Parliament voted to make telemedicine for early medical abortion permanent: but consider the details

13/05/2022 Comments Off on Parliament voted to make telemedicine for early medical abortion permanent: but consider the details

A commentary, revised 15 May 2022

This commentary is about the vote in Parliament on 30 March 2022 to retain telemedical abortion or end its use at the end of August 2022, treating that date as also representing the end of the Covid-19 pandemic in the UK.[1] A great deal of good lobbying and organising took place behind the scenes to achieve this outcome. I did not participate and I hope others will record and share their description of these efforts. Following the vote, members of Voice for Choice expressed their delight at the outcome. I too am very glad about this outcome, but what I do not understand is what happened to deliver it, as it is a very unusual story and I want to try and unravel it a bit.

According to the first paragraph of the Parliamentary webpage that records votes, the vote was 215 for retaining telemedical abortion and 188 against, with 250 MPs not voting.[2] Here is the breakdown of the votes by party:

To get a breakdown of the parties and how their members voted, I counted them manually here, as follows:

This is an unusual breakdown in votes, and leads to the immediate question of why so many MPs did not vote, particularly Tories, but also Labour. There are only two obvious reasons why some MPs didn’t vote: if Scotland had already made the decision to retain telemedical abortion independently, the 45 SNP MPs may have decided not to vote on the question for everyone else.[3] If they hadn’t already decided, they would equally feel they could not decide for the rest of the country either. On the other hand, the Welsh Government had definitely announced on 24 February 2022 that their temporary telemedical arrangements would be made permanent,[4] yet Plaid Cymru’s 3 MPs did vote and said yes.

As regards the Tory members, I am told that they had a “conflict”, in that the Government had written to and directed all the members of the Tory Party to vote NO. When such a “command” is given, it is quite difficult for MPs to ignore, as everyone knows. On the other hand, for those who follow the rules – because this was about abortion – everyone should have been given a free vote, which was acknowledged by Edward Argar for the government when the debate on this matter opened.[5] In the event, 184 out of 359 Tories (51%) did not vote NO.[6] It would be interesting to know their reasons.

The reasons why so many Labour MPs did not vote, including Keir Starmer, are also unclear, and from my point of view (as a member of the Labour Party), their reasons would be hard to justify. It is hard to swallow the thought that there may be more Tory MPs who didn’t vote because they are pro-choice while so many Labour MPs didn’t vote because they are not pro-choice. But this is speculation.

The bottom line, however, is that whatever the 112 MPs’ reasons for not voting were, the outcome could easily have been different. Yet the views of the non-voters are unknown and completely opaque.

Under temporary rules introduced by the Government during and because of the risks of transmitting Covid-19, the two kinds of pills used for an early medical abortion (up to 10 weeks’ gestation) can be used at home, following a telephone or video consultation with a qualified nurse, midwife or doctor. [Please note that before the pandemic, the mifepristone was taken in front of the doctor and the misoprostol was used at home, where the abortion occurred). In England, the Department of Health and Social Care announced in February 2022 that the temporary approval had been extended to 29 August 2022, at which point it would end because the pandemic would be over (sic).

The World Health Organization (WHO) has for some time supported self-care with medical abortion pills up to 12 weeks of pregnancy.[7] Not surprisingly, the Faculty of Sexual & Reproductive Health, the Royal College of Obstetricians and Gynaecologists and many others expressed their concern about the Government’s decision, because it flew in the face of solid clinical evidence and survey data showing that telemedicine for early medical abortion is safe and effective and that a large majority of women were satisfied with using the pills at home or even preferred it, especially when a 24/7 phone support line was open if they needed information or help. Two major changes took place when access to the pills became possible in this way: first and most importantly from women’s perspective, abortions overall could and did take place more than a week earlier than previously. Unnecessary routine examinations, particularly an ultrasound scan and routine blood tests, were finally dropped as clinically unnecessary.

Secondly, the organisation of abortion service delivery by the two main independent providers of NHS-funded abortion care – BPAS and MSI – changed substantially. To reverse that after two years, back to a system that was more costly and is now effectively out of date, would have been difficult and costly.  

What the government actually appeared to prefer, given that the Secretary of State for Health and Social Care (Sajid Javid) and the Public Health Minister (Maggie Throup) are according to the media both apparently anti-abortion, was that the issue would not come to a vote in Parliament at all. There had been a so-called public consultation on the subject earlier in the year, in which all the members of the anti-abortion group Right to Life apparently sent in individual letters opposing telemedical abortion, which added up to somewhat more (numbers wise though) than the number of supportive letters from a wide range of NGOs, health professional associations and many other organisations and individuals. Ms Throup declared that the “vote” against was greater than the “vote” for, as if the value of the vote of the individuals (especially since most were from one group) equated to that of e.g. a medical association. She therefore announced that telemedical abortion would be stopped. The total lack of understanding on her part of how to manage and interpret a public consultation and how to measure the views expressed was astounding.

So, our side got busy. In March, the House of Lords voted through an amendment tabled by Baroness Sugg to the Health and Social Care Bill (among some 120 other amendments the Lords tabled to that atrocious bill). It would make the telemedical abortion provision in England permanent. The government was thus forced to accept that a vote in the Commons would be necessary. On 30 March, the House of Commons began consideration of the 120+ amendments to the whole bill, and after a debate on telemedical abortion, lasting over two hours, they voted not in support of the Lords’ amendment but in support of a Government amendment to the Lords amendment – reversing the Government’s previous decision but also probably changing the outcome as, in a way, it opened a door for Tory MPs to support it.

The debate opened with a Labour MP suggesting that since Scotland and Wales had both made telemedical abortion permanent, England should follow suit.[8] The Minister immediately rejected this without apparently considering the consequences. The question of what might have happened in a devolved situation, had the vote gone the other way, is worth giving some thought to, however. One imagines women in England wanting to contact e.g. Welsh abortion providers, for example, in order to be able to use the pills at home… would that be illegal, I wonder?

The Minister then tried to argue that the Secretary of State could have ruled on this question without Parliament being involved. He described telemedical provision as “a detail” that did not deserve insertion into primary legislation. Why? Because allowing “that sort of thing” would serve to prevent the Secretary of State from reacting quickly to something, e.g. during a pandemic (a silly argument). He also claimed that “it would create legal uncertainty for women and medical professionals by including wording on the statute book that does not, in fact, change the law in the way it appears to” (meaning unclear) and he therefore proposed an amendment to the amendment. But he had to allow the vote nonetheless. Dr Rosena Allin-Khan for Labour’s health team strongly supported the Lords’ amendment, closing by saying: … “please do not ignore clinical best practice and the expert opinions of organisations and royal colleges”.

Barry Gardiner, Labour MP, said: “I too believe that it is a woman’s right to choose. One of the features of a physical consultation was that it gave the woman an opportunity to do so in a free environment. Does my hon. Friend share the concern that I know exists among many of our constituents that if the consultation is done by telephone, it is possible that a woman who is being coerced will not be understood to be being coerced by the consultant who is dealing with her? It is important that, in preserving the right to choose for the woman, we do not allow a situation in which that woman could be coerced, by a coercive partner, into making a choice that is not her own.” I was listening to the debate live, and I immediately wrote Barry Gardiner an email saying there was no evidence that I am aware of indicating this as a concern. I don’t know if he read the message but in the vote, he supported the amendment. I brought this up in the European Safe Abortion Networking Group a few days later. Unexpectedly, a Swedish colleague in the group said this concern had been raised in the Swedish parliament too. It makes me wonder whether this was one of several anti-abortion “false news” claims, circulated internationally, aimed at making people think that a perfectly acceptable means of having an abortion has dangers.

That became more probable when Fiona Bruce MP, long-time anti-abortion advocate, spoke next and said the all-party anti-abortion group were concerned about that too and 60 of them had written to the Health Secretary to express their many concerns. They claimed that taking the pills at home “without direct medical supervision had led to a number of deeply concerning, unacceptable health and safety risks to women and girls in this country. These included a lack of basic checks by abortion providers before sending abortion pills, and the occurrence of severe complications and later-term abortions due to the lack of in-person assessment.” This is almost all false, however. There are rare cases of women being more pregnant than they thought, but they are so rare that claiming that they invalidate this practice is a mistake. It would be like saying that if another medication causes a bad reaction in a handful of people, it must be removed from the market. In that case, we would have o medications. Bruce went on to press a further point: “…[S]everal women who have needed hospital treatment after taking an at-home abortion pill were clearly many weeks over that limit.” MP Alec Sherbrooke interrupted her at this point to ask: “Can she give data referring to the examples she is giving? I have been struck by the fact that in this debate, I have heard a lot of anecdotal evidence that has not been backed up by any reference to data, and I think that data is important for this debate.” Her reply was that her group, Right to Life, had indeed gathered data, which showed that “…one in 17 women taking abortion pills requires hospital treatment. That means that more than 14,000 women have been treated in hospital following the approval of pills-by-post abortion.”[9] This is pure fantasy, however, as was everything else she said about women being vulnerable, being distressed about having an abortion at home, the large numbers of doctors who are concerned, etc.

Jess Phillips MP spoke passionately in support of telemedical abortion on the grounds that women are adults and capable of making decisions that are safe for them. Like Dr Maria Miller MP she pointed out that the World Health Organization (WHO) says telemedical abortion is safe. She also noted that everyone seems to think telemedicine for all sorts of health care consultation is safe, so why just not for abortion. Try getting to see a GP in person, she suggested, zero chance.

The next speaker, Dr Caroline Johnson, expressed concern about lack of safeguards in giving adolescents under the age of 18 the pills to use at home. She was also worried that not everyone knows how pregnant they are, and may be much later in pregnancy than 10 weeks. She went on to say: “One can only imagine the distress felt by these women and children when they take an abortion pill to deliver what they believe to be a foetus of less than 10 weeks and out comes a baby of up to 30 weeks’ gestation who may at that point have been alive.” While it is true that there have been a few cases in this country of abortions at home beyond 12 weeks (but none at 30 weeks nor with a live fetus with a telemedical consultation), it is also the case that abortions with pills after 10 weeks are safe. The WHO supports telemedical abortion up to 12 weeks, for example. Moreover, abortion with pills is safe throughout the second trimester. In Sweden, for example, it is the main second trimester method used, though always in an outpatient clinic, not at home.

Dr Johnson then raised the issue of not being able to ascertain who actually uses the pills if they are sent by post. Her responses are all anti-abortion, while pretending not to be, using her role as a doctor to make unsubstantiated claims and raise unsubstantiated fears.

Have you ever heard an anti-abortion person acknowledge that women die from complications of illegal, unsafe abortions? I haven’t, not in 40 years. So much for caring about women. Instead, women are ignorant, women are liars, women don’t know how pregnant they are, women are coerced, women don’t know what they want – it’s incredible they don’t just lock us all up for our own protection from ourselves.

The next speaker, Jim Shannon, took the line of “both lives matter”, which for him, he said, means he supports women too… That stance was put to bed when Savita Halappanavar was allowed to die in Ireland a decade ago, and it is unacceptable to use it to justify keeping abortion illegal. He too was concerned about a woman “unexpectedly passing a mature baby at home”. He also questioned data on complications, and said that “the Government and the Minister’s Department say that “data on complications is incomplete”. Then he claimed there was a “well-known link between abortion and domestic violence”. Well, one in four women on average globally will have an abortion in her lifetime and a whole lot of women are subjected to domestic violence – but how are these connected? The connection is that there is coerced unprotected sex, if anything, leading to the request for an abortion. This MP at least said he questioned telemedical consultations with GPs as well, as a lot of his constituents were unhappy about them. This raises a lot of questions about quality of care and the lack of training to do telemedical consultations, but not only in relation to abortion particularly.

Then another doctor,[10] Ben Spencer, spoke and asked: “I have to say that I am unclear about whether we really have positive data to support saying that telemedicine abortions are safe. Is it not more a case of the absence of negative data?” No, it isn’t actually. This doctor clearly hasn’t even read the clinical literature, let alone what the World Health Organization has to say. But then he said he would like to see the government propose new legislation on abortion altogether. Perish the thought!

Thank heavens for Diana Johnson, who talked about trusting women! She continued: “Such is the strength of the evidence that the Welsh Government recently announced that they will be making telemedicine for abortion permanently available. This sends a clear message that, while women in Wales can be trusted to use a healthcare service in a way that meets their needs, women in England cannot. Not only will there be unequal abortion access between the devolved nations, but this decision will lead to health inequalities within England for the most vulnerable and marginalised. I struggle to see how the decision to bring this service to an end after August is in line with the Government’s commitment to put women at the centre of their own healthcare, as detailed in the vision for the women’s health strategy. / Telemedicine has already enabled an estimated 150,000 women to access abortion care at home. Its removal means that every woman, regardless of her personal circumstances and health needs, will be forced to attend a clinic. Lords amendment 92 would ensure that women can continue to access a consultation with a clinician by telephone. To make it crystal clear to everybody, very importantly, face-to-face consultations will still be available.”

Yes, evidence from 150,000 cases! There’s nothing like facts!! She went on to list the many organisations that support telemedical abortion and then said: “What I find most disappointing is that the Government are going against a wealth of robust and widely accepted peer-reviewed evidence from medical professionals and women’s charities, and appear to give greater weight to anecdote, erroneous opinion and misinformation focused on campaign groups with extreme views who bombarded a consultation. Sadly, that further emphasises that this is not an evidence-based policy decision.” And then she added: “Finally and crucially, women themselves strongly favour keeping telemedicine for early medical abortion. A clear majority want it to continue.

It took this long in the debate for the truth about what women have said even to be raised. One further, strong statement about supporting the amendment because it is based in evidence and is the right thing to do, led to the next speakers moving away from abortion and taking up the subject of tobacco… but only for a few minutes. A Northern Ireland MP, Carla Lockhart, brought it back again, again claiming telemedical abortion “presents huge risks to women’s health and safety”. Then she went into a rant about a 16-year-old who used the pills at home and was taken to hospital when feet appeared from her vagina, and the girl was found to have a 20-21 week pregnancy.

I don’t know whether this particular report was true or not, I would need to see the published evidence. But as I said above, such cases will happen, but they are rare.

At this point, the anti-abortion false news had been repeated far too often, and had begun to get boring. One might ask what the connection is between thinking that embryos are more important than women when a pregnancy is unwanted, and using false claims to support your views. Misogyny comes to mind. I had more respect for the anti-abortion movement in the days when they were simply against abortion. At least one could then say: far enough, then don’t have one.

Ms Lockhart’s rant got several MPs on their feet. Edward Leigh gets the prize for telling the biggest lie of all. First, he claimed that “this is not a debate about abortion” and then that “it is undoubtedly the case that more than 10,000 women who took at least one abortion pill at home provided by the NHS in 2020 needed hospital treatment”.

Thank heavens for MP Matt Warman, who is pro-choice and spoke strongly on that basis, who began by saying: “I rather think that men should enter the debate on abortion with a degree of trepidation and humility…

After another diversion about tobacco, voting on the telemedical abortion amendment began. Quite a few of the amendments to the Health and Social Care Bill that were proposed by the House of Lords were accepted. But many were not, and many others were amended further by different wording from the government. The government amendment that was proposed to revise the amendment by Baroness Sugg formally altered the 1967 Abortion Act, as follows:

Page 127, line 39, at end insert the following new Clause— “Early medical termination of pregnancy (1) Section 1 of the Abortion Act 1967 is amended as follows. (2) In subsection (3), for “subsection” substitute “subsections (3B) to”. (3) In subsection (3A)— (a) the words from “includes” to the end become paragraph (a); (b) after that paragraph insert— “(b) is not limited by subsections (3C) and (3D).” Wednesday 30 March 2022 LORDS AMENDMENTS 5 (4) After subsection (3A) insert— “(3B) Subsections (3C) and (3D) apply where— (a) the treatment referred to in subsection (3) consists of the prescription and administration of medicine, and (b) the registered medical practitioner terminating the pregnancy is of the opinion, formed in good faith, that, if the medicine is administered in accordance with their instructions, the pregnancy will not exceed ten weeks at the time when the medicine is administered (or in the case of a course of medicine, when the first medicine in the course is administered). (3C) If the usual place of residence of the registered medical practitioner terminating the pregnancy is in England or Wales, the medicine may be prescribed from that place by the registered medical practitioner. (3D) If the pregnant woman’s usual place of residence is in England or Wales and she has had a consultation (in person, by telephone or by electronic means) with a registered medical practitioner, registered nurse or registered midwife about the termination of the pregnancy, the medicine may be self-administered by the pregnant woman at that place.

Whew!! Verbose. In short, a registered medical practitioner, registered nurse or registered midwife can conduct a consultation by telemedical means to approve an abortion up to 10 weeks of pregnancy within the context of the 1967 Act, and arrange for the woman/girl to receive the pills by post.

Having listened to the whole debate and read the text of the two amendments afterwards, I’m no longer sure I am entirely happy with the outcome, for a number of reasons. Why? First, because the anti-abortion contributions outnumbered the pro-choice ones in the debate and were all based on fabricated and false information, which some MPs who are not anti-abortion were at least partly convinced by. As usual, those who were anti-abortion did not shift their views one iota due to the evidence they were presented with, but then their inability to accept facts is infamous.

I am very glad of course that in a Parliament in which winning a vote not supported by the government is almost impossible, we won this vote by a comfortable margin. That is, we didn’t lose. But I want to know why so many MPs did not attend and what would have happened if they had.

And now… moving forward

I’m also concerned that because the amendment had to become a new clause in the 1967 Abortion Act, the outcome was to keep control in the hands of doctors. I know this was inevitable as no one was trying to amend the abortion law as such. But it’s a pity. We need to be arguing for women to be able to access these pills not only when they know they are pregnant but also before they need them and in case they need them, with all the autonomy and benefits of very early abortion that would come with such new conditions. This change – which is not in line with the 1967 Abortion Act, would take away the control by doctors of the decision, as represented in the 1967 Act, and move the control of the decision to women. I believe we need a policy in which women can get the pills direct from a pharmacy – that for me could and should have been the outcome of allowing telemedical abortion. That is, the recognition that the use of abortion pills very early in pregnancy and through the first trimester is so safe and simple that medical control can recede into the background unless there are complications, which happen only rarely. But this outcome would have required changing the 1967 Abortion Act. That was not the playbill of the day.

The growing international shift to women obtaining abortion pills from the internet and from women-run hotlines both within countries and via two important international hotlines, or just straight from a pharmacy or drug seller, has perhaps not become a widely known fact or driving vision in the UK – yet. But from an international perspective, the change has been enormous and I believe it represents the future of early abortion.

Would Baroness Sugg’s amendment have passed had the government not tabled its amendment? The 72 Tories who voted yes to the government’s amendment to the Lords’ amendment might well have gone the other way in response to her amendment alone, even though they were not very different. And perhaps the numbers who did not vote at all might also have changed. No one can say. None of this was obvious on the day, at least not to me.

But my conclusion from the whole event is that while I am no less delighted at the outcome than my pro-choice friends, because telemedical abortion was saved, the grip of the medical profession on women’s access to abortion via the requirements of the 1967 Abortion Act, remains in place.

Acknowledgements

Thanks to Jayne Kavanagh, Toni Belfield and a third reviewer, for helpful editing suggestions. Any errors are my own. I have edited this blog twice already to correct a few mistakes and because of helpful comments. Further information on these points that I can share in a new blog would be welcome.


References and Notes

[1] This date was set long in advance. The Johnson government had already declared the pandemic over in April as regards requiring or even recommending that the public protect themselves and each other from the thousands of continuing new cases of infection daily.

[2] There was a discrepancy between the tellers’ count and the numbers recorded by name/party (216/187). In this instance, it doesn’t make much difference (unless you are the MP who was miscounted). In either case, we – the pro-choice movement – won the vote.

[3] That Scotland had already made this decision was stated during the debate at Westminster, but I have since been told it is not the case. If anyone has definitive information on this it would be welcome as Google reports a 2021 consultation in Scotland but not a decision.

[4] Written Statement: Arrangements for Early Medical Abortion at Home, 24 February 2022.

[5] Starting at Column 867 in Hansard

[6] That is, 72 Tories voted YES and 112 did not vote.

[7] WHO. WHO recommendations on self-care interventions Self-management of medical abortion. 2020.

[8] I have learned since then that Scotland has in fact not yet decided, but Wales has.

[9] See Column 871 to 872 in Hansard.

[10] I didn’t know the House of Commons had so many doctors in it. No wonder the NHS doesn’t have enough staff!

The persecution of Julian Assange, a Middle East Eye review by Jonathan Cook (4 May 2022) of The Trial of Julian Assange, by Nils Melzer, published by Penguin Random House

05/05/2022 Comments Off on The persecution of Julian Assange, a Middle East Eye review by Jonathan Cook (4 May 2022) of The Trial of Julian Assange, by Nils Melzer, published by Penguin Random House

https://wordpress.com/post/bererblog.wordpress.com/1755

I urge everyone to read this review and write a strong letter of protest to Priti Patel and George Biden against the extradition of Assange to the USA, where his illegal and prolonged mental and physical torture and ill-treatment will be continued, as it has been continued non-stop here in the UK, until it causes his death.

Nils Melzer is the UN’s expert on torture. The book provides “a shocking account of rampant lawlessness by the main states involved – Britain, Sweden, the US, and Ecuador. It also documents a sophisticated campaign of misinformation and character assassination to obscure those misdeeds.” 

Rwanda? Are you as out of your minds as Vladimir Putin?

14/04/2022 Comments Off on Rwanda? Are you as out of your minds as Vladimir Putin?

14 April 2022

Dear Members of Parliament and less and less honourable Members,

I am writing this in a state of utter disgust and disbelief that as members of Parliament in a country that pretends to be civilised and democratic, to follow the rule of law and respect the right to life, that you and that liar of a Prime Minister can even for one minute think not only of refusing asylum and refuge in this country to destitute people, who have committed no crime and have arrived here because they have been grievously and violently pushed out of their own countries, today Ukraine by a madman who is razing their country, and tomorrow because of others like him…. And then consider yourselves to have the right to forcibly remove them to a place thousands of miles away and effectively imprison them there indefinitely – against their will and without their agreement. It beggars belief. Treating them as sub-human, lower than cattle. It stinks of Hitler – airplanes replacing cattle cars – but with fascism intact. It’s racist, discriminatory, cruel and degrading treatment, and vile. It has to be illegal under international human rights law. It cannot be allowed.

The Tory Party has been abusing its majority in the House of Commons, taking no account of the opposition or the House of Lords, let alone the views of NGOs and the public, no matter how extensive and justified the opposition is, for far too long. They/you are crossing ugly red lines almost every day. They/you have begun to act as if they/you can do whatever they/you damn well please, no matter whose lives or which national institutions are destroyed, from the NHS on down, with no ethical basis or justification, and leading to no good end whatsoever. They/you have become a danger to the nation.

It is not only Boris Johnson and Priti Patel who must resign because of their lack of humanity, but the whole government. We need an election, and we need it now because, as a nation, we need to seriously reconsider our role in the world as the future comes to meet us. The destructive consequences of Brexit, in order to allow the government to do whatever it damn well pleases, has made this country into a renegade, rejecting the human rights of its citizens as well as those of asylum seekers and refugees.

Boris Johnson has violated every principle of public health during the Covid-19 pandemic, leading to widespread illness and the avoidable deaths of tens of thousands of people. No one is holding him to account for that, let alone for giving massive amounts of public money away to the companies of his friends to provide public health services they were absolutely incapable of providing. And now he has bribed Rwanda with millions of pounds, a poverty-stricken country that has experienced its own horrid civil war and unbelievable violence in the not too distant past, to act dishonourably and accept dirty money to imprison refugees who have come here seeking a safe haven.

If as members of Parliament, you allow this to happen, you too will be violating every principle of the responsibility you have to protect vulnerable and displaced people. You have failed to recognise that in the coming decades, because of the growing number of climate crises occurring daily in an increasing number of countries, that the numbers of refugees will rise dramatically all over the world, and that we must start discussing how to cope with what will happen to avoid causing a massive number of terrible deaths. Indeed, many people on these small islands of the United Kingdom may find themselves needing to find refuge in other countries as the already rapidly rising sea levels eat into our coastlines and as floods and frightening weather start to destroy farms, houses and infrastructure. What then? Who will we have a right to ask to offer help and asylum to us?  

I call on you to condemn and reject this charade, to demand that this clown of a Prime Minister, who dresses up as a doctor one day and a pilot the next, just to have his picture taken, as if that is his role in life, who believes he has the right to spend a fortune to fly into Ukraine to walk three steps in front of cameras in the middle of an empty square in Kyiv, expecting to be treated as the hero of all Ukrainians, and then come home, only to stop almost everyone from Ukraine entering this country, and then send Priti Patel to Rwanda to have her picture taken as she hands over bribery money to Vincent Biruta in order to ship any refugee she wants out of the country forever. Shame on all your heads for tolerating this. This whole country should be in the streets protesting, and you should be leading them.

It is not only Vladimir Putin who should be tried in the International Criminal Court, it is also Boris Johnson, Priti Patel and anyone else of you who allows these crimes against humanity to happen.

Yours faithfully,

Marge Berer

Set by e-mail to all Members of Parliament

An accusation going round the women’s movement that must be rejected

10/03/2022 Comments Off on An accusation going round the women’s movement that must be rejected

“You’re only supporting them because they’re white and look like you.”

I heard a version of this accusation about supporting Ukraine several days ago and decided I had to make a personal reply to it. First, “they” (Ukrainians) are not all white. According to the 2001 All-Ukrainian population census data, the representatives of more than 130 nationalities and ethnic groups live in Ukraine, including people of African and Asian descent, and people from many other ethnic minorities, from Roma to Jewish to Muslim, as well as from a wide range of Russian and Western Asian ethnic minority backgrounds.

Second, according to 2020 government data, Ukraine was also home to over 76,000 foreign students when this disaster hit. About a quarter of them are from Africa, with the largest numbers from Nigeria, Morocco and Egypt, and over 20,000 from India. Others are from ethnic minorities living in other European countries. Foreign students have gone to study in Ukraine, especially medical students, because the cost of living is lower and the quality of education is high. They make an important contribution to the Ukrainian economy.

There have been several reports of students experiencing racist treatment as they have tried to cross the country to reach a border. Social media footage has apparently shown some Ukrainian officials preventing them from leaving. Like the population hosting them, many are stranded and running out of food and water. One group were found by a journalist in a basement with no lights. One group, who asked for help getting to the border, were told “Poland is that way, start walking…” But when interviewed, they have also spoken positively of their experiences as students before the Russian invasion and are as upset to have to leave as everyone else.

Some African governments, e.g. Nigeria and Ghana, have been working hard to evacuate their citizens from the country, with some organising flights back home for those who make it across the border. The Ukrainian government has launched an emergency hotline for all students wishing to leave.

The EU has offered one year’s protected stay in an EU country to any refugee from an EU country, under a new policy agreed in record time on 3 March 2022. All non-EU residents, they say, will be accommodated and fed in the EU before being repatriated to their home countries. In an exceedingly miserly gesture, the British government has offered entry to only 50 Ukrainian nationals with visas, compared to tiny Moldova, which has already taken in at least 100,000 people.

But to get back to the main reason I wrote this, it is because I take the above accusation very personally. Ukrainians don’t just look like me, I am them. I am Eastern European by background. My four grandparents were from Moldova, Romania, Hungary and Russia. As children, they fled with their parents from the pogroms and from anti-semitic and anti-socialist policies in all four of those countries. So I take this invasion very personally too.

Lastly, if you look at all the invasions and wars littering the history of Russia – not just for the past 12 days but for centuries – let alone the mass internal assassinations in Russia (by Stalin, for example, who slaughtered millions of Russians). And if you understand what would have happened if the Zaporizhzhia nuclear power plant, the largest in Europe, had been set on fire or blown up by Russians last week. And when you ask why even the USA, the world’s most militarily aggressive country, and military alliances like NATO, are too nervous to engage, you may get a slightly different perspective on how important this assault on Ukraine actually is. And don’t forget the threat to all the neighbouring countries to Ukraine, who are next on Putin’s death-dealing list if this assault succeeds.

SOURCES: Ukranian census data 2001 ; BBC News, by Soraya Ali, 5 March 2022 + AFP Photo; EU Observer, by Nikolaj Nielsen, 3 March 2022

In Memoriam: Eddie Mhlanga: a doctor and a friend with the biggest smile and the warmest heart in the world

20/02/2022 Comments Off on In Memoriam: Eddie Mhlanga: a doctor and a friend with the biggest smile and the warmest heart in the world

Published in the ICWRSA Newsletter, 11 February 2022

It is with great sadness that we report that Eddie Mhlanga, professor, policymaker, obstetrician-gynaecologist, abortion provider, passionate advocate for public health and women’s health and rights, and much loved colleague, died on 5 February 2022 after a short illness. He was only age 68.

Here are some excerpts from published articles by and about him, about his professional life and his enormous contributions to women’s health care in South Africa.

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Dr Roland Edgar (Eddie) Mhlanga

Prof Eddie Mhlanga studied and specialised in obstetrics & gynaecology at the University of KwaZulu Natal, South Africa. In the early 1990s, he was the first Specialist: Obstetrics & Gynaecology in the then Gazankulu Homeland, South Africa, looking after Elim, Nkhensani, Letaba, Shiluvana, and Tintswalo hospitals. He occupied many leadership positions in the medical fraternity, including serving in the committee on Maternal, Neonatal & Child Health Initiatives at the World Health Organization (WHO). He re-joined Letaba Hospital in December 2021 as acting Head for Obstetrics and Gynecology, responsible for Mopani district, until he met his death. DeathObits.com, 7 February 2022

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In an interview with Laura López González on International Safe Abortion Day, 2018, Eddie said:

“I had a colleague who went and obtained an illegal abortion. I was the one who admitted her [after the procedure went wrong]. I promised her at 12 midday on a Thursday that I would see her at 2 o’clock in theatre. That was the last time I spoke to her because, at half-past one, she collapsed. She had been bleeding heavily and been in a lot of pain. When they called me to come to the theatre, she was already under anaesthetic. 

“I opened her up and found her womb was rotten from the infection. 

“We took that out and sent her to the intensive care unit [ICU]. Three and a half hours later, her condition had not changed. I took her back to theatre, opened her back up and found out that the infection – the pus – had spread from the pelvis right up to her kidneys. We had to scoop this pus all out.

“For the next 10 days, she was in the ICU. Every evening, I would go to the ICU and sit by her bedside. I’d hold her hand and pray, “Lord, give her another chance. She is no more a sinner than I am.” 

“After 10 days, she died.

“The following week, at the funeral, her mother was sitting there with her daughter’s four-year-old son. I looked at them and said: “No woman deserves to lose a daughter to unsafe abortion, no child deserves to grow up without a mother.”

“That was the moment where everything changed.” 

FROM: Laura López González, Bhekisisa Centre for Health Journalism, 28 September 2018

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The Chairperson of the Portfolio Committee on Health, Dr Kenneth Jacobs, has learnt with shock of the passing of Prof Eddie Mhlanga, the Chairperson of the National Committee on the Confidential Enquiry into Maternal Deaths, South Africa.

Prof Mhlanga was previously Chief Director: Maternal and Women’s Health in the national Department of Health and served on the International Federation of Gynaecology and Obstetrics task team set up to prevent unsafe abortions. He was also instrumental in helping to implement the Choice on Termination of Pregnancy Act (1996).

Prof Mhlangu’s death will send shock waves through the medical fraternity, Dr Jacobs said, as he epitomised selflessness and dedication to public service, especially within the field of women’s health. ‘Prof Mhlanga was an advocate for women’s and child healthcare. The country has lost a man with impeccable qualities,’ said Dr Jacobs. The Committee expressed its deepest condolences to Prof Mhlanga’s family during this difficult time.’” Parliament of South Africa, 8 February 2022

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Tributes on the web by more medical colleagues

Director of Maternal, Child and Women’s Health for the Department of Health, Eddie Mhlanga has sadly passed away. Dr Eddie Mhlanga is a member of the South African National Committee on the Confidential Enquiry of Maternal Death. He also serves on the FIGO (International Federation of Gynecology and Obstetrics) Task Team on the Prevention of Unsafe Abortion. As director of Maternal, Child, and Women’s Health for the Department of Health, Dr Mhlanga was instrumental in helping implement South Africa’s Choice on Termination of Pregnancy Act (1996).

Dr Mhlanga never stopped being an abortion provider. He was [until his death] the Provincial Specialist of Obstetrics and Gynecology, Department of Health for Mpumalanga province, providing clinical care in a low resource setting. He was previously chief director of Maternal, Child, and Women’s Health, in the National Department of Health. He was the past head of the Department of Obstetrics and Gynecology UKZN. As a woman and child health advocate, he was instrumental in the implementation of the Choice on Termination of Pregnancy Act and the Notification of Maternal Deaths. Death-Obituary.com

Bushbuckridge and the country at large lost one of the best obstetricians, rest in peace Prof Eddie Mhlanga. (Bushbuckridge Local Municipality, where he lived, is in the Ehlanzeni District of Mpumalanga in South Africa).

It is with a great sadness that the South Africa Society of Ob-Gyns (SASOG) has learnt of the untimely passing of Prof Eddie Xijekana Mhlanga. Tributes have poured in from within the progressive health community, citing Bra Eddie as a longstanding, ever-committed, health comrade and leader.  He was a gentle soul with strong principles who was not afraid to speak truth to power. Our SASOG colleagues and those who had been mentored by him remember a humble, much-loved colleague and a dedicated obstetrician who leaves a huge vacuum in our discipline…. The greatest tribute to him must be for those left behind to try to match the humility of one of South Africa’s finest professionals. Tribute to Prof Eddie Xijekana Mhlanga, 7 February 2022

Prof Eddie Mhlanga, there are no words, I simply cannot comprehend that you have left this earth. I’m numb. You were an amazing doctor, mentor, and friend. You have meant so much to so many. I cannot believe you are gone. May you rest in peace Xijekana. Society Alert.com, by Peace Udofia, 7 February 2022

It’s hard to choose just one word to sum up Eddie Mhlanga’s work and activism, but “fearless” is a good start. When Thabo Mbeki was president of South Africa in the 1990s and notoriously casting doubt on the link between HIV and AIDS, pressure mounted on the government to take a clear stand on the issue. Mhlanga, then a top official in the national Department of Health, publicly challenged Mbeki and didn’t mince words: “HIV causes AIDS and AIDS kills… People are dying after being infected with HIV and that is what we need to be concentrating on.” Society Alert.com, by Peace Eteng, 9 February 2022

Section27 is deeply saddened by the passing of its board member, Professor Eddie Mhlanga. He was a beloved member of the board and will be remembered for his incredible commitment to health and human rights. Section27, 8 February 2022

What a lovely funny guy with the cheeky grin.

Never afraid to teach or help.

You will be missed by so many.

May God grant your family strength to bear this loss.

– Mona Ponnen, on SA Doctors United Facebook

It will take a while to make sense of this. I spoke with him on 24 Jan … your infectious smile, humanity and big heart inspired me… Rest well, Prof Mhlanga… uyibekile induku ebandla (He has set the bar high in the church – in Zulu.)

– Malindi Mabaso, on SA Doctors United Facebook

[Note: She may be referring to a beautiful poem with this title, written by Spho Da Poet #Getto Conscious, posted 10 August 2018 on nigeriaelitesworld]

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To share the vision and touch the soul

by Linda Kastelman

“Eddie studied for his master’s degree at the University of North Carolina (UNC) School of Public Health, Chapel Hill, NC, USA. ‘Thank you, Jesus!’ So rose the shout of praise from the audience when Dr Roland Edgar (Eddie) Mhlanga, danced across a stage in spring 1994 to accept his masters of public health diploma at UNC School of Public Health. More than 40 of the joyful commencement guests were congregants at Barbee’s Chapel Missionary Baptist Church in Chapel Hill, a community that nurtured – and felt nurtured by – Mhlanga’s indomitable spirit during the time he spent away from his native South Africa. There was much that brought joy that year. Only days before – on April 27, 1994 – South Africa had held its first democratic elections, with people of all races being able to vote for the first time. For Mhlanga, forced out of his local congregation in the South African village of Acornhoek because he opposed segregation, the North Carolina church family was a special gift.

“The obstetrician’s journey to the United States was a blessing as well. His wife Lindiwe (“my better three-quarters,” he claims) had been selected as a WK Kellogg Scholar at UNC, and Mhlanga travelled to Chapel Hill with her. Having been involved himself in the Kellogg International Leadership Program, he believed the masters’ of public health curriculum at UNC offered analytical skills, competencies, and an understanding of community development that would be of great benefit to his and Lindiwe’s work in Acornhoek.

“Now head of the Department of Obstetrics and Gynecology at the Nelson R Mandela School of Medicine in Durban, South Africa, and adjunct associate professor in the Department of Maternal and Child Health at the UNC School of Public Health, Mhlanga is champion of the rural poor and a stalwart advocate for women’s and children’s health.

“He was drawn to the specialty, he says, because of desperate need in South Africa for advanced obstetric, gynecologic and pediatric skills during emergencies. As in the United States, many South African physicians are not willing to serve in poor, rural areas after they finish their long training.

“While serving as the first director of Maternal, Child and Women’s Health and Genetics in the National Department of Health in Pretoria, Mhlanga lobbied for reproductive and sexual health and rights –  work that in 1996 resulted in South Africa’s Choice on Termination of Pregnancy Act and later, legislation for the Notification of and Confidential Enquiry into Maternal Deaths.

“In 1999, as chief director of national health programs, he became involved in policymaking and education about nutrition and prevention and treatment of HIV/AIDS, tuberculosis, and sexually transmitted diseases. Subsequently, Mhlanga’s leadership in women’s and children’s health has been solicited by international agencies such as the World Health Organization and United Nations agencies including the Children’s Fund (UNICEF) and the Educational, Scientific and Cultural Organization (UNESCO), among others….

“The leader he admires most, though, is his late mother. “Sennie Mankareng n’waMalapane knew hunger and distress,” Mhlanga recalled, “but made certain her children did not sleep with hunger. [She] taught me that my sibling is the person next to me. [She] taught me diligence and discipline, without which I would not have been where I am today.” All these leaders, Mhlanga says, have been “able to communicate their understanding of the human condition and to transcend human barriers by touching the soul and heart of people. That attribute,” he says, “makes a great leader – to share the vision and touch the soul.” It’s a description that fits him well.”

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In South Africa, we cannot talk about abortion providers without talking about Dr Eddie Mhlanga, a man who has inspired and mentored many of South Africa’s abortion providers…. As a young doctor, Eddie Mhlanga realised that there was a vast need for child health and obstetric services across South Africa and especially its rural areas. He believed that “Every death of a woman is a major event. People need to stop and say, ‘What happened?’” This was reinforced when he treated a nurse, who was a colleague, who died from a septic abortion. This reaffirmed his belief that women don’t have to die due to lack of appropriate services and reproductive choice and this is what has driven his work. (Marie Stopes South Africa, 9 March 2016)

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Implementation of the new South African abortion law: a six-month overview from hospital reports

This journal article opens with a quote from Dr Eddie Mhlanga, then National Director of Maternal, Child and Women’s Health, who contributed support and leadership to the eight hospitals described in the report and the differing extent to which they were each able to provide abortions in the very early days after the national law on abortion was amended:

“Dr Eddie Mhlanga was able to make this assessment: ‘There is increasing acceptance of the procedure and practise of termination of pregnancy. In some provinces access is fairly limited, but I believe that in all provinces there is a concerted effort to deliver the service to women.’”

In: Reproductive Health Matters 1998;6(11):145-48. Excerpted from Barometer 1(2), September 1997, a new publication of the Reproductive Rights Alliance of South Africa, a national alliance of 30 organisations committed to creating and promoting reproductive rights. The newsletter aimed to monitor the implementation of the Choice on Termination of Pregnancy Act, passed in 1996.

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For International Safe Abortion Day, 28 September 2021, the Daily Maverick featured a roundtable discussion between Dr Tlaleng Mofokeng, the UN Special Rapporteur on the Right to Health; Professor Eddie Mhlanga, an obstetrician, gynaecologist and sexual & reproductive health rights activist; and Caroline Mbi-Njifor, the outgoing director of reproductive health services at Ipas. (Daily Maverick, 28 September 2021)

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Some of the many medical, academic and policy positions Eddie Mhlanga held (not in date order):

– Member and later Chairperson, South African National Committee on the Confidential Enquiry into Maternal Deaths

– International Federation of Gynecology and Obstetrics, Task Team on the Prevention of Unsafe Abortion.

– Director, Maternal, Child and Women’s Health, South African Department of Health, where he was instrumental in helping implement the Choice on Termination of Pregnancy Act (1996).

– Provincial Specialist of Obstetrics and Gynecology, Department of Health, Mpumalanga Province, where he provided clinical care and abortions in a low resource setting.

– Member, South African Society of Obstetricians and Gynecologists. 

– Head and Professor, Department of Obstetrics and Gynecology, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal.

– In the early 90s he was the first Specialist: Obstetrics & Gynaecology in the then Gazankulu Homeland, South Africa looking after Elim, Nkhensani, Letaba, Shiluvana and Tintswalo hospitals.

– Co-Lead Doctor, Global Doctors for Choice.

– Past board member of Ipas.

– Served the WHO (e.g. on the committee on Maternal, Neonatal & Child Health Initiatives), and also UNFPA, UNICEF, FIGO and IPPF in various capacities over the years

– Studied maternal and child health, University of North Carolina at Chapel Hill, USA

– Studied at University of Natal Black Section

– Re-joined Letaba Hospital in December 2021 as acting Head for Obstetrics and Gynecology, responsible for Mopani District, until he met his death following a very short illness.

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“It is with deep sorrow and sadness that as a province we have lost a seasoned medical specialist, clinician and academic with so much passion not just in women’s health but rural women, in particular those with limited access to healthcare. He was our hope towards achieving Zero avoidable maternal death. We send our deepest condolences to the Mhlanga family, friends and colleagues for our loss. May the memories of his contribution to the profession console us as we continue to carry on where he left. May his soul rest in peace,” said MEC Dr Phophi Ramathuba, Limpopo Health Department. Sekororo News Facebook, 6 February 2022

RE: End mass jabs and live with Covid, says ex-head of vaccine taskforce: I say NO NO NO NO NO

12/01/2022 Comments Off on RE: End mass jabs and live with Covid, says ex-head of vaccine taskforce: I say NO NO NO NO NO

Marge Berer

This is a copy of an email I sent to the Guardian Editor, Katharine Viner,

10 January 2022

Dear Ms Viner

I have been a loyal Guardian reader since… 1973. In the past several years, however, I have become increasingly concerned about a growing number of aspects of your editorial policy, to the point where, several months ago, I cancelled my already minimal subscription of £11.99 per month, which is for the mobile version. Having decided to write to you to talk about my concerns, I re-started the subscription. But my concerns continue to grow, as follows:

1. The differing content and layout of the: i. mobile version, ii. email version, iii. print version, iv. website version. I chose several years ago to get the mobile version daily, although previously for many years when I was in an office with others, we bought the paper daily and shared it. … No longer in an office, and not being interested in a fair amount of what you publish, I feel getting the paper version was an indulgence. Environmentally, read or unread, it creates a large amount of waste for one person. Yet I feel punished by this decision, as it means I miss important articles that I would have wanted to know about practically every day. You can’t leaf through a phone version like you do a paper copy. However, it isn’t clear to me whether the paper copy is the sum total of the day’s news and reports, or whether it’s the website. It certainly isn’t the phone. Periodically, I visit the website version to look up something I missed, told me by a friend, in the mobile version. Once in a while, I still buy the paper version in the supermarket if a headline jumps out at me. But all this eats up time, a scarce commodity, and creates annoyance. Have you considered a daily table of linked contents? Though it would be rather too large…

2. In the mobile version, there are few or no letters to the editor, one of my favourite sections, though there are more than none now, sometimes; sport is given a far higher status than both Covid-19 and international news (the latter is minimal and covers the USA far more than anywhere else) – by being higher up the page. I go elsewhere for most international news these days. At the same time, there is an unholy mix of important, well-argued and highly pertinent news articles and cutting-edge opinion pieces alongside a lot of what I can only call populist drivel, including moans about relationships, foodie stuff, let alone far more on sport often than serious news.

3. I give you a score of zero on Covid-19. The information you provide on Covid-19 is often poor and/or you report unsubstantiated views, especially from those (often Tories) who don’t take the short- and long-term public health implications of this pandemic seriously (including politicians, scientists and members of the public) – both in the context of the pandemics that preceded Covid-19 and those that will follow it in the future. The steady stream of epidemics and pandemics in the past century is one of the predicted outcomes of the growing climate crisis. You have barely reported what the members of Indie SAGE have been saying every Friday on YouTube since early in this pandemic, and yet individually and as a group they represent the most progressive and evidence-based point of view from a wide range of scientific expertise on how to defeat Covid-19 that exists in this country. On 7 January 2022, Anthony Costello said UK government policy on Covid-19 represents a crime against humanity, which in the human rights world that I inhabit, should mean a criminal trial for causing gross endangerment to health and a high number of avoidable deaths, not a photo of Boris dressed as a doctor or the sort-of wishy-washy criticism you indulge him in. Let alone opinions about how we will just have to learn to live with this. And at least in the mobile version, you have more or less ignored the World Health Organization’s steady stream of valuable information and recommendations, as well as those of WHO Europe, which are so cogent for us and one of 100 other reasons why Brexit is the disaster it was predicted it will be.

You have also been extremely poor at reporting what other countries have done successfully to contain and control this virus – far more effectively than the UK has done – e.g. China, Taiwan, Korea, New Zealand and much of Scandinavia. I don’t think you have published one opinion about stopping people from travelling internationally, as a major source of preventing infections being carried across borders. You have failed miserably to emphasise and promote (daily) the crucial need for all middle and low income countries – through the WHO COVAX programme – to be able to produce vaccines with global financial support in order to be able to achieve high levels of vaccination. “No one is safe until everyone is safe.” (WHO) How often have you published that statement of fact? You have given barely any attention to the necessity of removing the profit-driven refusal of countries, especially the UK, whose position on this is key, to ensure that can happen.

Yesterday’s headline in my phone: “End mass jabs and live with the virus, says ex-head of vaccine taskforce” with the inevitable photo of Boris, made me livid. Let him live with the virus if he’s so keen, and lock him up somewhere far away by himself to do it. I don’t want to live the rest of my short life in my sitting room, thank you very much. “Omicron could be “first ray of light” towards living with Covid.” What? Rhubarb! Ask WHO. The story contradicts the headline almost immediately. Consider how many people look at the headline and think, oh well, I’ll stop using that bloody mask then, eh! If they ever did. Have you ever addressed the fact that young men are the worst offenders when it comes to refusing to mask on public transport? Have you ever reported that in Spain “you must wear a mask” means you will be kicked out if you don’t, not tolerated or ignored, as happens here?

You published a report maybe 10 days ago by an expert on masks, about which kinds of masks are the best for protecting ourselves. Did you give one line of information about what brands, where to buy them without paying £12 or £15 per mask, as my local pharmacy charges? No! Have you ever addressed the price of masks for people who are poor, and that they should be treated the same as prescriptions? Have you ever reported that the cheap light blue masks provide inferior protection? When was the last time you told your readers about how the virus is airborne and comes out of their noses as well as their mouths, and can get in through their eyes as well? Or about the importance of physical distancing when you are in a public space, including outdoors in the street! Have you ever mentioned that cigarette smoke will carry virus far and wide if there’s a breeze? Or that runners without masks should stay away from others on the pavements because they are huffing and puffing as they run? No!

4. Your political reporting on Labour Party policy has been superseded by your almost always negative focus on “the leader” (whether Jeremy or Keir) and has been cringe-makingly poor for many years now, while you under-report what Labour, the Lib Dems, the Greens, the SNP and Plaid Cymru are doing (including locally) that is progressive. I’m sure you would never describe yourself as a Tory-supporting newspaper, but you are – by default – due to your failure to give front and centre positive space when deserved to all the opposition parties. Have you considered promoting a united opposition to the Tories or an end to first-past-the-post voting, which the majority of members of the Labour Party approve of?

5. I’m relieved that Jonathan Freedland has finally got off his “my Israel right or wrong” high horse and is writing about political issues the way he used to. I missed his critical voice. But more broadly, that you have swallowed and repeated so much right-wing, cleverly put-together slander about anti-semitism in the Labour Party is unforgivable. Do you not know that the only people Keir Starmer is kicking out of the Labour Party for anti-semitism these days, apart from Corbyn, who did not deserve it no matter what your opinion of him is, are Jewish? I have never seen you mention that. You have never reported the denial of citizenship to Palestinians by Israel, nor gross daily violations of human rights against Palestinians by Israel, nor news such as the current hunger strike among Palestinian prisoners who have never been charged with anything. It is beyond my understanding how you can justify that. Do you remain silent about Russia doing that, or Myanmar, or Kazakhstan …or…? No!

I would like to end by giving you a list of the articles that keep me reading the Guardian, as there are a lot of those too, but not today. I’d like to see your editorial policy change, so that everything you publish is as good as the best that you publish. You don’t need to entertain your readers, as you seem to think. Look at yesterday’s mobile version below after you have read this. You need to inform us and motivate us your readers to be informed about and take action against injustice. I look forward to you finding a way to ensure that all the important stories and opinion pieces are included in the mobile version, and disappear the populist stuff to make room for them.

Thank you!!

With best wishes,

Marge Berer

FGM guilty conviction in Dublin quashed

21/11/2021 Comments Off on FGM guilty conviction in Dublin quashed

by Marge Berer, 21 November 2021

This was the headline on more than half a dozen Irish news sites on 18-19 November 2021. In all but two, the same report was repeated, almost word for word as if the writers had just copied and published what an unacknowledged source had published. Clearly they’d not had someone in the courtroom to witness the actual hearing, with two exceptions.

According to the journal.ie, several key aspects at the original trial, which had led to the conviction and imprisonment of both parents, were rejected at the appeal. One was that the translation of both the parents’ testimonies into English had been incompetent and misrepresented what they had actually said in important ways. The Appeal Court accepted this criticism:

“In one example, Mr Hartnett [counsel for the father] said a question to the accused about his daughter, when he was asked ‘would you hurt her?’, was translated as ‘do you hate her?’ Mr Hartnett said this was indicative of the translator’s ‘lack of competence’ and that the translator was ‘not so much translating but attempting to put his own view on what the witness wanted to say and putting it to the court’. Giollaiosa O Lideadha SC, for the child’s mother, said he agreed with Mr Hartnett’s submission.”

According to the rte.ie report, the parents appealed both their convictions on the grounds that their right to a fair trial had been breached when their answers to questions from counsel during proceedings were mistranslated. Hence, it may not be surprising that bad translation dominated the news articles. It is odd, however, that bad translation was the only failing mentioned as the reason for quashing the conviction, even though it was certainly not the only failing, which only the journal.ie made clear.

According to the journal.ie, the most important reason for quashing the verdict was that two medical experts disagreed over whether FGM had been carried out on the child concerned or not. Their report said:

“Professor Birgitta Essen said a video recording of the child’s genital area indicated the girl was not left with any signs of scarring after she was treated for bleeding in the perineum. However, Professor Sri Paran, the consultant paediatric surgeon who had treated the girl when she was admitted to hospital – told the court he had cauterised the wound and that was why no scars were visible.

“Professor Essen told the court she has 25 years‘ expertise in studying FGM victims from “newborn to adulthood” and had appeared as an expert witness in similar cases in Europe and North America. In her opinion, the girl had not been a victim of FGM because her clitoris was still visible. Referring to FGM criteria from the World Health Organization, Prof Essen added that the absence of scar tissue in the genital area also indicated that FGM had not been performed.

“But Prof Paran, who is also an associate professor at Trinity College and UCD, disputed Prof Essen’s interpretation. The surgeon said his priority had been to stop the bleeding which had been coming from “under the clitoral hood” when the child arrived at theatre. When examined by counsel for the State, Shane Costelloe SC, about the lack of scarring on the child afterwards, Prof Paran replied that the effect of cauterisation had covered up the scars but “underneath the surface, there was scar tissue”. Although Prof Paran conceded he had no prior experience of FGM, he said he was confident the girl had not injured herself as a result of a fall.”

So I must ask: now what? The disagreement between the treating physician and an expert witness on FGM over whether or not FGM took place, or what had caused the child’s injuries, persists. This is more than unfortunate because disagreements between witnesses described as medical experts have been a problem in several previous FGM cases too. The first was the earliest reported case of an attempt to take a child into care for safeguarding, in 2014 in Leeds Family Court, which found that expert opinion on whether the child’s genitals were normal, or had been injured or cut, was contradictory. Three people, all of whom presented themselves as experts to the court, were invited to examine the child and testify. My summary of what happened, based on the records, was as follows: “Experts 1 and 2 both examined G and said they thought they had seen evidence of FGM. However, their descriptions of the FGM differed. Expert 1 later changed her evidence and said she had made a mistake. The judge described Expert 2’s evidence as “confused, contradictory and wholly unreliable”. Expert 3 did not examine G but saw the two other reports and watched a DVD of their examination of G. She said she saw no evidence of FGM.” [1]

The most well-known case, R v N (Female Genital Mutilation), the first and so far only conviction in London at the Old Bailey in 2019, also involved such a disagreement. As in Dublin in 2020, the parents claimed there was a straddle injury from a fall and denied that their daughter had been subjected to FGM. Importantly, in both cases, no information regarding who had carried out the genital cutting (let alone where, or when) was ever presented, even though it was shown that the parents themselves could not possibly have done it. Yet both resulted in a guilty verdict, implying that something more was at play. Certainly the 2019 London trial was a kind of witch hunt, with many people wanting a guilty verdict. [1]

So I must ask again, what next? The rte.ie report said the State would be requesting a retrial (my emphasis). A request can presumably be turned down, however, and no re-trial take place. Is there a good chance of another conviction, given that a lot of evidence was rehearsed at the appeal and led to the conviction being quashed? How would the public good be served by a retrial? The parents were in jail for two years and separated from their children.

There is, however, seriously unfinished business in relation to the mother convicted at the Old Bailey in 2019, who remains in jail. Her future hangs in the balance.

It is highly problematic that medical experts can disagree so profoundly about whether or not FGM actually took place, and that a guilty verdict can follow a prosecution in which no information about who carried out the FGM was ever presented. Did the 2019 London trial influence the 2020 Dublin trial? It seemed so at the time. Now, I have to ask, will the reverse occur? Certainly, in light of the Dublin decision to quash the conviction, an appeal against the guilty verdict should be pursued in London – and the sooner the better.

With thanks to Susan Bewley for editing comments!

Reference

1. Prosecution of female genital mutilation in the UK: injustice at the intersection of good public health intentions and the criminal law, by Marge Berer, Berer Blog, 2 March 2020. This article was accepted for publication on 1 March 2020 by the journal Medical Law International. This version on my blog is the pre-publication, accepted text of the article, which I only am permitted to share there under Sage Publications’ green access policy.

Motion passed at Labour Conference on Israel and Palestine, 27 September 2021

01/10/2021 Comments Off on Motion passed at Labour Conference on Israel and Palestine, 27 September 2021

Composite one

Conference condemns the ongoing Nakba in Palestine, Israel’s militarised violence attacking the Al Aqsa mosque, the forced displacements from Sheikh Jarrah and the deadly assault on Gaza.

Together with the de facto annexation of Palestinian land by accelerated settlement building and statements of Israel’s intention to proceed with annexation, it is ever clearer that Israel is intent on eliminating any prospects of Palestinian self-determination.

Conference notes the TUC 2020 Congress motion describing such settlement building and annexation as ‘another significant step’ towards the UN Crime of Apartheid, and calling on the European & international trade union movement to join the international campaign to stop annexation and end apartheid.

Conference also notes the unequivocal 2021 reports by by B’Tselem and Human Rights Watch that conclude unequivocally that Israel is practising the crime of apartheid as defined by the UN.

Conference welcomes the International Criminal Court decision to hold an inquiry into abuses committed in the Occupied Palestinian Territories since 2014.

Conference resolves that action is needed now due to Israel’s continuing illegal actions and that Labour should adhere to an ethical policy on all UK trade with Israel, including stopping any arms trade used to violate Palestinian human rights and trade with illegal Israeli settlements.

Conference resolves to support “effective measures” including sanctions, as called for by Palestinian civil society, against actions by the Israeli government that are illegal according to international law; in particular to ensure that Israel stops the building of settlements, reverses any annexation, ends the occupation of the West Bank, the blockade of Gaza, brings down the Wall and respects the right of Palestinian people, as enshrined in international law, to return to their homes.

Conference resolves that the Labour Party must stand on the right side of history and abide by these resolutions in its policy, communications and political strategy.

Young Labour
Wolverhampton South West CLP

Published online by Labour List at: https://labourlist.org/2021/09/labour-conference-passes-young-labour-israel-and-palestine-motion/, 27-09-21

Letter to Rt Hon Margaret Beckett DBE MP, Deputy Chair, Committee on Standards in Public Life

01/10/2021 Comments Off on Letter to Rt Hon Margaret Beckett DBE MP, Deputy Chair, Committee on Standards in Public Life

Sex matters in many areas of life. But public institutions have adopted policies which replace clarity about the two sexes with self identification on a spectrum of ‘gender identity’. In doing this they have departed from the law. Erasing sex undermines equality, safeguarding, data collection, evidence-based policy making and the rule of law, especially the application of the Equality Act 2010. 

This is happening not through democratic processes, but at the behest of lobby groups claiming to represent the interests of a transgender minority. It is enabled by institutional capture, the threat of being called “transphobic”, and the chilling effect of intimidation and closing down of debate.

When JK Rowling  expressed her concerns in measured, careful and compassionate terms, the ferocity of the response served as a warning to others. Ordinary people from every sphere of life face similar attacks. They fear losing their security, their freedom to speak, their livelihoods and maybe even liberty.

As one NHS consultant said, in words that were read out in House of Lords:

“I have campaigned for equality across the board all my life and yet now I’m dismissed as a bigot and a transphobe for even trying to raise concerns at all.”

This is a situation that public bodies have walked into with the best of intentions. Roughly 250 Government departments and public bodies, including police forces, local councils and NHS trusts, are members of Stonewall’s “Diversity Champions” scheme. Others are trained by Gendered Intelligence, Mermaids, and other allied organisations. These institutions adopt a broad definition of “transphobia” and commit to an approach of “zero tolerance”. 

Public bodies demonstrate their allegiance through measures such as rebranding their logos with rainbows, substituting gender for the protected characteristic of sex in their equality policies and monitoring, and adopting a definition of “transphobia” that makes dissent a disciplinary matter. 

We support the aims of ensuring that transgender people are not discriminated against or harassed in employment and as users of services. But the demands of these organisations go beyond that, and seek to compel  acceptance of a set of beliefs about sex and gender identity; what it means to be male or female. 

Individual practices are now being tested in court, and judges are expressing surprise at the lack of evidence, data and oversight underpinning them. Examples include Keira Bell’s challenge of the Tavistock Clinic’s treatment of gender dysphoric children with puberty blocking drugs; the ongoing judicial review of the accommodation of male prisoners who have obtained a “gender recognition certificate” in women’s prisons; and the judicial review of the Office of National Statistics’  advising people to disregard what it says on their birth certificate when answering the sex question in the census. Her Majesty’s Passport Office has admitted that it has no record of how many people it has allowed to change the sex recorded on their passport from “M” to “F” with a simple template letter downloaded from the internet and signed by a GP. The Equality and Human Rights Commission is being challenged for its failure to publish clear guidance on single sex services. 

Legal cases are one way to bring arguments and evidence into public debate and scrutiny. But they are expensive, and these policies are pervasive; across schools, universities, the NHS, local government, regulators, the charitable sector. The dots need to be joined up. And those who are disadvantaged and put at risk when safeguarding protections are corroded, and single sex services removed or made ambiguous, are often the most vulnerable and least able to complain. 

These cases have been supported by an extraordinary movement of grassroots groups, funded by thousands of people contributing small amounts of money. This mobilisation is testament to a failure of the institutions of public life to hold open space for debate and deliberation. 

Recently in parliament a debate broke through the chilling effect, following the introduction of a bill on maternity leave for Ministers, which avoided using either the words “woman” or “mother”. It took courage for MPs and Lords to speak up. As cross-bench Lord Baroness Tanni-Grey Thomson said 

“This is a contentious issue and in this debate there will be many views… We need to be able to have an open discussion, without fear of retribution, of being cancelled or shouted down for discussing terminology or having a different view. …

I thought long and hard about joining the debate today and whether I could deal with any potential backlash that may come my way for saying that the word “woman” should be in this Bill. …Being told what my opinion should be does not encourage sharing of views and is detrimental to the long-term goal of equality.”

We urge you to read the whole of those debates, particularly those in the House of Lords on 22 and 25 February where Lords from across the house expressed grave concerned about the impacts of the erasure of sex on law and policy, on freedom of speech and on public decision making and the culture of public institutions. 

This is a systemic issue, across national and local government institutions and private and voluntary institutions. Fear of speaking clearly and recognising reality makes it impossible for people to do their jobs with integrity, objectivity and accountability and to pursue equality. 

The  Committee on Standards in Public Life, uniquely and unquestionably, has a remit and responsibility to take this up. We urge you to speak up and to call for leaders of institutions to refocus on building cultures that enable selflessness, integrity, objectivity, accountability, openness, honesty and leadership, not identity politics. We call the Committee to open an inquiry into the political erasure of sex in the UK.

Kind regards…

[I signed this letter dated 28-9-21 with some of the members of the women’s group I am a member of. The letter arose from our reading and discussion of a statement called “Sex Matters”, which I recommend. It was also sent to the Committee on Standards in Public Life and can be found here: https://sex-matters.org/take-action/take-action-archive/sign-our-letter/]

To the readers of my blog

29/06/2021 Comments Off on To the readers of my blog

Dear readers,

I have not written much on this blog this year as work and mental survival have swallowed up my time and energy. However, I want to say very briefly that I do not appreciate people signing on to read this blog who do not identify themselves but who use made-up names. Several months ago, I removed everyone from the list who fit this “category” — having only just discovered I could do so. I will do it again.

To those of you who have stayed with me and who do identify yourselves, I thank you for your support. Doing a blog as an individual, I have discovered, is not the same as doing it as someone in a position such as a journal editor. I need to re-think what the point is, and I am hoping/intending to start writing again after the summer if not before!

Very best wishes, Marge