed in 1995 and based on that, the District Mental Health Program (DMHP) launched in 1996 and sought to integrate mental health care with public health care. This model has been implemented in all the states and currently there are 125 DMHP sites in India.
National Human Rights Commission (NHRC) in 1998 and 2008 carried out systematic, intensive and critical examinations of mental hospitals in India. This resulted in recognition of the human rights of the persons with mental illness by the NHRC. From the NHRC's report as part of the NMHP, funds were provided for upgrading the facilities of mental hospitals. This is studied to result in positive changes over the past 10 years than in the preceding five decades by the 2008 report of the NHRC and NIMHANS. In 2016 Mental Health Care Bill was passed which ensures and legally entitles access to treatments with coverage from insurance, safeguarding dignity of the afflicted person, improving legal and healthcare access and allows for free medications. In December 2016, Disabilities Act 1995 was repealed with Rights of Persons with Disabilities Act (RPWD), 2016 from the 2014 Bill which ensures benefits for a wider population with disabilities. The Bill before becoming an Act was pushed for amendments by stakeholders mainly against alarming clauses in the "Equality and Non discrimination" section that diminishes the power of the act and allows establishments to overlook or discriminate against persons with disabilities and against the general lack of directives that requires to ensure the proper implementation of the Act.
Lack of any universally accepted single licensing authority compared to foreign countries puts social workers at general in risk. But general bodies/councils accepts automatically a university-qualified social worker as a professional licensed to practice or as a qualified clinician. Lack of a centralized council in tie-up with Schools of Social Work also makes a decline in promotion for the scope of social workers as mental health professionals. Though in this midst the service of social workers has given a facelift of the mental health sector in the country with other allied professionals.

Prevalence and programs

See also: Global mental health

Evidence suggests that 450 million people worldwide are impacted by mental health, major depression ranks fourth among the top 10 leading causes of disease worldwide. Within 20 years, mental illness is predicted to become the leading cause of disease worldwide. Women are more likely to have a mental illness than men. One million people commit suicide every year and 10 to 20 million attempt it.

Australia

A survey conducted by Australian Bureau of Statistics in 2008 regarding adults with manageable to severe neurosis reveals almost half of the population had a mental disorder at some point of their life and one in five people had a sustained disorder in the preceding 12 months. In neurotic disorders, 14% of the population experienced anxiety disorders, comorbidity disorders were the next common mental disorder with vulnerability to substance abuse and relapses. There were distinct gender differences in disposition to mental health illness. Women were found to have high rate of mental health disorders and Men had higher propensity of risk for substance abuse. The SMHWB survey showed low socioeconomic status and high dysfunctional pattern in the family was proportional to greater risk for mental health disorders. A 2010 survey regarding adults with psychosis revealed 5 persons per 1000 in the population seeks professional mental health services for psychotic disorders and the most common psychotic disorder was schizophrenia.

Canada

According to statistics released by the Centre of Addiction and Mental Health one in five people in Ontario experience a mental health or addiction problem.[citation needed] Young people ages 15 to 25 are particularly vulnerable.[citation needed] Major depression is found to affect 8% and anxiety disorder 12% of the population.[citation needed] Women are 1.5 times more likely to suffer from mood and anxiety disorders.[citation needed] WHO points out that there are distinct gender differences in patterns of mental health and illness.[citation needed] The lack of power and control over their socioeconomic status, gender based violence; low social position and responsibility for the care of others render women vulnerable to mental health risks.[citation needed] Since more women than men seek help regarding a mental health problem, this has led to not only gender stereotyping but also reinforcing social stigma. WHO has found that this stereotyping has led doctors to diagnose depression more often in women than in men even when they display identical symptoms. Often communication between health care providers and women is authoritarian leading to either the under-treatment or over-treatment of these women.

Organizations

Women's College Hospital is specifically dedicated to women's health in Canada. This hospital is located in downtown Toronto where there are several locations available for specific medical conditions. WCH is an organization that helps educate women on mental illness due to its specialization with women and mental health. The organization helps women who have symptoms of mental illnesses such as depression, anxiety, menstruation, pregnancy, childbirth, and menopause. They also focus on psychological issues, abuse, neglect and mental health issues from various medications.
The countless aspect about this organization is that WCH is open to women of all ages, including pregnant women that experience poor mental health. WCH not only provides care for good mental health, but they also have a program called the "Women's Mental Health Program" where doctors and nurses help treat and educate women regarding mental health collaboratively, individually, and online by answering questions from the public.
The second organization is the Centre for Addiction and Mental Health (CAMH). CAMH is one of Canada's largest and most well-known health and addiction facilities, and it has received international recognitions from the Pan American Health Organization and World Health Organization Collaborating Centre. They practice in doing research in areas of addiction and mental health in both men and women. In order to help both men and women, CAMH provides "clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues." CAMH is different from Women's College Hospital due to its widely known rehab centre for women who have minor addiction issues, to severe ones. This organization provides care for mental health issues by assessments, interventions, residential programs, treatments, and doctor and family support.

United States

According to the World Health Organization in 2004, depression is the leading cause of disability in the United States for individuals ages 15 to 44. Absence from work in the U.S. due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention). In 2004, suicide was the 11th leading cause of death in the United States (Centers for Disease Control and Prevention), third among individuals ages 15–24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high.[citation needed] By way of comparison, a study conducted in Australia during 2006 to 2007 reported that one-third (34.9%) of patients diagnosed with a mental health disorder had presented to medical health services for treatment.
There are many factors that influence mental health including:

• Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment.
• Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability.

Emotional mental illnesses should be a particular concern in the United States since the U.S. has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries. While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on the average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care. The government offers everyone programs and services, but veterans receive the most help, there is certain eligibility criteria that has to be met.

Policies

The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the "mental hygiene" movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.
In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: "I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience…." Many asylums were built in that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In those asylums, traditional treatments were well implemented: drugs were not used as a cure for a disease, but a way to reset equilibrium in a person's body, along with other essential elements such as healthy diets, fresh air, middle class culture, and the visits by their neighboring residents.[citation needed] In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.
In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital. One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists – including Beer himself – which marked the beginning of the "mental hygiene" movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues. However, prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the depression.
In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days. However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power. Besides, the community helping system was not fully established to support the patients' housing, vocational opportunities, income supports, and other benefits. Many patients returned to welfareand criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.
After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act of 1980 to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone. Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were diagnosed with a "chronic mental illness." People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge. Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.
However, several critics maintain that deinstitutionalization has, from a mental health point of view, been a thoroughgoing failure. The seriously mentally ill are either homeless, or in prison; in either case (especially the latter), they are getting little or no mental health care. This failure is attributed to a number of reasons over which there is some degree of contention, although there is general agreement that community support programs have been ineffective at best, due to a lack of funding.
The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programs, which increase the likelihood of prevention programs being included in future US mental health policies.[page needed] The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.
In 2013, United States Representative Tim Murphy introduced the Helping Families in Mental Health Crisis Act, HR2646. The bipartisan bill went through substantial revision and was reintroduced in 2015 by Murphy and Congresswoman Eddie Bernice Johnson. In November 2015, it passed the Health Subcommittee by an 18–12 vote.

Abortion in Africa

Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus. An abortion that occurs without intervention is known as a miscarriage or spontaneous abortion. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. A similar procedure after the fetus has potential to survive outside the womb is known as a "late termination of pregnancy" or less accurately as a "late term abortion".

Ads for abortion clinics in East London, South Africa

Abortion in Algeria

Algeria is the most restricted country in the region regarding abortion. There are many laws and punishments regarding abortion. If there are posters, publicity, public meetings, group meetings that have to do with abortion, anyone involved can be punished.

The 3 grounds
A government bill on health issues proposed to make abortions legal on three grounds. One being that a woman could have an abortion if they were psychologically and or mentally at risk. The second one being non-viable or severe fetal abnormality or disease. The third ground being that the health or the life of the woman will be at risk if the pregnancy was to continue. When the woman is to see the doctor, the doctor must get the consent of that woman and inform her of the whole situation.

This is the text that was published when the bill was passed, “Therapeutic termination of pregnancy is intended to preserve the health of the mother and when her life or psychological and mental balance is seriously threatened by pregnancy. The detailed rules for the application of this article are laid down by regulation.”

Before August 14, 2018
This new law for abortion was being debated for way too long in the National Assembly. Before this, Algerians only option for abortion was to go to clinics or “Tunisia”. These clinics did not have any safety or good hygiene environments. The clinics did not meet any of the standards therefore would be risking the woman’s life.

There have been many cases of death of a pregnant woman and where there have beem fetuses’ and newborns found in dumpsters and trash cans. This shows that there has been a huge distress of a woman seeking an abortion.

Secret abortion clinics
There have been secret abortion clinics in Algeria. Many of the clients were young girls who made a mistake and wanted it to go away. Other clients were women who were housewives and when the husband found out about the babies, the mothers were forced to give them up. One common reason why these women go to the secret abortion clinics is because they don’t want to be pushed away from their families. Another reason being that they are truly not ready to care to a child. These women do a lot to get these illegal abortions done for example saving money for long periods of time and selling jewelry.

Abortion and Rape
In 1998, there was a big uproar about abortion in Algeria’s laws because of women being raped by Islamic Rebels. There were obvious ground rules, but women wanted a change. Women wanted to have the right to get an abortion if they had been raped. While the decisions were being made for four long years, 1,600 young women had been abducted by roving bands of the Armed Islamic Group.

The ground of rape was no included in the three grounds for the new law on abortion. A journalist made the point that the three group points and the ground point of rape used to be included when Algeria was fighting for independence but is not anymore. This is implying that the country has gone backwards since then in terms of abortion.

International Campaign for Women’s Right to Safe Abortion
This is a campaign that supports Women’s rights and protects so they can live in a safe environment. On the website they talk about many problems that are going on all over the world that involve women. One of the important topics they talk about on this website and campaign is Abortion in Algeria. This campaign works with many people and protest with the women to get women the support they need with abortion. The campaign keeps people up to date and gives money to make a difference in theses women’s lives.

Abortion in Angola

Abortion in Angola is only legal if the abortion will save the woman's life. In Angola, any abortion performed under different conditions subjects the woman and the person who performs the procedure to up to three years in prison. If the woman dies as a result of the abortion, the criminal charges are increased by one-third.

Barriers to legal reform
Angolan measures to reduce the number of unsafe illegal abortions by making legal abortions more accessible have been difficult to pass because of the conservative populace.

Unsafe abortion
Unsafe abortions are one of the leading causes of maternal death in the developing world. In many African countries, abortions are considered taboo. Women who get abortions often are associated with negative stereotypes due to cultural beliefs. Many of these cultural issues force women to seek abortions in unsafe ways. According to the Women's international Network News, these "back-alley" abortions are the cause of thousands of deaths every year.

More political attention has been given to the issue of abortions in Angola due to the unsafe procedures and the health effects on young women. Justice Minister Guilhermina Prata recently presented legislation with the intent to help decrease the number of illegal abortions done in Angola. In the region of Sub-Sahara Africa, the majority, if not all, of illegal abortions are unsafe. It is believed that 40 percent of women who have an illegal abortion die due to complications of the surgery. Information on unsafe abortions in Angola is difficult to obtain. However, due to the nature of the health care system and the prevalence of unofficial fees, the number of illegal abortions is potentially much higher than is reported. The debate regarding unsafe abortions in Angola is not new and is highly affected by the cultural and religious atmosphere in the country.

Abortion in Benin

Abortion in Benin is only legal if the abortion will save the woman's life. A select list of experts are allowed to examine a pregnancy to determine whether the only option for saving the woman's life is to induce abortion.

Impact of strict abortion laws
Self-induced abortions have been growing in Benin, especially among students in high school or university, and the average age of abortion recipients is 19.

Abortion in Botswana

Abortion in Botswana is only legal if the abortion will save the woman's life, if the pregnancy gravely endangers the woman's physical or mental health, or if it is a result of rape or incest. In Botswana, abortions that meet these requirements must be performed within the first 16 weeks of pregnancy in a government hospital and must be approved by two physicians.

Impact of restrictive abortion laws
Though women in Botswana are recognized as having some of the best access to abortions in Sub-Saharan Africa because of these exceptions, many women are still resorting to unsafe abortions and self-induced abortions, commonly leading to maternal death.

Socio-cultural impacts on abortion
In Botswana, many families still follow the lobolo custom where men pay a woman's family in order to take her as a bride. This has established an expectation that husbands have paid for and own their wives' bodies, including their reproductive rights. Even though this sentiment may lead to pregnancy that is a result of rape, hospitals and clinics are unlikely to approve marital rape cases as justifying abortion, as cultural norms suggest husbands are entitled to their wives' bodies.

Abortion in Burkina Faso

Abortion in Burkina Faso is only legal if the abortion will save the woman's life, the pregnancy gravely endangers the woman's physical or mental health, the child will potentially be born with an incurable disease, or in cases where the pregnancy is a result of rape or incest, so long as it is proven by a state prosecutor. Even these abortions are limited to the first ten weeks of pregnancy.

In Burkina Faso, any abortion performed under other conditions subjects the person who performs the procedure subject to one to five years’ imprisonment and imposition of a fine of 300,000 to 1,500,000 CFA francs.

Impact of restricted abortion laws
In the early 1990s, at least 5% of women admitted into healthcare facilities for maternal health concerns had life-threatening complications from unsafe abortions, and 70% of these women were between 16 and 24 years of age. During the same time period, 35% of women who sought medical treatment for infertility had previously been recipients of an illegal abortion.

Abortion in Burundi

It has been suggested that this article be merged into Abortion law#National laws. (Discuss) Proposed since March 2019.
Abortion in Burundi is only legal if the abortion will save the woman's life or if the pregnancy gravely endangers the woman's physical, or potentially mental, health. In Burundi, two certified physicians must agree that the pregnancy is threatening before giving medical assistance. Even in cases in which an abortion practitioner has deemed that the pregnancy has endangered the woman, both the physician and woman may be subject to prison time and fines.

Abortion in Cameroon

It has been suggested that this article be merged into Abortion law#National laws. (Discuss) Proposed since March 2019.
Abortion in Cameroon is only legal if the abortion will save the woman's life, the pregnancy gravely endangers the woman's physical or mental health, or the pregnancy is a result of rape.

Statistics
In 1997, a survey in Yaoundé found 20 percent of women aged 20–29 had had at least one abortion. 80 percent of these procedures took place in a medical facility, but they were not always safe, and women often faced complications. The odds that a pregnant woman would seek an abortion were increased if they were educated or had children. Of women reporting past abortions, 40% had two or more. The survey found that 35% of all reported pregnancies in the capital city ended in abortion.

Access to reproductive health care
In 1990, the Cameroon government passed Act No. 90/035 to prohibit birth control education. Reports found that abortion and secretive reproductive health services were widespread and made up 40 percent of OB/GYN emergency admissions. However, most access to abortion clinics were limited to urban centers within the country.

Abortion in the Central African Republic

It has been suggested that this article be merged into Abortion law#National laws. (Discuss) Proposed since March 2019.
Abortion in the Central African Republic is prohibited by law unless the pregnancy is the result of rape. According to general medical practice, the medical procedure is only legal if the abortion will save the woman's life, though this is not explicitly stated in any law. Anyone who performs an abortion faces up to five years in prison and a fine, and physicians risk losing their medical licenses for up to five years.

History
Prior to 2006, law in the Central African Republic explicitly outlawed abortion. In 2006, the National Assembly legalized abortion care in cases of rape, as women regularly faced sexual violence, rape, and gang rape in the war-ravaged country.

Women's health implications
Women with unwanted pregnancies in the Central African Republic do not have legal access to medical care. They still seek reproductive health care, but experts believe they often resort to conditions that are not sterile or medically safe.

Abortion in Chad

It has been suggested that this article be merged into Abortion law#National laws. (Discuss) Proposed since March 2019.
Abortion in Chad is prohibited by law. According to general medical practice, the medical procedure is only legal if the abortion will save the woman's life, though this is not explicitly stated in any law. Anyone who performs an abortion faces up to five years in prison and a fine, and physicians risk losing their medical licenses for at least five years and possibly indefinitely. Someone charged for regularly performing abortions faces up to ten years in prison. According to local experts, women and their physicians are rarely prosecuted for receiving or giving illegal abortions.

Abortion in Egypt

Abortion in Egypt is prohibited by Articles 260–264 of the Penal Code of 1937. However, under Article 61 of the Penal Code, exceptions may be granted in cases of necessity, which has typically been interpreted to permit an abortion necessary to save the life of the pregnant woman. In some cases, this exception has been extended to cases where the pregnancy poses dangers to the pregnant woman's health, and to cases of foetal impairment. A physician can only perform an abortion in such cases when two specialists approve, unless the woman's life is in imminent danger.

Any person who induces an abortion may be imprisoned, and physicians who do so may be sentenced to prison. Convictions are uncommon, because the prosecution must prove that the woman was pregnant and the means by which the pregnancy was interrupted.

In 1998, Muhammad Sayyid Tantawy, the Grand Imam of al-Azhar, issued a fatwa calling for access to abortion for unmarried women who had been raped. In 2004 he approved a draft bill that would permit abortion in the case of rape; the bill was unsuccessful.

Despite legal restrictions, abortions are common. In a 2000 study of 1025 women from six villages in Upper Egypt, 416 were found to have had at least one abortion; among this group, there were 265 abortions per 1000 live births. Abortions are carried out by indigenous methods, at clandestine clinics, or at great expense by private gynecologists.

In addition, unsafe abortions are common: a 1998 study found that about 20% of obstetric hospital admissions were for post-abortion treatment. One study estimated that between 1995 and 2000, there were 2,079,216 abortions, and 2,542 maternal deaths due to unsafe abortions.

Abortion in Ghana

Abortion in Ghana is illegal. Abortions are criminal offenses subject to at most five years in prison for the pregnant woman who induced said abortion, as well as for any doctor or other person who assisted this pregnant woman in accessing, or carrying out, an abortion. Attempts to cause abortions are also criminal, as are the purveyance, supply, or procurement of chemicals and instruments whose intent is to induce abortions.

Terminology
The definition of abortion is quite wide. According to Act 29, section 58, article 3, of the Criminal code of 1960, “Abortion or miscarriage means premature expulsion or removal of conception from the uterus or womb before the period of gestation is completed.” Thus, both words, abortion and miscarriage, can be used interchangeably to refer to the same phenomenon. The law would seem to cover induced abortions, where the pregnant woman willfully expels a viable fetus, and also spontaneous abortions, or miscarriages, which may be encouraged by the pregnant woman through various means. Medically, there have been attempts to clearly distinguish between the two, but the laws in Ghana concerning this matter do not make this distinction.

Exceptions
In some situations, abortions are legal. The laws of Ghana allow abortions where (1) the pregnancy was as a result of rape, defilement, or incest, which are themselves all crimes in Ghana, and (2) where the pregnant woman requests the abortion. The pregnant woman's next of kin may request the abortion if the woman lacks the capacity to request it. For instance, if she is unconscious and in need of immediate medical attention that may entail abortion; if she is mentally incapable of making medical decisions (for example has an Intellectual disability); or if she is a minor according to the law. In Ghana, the age of minority is below eighteen years, although the legal age for marriage is sixteen years of age.

Law
Abortion is a criminal offence pursuant to Act 29, section 58 of the Criminal code of 1960, amended by PNDCL 102 of 1985, which states that:

Subject to the provisions of subsection (2) of this section
any woman who with intent to cause abortion or miscarriage administers to herself or consent to be administered to her any poison, drug or other noxious thing or uses any instrument or other means whatsoever; or
any person who—
administers to a woman any poison, drug or other noxious thing or uses any instrument or other means whatsoever with intent to cause abortion or miscarriage, whether or not the woman is pregnant or has given her consent
induces a woman to cause or consent to causing abortion or miscarriage;
aids and abets a woman to cause abortion or miscarriage;
attempts to cause abortion or miscarriage; or
supplies or procures any poison, drug, instrument or other thing knowing that it is intended to be used or employed to cause abortion or miscarriage; shall be guilty of an offence and liable on conviction to imprisonment for a term not exceeding five years.
It is not an offense under section (1) if an abortion or miscarriage is caused in any of the following circumstances by a registered medical practitioner specializing in Gynaecology or any other registered medical practitioner in a government hospital or a private hospital or clinic registered under the Private Hospital and Maternity Home Act, 1958 (No. 9) or in a place approved for the purpose by legislative instrument made by the Secretary:
where pregnancy is the result of rape or defilement of a female idiot or incest and the abortion or miscarriage is requested by the victim or her next of kin or the person in loco parentis, if she lacks the capacity to make such request;
where the continuance of the pregnancy would involve risk to the life of the pregnant woman or injury to her physical or mental health and such a woman consents to it or if she lacks the capacity to give such consent it is given on her behalf by her next of kin or the person in loco parentis;
where there is substantial risk that if the child were born it may suffer from or later develop a serious physical abnormality or disease.
For the purposes of this section, abortion or miscarriage means premature expulsion or removal of conception from the uterus or womb before the period of gestation is completed.

Statistics
According to national statistical data from 2009, 7% of all pregnancies are aborted. Within the population of women between 15 and 49, 15% have had abortions. For every 1,000 women in Ghana of childbearing age of 15 to 44, 15 abortions are performed. Another study carried out in the 1990s suggested that in southern Ghana, the number is marginally higher, at 17 abortions for every 1,000 women. This number is lower than the statistics available for West Africa as a whole: abortions rates are at 28 per 1,000 women

Ghanaian women of the following demographics are more likely to have abortions: women who have never been married; women in their twenties; women with no children; wealthy women; and women from urban areas. Never-married women are twice as likely to seek the procedure as those who are married. The tendency to seek abortion decreases with number of children: women with no children are seven times more likely to seek an abortion than women with three or more children. For these women, the most prominent reason for seeking the abortion was the stigma associated with having a child out of wedlock. Women who have had previous abortions are far more likely to seek the procedure. Researchers peg this to the possibility that these women may have more knowledge, both of the legal status of abortions, and more likely, where to obtain the procedure. Women in the top 40% of the wealth distribution in the country are 67% - 80% more likely to have abortions that their poorer counterparts. Younger women are more likely to seek abortions, with women between 20 and 24 years being most likely, at 25 abortions per 1,000 women, and the frequency decreasing with every successive age group. Urban women are far more likely to have abortions, with 34 abortions per 1,000 women. Overall, urbanites are 110% more likely to seek abortions than their rural counterparts, at 21 abortions per 1,000 women versus 10 abortions per 1,000 women.

The reasons that Ghanaian women give for seeking abortions include: the financial inability to care for a child; the pregnancy interfering with their occupation or schooling; and wanting to space out their childbearing or to limit family size. Also due to limited number of legal practitioners to perform safe abortion, it is expensive therefore lots of women cannot afford it and they turn to have unsafe abortion by unskilled practitioners

Approximately 45% of abortions in Ghana are unsafe. 11% of Ghanaian maternal deaths are due to unsafe abortions, and maternal mortality is the second leading cause of death among Ghanaian women. Some women experience complications from these experiences. Because so few women know that abortions are legal on many grounds in Ghana, they do not seek, or demand post abortion care, even when they have legitimate reasons to obtain legal abortions. According to a 2007 survey, only 3% of pregnant women, and 6% of women actively seeking abortions, knew the laws surrounding the procedure.

These numbers are relatively unreliable, because of how stigmatized abortions are in Ghana. Much of this data was collected based on face-to-face interviews, rendering it unlikely that they will reveal an accurate estimate of the occurrence of abortions. According to a paper, the number of abortions in Ghana is more likely to be closer to the West African rate of 28 per 1,000 women.

Abortion and Contraceptives
The low rate of contraceptive use is part of the driver for abortions. According to national statistical data, contraceptive use has increased over the decades, but from 13% use by married women in 1988, to just 25% by this demographic in 2003 followed by a slight decline to 24% in 2008. A much higher proportion of sexually active unmarried women use modern contraceptives, but in 2008, this number was just 28% of the population. As such, 35% of married women, and 20% of sexually active unmarried married fall in the pool of people who are not seeking children, and yet are not using any modern contraceptive methods.

As a consequence of this dearth, upwards of 37% of pregnancies in Ghana are unintended. A further 23% are mistimed, that is to say, do not occur at a time preferred by the individuals. 14% of all pregnancies are not wanted by the individuals pregnant. This translates to more than 300,000 children being products of unwanted pregnancies.

Overall, the average number of children Ghanaian women have has decreased from 6.4 to 4.0 between 1988 and 2008. Nonetheless, this does not match the recorded desire of women, who wish to have less than four children. For more than a third of these women who are not looking for children nor are on contraceptives, the reason they give for not doing so are often health related, or a fear of the side effects and the risks associated with the use of contraceptives. The proportion of women in this pool rises with education and urbanity. Poorer women are overall more likely to have unplanned births, and less likely to use modern contraceptives, than their wealthier counterparts.

Abortion in Kenya
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Abortion in Kenya is prohibited by article 26(IV) of the constitution unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law. Unsafe abortions are a leading cause of maternal morbidity and mortality in Kenya.

The 2010 Kenyan constitutional referendum that introduced article 26 broadened access to abortion by allowing it for maternal health reasons. Christian churches, who feared it would lead to the legalisation of abortion, opposed the amendment.

A survey of 2012 by the Kenyan Ministry of Health, African Population &amp; Health Research Center and IPSAS found that there were 464,000 abortions induced that year, which translates to an abortion rate of 48 per 1,000 women aged 15-49; and an abortion ratio of 30 per 100 live births. About half (49 %) of all pregnancies in Kenya were unintended and 41 % of unintended pregnancies ended in an abortion. Marie Stopes International estimates that 2,600 women die from unsafe abortions annually, an average seven deaths a day.Nearly 120,000 women are hospitalized each year due to abortion-related complications.

The publication these statistics in 2018 and the death of activist Caroline Mwatha in February of 2019 following an unsafe abortion has brought the debate on abortion to the forefront in recent times.

Abortion in Namibia

Abortion in Namibia is restricted under the Abortion and Sterilisation Act of South Africa (1975), which Namibia inherited at the time of Independence from South Africa in March 1990. The act only allows for the termination of a pregnancy in cases of serious threat to the maternal or fetal health or when the pregnancy is a result of rape or incest.

Legal position
Abortion is only allowed when continuing the pregnancy will "endanger the woman’s life or constitute a serious threat to her physical or mental health or there must be a serious risk that the child to be born will suffer from a physical or mental defect so as to be irreparably seriously handicapped, when the foetus is alleged to have been conceived in consequence of unlawful carnal intercourse (rape or incest); or when the foetus has been conceived in consequence of illegitimate carnal intercourse and the woman is, owing to a permanent mental handicap or defect, unable to comprehend the implications of or bear the parental responsibility for the “fruit of coitus”."

In addition to the woman’s doctor, two other doctors are required to certify the existence of grounds for an abortion, and the operation must be performed by a medical practitioner in a State hospital or an approved medical facility."

In a statement at the 1994 International Conference on Population and Development in Cairo, then Minister of Health and Social Services Nickey Iyambo stated:

On the question of abortion, the position of Namibia is that it can only be performed under strict medical supervision within the confines of the laws, which state that consent to abortion can only be given in cases of rape, incest and when the life of the mother is in danger. Mr. President, ladies and gentlemen it must be clearly understood that Namibia does not promote abortion as a means of family planning but as a public health issue.

Impact of abortion restrictions
The lack of emergency contraceptive use and access to safe legal abortions are contributing factors to the problem of abandonment of newborns, which is acknowledged to be a serious problem in the country.

Medical Practice

For abortion to be as safe as possible for a woman , the procedure needs to be performed as early in pregnancy as her decision about continuing the pregnancy permits .

Health Implications involved

If the process is not done accordingly and by a professional, it might lead to infertility, death or one might end up paralyzed

Abortion in Nigeria

Abortion is a controversial topic in Nigeria. Abortion in Nigeria is governed by two laws that differ depending on geographical location. Northern Nigeria is governed by The Penal Code and southern Nigeria is governed by The Criminal Code. The only legal way to have an abortion in Nigeria is if having the child is going to put the mother's life in danger.

Nigerian Law
Nigeria’s abortion laws make it one of the most restrictive countries regarding abortion. Nigeria's criminal law system is divided between the northern and southern states of Nigeria.

The Criminal Code is currently enforced in southern states. The abortion laws of the Criminal Code are expressed within sections 228, 229, and 230. Section 228 states that any person providing a miscarriage to a woman is guilty of a felony and up to 14 years of imprisonment. Section 229 states that any woman obtaining a miscarriage is guilty of a felony and up to imprisonment for 7 years. Section 230 states that anyone supplying anything intended for a woman's miscarriage is also guilty of a felony and up to 3 years of imprisonment.

The Penal Code operates in northern states, with abortion laws contained in sections 232, 233, and 234. The sections of the Penal Code parallel the Criminal Code, besides the exception for abortion with the purpose of saving the life of the mother. The Penal Code's punishments include imprisonment, fine, or both. The offenses of these codes are punishable regardless of whether the miscarriage was successful. No provisions have been made to the Criminal Code making exceptions for the preservations of the mother's life. However, the cases of Rex vs Edgar and Rex vs Bourne have made it generally accepted that abortion performed to preserve the mother's life is not an appropriate transgression of the Criminal Code.

Statistics
Since abortion is illegal in Nigeria, many women resort to unsafe abortion methods, leading to abortion-related complications and increasing mortality and morbidity rates in the country. According to research done by the Guttmacher Institute, an estimated 456,000 unsafe abortions are done in Nigeria every year. In a joint study carried out by the Society of Gynecologists and Obstetricians of Nigeria and Nigeria's Ministry of Health, estimates of women who engage in unsafe abortion were put at about 20,000 each year. Research has revealed that only 40% of abortions are performed by physicians with improved health facilities while the remaining percentage are performed by non-physicians.

History
Throughout history, Nigeria's abortion laws have mobilized several groups and movements with opposing missions regarding the liberalization of abortion laws and promotion of women's rights. In the 1972 conference of the Nigerian Medical Association (NMA), the first attempts were made to reform abortion laws in Nigeria. However, a lack of support caused no revisions to result from this attempt. In 1975, the National Population Council further advocated for women's access to safe and legal abortion on the basis of promoting health and well-being of the mother. Defended by the Nigerian Medical Association (NMA) and the Society of Gynecologists and Obstetricians of Nigeria (SOGON), this sparked a controversy in 1976. At the yearly SOGON convention, the Prime Minister of Health gave a speech noting the possibility for national reform of abortion laws.

In 1981, the National Council of Women's Societies countered the SOGON's proposed bill regarding termination of pregnancy, preventing it from reaching the House of Representatives. The National Council of Women's Societies expressed that more efforts should be put towards family planning education and prevention of pregnancy outside of marriage. They expected parents of the House to enforce strong moral values for the country. In 1998, the Women's Health Research Network of Nigeria emerged with the purpose of promoting research and encouraging other groups to advocate and unite around women's health issues.

The Campaign Against Unwanted Pregnancy (CAUP) was created in 1991 with the mission of defending women's sexual and reproductive rights and eliminating unsafe abortion. In 1992, CAUP organized a reform meeting in which the Minister of Health and NMA president reviewed legislation regarding abortion. However, this reform was met with much opposition and was not successful. An important goal of the CAUP is public health education. In 1997, they established the Action Group for Adolescent Health (AGAH), in which they trained medical students to become public educators on sexual and reproductive health. From 1999 to 2004, CAUP organized many workshops and lectures on sexual health and women's rights with the hope of empowering Nigerian citizens with the knowledge to lead a healthy lifestyle and advocate for change. The focus of CAUP since 2002 has been abortion bill reform. A group of experts collaborated to outline changes in 2003. As of 2004, the bill was in its eighth stage of revision.

In 2015 The Violence Against Persons Prohibition Act (VAPP) was passed into law. This act is meant to provide sexual assault and relationship violence survivors with aid. This act is helping women get the contraceptives they need to prevent unwanted pregnancy, the leading cause for abortions.

Despite the combined and continued efforts of various Nigerian and International advocacy groups, only a woman whose life is endangered can undergo a legally performed abortion today.

Practices and Consequences
Many regions in Africa are known for their unsafe practices in health care and disease, specifically when it comes to young pregnant women and abortion. A major problem in these regions is that access to adequate health care is limited, meaning that options for safe health care practices are not easily accessible and some turn to unsafe methods of handling their pregnancies. Abortion accounts for 40% of maternal deaths in Nigeria, making it the second leading cause of maternal mortality in the country.

Health care systems in African countries have failed to make the proper changes to ensure a better future for their citizens. The government has either failed to make these issues a priority or they have attempted to introduce policies that had an opposite result of what was desired. Specifically in Nigeria, religious and cultural factors are major reasons behind the failure to address certain abortion issues.

Many of the issues surrounding unsafe abortion focus on adolescents. Although unsafe abortion practices do affect most of the sexually active women in the country, it is believed that adolescents may require special circumstances and could be a reason for change in this area. Adolescents are the most in need of these services, if they adopt safe practices to avoid unplanned pregnancy, these problems could start to decline. A major issue with teens in Nigeria, is that they are the most likely not to use contraceptives to avoid pregnancy and the most likely to turn to unsafe abortion practices.

Contraceptive use is a common issue for teens in Nigeria and there are no services to support this. Contraceptives are an important resource in a community where abortion and high fertility is an issue.

The need for increased access to safe abortion practices in Nigeria is very apparent. There are several different methods used to try and ensure a healthy and safe approach to abortions, but Nigeria hasn't always been able to keep up with the costs of these medical advances. In Nigeria, there are three first-trimester safe practices that are utilized to compare costs and effectiveness. Hospital-based dilatation and curettage, hospital-and clinic-based manual vacuum aspiration, and medical abortion using misoprostol are all considered to be a huge cost savings and ultimately puts the mother in its best interest.

Prior to women practicing these medically safer and more cost-effective methods, the rate of self-induced abortions was extremely high relative to other countries and regions. The side effects of using other methods have proved to be damaging to the mothers, resulting in high fevers, urinary tract infections, and genital trauma.

There are also issues where the women who did induce their own abortions did so incorrectly and could have caused other complications by overdosing on misoprostol - a method that is most commonly used safely and cost effectively. An important aspect to take into consideration is that Nigeria is a region where there are low health system requirements and where they strive to use non-surgical options.

Causes for Abortion
Unwanted pregnancy is the leading cause for abortion in Nigeria. Unwanted pregnancies have many causes. Nigeria's growing economy and increasing urbanization is making the price of living higher. This is making it more necessary for women to be working, as well as the men, to help support the family. When there are more children it makes it harder for the women to focus on work because they are expected to take care of the family first, thus women would rather be working, than pregnant or taking care of a child.

Another reason for the high rates of unwanted pregnancy in Nigeria is low contraceptive use and lack of family planning. Much of this is a result of lack of education on the use of contraceptives, as well as a lack of access to health care and contraceptive products in Nigeria. Due to the lack of contraceptive use, there is a trend of uneducated, young, childless women, and women with many children who end up with unwanted pregnancies. Both of these groups of women live in rural areas, where healthcare is spread out, hard to find, and government campaigns to help educate the public on family planning and contraceptives don't get as much advertisement.

Nigerian women want around 6.7 children. They have 25 years from the ages of 20-45 where they are mostly likely to get pregnant. They spend around 15 of those years pregnant, trying to get pregnant, and not having sex immediately after pregnancy, as accustomed in Nigerian culture. This equates to them having around ten childbearing years where they don't want to be pregnant Nigerian women have a long span of their life where an unwanted pregnancy can take place, thus these women need contraceptives to make sure an unwanted pregnancy will not occur.

Abortion in South Africa

Abortion in South Africa was legal only under very limited circumstances until 1 February 1997, when the Choice on Termination of Pregnancy Act (Act 92 of 1996) came into force, providing abortion on demand for a variety of cases.

Legal position
In South Africa, any woman of any age can get an abortion by simply requesting with no reasons given if she is less than 13 weeks pregnant. If she is between 13 and 20 weeks pregnant, she can get the abortion if (a) her own physical or mental health is at stake, (b) the baby will have severe mental or physical abnormalities, (c) she is pregnant because of incest, (d) she is pregnant because of rape, or (e) she is of the personal opinion that her economic or social situation is sufficient reason for the termination of pregnancy. If she is more than 20 weeks pregnant, she can get the abortion only if her or the fetus' life is in danger or there are likely to be serious birth defects.

A woman under the age of 18 will be advised to consult her parents, but she can decide not to inform or consult them if she so chooses. A woman who is married or in a life-partner relationship will be advised to consult her partner, but again she can decide not to inform or consult him/her. An exception is that if the woman is severely mentally ill or has been unconscious for a long time, where consent of a life-partner, parent or legal guardian is required.

The Constitution does not explicitly mention abortion, but two sections of the Bill of Rights mention reproductive rights. Section 12(2)(a) states that, "Everyone has the right to bodily and psychological integrity, which includes the right to make decisions concerning reproduction," while section 27(1)(a) states "Everyone has the right to have access to health care services, including reproductive health care." In the case of Christian Lawyers Association v Minister of Health an anti-abortion organisation challenged the validity of the Choice on Termination of Pregnancy Act on the basis that it violated the right to life in section 11 of the Bill of Rights; the Transvaal Provincial Division of the High Court dismissed their argument, ruling that constitutional rights only apply to born people and not to fetuses.

In general, only medical doctors may perform abortions. Nurses who have received special training may also perform abortions up to the 12th week of pregnancy. A medicine-induced abortion can be performed by any medical doctor at his/her premises up to 7 weeks from the first day of the last menstrual period. The usual method is a dose of an antiprogestin, followed by a dose of a prostaglandin analogue two days later.

Health workers are under no obligation to perform or take active part in an abortion if they do not wish to, however they are obligated by law to assist if it is required to save the life of the patient, even if the emergency is related to an abortion. A health worker who is approached by a woman for an abortion may decline if they choose to do so, but are obligated by law to inform the woman of her rights and refer her to another health worker or facility where she can get the abortion.

Abortion can be had for free at certain state hospitals or clinics, although sometimes only if the woman is referred by a health worker. Most abortion centres will insist on providing pre- and post-abortion counselling, and the woman can legally demand it, but it is not a legal requirement that abortion centres provide it.

Statistics
There has since the legalisation of abortion on demand been a decrease in deaths from backstreet abortions, but the number of deaths following abortions are still quite high according to statistics gathered in Gauteng province—5% of maternal deaths following childbirth are abortion related, and 57% of these are related to illegal abortions.

A recent study in Soweto showed the following: the rate of abortions for women older than 20 years decreased from 15,2% in 1999 to 13,2% in 2001, the rate for women aged 16–20 decreased from 21% to 14,9%, and the rate for women aged 13–16 decreased from 28% to 23%. In 2001, 27% of abortions were second-trimester.

Abortion in Uganda

Abortion in Uganda is illegal unless performed by a doctor who believes pregnancy places the woman's life at risk. The Ugandan Ministry of Health estimates that as of 2008, 26% of all maternal deaths result from abortion complications. This is aggravated by legal, socioeconomic, and geographical barriers to safe abortion, which compel women to use unsafe abortion methods and deter them from seeking post-abortion medical care. Contraception is not commonly used, leading to Uganda’s need for family planning.

Laws on women's sexual reproduction and abortion
The legal status of abortion in Uganda is unclear because it provides for some exceptions while criminalizing the procedure in most cases. The Ugandan Constitution, in Article 22, item 2 states: "No person has the right to terminate the life of an unborn child except as may be authorised by law." However, what is authorized by law remains poorly understood.

The Penal Code of 1950, Article 141 on "Attempts to procure abortion" states:

Any person who, with intent to procure the miscarriage of a woman whether she is or is not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means, commits a felony and is liable to imprisonment for fourteen years.

Article 142 lays out a punishment of seven years for an attempt to procure a miscarriage.

Nonetheless, under other provisions of the Penal Code an abortion may be performed to save the life of a pregnant woman. Section 217 of the Code provides that a person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon an unborn child for the preservation of the mother’s life if the performance of the operation is reasonable, having regard to the patient’s state at the time and to all the circumstances of the case. In addition, Section 205 of the Code provides that no person shall be guilty of the offence of causing by willful act a child to die before it has an independent existence from its mother if the act was carried out in good faith for the purpose of preserving the mother’s life.

Uganda, like a number of Commonwealth countries, whose legal systems are based the English common law, follows the holding of the 1938 English Rex v. Bourne decision in determining whether an abortion performed for health reasons is lawful. In the Bourne decision, a physician was acquitted of the offence of performing an abortion in the case of a woman who had been raped. The court ruled that the abortion was lawful because it had been performed to prevent the woman from becoming “a physical and mental wreck”, thus setting a precedent for future abortion cases performed on the grounds of preserving the pregnant woman’s physical and mental health. The liberalization and legality of abortion in Uganda has been complicated by the use of rape as a weapon of war and terror by rebel groups in the region."

In Uganda, an abortion is permitted to save a woman's life, preserve the physical health of the woman, and to preserve the mental health of the woman. An abortion is not permitted in terms of rape or incest, fetal impairment, economic or social reasons, or by request. A legal abortion has to be performed by a licensed and registered physician with the consent of two physicians prior to the medical procedure.

Government family planning
In 1988, the Ugandan government launched a comprehensive program in response to the country's high fertility and growth rates, which adversely affected per capita incomes and threatened the sustainability of social services. The major goal was to increase the contraceptive rate from 5 percent to 20 percent by 2000. The services for birth control in Uganda are now accessible at clinics and are operated by the Family Planning Association of Uganda. Contraceptives like condoms helped to reduce the rate of HIV/AIDS in Uganda, but there are still a significant number of unwanted pregnancies leading to abortion.

There was direct support provided in the government's policy on contraceptive use, and since 1995, 8 percent of married women aged 15 to 49 use contraception. The total fertility rate from 1995 to 2000 was 7.1, and the age specific fertility rate per 1,000 women aged 15 to 19 from 1995 to 2000 was 180. The government has shown a lot of concern for the morbidity and mortality resulting from induced abortion, but there has been a number of complications in childbearing and child birth. In Uganda, the female life expectancy at birth from 1995 to 2000 was 40.4 percent.

Movements
Movements such as Pro-Life Uganda (Pro-Life Uganda) and Pro-Choice Uganda (Pro Abortion) fight for their belief that either a woman has the right to choose what happens to her and her body (Pro-Choice Uganda), or the fetus' life is sacred and everyone deserves to live (Pro-Life Uganda). There was a movement that took place that involved the Pro-Life organization, Christian founded anti-abortion that advocates against abortion. This group was joined by 100 delegates from the U.S., United Kingdom, Uganda and Spain in a three-day workshop to help the young women of Uganda understand the preciousness of life, and to counsel the young women against the practice of abortion.

Abortion in Zimbabwe

Abortion in Zimbabwe is available under limited circumstances. Zimbabwe's current abortion law, the Termination of Pregnancy Act, was enacted by Rhodesia's white minority government in 1977. The law permits abortion if the pregnancy endangers the life of the woman or threatens to permanently impair her physical health, if the child may be born with serious physical or mental defects, or if the fetus was conceived as a result of rape or incest. Nevertheless, an estimated 70,000+ illegal abortions are performed in Zimbabwe each year, resulting in around 20,000 maternal deaths.

Terminology
The Termination of Pregnancy Act defines abortion as "the termination of a pregnancy otherwise than with the intention of delivering a live child."

History
Before 1977, abortion in Zimbabwe (then Rhodesia) was governed Roman-Dutch common law and English case law, namely the 1861 Offences Against the Person Act, which permitted abortion only to save the life of the pregnant woman. This principle was clarified in the 1938 case Rex v. Bourne, in which Justice Malcolm Macnaghten ruled that abortion could be legally performed to save the mother's life. At the time, Bulawayo was the "abortion centre" of Rhodesia, with most abortion procedures being performed by gynaecologists at Bulawayo Central Hospital.

With the advent of the women's liberation movement in Rhodesia in the early 1970s, debate over the country's abortion law increased. In July 1976, the government's Commission of Inquiry into the Termination of Pregnancy in Rhodesia published its recommendations that some restrictions on abortion be loosened. In the report, the commission acknowledged that "perhaps the majority of younger Rhodesians wish to see abortion laws liberalized." The commission recommended that abortion be permitted under the following conditions:

"Where the continuation of the pregnancy constitutes a danger to the life of the mother and termination is necessary to ensure her life;
"where the continuation of the pregnancy constitutes a serious threat to the physical health of the mother and termination is necessary to ensure her continued health;
"where the continuation of pregnancy creates a great danger of serious and permanent damage to the mother's mental health and termination is necessary to avoid such danger;
"where there exists a serious risk on scientific grounds that the child to be born will suffer from a mental or physical defect so that he will be seriously handicapped;
"where the child is conceived as a result of rape or incest;
"where the mother is an idiot or imbecile."
The commission's report, and the proposed legislation in Parliament that followed, sparked public debate on the issue, and in the months that followed, The Rhodesia Herald regularly published letters from white Rhodesians on what it described as "a key social issue in Rhodesian society."

In the journal Zambezia, Diana Seager, a sociology lecturer at the University of Rhodesia, expressed dissatisfaction with the commission's finding, writing that while they made a "seemingly liberal gesture... in substance reccomendations are no different from previous legislation." Jacquie Stafford, president of the National Organisation for Women, wrote to The Herald that "the reccomendations of the Commission... were quite conservative... not going as far as many women would have liked." Political activist Diana Mitchell asked in a letter, "why are the women of Rhodesia not consulted on this controversial subject?" She opined that abortion "should be left to the individuals concerned." At the same time, other letters to The Herald expressed opposition to liberalized abortion laws. Roy Buckle, a Salisbury resident, argued that expanded access to legal abortion represented the "thin end of the wedge and that further liberalization will follow." None of the writers were black Rhodesians, and none of the letters addressed how black women might be affected.

As much as abortion was a social and moral issue, it was also a racial issue in Rhodesia. Many on the far-right of the white population viewed abortion primarily as a means to combat the rapid growth of the black population. As a result, liberalized abortion laws might be viewed by black Rhodesians as a means for genocide of their race.

In December 1976, acting on the commission's findings, the Parliament introduced legislation addressing abortion. The Termination of Pregnancy Act (No. 29 of 1977), which took effect on 1 January 1978, expanded abortion access, allowing the procedure under three conditions: if the pregnancy endangers the life of the woman or threatens to permanently impair her physical health, if the child may be born with serious physical or mental defects, or if the fetus was conceived as a result of rape or incest. Under the former law, the latter two conditions were not circumstances under which a legal abortion could be obtained. Although the new law expanded abortion access, it did not go far enough for some: Jacquie Stafford, president of the National Organisation for Women, wrote in a letter to The Herald that the law "showed nothing but contempt for the women of this country, and makes me wonder at the sanity of our parliamentary representatives."

After Zimbabwe's independence in 1980, the new black government retained the Termination of Pregnancy Act.

In recent years, there has been growing vocal support to amend the law and expand legal abortion access. Many support expanded legal abortion access in order to end unsafe illegal abortions which often threatens the health of the mother, or results in maternal death. Zimbabwean women are 200 times more likely to die from an abortion procedure than women in South Africa, where obtaining an abortion is easier. And Zimbabwe's maternal mortality rate is three times higher than South Africa. One abortion-rights group active in Zimbabwe is Right Here Right Now (RHRN), which advocates for a review of the Termination of Pregnancy Act, which they consider "archaic". Other calls to expand access to legal abortion came from the organization Zimbabwe Doctors for Human Rights, as well as former Minister of Finance Tendai Biti.

Current legal status
Abortion is legally permitted under limited circumstances. In accordance with the Termination of Pregnancy Act, an abortion may be legally performed if the pregnancy seriously endangers the mother's life or threatens to permanently impair her physical health, if there is a significant risk that the child would be born with serious physical or mental defects, or if the fetus was conceived as a result unlawful intercourse, defined as rape, incest, or intercourse with a mentally handicapped woman (other sexual offenses, like statutory rape, are not legal grounds for an abortion).

An abortion may only be performed by a medical practitioner in an institution designated by the Ministry of Health and Child Care, with the written permission of the hospital superintendent or administrator. In order for the abortion procedure to be performed, two medical practitioners who are not from the same medical partnership or institution must certify that the requisite conditions indeed exist. In cases of unlawful intercourse, (rape, incest, or intercourse with a mentally handicapped woman), a court magistrate of the jurisdiction in which the abortion would take place must issue a certificate certifying that the pregnancy was probably that the result of unlawful intercourse as defined in the Act. Abortion services are provided by the Ministry of Health and Child Care, and are free to low-income and unemployed women.

Illegal abortion carries a penalty of imprisonment up to five years and/or a fine. The Termination of Pregnancy Act set the fine at Z$5,000 (approx. US$563 in 1997). However, Zimbabwe no longer uses the Zimbabwean dollar. Under section 60 of the Criminal Law and Codification Reform Act, illegal abortion is punishable by up to five years in prison and/or a fine not exceeding level 10.

Statistics
Illegal abortions
A UNICEF report in 2005 estimated that around 70,000 illegal abortions take place in Zimbabwe each year. Government estimates indicate that more than 80,000 illegal abortions happen every year, resulting in around 20,000 maternal deaths. In 2017, Ministry of Health and Child Care official Dr. Bernard Madzima estimated that illegal abortions causes 16% of maternal deaths, half of whom were adolescents. Most illegal abortions obtained by adolescent mothers occur in rural areas. Illegal abortions are also often performed illegally by city doctors. In 2014, over 2,000 young women ages 17 to 25 sought post-abortion care at Harare Hospital, and at Parirenyatwa Hospital treats over 100 women per month seeking post-abortion care.

Public opinion
A 2018 survey on the Constitution of Zimbabwe found that that 40% of respondents favored full constitutional abortion rights, 39% supported abortion rights in certain instances, and 19% were completely opposed to any constitutional abortion rights. The survey results showed that Zimbabwean men were more supportive of abortion rights than women, with 46% of men supporting full rights for women to an abortion, compared to 39% of women holding the same view.

2018 survey, question on whether the Constitution should protect abortion rights

Full abortion rights (40%)

In some instances (39%)

No legal abortion (19%)