ICPD+25: The Cairo “compromise” on abortion and its consequences for making abortion safe and legal

31/07/2019 Comments Off on ICPD+25: The Cairo “compromise” on abortion and its consequences for making abortion safe and legal

In 2009, Mindy Jane Roseman and Alice Miller, now professors at Yale Law School in the USA, published a book called Reproductive Health and Human Rights: The Way Forward (University of Pennsylvania Press), a collection of papers that critically reflected on the previous 15 years of international efforts aimed at improving health, alleviating poverty, diminishing gender inequality and promoting human rights. I contributed chapter 11, on the Cairo compromise. Because ICPD is having its 25th anniversary conference this year, someone contacted me to request a copy of my chapter, which is under copyright. The publisher confirmed I could post it here, on my blog, so I am doing so. Here is the full text of the chapter, minus the references, as this blog does not allow attachments and the whole is 50 pages:

In: Reproductive Health and Human Rights: The Way Forward (edited by Laura Reichenbach and Mindy Jane Roseman), University of Pennsylvania Press, Philadelphia © 2009 (pp 152-166)

The Programme of Action of the International Conference on Population and Development is an extraordinary document. It is more than ten years since the conference, yet its comprehensive analysis of what constitutes sexual and reproductive health, reproductive rights, gender equality and equity, attention to the needs of adolescents and socio-economic development as it relates to population health, and how these can and must be achieved, is unsurpassed. For those for whom the document itself is a distant memory, it is worth re-reading. There is one exception to its brilliance, however, which is the subject of this chapter, that is, how the document addresses induced abortion.

Induced abortion is referred to a number of times in the Programme of Action, either specifically (paras. 7.6, 7.24, 8.19 and 8.25), by inference as a method of fertility regulation (paras. 7.2, 7.3 and 7.5b), or in relation to unsafe abortion as one of the causes of maternal mortality and morbidity (para. 8.20) (Programme of Action 1994).

The great contradiction contained in this document, and the reason why in the short run it was such a let-down on the subject of abortion, is that although it urged on page after page that reproductive health and fertility regulation were to be considered as reproductive rights, the safety and legalisation of one of the most commonly used methods of fertility regulation − and a major cause of avoidable mortality and morbidity in women − was eschewed. All the negotiators managed to eke out in the effort to achieve a broad-based consensus was the proposition that “in circumstances where abortion is not against the law, such abortion should be safe” (para. 8.25).”

What the Programme of Action says about abortion

The perception of abortion contained in the Programme of Action explains a great deal in relation to the continuing conflict that has taken place on the subject in the years since. In the paragraph defining what constitutes reproductive health, the Programme of Action calls for:

“…the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, and other methods of their choice for regulation of fertility which are not against the law…” (para. 7.2)

From the perspective of what health services should be doing, it says that:

“Reproductive health care in the context of primary health care should, inter alia, include… abortion as specified in paragraph 8.25, including prevention of abortion and the management of the consequences of abortion… [and that] diagnosis and treatment for complications of pregnancy, delivery and abortion… should always be available, as required.” (para. 7.6)

These first mentions in Chapter 7, having clearly been edited to reflect the more detailed text in Chapter 8, take an equivocal tone about abortion, not treating it as a means of fertility regulation or as a legitimate reproductive health service, but as something that must be prevented. In Chapter 8, the public health problem of unsafe abortion is stressed but instead of recommending that all abortions should be made safe, which would resolve the public health problem fully, it recommends that all unwanted pregnancies should be prevented, as if this were feasible:

“a significant proportion of the abortions carried out are self-induced or otherwise unsafe, leading to a large fraction of maternal deaths or to permanent injury to the women involved… Greater attention to the reproductive health needs of female adolescents and young women could prevent the major share of maternal morbidity and mortality through prevention of unwanted pregnancies and any subsequent poorly managed abortion.” (para. 8.19)

Thus, moral judgment on abortion constantly trumps the public health imperative to save women’s health and lives. Safe abortion should be provided only if it is legal, on the one hand, and on the other hand, it should be prevented and recourse to it should be reduced, or better, eliminated. That women must be encouraged to use family planning is repeated time and again. Abortion is seen as a matter for governments only insofar as “[g]overnments should take appropriate steps to help women avoid abortion” (para. 7.24), which is fine as far as it goes, but refuses to address what governments should do once a woman has an unwanted pregnancy and seeks an abortion. It is commonly known that contraceptive methods are not perfect and people are not perfect users of them, and that in some cases men stop women from using contraception, while in other cases rape, sexual abuse, and coercive sexual relations are the reason for unwanted pregnancy. Yet the document calls only for increased use of family planning (viz. contraception), as if contraception will eliminate “any subsequent poorly managed abortion” (para. 8.19).

Thus, women seeking abortion in countries where it is legally restricted and/or not provided safely are left with unsafe abortions. For them, the document recommends only “compassionate counselling” and “diagnosis and treatment of complications”, in flagrant contravention of the duty on health professionals to “do no harm”, one of the historical pillars of medical ethics.

Unlike the rest of the Programme of Action, the stance on abortion is not based on evidence of what is required to promote and protect reproductive health or to reduce maternal mortality, or on the right to decide the number and spacing of children. Instead, these paragraphs wash their hands of responsibility for the harm that results from unsafe and illegal abortion. Women living in countries where abortion is unsafe and illegal can only hope to be patched up after the fact.

The greatest impact, however, has been due to the following sentence, repeated in two different chapters:

“In no case should abortion be promoted as a method of family planning.” (paras 7.24 and 8.25)

This statement, a masterpiece of equivocation, was originally imposed by the Reagan administration in the final recommendations of the 1984 global population conference in Mexico City. It has proven to be a potent weapon in the hands of a right-wing United States (US) government, which has used it to block work on making abortion safe and legal, in tandem with the threat of withholding funding. I well remember some of those who claimed to support abortion rights at the Cairo conference coming out of the negotiations saying that they “could live with” this phraseology. Many of them probably did not think abortion should be “promoted” either, as the ambivalence about abortion among them was and perhaps still remains strong (Løkeland 2004). They were also willing to support the repeated references to preventing abortion, which they also agreed with, and they found it difficult to argue against respect for the law and the so-called “culture” in countries where abortion was illegal, even if the law and culture concerned were based on the oppression of women. Thus, although para. 7.3 says that the right to reproductive health “…also includes [women’s] right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents…” (para. 7.3), the Programme of Action in fact never recognises that for women living in poverty and young women, unsafe abortion is a form of economic discrimination, because women with money can pay for safe abortions; that abortion may be necessary as a consequence of sexual coercion;ii  and perhaps most importantly that because the means to provide safe abortions exist, making women have unsafe abortions is a form of violence against women (Amuchastegui Herrera and Rivas Zivy 2002). The anodyne term “unsafe abortion” makes it possible to forget the horrific morbidity and mortality that can result. Figures 1 and 2 are a reminder of what unsafe abortion actually means (Kinsey-Clinton 2002; Oye-Adeniran, Umoh and Nnatu 2002).

Figure 1. Police photograph of Gerri Santoro, who died in 1964 at the age of 27 in a Connecticut (USA) motel room after a botched illegal abortion. The man who did the abortion used borrowed medical implements and a textbook.

Figure 2. Loops of gangrenous small intestine protruding from the vagina, 20-year-old girl, Lagos University Teaching Hospital, Nigeria

This was the underbelly of the great compromise of Cairo, that with women’s autonomy hanging in the balance, those who believe that motherhood should be forced on women had to be assuaged and were more important than women themselves. However, the longer-term outcome of that fierce battle of wills and ideologies, which drew in people from all over the world, in spite of its equivocal outcome, put the public health problem of unsafe abortion on the global agenda in a way it had never been before. And on the agenda it has staunchly remained. The question of whether this has been a good thing or not, and whether what the document said would remain relevant, especially with the appearance of new politicians and governments with the passage of time, is the subject of the rest of this chapter.

The compromise: contradictory stances

A compromise by definition ends up pleasing no one entirely. This compromise allowed the document to be passed by a large majority of countries, a major success for the thousands of people who worked hard for that goal. However, for a compromise to be workable, the terms cannot be so contradictory that implementing them is impossible. However, this is what has happened as regards abortion with the Programme of Action. Since 1994, both those who support safe, legal abortion and those who oppose it have focused only on the sentences and phrases in the Programme of Action that support their own position. Since ICPD, the Vatican has engaged in a pro-active campaign against abortion that has been all the more effective in the context of the rise of religious and political fundamentalism in all world regions and religions. From the day George W. Bush took office in 2001, he has added fuel to that campaign. On the other hand, for those who support women’s right to safe abortion, outrage and dismay at the terms of the compromise in many cases motivated a renewed effort to campaign for safe, legal abortion.

Both sides remain uncompromising post-Cairo, though there are recent efforts on the part of some pro-choice activists in the US to seek another sort of compromise position, based on so-called “fetal value” and “prevention of abortion”. Unfortunately, this does not arise in response to a comparable willingness to compromise by anti-abortionists, and I believe it is doomed to failure (Kissling 2005). Yet all anti-abortionists do not support the same goals either, and the various anti-abortion partners during the Cairo negotiations did not all have the same ends in mind, nor the same ends as the Bush administration does today. The Vatican was and remains opposed to the whole concept and practice of fertility regulation, not just abortion, while the then largely pro-natalist Latin American governments that had weak family planning programmes or sided with the Vatican in 1994 today mostly have far more substantial family planning programmes and many are actively debating abortion law reform. The countries where a conservative interpretation of Islamic law is dominant were opposed to the legalisation of abortion on the grounds of “culture” and support for “the rights of the family” over the rights of the individual (woman). This was both a pro-natalist and anti-women’s rights position rather than a strictly religious one. Indeed, a number of theological interpretations of Islam and a number of Islamic countries permit abortion in the first months of pregnancy (Serour, Ragab and Hassanein 1996).

The Bush administration has had to take a complex stance, because it has had to engage internally with almost 40 years of US government support for family planning programmes globally and a long-standing commitment to reducing maternal deaths, which has included support for post-abortion care programmes. The upheaval caused by the changes in leadership, senior staffing and policy in key US government offices, such as the United States Agency for International Development (USAID) and the United States Food and Drug Administration (FDA), that have emerged under Bush will, I believe, prove disastrous for the United States in the long run. Most countries have made efforts, both large and small, to incorporate the ICPD Programme of Action into their national policies, programmes and services (Haslegrave 2004), while the biggest donor in the field before 1994 has rapidly been back-pedaling. This has caused havoc in countries where long-standing US funding was withdrawn or threatened with being withdrawn (Crane and Dusenberry 2004).

The bullying that has accompanied US efforts to derail the implementation of the Programme of Action is thought to be unprecedented. At first, it was only whispered about in the corridors but then it was confronted openly, and anti-ICPD resolutions put forward by the US were roundly defeated in every post-ICPD-related international meeting (UNFPA 2005). While the Bush administration has certainly succeeded in stopping work being done in the short term, it is also causing great resentment.

However, USAID under Bush has a right to claim that it too is implementing the ICPD Programme of Action, as regards the stricture that “In no case should abortion be promoted as a method of family planning.” (paras. 7.24 and 8.25) This is the basis for the memorandum containing the Bush version of the Global Gag Rule. In it, neither financial support nor technical assistance for activities related to abortion are permitted.iii In this memorandum, abortion is considered a method of family planning when it is for the purpose of spacing births. This includes, but is not limited to, abortions performed to protect the physical or mental health of the pregnant woman. It does not include abortions if the life of the woman would be endangered if the fetus were carried to term or abortions following rape or incest (since abortion under these circumstances is not considered a family planning act). Also excluded from this definition is the treatment of injuries caused by an abortion; thus, post-abortion care is explicitly permissible, and again is a Programme of Action goal (Global Gag Rule Impact Project 2003).

In addition to refusing to fund abortions as a method of family planning, the Gag Rule’s definition of promotion of abortion includes, but is not limited to, operating a family planning counselling service that includes advice and information regarding the benefits and availability of abortion as a method of family planning; providing advice that abortion is an available option in the event other methods of family planning are not used or are not successful or encouraging women to consider abortion; lobbying a foreign government to legalize or make available abortion as a method of family planning or lobbying such a government to continue the legality of abortion as a method of family planning; and conducting a public information campaign regarding the benefits and/or availability of abortion as a method of family planning (Global Gag Rule Impact Project 2003). All NGOs in countries who are recipients of USAID funds have been required to sign the Global Gag Rule before their grants are approved or continued. Not having an alternative source of funding, most of these NGOs are believed to have signed (Crane and Dusenberry 2004; Global Gag Rule Impact Project 2003). There are also notable exceptions, such as that of the International Planned Parenthood Federation (IPPF 2007).

The problem with all this is not what “promotion” of abortion means, since abortions will be needed regardless of whether anyone promotes it, but also what “family planning” means. The fact of the matter is that the practice of family planning and abortion can never be separated. In this, the Vatican at least has a consistent world view, while the Gag Rule is contradictory. But the Bush government is not interested in philosophical or linguistic debates. It is the very ambiguity inherent in its policy that gives the Gag Rule power, because if USAID even thinks an NGO has transgressed (and they have people tasked with watching for this at country level), they can cut their funding off. The threat alone has worked very well in stopping NGOs that are dependent on USAID from doing anything related to abortion, for fear that they will be de-funded (Crane and Dusenberry 2004).

Whither the right to safe, legal abortion

As powerful as the alliance against abortion was in 1994, the momentum generated by ICPD and the overwhelming acceptance at country level of the need to protect and promote sexual and reproductive health and rights has been far stronger. In the Soviet Union and Eastern Europe, abortion had been legalised in the 1950s and in some cases even earlier. In the US and Canada, most of Europe, New Zealand, and Australia, the main battles for legalisation of abortion had taken place and been won by the end of the 1970s. However, in 1984 at the Fourth International Women and Health Meeting in Amsterdam, many of the women from developing countries said they could not participate in a network if the word “abortion” was in the name and could hardly raise the issue aloud in their own countries. In the more than twenty years since then, a sea-change has taken place; unsafe abortion is a public health problem that is being raised in country after country in the developing world.

The language of ICPD+5 on abortion in 1999 was the basis for the WHO Safe Abortion guidance document (WHO 2003b) and the lever for more work on abortion on the part of governments. It also spurred an increase in funding for making abortion safe on the part of several European donors, especially Sweden, the Netherlands, and the UK governments.

All over Latin America and the Caribbean, abortion is the subject of public debate, in which the supporters of safe abortion are becoming far more numerous. The Mexico City legislature has made abortion legal during the first trimester, although it is being appealed to the Supreme Court. (Billings et al. 2002; The Guardian 2007). In Cuba and Guyana, the laws are liberal. In St Lucia and Trinidad, the law has been changed, and Jamaica is considering legal reform as well (Center for Reproductive Rights 2007). A Parliamentary bill to make abortion legal up to 12 weeks of pregnancy in Uruguay in 2004 was lost by only four votes, although some 63% of the population support law reform (Hierro López 2004), and in Brazil, a bill has also been tabled though the outcome is currently uncertain (Adesse and Campello Ribeira de Almeida 2005). Campaigns for health services to provide legal abortion under existing laws, such as those allowing abortion on grounds of rape, are ongoing in Mexico and Brazil (Brazil to ease abortions for pregnant rape victims 2005). Clarifying the legal situation to allow abortion when the fetus is unviable is being supported by obstetrician−gynaecologists in Peru and Brazil (Catholic World News 2004; Ferreira da Costa et al. 2005). In Colombia, a human rights lawyer successfully challenged the law on abortion in the Constitutional Court as a violation of several of the human rights instruments signed by the country. The court situated its decision in the tradition of ICPD and Beijing, and subsequent interpretations of human rights by international human rights bodies. Abortion is now legal to save the life and health of the woman, in cases of rape and when the fetus is not viable (Women’s Link Worldwide 2005; Women’s Link Worldwide 2006).

In Africa, abortion has been legal in Tunisia, Zambia, and South Africa for some time. Ethiopia recently liberalised its law as well. Campaigns are taking place for liberalisation of the law in Kenya, Nigeria, and Ghana. Mozambique is also planning legal reform. In Asia, Nepal’s Family Planning Association defied the Global Gag Rule and worked for legalisation of abortion, with law reform succeeding in 2004. Abortion services are being made available through the health system (Shakya et al. 2004; Thapa 2004) and through several non-governmental clinics (Barbara Crane, Ipas, pers. communication 2006). Cambodia has also liberalised its law. India, in spite of a long-standing liberal law, is often held up along with Zambia as the exception to the rule that where it is legal, abortion will be safe, but efforts to tackle morbidity and mortality from unsafe abortions are growing (Hirve 2004).

Safer surgical methods of abortion, particularly manual and electric vacuum aspiration, are more widely available and training in using them has been carried out in a growing number of countries thanks to non governmental organizations like Ipas (Hessini 2005), Marie Stopes International, and a growing number of private providers. At the same time, women’s access to medical abortion in legally restricted settings, using at least one of the two types of abortion pill that have been included on the WHO List of Essential Medicines since mid-2005, is reducing many first trimester abortion deaths, according to providers of post-abortion care.iv

At the ICPD, it was agreed that where abortion was illegal, post-abortion care services (“management of the consequences of abortion” [para. 7.6]) should always be provided. Many hospitals are more willing and better equipped to treat women with incomplete abortions than in the past, when the morbidity from dangerous invasive methods was far worse than it is today. Progress has been made in Mexico, Brazil, Bolivia, Peru, Nicaragua, El Salvador, and Guatemala, among others, in increasing availability of post-abortion care, but a recent review of post-abortion care initiatives in public hospitals in seven Latin American countries shows that much work remains to be done (Billings and Benson 2005). In Guatemala, for example, post-abortion care has recently been scaled up and is available in the majority of district hospitals. Unfortunately, at least in the first two years of this programme, mortality from unsafe abortion had not been reduced (Kestler et al. 2006).

In Africa, “a recently developed model of costs for abortion care shows that treating incomplete abortions in tertiary facilities costs ten times more than providing elective abortion in a primary health centre” (Johnson 2004). Moreover, in 2006, a paper examining the extent of hospitalisation for abortion in 13 developing countries where abortion is still illegal reported that hundreds of thousands of women are being treated each year, taking up hospital beds and resources that could be used to improve women’s health as well as make abortion safe (Singh 2006).

Thus, there is a long way to go, and all is not rosy. Fundamentalism grows apace and the gulf between fundamentalist and secular world views is widening, with women’s rights hanging in the balance. The situation for women needing an abortion in Poland is dire (Polish Federation for Women and Family Planning 2005), and the battle to legalise abortion at a woman’s request will be uphill for decades to come in many countries. The problem of morbidity and deaths from unsafe second trimester abortions is often hidden, as has been shown in Mexico (Walker et al. 2004), and even in the developed world second trimester abortions are less accepted than those in the first trimester. As one Norwegian author has argued, even in Europe “the legal right has been won, but not the moral right” (Løkeland 2004).

On the other hand, in the now ratified 2003 African Charter on Human Rights and Peoples’ Rights Relating to the Rights of Women, states are called upon to protect women’s reproductive rights by authorising abortion in cases of sexual assault, rape, incest, fetal impairment and where continuing the pregnancy would endanger the life or mental or physical health of the woman (African Union 2003). Rulings on the part of several United Nations treaty bodies have also supported abortion rights. For example in November 2005, the United Nations Human Rights Committee, which monitors countries’ compliance with the International Covenant on Civil and Political Rights, decided its first abortion case, brought by a woman who had been refused a legal abortion and forced to carry a non-viable fetus to term. The Committee established that denying a woman access to legal abortion violates her most basic human rights. This was the first time an international human rights body has held a government accountable for failing to ensure access to legal abortion services (Center for Reproductive Rights 2005).

In 1994, the same year as the ICPD, Jain and Bruce proposed some sensible indicators to measure whether women were achieving their reproductive intentions in a healthy manner. These included: the extent to which women are able to have a desired pregnancy which results in a positive

outcome, prevent an unplanned pregnancy, terminate an unwanted pregnancy safely, achieve the desired interval between two consecutive births and prevent any associated reproductive morbidity (Jain and Bruce 1994). These acknowledge, simply and without compromise that safe, legal abortion is a central aspect of fertility control.


It is time for unsafe abortion, and the ICPD compromise on abortion with it, to become an anachronism. In a few short years, the 20-year period that was originally set to achieve the goals of ICPD 1994 will be upon us. It would be too optimistic to say that the trend towards greater access to safe, legal abortion is inexorable. History is cluttered with instances of political backsliding and stalled initiatives, especially when it comes to implementing verbal support for women’s rights. However, the Vatican and the current fundamentalist stranglehold on US politics notwithstanding, the trend is that unsafe, illegal abortion is on its way out, not least because low fertility is here to stay for the foreseeable future – with a two-child norm for the majority of the globe, many one-child families, and a growing number of people who have no children. More and more women are being educated and are in paid employment. Although access to contraception is still limited for many and unsafe abortions still take place, more women and men are practising fertility regulation. With fewer children to raise, they have time for doing other things with their lives as well. The right to family planning has been accepted by most women and men – and almost all governments and has been accepted as a socially acceptable, legitimate practice, even in some conservative societies. Efforts on the part of those who would turn the clocks back are unlikely to succeed in the long run, whether those who, as anti-abortionists, would rescind all access to contraception and safe abortion or those who are proposing to push the fertility rate back up where it has fallen below replacement level, e.g. in Europe, while claiming to be pro-choice.v

Would women be worse off insofar as abortion is concerned if the Cairo compromise had not taken place? Yes, without a doubt, which is why the pro-choice government delegates and NGO representatives at the conference spent so many gruelling hours hammering it out. However, the terms of the compromise do not support making all abortions safe and legal.

As is common with extremists, the Bush government has gone overboard in its efforts to limit sexual and reproductive rights. Like all donors, however, the US needs to give financial support to other countries both in order to assert its leadership in the world and to have influence over the policies and programmes of those countries. Recipients of funding need to recognise their collective power and refuse, individually and collectively, to accept the Gag Rule, just as governments overwhelmingly voted no when Bush administration representatives at the UN Special Session on Children in May 2002 (Girard 2002) and regional ICPD+10 meetings in 2003 and 2004 tried to introduce clauses to undermine the 1994 Programme of Action (Haslegrave 2004).

A women-centred perspective considers abortion legitimate not only if it is to save the life and health of a woman, or as a consequence of rape or incest, or because of fetal impairment, but also on social and economic grounds, to protect a woman’s existing children and as a method of birth spacing or limiting births. A woman’s reasons for abortion always come back to the fact that she does not wish to carry a particular pregnancy to term. A women-centred perspective considers the need for abortion to be a necessary part of sexual and reproductive life. The legalization of abortion is fundamental to the long-term safety of abortion and the ability of health services to provide it as a legitimate procedure.

Making abortion legal is the only way that morbidity and mortality from unsafe abortions have been reduced historically, as evidenced in an analysis of national data from more than 160 countries (Berer 2004). If women are to have not only the inalienable right to life, but also the right to life on their own terms, the argument for making abortion safe, legal and accessible is unassailable.

Copyright (C) 2009. University of Pennsylvania Press

“All rights reserved. Except for brief quotations used for purposes of scholarly citation, none of this work may be reproduced in any form by any means without written permission from the publisher. For information address the University of Pennsylvania Press, 3905 Spruce Street, Philadelphia, Pennsylvania 19104-4112.”




How not to succeed in publishing a paper on an FGM trial, and keep trying

27/07/2019 Comments Off on How not to succeed in publishing a paper on an FGM trial, and keep trying

In February 2019 an African-born woman living in the UK was the first person to be convicted of the genital cutting (FGM) of her small daughter. I observed the trial and wrote a long blog about it, which I posted here. I have never previously considered a “blog” to be a published piece of writing. As a journal editor, I believe what is published needs to be peer reviewed or go through at least some sort of editorial process. To me, a blog is a thinking place, to get your ideas down, and then work on them until they’re ready for submission for publication. Or at least, that is what I tell myself today. However, to be honest, I hadn’t really thought about it at all until I found myself unable to publish a revised version of the article in a “real” publication because an earlier version of it had appeared on my blog — even though very few people read this blog — and a survey would probably show that they (you) are not readers of at least three if not all four of the places I’ve submitted it for publication so far.

The sentencing took place on 8 March 2019. I revised the paper because of that. I had already revised it when I decided it should be submitted somewhere for publication. So far, I have revised it at least four or five times.

Of the four places I have submitted it to so far, the first one (a clinical journal) turned it down because they were afraid they might be sued for being critical of the legal handling of the case. What? my friends said, of course people can criticise lawyers and judges. But this was a medical journal. The second one (a review magazine) accepted the paper. I was thrilled. Then several weeks later they must have noticed on the last page during editing that an earlier version could be found on my blog (well,  I wasn’t trying to hide it!). So they dumped it. They didn’t think there was anything wrong with accepting a paper and then changing their minds. Indeed, they even offered to pay me for the loss of time involved. I felt that would make me complicit in breaking what I have always understood as a contractual agreement, so I said no, very cheesed off. My friends said there must be another reason. I thought they were right. But there wasn’t.

Then I sent it to a newspaper that publishes longer papers every week. No reply at all… The fourth place (a medico-legal journal) also said they would like to publish it but again, I would need to revise it substantially from the version on the blog first. In hopes it might help, I took the blog post down. It didn’t help. Frankly, I don’t know what they expected. The bulk of the paper is a description of what happened in the trial. I couldn’t rewrite that. I revised a fair amount of the commentary/discussion sections of the paper, sharpening my thinking, bringing in new information, but I was kidding myself to think they would accept it, just as they were kidding themselves that I could revise it to their satisfaction.

Never mind. As an editor, I know too well how often authors go through this. Why should I be exempt? And the paper was getting better and better in the process, if I do say so myself. Unfortunately, no one was reading it except me.

So, in case you’re wondering why it isn’t posted here anymore, this is why. And in the five months I have lost on this so far, I have discovered to my great disappointment that two publications that I respected a lot were more concerned about publishing something that had appeared in an earlier version on a blog than doing their part to help challenge the conviction of a woman that I believe was unsafe. A woman who is in prison for the next 13 years. Which is why I wrote the paper in the first place. What does that say about their priorities and sense of political responsibility as publications, do you think?

I’ve not given up. I revised it again last night, even more than before… I submitted it to another journal, but their word limit was half the length of the paper and it took them less time to reject it than it took me to go through the online submission process. Then I sent it to the editor of a journal whose subject is totally in line with the dual issues covered by the paper. No, thanks, it’s not academic enough, but more like a blog. Now what?

The role of the police and the courts in prosecuting allegations of FGM: a review of “The FGM Detectives”, Channel 4 TV, and the case that just ended at the Old Bailey

26/03/2018 Comments Off on The role of the police and the courts in prosecuting allegations of FGM: a review of “The FGM Detectives”, Channel 4 TV, and the case that just ended at the Old Bailey

The Channel 4 TV programme was shown on 27 February 2018, reported by Cathy Newman. It depicted the failure of a British detective named Leanne Pook to bring a successful prosecution against a Somali father of a six-year-old girl for allegedly arranging for her to have FGM, after an investigation that took two years. The programme was supportive of the police action right to the end, yet it provides a disturbing picture of why the police and the Crown Prosecution Service have failed to successfully prosecute cases of FGM four times now. The case also highlights, as have previous court cases, the important role of the court in not allowing the accused parent to be found guilty, due to the lack of evidence. It shows, in my opinion, that the involvement of the police and the criminal law is not the way to prevent FGM, or to support those who have had or may be at risk of FGM.

The programme illustrated how the right to bodily integrity of a six-year-old girl believed by the police to be a victim of FGM was violated by the police. The investigation was based entirely on the uncorroborated report of a conversation between a taxicab driver, the girls’ father, and a passenger in his cab. The passenger, who was a member of an anti-FGM group in Bristol called Integrate, presumably raised the issue of FGM with the driver because he was Somali. The passenger alleged that the father said he was not against minor forms of FGM, and that he had had that done to his daughter.

The programme opens: “Thousands of British women and girls have had their vaginas deliberately mutilated.” This is false. First, there is no evidence worth the name that most of those living with FGM in Britain have had FGM in Britain. Secondly, FGM is practised on the external female genitalia, the clitoris and labia, and sometimes also by sewing the edges of the vaginal opening together. There is no mutilation of the vagina.

DCI Pook, who led the investigation of the case was, in addition to being a police officer, a trustee of the local anti-FGM group in Bristol called Integrate. The taxicab passenger reported his conversation with the driver to someone more senior than him at Integrate, who in turn reported it to DCI Pook. The programme follows her investigation of the taxi driver, his wife and his six-year-old daughter, and her unsuccessful attempts to gather any evidence to prosecute the father for FGM beyond the passenger’s description of his conversation with the father.

The police considered the passenger’s statement to be enough for them to pursue the case. DCI Pook was very keen to do this; she wanted to be the first to bring a successful FGM prosecution in this country, which emerged strongly during the programme, raising questions about her ability to be impartial, question which were asked after the trial collapsed.

The programme was extremely vague about why the investigation should have taken two years. The police did not prosecute the girl’s mother, though they found the phone number of a “circumciser” on her phone, who the father said had been contacted to circumcise one of his sons. The programme did not indicate whether the circumciser was ever questioned and nothing more was said about him. In the programme, the investigation never went beyond the questioning of the girl and her parents, and discussion about the examination at two different times of the girl’s genitals. Yet one would expect other family members, friends, neighbours and other Somali community members close to this family to be questioned.

Yet, 17 minutes into the programme, DCI Pook is shown to be participating in a street demonstration against FGM with women and children from Bristol and is also shown talking to a group of parents and adults, about the importance of investigating FGM. This is followed by a meeting with youth members of Integrate, where a discussion about claims that a small nick is not abuse are challenged. This shows that DCI Pook’s role as both the investigating police officer and anti-FGM advocate are completely intertwined in this investigation, with no question of a possible conflict of interest being raised. The question of the consequences for the child or her parents that the whole community knows about this investigation is never mentioned.

The girl’s parents deny ever having had anything done to their daughter, and her father denies ever making the comment that he was accused of making while driving his taxi.

The only other possible source of evidence shown by the programme to be sought, was the girl herself. Investigating her took two forms: first, she was questioned by someone considered to be an expert at using drawings with children as a means of getting information from them. The girl was asked to do a drawing of her body in the hope she would recall the FGM because it would have been traumatic, so she might say something about it. This did not happen, however. The expert failed to elicit any verbal or visual evidence that FGM had taken place.

The second step was to examine the girl’s genitals. In order to do that, the programme reports, she had to be willing, so she was interviewed at her school. There is a meeting with 5 or 6 staff from the school. We are not told who was present when the girl’s permission was sought nor what was said to her, but we are told she agrees. The child’s parents are informed it will happen but they are not permitted to be present, nor was their permission sought. The programme gives no information about who conducted this physical examination. We learn later that some kind of equipment (unidentified) was used and that pictures were taken of her genitals. We have to assume the examiner would have opened her labia and closely examined her clitoris for evidence.

The police were at least honest enough to say at some point afterwards that the little girl described the examination as disgusting. This is hardly surprising. In my opinion, the examination constituted a serious violation of her bodily autonomy, of her right to privacy and to be able to withhold her consent. Yet a six-year-old girl could not possibly have understood what the examination would involve, and even if she had, how could she have refused? Adults from her school, the police, all apparently supporting it, her parents absent – all major forms of pressure. Even if she had had FGM in the past, it is highly questionable that this is ethically acceptable.

But that’s not how DCI Pook saw it. Her response to the girl’s reaction is that an investigation must be thorough enough that the victim is not relied upon alone for the evidence (or in this case lack of evidence). The child was in fact examined twice, we learn later, but we were not told how often she was questioned nor what the questioning covered. DCI Pook reports that the first person who examined her found something that might have come from a small cut on the child’s clitoris. A detective reports that the girl had at some point been taken out of the country during school holidays, which he describes as an opportunity for her to have been cut elsewhere. Indeed, or it might have been a holiday or a family visit. No further details are given, and no evidence is offered of this being more than a supposition.

By this point in the programme, however, the lack of evidence is becoming obvious. To counter this, DCI Pook embraces the idea that a “small cut” may have been done without leaving visible damage or scarring – a tiny nick (enough to draw a drop of blood) or a pinprick – and she decries the belief that this should not be prosecuted as FGM, and indeed she seems to conflate it with a severe or mutilating cut. Another officer says a nick or a pinprick of any kind is still painful. Several of the male officers talk about the importance of the police protecting little girls from such abuse. Yet they have protected this little girl from nothing whatsoever.

The facts of this case are, whether she had been subjected to any form of FGM or a pinprick or not, no mark nor scar nor any other evidence from any person was found to indicate that anything had been done to her.

Moreover, it is reported that the photographs of the little girl’s genitals from the first examination were sent to an “FGM expert” to analyse. While this expert says she thinks the photos may indicate an injury, she believes they are “not good enough” as evidence. So she asks to conduct her own physical investigation of the girl as she wants to feel 100% sure there is an injury before she is involved in sending someone to prison. Hence, and the timeline here is totally unclear, it was agreed that a second physical examination of the child would be carried out by this expert, who is again not identified in the programme, and whose credentials are therefore unknown.

One of the male police officers is unhappy about a second examination because the first examination was unpleasant for the child, and this upsets him. Even so, and for reasons best known to themselves, the police decide it is time to arrest the parents, take them into the station and question them separately. Were they not questioned before the child was examined? We don’t know.

More than half a dozen police officers dressed in jeans and t-shirts, not in uniform so as “not to upset the community” set off to the family home. Unfortunately, the parents are not at home so they are asked to attend the police station, which they do and are arrested there. Their home is searched by a police team in their absence.

The father, it is reported, is questioned through an interpreter. This implies his English is limited, which is a critical matter but the programme does not treat it so. Yet in the second FGM trial in London, in 2015, in which another Somali man was accused of asking for his wife to be re-sewn up following delivery of a baby, he needed an interpreter in order to be questioned in court, and he was acquitted in part due to the probability that his English in the delivery room was misunderstood.

In any case, the programme reports that during questioning, the father denies there had been any FGM or any intention of FGM, and he denies ever having had the conversation with the Integrate team member in his taxi. The police officer questioning him says to him that the examination of his daughter had indicated an injury to her genitals and that the expert who had examined the photographs had also seen an injury. Although both these claims are patently false, the programme does not note it. The mother is similarly told that an injury had been identified. She reads out a prepared statement that she is opposed to FGM, and she refuses to answer any questions. Did the parents have any legal advice? We are not told. Had it been my programme, I would certainly have interviewed their legal team.

Meanwhile, in between each of these bits of the programme, there are shots of traffic on Bristol’s roads, sometimes speeded up, and shots of DCI Pook driving her car and talking to the camera… often with tense music playing which is totally out of place.

The search of the family home yields half a dozen plastic bags full of papers, but the only possibly incriminating item found is a phone number on a small bit of paper stuck behind a picture hanging on a wall. The phone number turns out to be the father’s phone number, however, not incriminating at all. How disappointing for the police, who still assert that if you hide something behind a picture frame like that, it is usually incriminating in some way. DCI Pook is not discouraged though. She explains that you rarely get one big piece of evidence in a case, as happens on TV. So they are cracking on.

It is time for the second examination of the girl’s genitals, by the “expert”. This examination found her genitals to be completely intact, with no evidence of any injury or FGM. We learn this indirectly through watching DCI Pook listening to the expert on the phone. The expert appears to apologise for disappointing her, and we hear DCI Pook say (in a very disappointed voice) that it was OK, never mind, the expert was just doing her job.

After she hangs up the phone, DCI Pook doesn’t say: “Isn’t it wonderful that this little girl has no evidence of any injury!” No, she says this news is a disaster for the police, and one of her male officers agrees. It seems they really wanted this little girl to have had FGM. DCI Pook looks straight into the camera and says: “This is a hammer blow to our case… I’m disappointed because I think we won’t get justice for this little girl.”

Oh, it seems that in spite of this phone call she remains convinced that FGM has happened to this child! What did the expert say to make her think so? DCI Pook tells us that the expert’s written report of her examination states that the lack of genital evidence may indicate that any injury may have healed. I would have liked to see the report myself, however, as this beggars belief.

But meanwhile, DCI Pook is good to go again, though she needs to find something to “strengthen the case”. The girl’s mother’s cell phone provides it, as noted earlier. They find a text and a phone number of a man whom the mother says has recently circumcised one of her sons. When she is asked if she has also had her daughter circumcised, she says “No comment”. Of course, if someone says “No comment” instead of yes or no, the assumption is that they are guilty. Does this prove they are? No. The programme does not report whether the son is examined for evidence of recent circumcision, surely an extraordinary omission. Nor does it say whether the alleged circumciser, whose evidence would surely have been key in this case, was found and interviewed. This is even more extraordinary.

At this point in the programme, we learn that “the evidence” has been submitted to the Crown Prosecution Service (CPS) to see if they think it is enough for criminal charges to be brought. After more speeded up footage of Bristol, of boats on the river this time, and to increasingly loud tense music, we learn that the CPS has given permission for a charge of child cruelty against the father to be brought and for “allowing or arranging for [the child] to have FGM”. They give permission for the father to be arrested and charged. If found guilty, we are told, he faces up to 10 years in prison.

When the court date is set, DCI Pook tells the camera, some of the Somali community have been heard to say they may organise a protest. Who has reported this to her is unstated, but the implication is that someone has been monitoring the Somali community’s response and reporting to the police. DCI Pook expresses concern that her witness, the taxi passenger, may be threatened, and she is shown talking to him on the phone to get reassurance that this has not in fact happened.

he next thing covered by the programme, although far too briefly, is when the Bristol Crown Court hears the evidence. The courtroom is packed. DCI Pook thinks this is mainly journalists, which she thinks indicates the importance of the case. However, the outcome is not at all what she is looking for. After what seems to be a very short space of time, the judge questions inconsistencies in the main witness’s statement and the evidence is described as “beginning to unravel”. The judge concludes that on the basis of the existing evidence, he would direct the jury to acquit the defendant. The programme tells us that the judge found the evidence deeply troubling and “wholly inconclusive at the highest”. She reports that the judge describes the equipment used to examine the little girl the first time as being 15 years out of date (what equipment was this, I want to know!) and that the photographs taken at that time were so blurry as to be of no use clinically or forensically as evidence. The main witness, though honest, the judge believes, had been influenced by his role in the charity Integrate. The CPS accepts the judge’s decision, but they also defend themselves by saying they thought there had been sufficient evidence to prosecute and that it was in the public interest to do so. Thus, the CPS also seems to have learned nothing from two previous failures, the first of which was comparable to this case.

And thus, if we forget the child and her parents for a minute, there is total self-justification all around. Thank heavens for the competence of the judge.

The programme returns to DCI Pook, now sitting by the river, who claims this is all part of the job. She is shown justifying herself to the media, and then says to the camera: “There were some evidential difficulties, we never denied that…”. She remains firm, however, that in spite of the negative impact on the family and the community, the police had a job to do and they did it. She says they have children to protect and that’s what they were doing. But were they, in this case? I don’t think so.

As DCI Pook walks away from the camera, the reporter says the police have had difficulty prosecuting anyone successfully because young victims keep silent – thereby implying that the child in this case had been silenced or was lying. This is frankly outrageous. “Victims” who are old enough to understand what has happened to them are not keeping silent. Yet it seems that no one involved in this criminal investigation or in making this TV programme thinks it is even remotely possible that the child concerned had never had FGM, in spite of the lack of evidence and the judge’s unequivocal assessment of the situation, which the programme corroborates in spite of itself. I’m left speechless. The programme closes with a report that yet another FGM case was due to be heard in London in the third week of March 2018.

And so it was.

This most recent case was heard at the Old Bailey in London, ending on 22 March in an acquittal. Here is how the Mail Online reported it in cringe-making language:

“The 50-year-old man, who cannot be named to protect the identity of the child, was cleared of two charges of FGM, alternative charges of wounding with intent and child cruelty… The defendant had been accused of twice arranging for someone to go to the family’s home in south London to cut the young girl with a razor as she lay on a mat in the hallway. The girl said she cried in pain and begged for it to stop but her father just encouraged the cutter, jurors were told. The child could not recall the identity of the person who allegedly subjected her to the ordeal twice… The prosecution said it did not happen for cultural or family reasons, but as a punishment. The allegations came to light after the girl told a friend, whose mother contacted Childline.”

I was unable to attend this trial and no one has covered it in a TV programme (yet). Here are the only other things I have found about it in the Guardian: During an interview in July last year, the daughter, now aged 16, said she had been subjected to FGM twice between 2009 or 2010 and 2013. On each occasion she claimed she was made to lie on a mat in the hallway of her home, naked from the waist down. Jurors also heard that she could not identify the cutter but said she recalled her father “egging the person on”.

The Guardian said the father was a 50-year-old solicitor and a Catholic. He was accused in court of being violent towards his children as well. His defending counsel said the divorce of the girl’s parents had led the mother to turn the children against him, and that they had rewritten their own histories as a result. Oddly, the Guardian reported: “The court heard the girl had been cut as a form of punishment after stealing money from the family home.”

As part of her defence of the father, Kate Bex QC, suggested that FGM was “predominantly perpetrated by female cutters on women” for reasons including “purification, honour and social acceptance”. But it is not true that only women do the cutting; it is also known to be done by men. The QC also apparently claimed the father could not have been responsible for the FGM because he was a Catholic, yet that is irrelevant. FGM is a traditional cultural practice and while some people claim it is an Islamic practice, those who have studied religious texts and history have shown it is not. Moreover, while FGM is found in some predominantly Muslim countries, it is not found in others, while it is found in certain predominantly Christian countries, in the Middle East and North Africa and also in sub-Saharan Africa and parts of Asia. Yet these two claims by the QC were reported by the Guardian to be (among) the reasons why the father was acquitted.

Evidence appears to have been submitted to the court that examination of this girl showed she had actually had her genitals cut in some way. But as the father denied arranging it and the girl had no memory of who had done it to her on either occasion, and no news report mentions further evidence, the father was acquitted. The Guardian says the jury deliberated for more than six hours before finding him not guilty of two counts of FGM, two alternative counts of wounding with intent and three counts of cruelty to a child. It seems that even though FGM was done, and perhaps more abuse, who had actually done it was not known. Why the father was not found guilty of anything is unclear, though it seems it was his word against his daughter’s. Without having heard the trial, however, it is impossible to know, and speculation is useless.


The four cases have one thing in common. There was insufficient or no evidence presented, and there was an absence of credible witnesses or corroborating statements. In three of the four cases, no genital evidence of FGM was found either. Hence, it can be concluded that these four cases were all doomed to fail.

Moreover, limited knowledge of English among those put on trial was recognised in interrogations of them through the use of interpreters, but this was not properly taken into account as a complicating factor in two of the four cases. Perhaps most importantly, in three of the four cases one onlooker reported someone they thought was suspicious to the police. I believe that the way the police and some anti-FGM activists are presenting this situation, as illustrated in the Channel 4 programme, it sounds like a witch hunt and the consequences for the communities affected and the children concerned are being swept aside in the fervour of wanting to find someone to hold responsible.

Lastly, although no one has yet publicly questioned whether the examination of the genitals of babies and small children for FGM is a violation of those children’s rights to privacy and bodily integrity, I am absolutely convinced it is. I am aware that this is also an issue with accusations of sexual abuse and rape of children, which I cannot comment on, but it would appear that the people who have carried out FGM examinations seem to be anything but experts.

The Guardian article ends with a quote from Leethen Bartholomew, the head of the National FGM Centre, which includes this statement: “The effects of FGM have a lifelong impact on survivors, both physically and psychologically, so it is vital support is in place for her for as long as she needs it.” This makes it seem that women who have had FGM are incapable of living their lives on their own two feet. It is the sort of statement that fuels extremist responses.

Criminalising FGM has stigmatised whole communities in the UK, such as the Somalian community. FGM has been falsely identified as an Islamic practice, thereby contributing to the stigmatisation of the religion and those who practise it as barbaric, alongside the link to terrorism. People who believe some form of FGM is necessary in order to remain part of their community are seen as monsters. Even the use of a pinprick to replace actual genital cutting, a positive sign that the practice is being transformed into something symbolic but not damaging, is still condemned as horrific and an abuse. When mothers argue that it is the only way their daughters will be accepted as marriageable, in a community where marriage is critical to belonging, this should not be seen as violence for its own sake but as a patriarchal demand that must be challenged among both men and women. Meaning that the way to try to prevent it should not be the use of criminal law.

There have been exaggerated claims of FGM prevalence in the UK, without any distinction between those adults who may have been cut in their home countries as children before coming here, and the completely unknown prevalence in children today who were born here. Health professionals are required to act like the police and to question women patients with girl children, on the assumption that their nationality/background is enough to indicate their children are at risk. Although no one has yet been identified as having done even one cut on one little girl in this country, there is an assumption put about that it is not only happening, but happening widely. All this is indicative that the practice has been demonised in many people’s minds.

I believe it is past due time to give serious reconsideration to how FGM is dealt with and perceived in the UK, and to finding ways of addressing it completely differently. The communities concerned need to have the leadership in this – for example, community-led educational information, based on the understanding of women who have experienced FGM and their families as to why they should not make their daughters and grand-daughters go through it too. Moreover, communities where FGM is/was practised should not be described individually or collectively as uncivilised, abusers or criminals by anti-FGM activists. That is racist.

In a paper I published in 2015, I called for the health consequences of FGM to be addressed because these are what women with FGM have asked for help with. A study among midwives in Belgium, published in Midwifery in 2014, found that the most common complications midwives said women sought help for were: psychological problems (63.1%), chronic pain (32.3%), sexual problems (30.8%), recurrent urinary tract infections or incontinence (24.6%), fistula formation (13.8%) and bleeding (9.2%). Complications in pregnancy and childbirth have been described in the UK as well. Practical help with these sorts of problems are a much more supportive way to address this issue with affected women. Health professionals need training to do so.

The police and the criminal justice system are not the answer.

 See my previous writing on this issue which covers the first two cases that took place in the UK:

Reflections on the recent arrest in London of two people for female genital mutilation (FGM). Berer Blog, 14 April 2014.

Acquittals in the FGM case in London: justice was done and was seen to be done, but what now? Berer Blog, 10 February 2015.

The history and role of the criminal law in anti-FGM campaigns: Is the criminal law what is needed, at least in countries like Great Britain? Reproductive Health Matters 2015;23:145-157. https://www.tandfonline.com/doi/full/10.1016/j.rhm.2015.10.001



Letter to the Editor, The Guardian, 4 March 2018

04/03/2018 Comments Off on Letter to the Editor, The Guardian, 4 March 2018

The article “Sex workers in Haiti speak out on aid agency scandal” (1 March 2018, p.41) is very poor journalism in that it mixes together issues that don’t belong together. Firstly, while it points out that poverty and loss of family in Haiti left many women with no option but to sell sex for a living, this is not a new problem for poor women in Haiti, and it certainly did not start with the 2010 earthquake, let alone with the arrival of aid workers. Secondly, aid workers have been working in Haiti for decades.

 Thirdly, the article appears to make the assumption that aid workers, who may spend years in a country, have no right to have sex – with anyone – while they are there. Indeed, the first half of the article is only about the fact that some aid workers are having sex with sex workers and paying above the national rate for it. This is not at all what this scandal is about.

Only after four columns of text does the article finally mention what the headline says it is about – that some “foreign workers” have been seen to ask for sex in exchange for supplies, and that a 2015 UN report found that “members of its peacekeeping mission in Haiti traded sex for aid with more than 225 women between 2008 and 2014”. Is this new news from this journalist? No.

After that, the article does not present any new evidence of this abuse of power. Instead, it reports that selling sex is illegal in Haiti and describes some personal experiences of sex workers that are unremarkable and irrelevant to the scandal. There is not one word more on whether staff of aid agencies in Haiti are abusing their power by trading supplies for sex, nor if so, how many, when or where. Yet the future of Oxfam and other aid agencies hangs in the balance. In the absence of actual evidence, the headline is false and misleading, and the article should never have been published.

Response to “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”: what’s the real point here?

22/02/2018 Comments Off on Response to “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”: what’s the real point here?

Letter to the Editor of the European Journal of Contraception & Reproductive Health Care, by Marge Berer

Received 04 Jan 2018, Accepted 23 Jan 2018, Published online: 19 Feb 2018



In your recently published article “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”, [1] the cases of three women who changed their minds about going through with an abortion after taking the mifepristone pill are presented with the aim of encouraging further research as to whether progesterone treatment is effective in reversing the effects of the mifepristone. Interest in the topic has arisen among people who appear to be anti-abortion and whose main purpose appears to be to find a clinical means to stop abortions already in process from taking place. In focusing on efforts to rescue the embryo, however, the authors, the editors and the reviewers all ignored the pregnant women and the reasons for their actions in this situation as well as the behaviour of the health care professionals.

What is striking about all three of the cases described is how quickly, and in two of the three cases, how immediately the women changed their minds and sought “reversal” of the mifepristone. This raises two quite different sets of questions about the behaviour of the health professionals involved that the report does not consider or answer. Firstly, were the providers of the pills not aware of what must have been quite serious ambivalence and conflicting feelings about the abortion in these women, and if not, why not? Surely it is part of their professional remit to ask the woman if she is sure of her decision, and if she is uncertain, advise her to wait to take the pills until she is sure. Secondly, did those same health professionals while they were handing over the pills say or do anything to upset the women, such as condemning them for seeking abortion or showing them their scan or nasty visuals of chopped up fetuses, as anti-abortion people often try to do, in order to discourage them from going ahead, which then led them to change their minds so abruptly?

And what about the women concerned? It is well known that a proportion of women who make a clinic appointment for a surgical/aspiration abortion do not turn up for the procedure because they have changed their minds, and that they may or may not return later. I well recall a now retired Ob-Gyn in the UK saying the proportion was around 10%, though that was many years ago.

In any case, in whatever the proportion of women who do so, wavering and a change of mind about whether to continue or end an unplanned pregnancy is not uncommon and may happen more than once in both directions before a woman ever seeks an appointment. Hence, I would argue that there is a far better way to address the fact that some women may change their minds, which takes into account all the women who opt for medical abortion pills to end a pregnancy. The fact is, women have a right to feel ambivalent and change their minds, and they should therefore be in complete control over whether and when they take the pills – instead of having to take them in front of a health professional at the health professional’s convenience.

In other words, all women opting for medical abortion should be able to use both the mifepristone and the misoprostol pills at home, in their own time, where they can change their minds (or not) as often as they need to, and only use the pills (or not) when they are sure of their decision. Then the search for an antidote to mifepristone would be unnecessary.

The publication of this article also raises issues about the role of editorial and peer review in the face of anti-abortion efforts to dress up their political aims as science. The authors of the paper should not have been allowed to ignore the situation of the women whose histories it presents, or the reasons for their change of mind, or what role the providers of the pills might have played in their doing so and in supplying the progesterone. Allowing these crucial aspects to be ignored was a failure of the editorial and peer review process and resulted in giving the paper the credibility of scientific publication when its underlying aim was to promote a way to stop abortions.

Disclosure statement

No potential conflict of interest was reported by the author.


  1. Garratt D, Turer JV. Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone. Eur J Contracept Reprod Health Care. 2017;22:472–475.

[Taylor & Francis Online], [Web of Science ®][Google Scholar]


Abortion and Human Rights: Health & Human Rights Special edition Vol.19, No.1, June 2017

18/06/2017 Comments Off on Abortion and Human Rights: Health & Human Rights Special edition Vol.19, No.1, June 2017

This is a special edition of the HHRJ Journal on one of the key topics of the Campaign – abortion law and policy and the value of human rights in seeking to improve policy and practice. Being one of the three guest editors for this edition has been an important part of my Campaign work for the past year. I hope you find the papers valuable. Marge

le of contents and all papers are at:


All the papers are open access.

I especially recommend the following papers:

DISCUSSION Abortion Law and Policy Around the World: In Search of Decriminalization   Marge Berer HTML | PDF

Theorizing Time in Abortion Law and Human Rights   Joanna N. Erdman HTML | PDF

Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study
Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield  HTML | PDF

Pregnancy and the 40-Year Prison Sentence: How “Abortion is Murder” Became Institutionalized in the Salvadoran Judicial System
Jocelyn Viterna and Jose Santos Guardado Bautista

Pregnancies and Fetal Anomalies Incompatible with Life in Chile: Arguments and Experiences in Advocating for Legal Reform
Lidia Casas and Lieta Vivaldi

Legal Knowledge as a Tool for Social Change: La Mesa por la Vida y la Salud de las Mujeres as an Expert on Colombian Abortion Law
Ana Cristina González Vélez and Isabel Cristina Jaramillo

Macro- and Micro-Political Vernaculizations of Rights: Human Rights and Abortion Discourses in Northern Ireland
Claire Pierson and Fiona Bloomer

Decriminalization and Women’s Access to Abortion in Australia
Barbara Baird

Australia: Abortion and Human Rights
Ronli Sifris and Suzanne Belton

PERSPECTIVE Abortion Care in Nepal, 15 Years after Legalization: Gaps in Access, Equity, and Quality
Wan-Ju Wu, Sheela Maru, Kiran Regmi, and Indira Basnett

Journal and conference announcements bombarding my email addresses: what’s an author to do?

10/06/2017 Comments Off on Journal and conference announcements bombarding my email addresses: what’s an author to do?

When open access journals first came onto the scene, I was really worried about the various ways they would change the journal publication landscape and practice. More importantly than anything else, I felt it was unfair and inequitable to charge authors to have their papers published so that I, as a reader, could get access to them free. On the other hand, I have grown to like the idea a great deal, in that I began to feel entitled to access to articles and annoyed when I couldn’t get them. And there are some journals, I have no idea how many, that waive the open access fee for a certain number of global south authors so as not to exclude them from publishing. But I remain concerned that this will only be available to a few and that all the work that was done to open the door to publication to them will be undone as more seek a waiver.

To address the threat to equity of access for global south and individual authors, the compromise we negotiated with Elsevier for RHM when I was still the editor was a decent one – articles were behind a subscription paywall for one year, and then became open access. The journal paid for publication and for subscriptions for its global south readers, who were the great majority of readers, while authors did not have to pay. This meant both that authors who could not afford the open access fees would not be discriminated against nor would they lose the opportunity to publish, while readers too got access, including those who could not or would not pay the subscription, even if it took a year. But this was an unusual deal and as far as I know, it has not been much replicated.

What I did not expect, but what has taken place to an alarming extent, is that open access has become big business. Apparently bogus journals are seeking to fleece unsuspecting authors of their money by offering to publish their work. If what comes into my inbox and my spam box is any indication, such journals have been launched by the cartload. I am being bombarded on an almost daily basis with requests to publish with one journal or another by submitting a paper. Some of these emails are addressed to me personally and mention a paper I have published previously as the source of their knowledge of me. Others are generic. Still others invite me to review a paper or attend a conference or to serve on a committee for a conference, and some try to sell me scientific equipment of one kind or another. I presume my address is being shared widely to make this happen. Apart from titles that have something to do with women’s sexual and reproductive health, or more commonly obstetrics & gynaecology, the rest, while mostly in the health and medical field, are totally inappropriate for me, as their subject is one I know nothing about. What I find most shocking, however, is that some of them are written in absolutely appalling English. Who they think they are kidding, I don’t know.

In September 2016, I began to collect these emails in a folder, planning to write a blog about them as a scam. I never got around to it until now, so they have piled up since then. They are in my inbox at both my email addresses and in the junk mailbox of both my email addresses. There are hundreds of them. I decided to list them here to show how absurd this has become, or should I say appalling. Many have written more than once, and some, when I do not reply, write again and push me to respond.

Here are several examples:

  1. Dear Dr. Marge Berer,

How are you? I hope you are healthy and happy. The Merry Christmas Grand Celebration is very keen, for the rewarding start of this special event, I need one praiseworthy manuscript. I realize that best fit manuscript is your transcript only. Hence, I feel honored to invite you for your manuscript submission and I am confident that my expectations on your works will help me to rejoice this event.


I hope to cheer this occasion with your legendary article.  Await your reply.

Best Regards, B…G… Journal of Gynecology and Women’s Health (JGWH) 14/12/16

2. Distinguished Dr. Marge Berer,

I recently came across your work titled “The history and role of the criminal law in anti-FGM campaigns: Is the criminal law what is needed, at least in countries like Great Britain?”. As far as I understood, it has been written at the -. Following this, the editorial team of Omniscriptum Publishing Group reaches out to you with a free of charge publishing offer.  Briefly speaking, we invite you to publish this work as an independent printed book which will be listed by major libraries and online bookstores. Could you please let us know your thoughts regarding this opportunity? If you would like we can discuss the next steps. I would be happy to answer any questions. 3.

3. …It would be appreciated, if you submit on or before 26thMarch, 2017. If you submit, we will process and publish within 21 days followed by rapid peer review process…

4. Dear Colleague,

Happy International Women’s Day. It’s always been a pleasure and privilege to work with so many female researchers. On the occasion of Women’s Day, Clinical Obstetrics, Gynecology and Reproductive Medicine (COGRM) is providing special concession on the publication fee until 24th March, 2017. Articles submitted before the mentioned date will be published (if accepted after peer-review process) with processing fee of USD 300 instead of USD 890. COGRM follows rapid peer review from the experts throughout the world, which helps us to publish an article within 7-10 days of submission.


Here is a list of all the supposed journals and conferences I have heard from so far (with the number of times an email has been received, e.g. x 4):

Reproductive Immunology x 4

SM Tropical Medicine Journal

SM Journal of Community Medicine

Annals of Community Medicine and Practice

GNWH Nursinghealthcare

Journal of Neonatal Biology

Austin Journal of Obstetrics and Gynecology x 2

Journal of Gynecology and Obstetrics x 2

Global Journal of Medical Research

NWH Nursinghealthcare

Trauma and Emergency Care

SM Group

Journal of Forensic Psychology

Global Women’s Health x 2

HSOA Journal of Reproductive Medicine, Gynaecology & Obstetrics

Pediatric Nursing

Dermatology 2017

General Practice 2016

Journal of Family Medicine

Journal of Psychology & Psychotherapy

Andrology & Gynecology: Current Research

Sexual Medicine: Annals of Clinical Case Reports

2016 5th EEM International Conference on Hospitality, Leisure, Sport, Tourism & Education

Family Nursing 2017

Breast Cancer 2017

Journal of Gynecology & Neonatal Biology

Science can be Beautiful

Journal of Nursing & Women’s Healthcare

Protein Lab

Reproductive Immunology: Open Access x 3


Hospital Management 2016


Journal of Women’s Health, Issues and Care x 2

Journal of Community and Public Health Nursing x 2

Mental Health 2017 x 2

Nursing Education 2017

Apps Store Now India Development Company

Journal of Modern Physics

Pharmacy Express

Family Practice Special Issue

WordPress Magento

Mathews Journal of Gynecology & Obstetrics x 2

Applied Psychology 2017

Call for Participation to the 2nd International Conference on Medicine and Natural Sciences, Albania

5th International Congress of Gynaecology and Obstetrics

Translational Reproductive Biology And Clinical Reproductive Endocrinology

Journal of Gynecology and Women’s Health

International Journal of Reproductive BioMedicine

Journal of Environmental Protection x 2

Forensic Science and Criminology x 2

Journal of Pregnancy and Child Health x 3

Journal of Gynecology and Women’s Health x 5

EC Gynaecology Journal x 2

Journal of Sexual and Reproductive Medicine

Journal of Reproduction and Infertility

Functional Food Centre (repeatedly)

Health x 2

Special Issue: “Current Research on Safety and Environment”/ The selected papers will be submitted to the Elsevier: “Journal of Chemical Health and Safety” x 6

Journal of Pregnancy & Child Health x 2

Acta Psychopathologica x 2

Journal of Fertilization: In Vitro

Obstetrics & Gynecology International Journal x 3

Gynecology and Womens Health Research x 3

Midwifery Congress 2017 x 2

Pregnancy & Child Health

Journal of Traumatic Stress Disorders & Treatment x 3

Diana – ProteoGenix

Reproductive Medicine 2017 x 4

Public Health 2017

Internal Medicine Review

Gynecology and Obstetrics Research – Open Journal x 2

Trauma and Critical Care 2017

Open Access Journal of Urology & Nephrology (OAJUN)

25th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)

International Conference on Obesity and Diabetes

Reproductive System & Sexual Disorders International Journal

The 4th International Congress of Forensics & Police Tech Expo-2017

Journal of Women’s Healthcare and Wellness

Women’s Health & Gynecology

Women’s Health Bulletin

Primary Healthcare

Women’s Health – Open Journal

Global Biotechnology Congress 2017

Austin Public Health

JSM Sexual Medicine

EC Gynaecology x 3

Global Conference on Nursing and Healthcare

Annals of Clinical Case Reports

Scientia Ricerca

SOJ Gynecology, Obstetrics & Women’s Health


Thinkers Hub Conferences

Journal of Reproductive Endocrinology & Infertility x 3

Surgical Nursing

Peer Reviewed Academia Sciences


The Scientific Pages of Anthropology

Nursing Conference

Journal of Psychology & Psychotherapy

Journal of Drug Abuse

Pregnancy & Child Health Journal x 2

Forensic Science-2017 x 3

Sociology and Anthropology

World Nursing and Healthcare conference

Clinical Obstetrics, Gynecology and Reproductive Medicine

Reproductive Immunology: Open Access

Innovate Nursing 2017

Journal of Women’s Health and Gynecology x 6

Journal of Community and Public Health Nursing

Plastic Surgery: Clinics in Surgery

Journal of AIDS & Clinical Research x 2

Drug Discovery & Therapy World Congress 2017

Nursing 2017

Journal of Addiction Research & Therapy

Juniper Online Journal of Public Health

Journal of Forensic Toxicology & Pharmacology

Sanaz – ProteoGenix

Protein Profiling

NEW Cyagen and Vectorbuilder Newsletter x 2

Reproductive Medicine_Com

HIV Scientific meeting

Agriculture & Food, 5th International Conference 2017 x 2

Reproductive System & Sexual Disorders International Journal x 4

Journal of General Practice

Breast Pathology 2017 x 2

Women’s Health (Sage) x 3

Journal of Nursing

World Conference on Science, Technology & Medicine x 2

Surgical Nursing 2017

Nurse Practitioner 2017

Stockholm Nursing Conference

Healthcare Asiapacific 2017

Open Access Journal of Urology & Nephrology x 2

Maternity Complications and Women’s Health Journal x 3

Archives of Medicine x 2

Journal of Family Medicine & Community Health x 2

Embryology 2017

Annals of Men’s Health and Wellness x 2

Journal of Women’s Health Care

Andrology and Gynecology Reports


Andrology-Open Access

Pharma-2017 x 2

Dr. Sanchita Roy (editor09@sdjournals.net)

Dr. Sarmila Das (editor02@sdjournals.net)

AIDS Clinical Research & STDs

Journal of Forensic Psychology x 2

Annual Summit on Sexual & Reproductive Health, Oncology & Medicine x 2

Dr. Kateryna Bielka, M.D. kateryna.bielka@journals.ke-i.org x 2

Acta Psychopathologica

International Journal of Surgery Research and Practice

Journal of Psychology and Brain Studies

Social Sciences 2017


Forensic Research 2017

Family Medicine 2017 x 2

Journal of Psychiatry

Obesity Summit

Ms Aloka Jana (editor04@ikkppress.org)

Journal of Medical Implants and Surgery

Journal of Research and Development

Neonatal Nursing 2017

Journal of Forensic Research

International Conference on Women’s Health, Gynecology & Obstetrics x 2

Midwifery Congress

Journal of Basic and Clinical Reproductive Scienc

Women’s Health Research

Lipids 2017

Sexual and Reproductive Health 2017

Euro Primary Care 2017 x 2

Journal of Gynecology and Women’s Health

Generic-Biosimilars 2017

Austin Journal of Civil & Legal Sciences

Avid Science

Medical & Clinical Reviews

Euro Midwifery-2017 x 3

Journal of Surgery

Public Health Congress

Forensic Congress 2017

Journal of Endocrinology and Diabetes

Insights in Reproductive Medicine

Gynecology 2017

Journal of Sexual & Reproductive Medicine

Journal IJCAR

InTechOpen invites you to write a chapter for a new Open Access book project “Family Planning,” edited by Dr. Zouhair O. Amarin.

Journal of Basic and Clinical Reproductive Science

GB HealthWatch

Journal of Genital System & Disorders

Clinical Practice (Therapy)

Advances in Journalism and Communication

Journal of Family Medicine and Disease Prevention

Oral Presentations for Scientists


Whew!!! I have no idea what to do about this, but it feels like a permanent invasion of my territory and a form of e-trash being dumped on me. I have no idea who to complain to, nor how to stop them coming but will share this blog with the European Association of Science Editors to see if they have some advice or want to let others know this is happening.