Letter to Rebecca Long-Bailey

30/01/2020 Comments Off on Letter to Rebecca Long-Bailey

On 18 January, I wrote a letter to Rebecca Long-Bailey MP as a member of the Labour Party and an abortion rights advocate, to ask her more about her views on abortion, as reported in the Guardian, Telegraph and Catholic Herald during the previous week, and to respond to them. I felt none of these newspapers, who only looked at her views on late abortions for fetal anomalies, asked her enough about where she stands, which I think it is crucial to know for anyone considering voting for her. The Labour Party has been in the forefront of support for abortion rights for many years. While everyone has a right to their personal opinions, I feel the Party must not have as its leader a woman who is opposed to abortion, let alone one who would invite the Pope, who is virulently opposed to all abortions, to any Labour consultation on abortion. She has not (yet) responded to me. Here is my letter:

Ms Rebecca Long-Bailey MP

18 January 2020

Dear Ms Long-Bailey,

I am writing to you as a member of the Labour Party and as a long-standing advocate for women’s right to safe abortion. I am a member of the Voice for Choice coalition in the UK and the founder and former editor for 23 years of the journal Reproductive Health Matters. I have also worked internationally for women’s right to safe abortion for over 45 years.

Reading the various Guardian, Catholic Herald, Telegraph and other stories about your views on abortion the past few days, I’m concerned about several things. One is that you seem to be confused about what you actually support and don’t support in regard to abortion, because you make a distinction between your personal views and your views as a member of the Labour Party and of Parliament.

If you “do not agree with allowing abortion on the grounds of disability after the standard limit of 24 weeks”, then you are opposed to an important aspect of the current British abortion law, with the implication that if it came up in Parliament, you would argue and vote to restrict the current law. But then, the Guardian says, you “stressed that this was a personal view”. Surely this is untenable. If you “argued last year against being able to abort on the grounds of disability later than if there is no disability”, then this is a political stance, not just a personal view.

Which leads to my second concern. Are there other aspects of the current British abortion law that you do not support? No one from the press seems to have thought to ask you this, but it is a relevant question. I would be very keen to learn the answer. I’m glad you supported law reform for Northern Ireland, but given the fact that their previous law violated an international human rights convention, there was little choice. What about now, with Stormont finally sitting again. If the DUP tries to restrict the new law, where will you stand?

For me, this is nothing to do with your being Catholic, and I’m sorry to learn people are holding that against you. I have many friends who are Catholic who support abortion rights fully. There is an international Catholics for Choice network, and there are millions of Catholic women around the world who have abortions every year for whom it was a necessity. But how pro-choice are you?

According to the Guardian, you said you “would play a part in ensuring the views of the Catholic church were heard in any Labour consultation on new laws and regulations on abortion”. That is certainly not just a personal view. And what Labour consultation?

I’m afraid I will not be voting for you on 11 February on the basis of that remark alone. As a humanist and a secular person, I believe politics and religion should be kept absolutely separate. Not least when we are talking about a church that is virulently anti-women’s rights and that has covered up and failed to put a stop to its own sexual abuse of children.

Returning to the issue of abortion and disability: In 2017, the UN Committee on the Rights of Persons with Disabilities contradicted themselves in their recommendations to the UK when they disagreed with allowing abortion at any stage in pregnancy on the ground of fetal impairment.[1] Thankfully, the government rejected their recommendation to change our law.

I wrote to the Committee at the time as follows:

“…It is surely a contradiction in terms to call [as they did] for ‘women’s rights to reproductive and sexual autonomy to be respected’ and then to call for an exception to those rights for any reason and in this case, for one reason only.

“This is no different from other groups calling for abortion not to be allowed in cases of rape or incest, and still others in cases where the embryo/fetus is female, and still others in cases where there is a risk to the woman’s life. All three of these are actual stances taken by those who are anti-abortion in different parts of the world. For anyone apart from the pregnant woman herself to decide… denies women’s rights to reproductive and sexual autonomy. It means that there will always be someone – who is not the woman herself – who will assert their power to determine what she is and is not permitted to do. In the end, it means someone else can always deny her an abortion. That is the power you wish to exercise in your recommendation to the UK….

“The only way to avoid this conundrum is to reject assertions that the embryo/fetus: a) has human rights before birth, or that: b) any condition in the embryo/fetus is the reason for abortion or for refusing abortion. In other words, it must always and only be the woman’s reasons for abortion that count – and the bottom line is that she seeks an abortion because she cannot cope with having that baby at that time….

“Fetal anomalies are medical conditions that arise when something serious or even fatal goes wrong during fetal development. Medical science is working hard to identify these conditions and figure out why they occur and whether they can be treated or prevented. Women carrying an embryo/fetus with one or more of these conditions needs to know they are there, so as to be able to decide whether this is a pregnancy and potentially a child who, if it can survive at all, she can cope with for the rest of her life. She has to take into account her own, her partner’s and her existing children’s life circumstances, and whether she will get any support to do so.”

In the end, if motherhood is not voluntary, an extreme form of discrimination and forced labour is imposed on the pregnant woman.[2] The alternative to removing the right to an abortion on grounds of fetal impairment after 24 weeks is to remove the 24-week restriction on abortions for all grounds. Only a tiny handful of women will be affected no matter what their reasons for abortion. But they will be eternally grateful for the same support that 99.99% of other women who seek an abortion receive.

I hope you will reconsider your position.

Kind regards, Marge Berer

  1. “Concluding observations on the initial report of the United Kingdom of Great Britain and Northern Ireland” CRPD/C/GBR/CO/1, 29 August 2017 (As adopted during the 18th session of the Committee on the Rights of Persons with Disabilities (14 -31 August 2017)
  2. R Copelon, et al. Human rights begin at birth: international law and the claim of fetal rights. Reproductive Health Matters 2005. https://www.tandfonline.com/doi/full/10.1016/S0968-8080%2805%2926218-3

The Case of Dr Carlos Morín, Barcelona, Spain – “Hasta el final”

23/06/2016 Comments Off on The Case of Dr Carlos Morín, Barcelona, Spain – “Hasta el final”

The history of the persecution of Dr Carlos Morín, former director of the Ginemedex clinic in Barcelona, Spain, the staff of his clinic and the thousands of women who had abortions there began in Britain in 2004 and reached its climax, at least for the moment, on 17 June 2016, in the Regional Court of Barcelona, where during a re-trial ordered by the Supreme Court, three years after he and all his staff had been acquitted of all charges against them, Dr Morín was found guilty of having carried out 11 illegal abortions and a psychiatrist from the clinic, Dr Pascual Javier Ramón, was found guilty of signing the forms authorising the abortions.

What happened in between is the stuff of nightmares. The case was dragged through the justice system and the media for more than ten years by anti-abortion groups, who succeeded in having all Dr Morín’s clinics closed six years before he was even tried in court, and everyone who had been working in the clinics and the patients were investigated. Not only Dr Morín and his wife, who worked with him, but also many members of their staff were finally put on trial in 2012. In the interim, he was unable to practise his profession as a doctor and suffered from both public condemnation and bankruptcy, due to huge legal costs throughout the whole process.

The story began in Britain on 10 October 2004, when the Sunday Telegraph ran a story, based on “undercover” work[1] by a woman journalist pretending to be pregnant, that women beyond the legal time limit for abortion in England and Wales were being helped by the British Pregnancy Advisory Service (Bpas) to obtain abortions in Dr Morín’s clinic in Spain. Following an investigation by the Chief Medical Officer for the Department of Health, Bpas were criticised for the way the undercover call was handled, but were exonerated of any wrongdoing.

Moreover, according to the Chief Medical Officer’s report, the Barcelona newspaper La Vanguardia reported on 14 October 2004 that the Health Department of Catalunya had come to the conclusion that the Barcelona clinic “attends patients in a correct and legal manner”. The Catalunyan Department added that they had carried out an inspection which confirmed that the clinic concerned had provided services within the terms defined by the regulatory and legal system.

The British Chief Medical Officer’s report also stated: “My investigation has shown that it can be difficult for women to access late abortion services.” (Chief Medical Officer report, 2005)

Thus, no wrongdoing was found in either Britain or Spain. The situation did not end there, however. It was advanced further following an undercover visit to the Ginemedex clinic by a Danish public television crew, which was aired on TV in 2006 in Denmark, France and the Netherlands. That led to an investigation of a clinic in the Netherlands who, like Bpas, sometimes referred women with late second trimester abortions (25-28 weeks) and rarely a third trimester abortion who were beyond the legal time limit in their countries to the Ginemedex clinic. The ultra-religious group E-Cristians used the Danish TV show to call for an investigation of whether the Ginemedex clinic was doing abortions outside the law.

Under the law in Spain until 2010, abortion was legal up to 12 weeks if the pregnancy resulted from rape, up to 22 weeks in cases of severe fetal anomaly, and with no time limit if it was necessary to avoid a grave danger to the life  or the physical or mental health of the pregnant woman. Throughout this period, the Ginemedex clinic followed the guidelines for assessing the women who came to them in line with legal protocols. The woman was seen by a psychiatrist who also authorised that the abortion was legal and on that basis, the staff carried out the abortions.

According to Anne-Marie Rey, an abortion rights activist in Switzerland since 1971, who has closely followed the case from the beginning:

“Up to 2007, the Ginemedex clinic was a last resort for women who sought an abortion in advanced stages of pregnancy. Women were sent to Barcelona from many countries, when it was not possible to help them at home. Personally I gave his address to several women from Switzerland and they were always treated with respect and empathy. Yes, Dr Morín did interpret the Spanish abortion law liberally. But, in fact, he only applied the World Health Organization definition of “health” as “a state of complete physical, mental and social well-being”. And he applied this interpretation also in the case of desperate women who needed an abortion late in pregnancy, after 24 weeks gestation.”

As has been shown all over Europe, women requesting an abortion after 24 weeks of pregnancy are rare. In Britain, for example, in 2002, of the 175,932 abortions that took place, only 117 were after 24 weeks of pregnancy, that is, 0.06% of the total. (Chief Medical Officer report, 2005) This number and proportion are not unusual. The Chief Medical Officer’s report stated that in 2003, of all the patients seen within the 26 abortion clinics in Catalunya, only 812 patients were foreign (of whom only 14 were from the UK). 98.9% of the abortions on foreigners were at less than 22 weeks of pregnancy. In 3 cases it was in the 24th week and in 5 cases in the 26th week. (Chief Medical Officer’s report, 2005)

What came next, according to an article by the anti-abortion group Religion en Libertad, with information they say came from E-Cristians, would not have taken place without; 1) foreign media involvement, 2) follow-up by anti-abortion groups who kept written records and spent money, 3) the written testimony of a woman who attended the Ginemedex clinic, who was given protected witness status, and 4) a judge and prosecutor who decided to pursue the case “hasta el final” (up to the very end).

In 2007, as part of what became a long investigation, Dr Morín was charged with carrying out “illegal abortions”. He was jailed for two months until a judge ruled that he could be released pending trial, his four Ginemedex clinics were closed, and the clinics’ records, including the personal records of several thousand women, were confiscated for examination. The investigation, including interviews with all the staff and many patients, took six years. In September 2012, the case opened in the Audiencia de Barcelona, a regional court.

Between 2007 and 2012, when the case was finally heard, many other clinics in Spain were also affected. According to one report,[2] there were increased political inspections and administrative and judicial harassment for all abortion clinics and the women patients they cared for, and there was more radical anti-choice activity. Complaints were laid against other abortion providers in registered clinics. One clinic especially suffered “virulent persecution by both anti-abortion groups and by the government itself” for a time, until the situation was clarified.

Some 115 charges of illegal abortion were laid against 12 people, including Dr Morín, his wife (who helped to run his clinics), the psychiatrist Dr Pascual Javier Ramón, and 9 other physicians and nurses. There were hundreds of statements submitted by the prosecution and thousands of pages of judicial and police reports.

According to Religion en Libertad, up to 2012 when the case came to court, E-Cristians had spent 55,000 Euros, including for “extra-judicial actions” and the involvement of lawyers who “knew the terrain” and another 39,000 Euros for other costs (Defiende usted la vida? 2012) [3]

The case concluded with a verdict on 31 January 2013. The verdict was the acquittal of every person charged and on every charge, as reported in El País on 1 February 2013. The court accepted that the abortions were performed “with the consent and at the express request of pregnant women” despite some administrative irregularities. However, both the Prosecutor in the case and the anti-abortion groups who had accused Dr Morín and his staff (E-Cristians, Spanish Alternative, Thomas More Foundation and the College of Physicians of Barcelona) did not accept the verdict and appealed to the Supreme Court. Nine months later, the Supreme Court criticised the Regional Court’s judgement and ordered a re-trial in the Regional Court with different judges. They gave two reasons: first, they argued that the Danish television programme should have been taken in evidence, which the Regional Court had decided against doing. Second, they said that because Dr Morín exercised his right not to testify, the judges did not allow the prosecutor to read out the questions they had prepared to ask him. The Supreme Court thought, however, that these had to be made public and answered, in order to determine, as claimed by the Prosecutor, whether there were contradictions between the pre-trial and the trial evidence.

In March 2015, Dr Morín appealed to the European Court of Human Rights in Strasbourg. Within less than two months, the Court replied that they would not consider the case because the request did not comply with the requisites of admissibility of articles 34 and 35 of the Convention. (CEDH-Lesp11.00R, MMI/MCM/agz, Demanda No.13465/15, letter dated 30 April 2015) The presumption is that he had not exhausted his right of appeal to the very top of the Spanish court system.

The re-trial took place in the Regional Court of Barcelona in January-February 2016. This time, both Dr Morín and Dr Ramón were found guilty and sentenced – not to 390 years or 278 years in prison as the Prosecutor had asked for originally, but to 18 months in prison – and not for over 100 illegal abortions but for 11 illegal abortions. All the other defendants in the case were again acquitted. One could be forgiven for asking whether this new judgement was in fact safe, let alone just.

The final irony, however, is that according to El País of 17 June 2016, the sentence is not firm and can actually be appealed, once again, to the Supreme Court. [4] Thus, it would appear that in Spain, if ultra-religious, anti-abortion NGOs, who have no legal standing, don’t like the verdict of a court of law, the defendants can be tried again in the same court on the same charges by different judges, with different verdicts and opinions on what constitutes evidence, for as long as it pleases the courts to take, and the European Court of Human Rights is prevented by its own rules from considering whether the human rights of the defendants have been and continue to be violated.

A note of thanks to Carlos Morín – I join with Anne-Marie Rey who said on 20 June upon hearing of the verdict: “This latest sentence is a scandal. Thank you, Dr Morín, and all your staff, for all you did for those women! And for your standing up for the right of women to decide for themselves in difficult life situations. I do hope some help is still possible for Dr Morín in return.”

Acknowledgement Thanks to Anne-Marie Rey for providing a wide range of documentation about this history over several years and for her help in preparing this article. Any errors are the author’s alone.

References

An Investigation into the British Pregnancy Advisory Service (BPAS) Response to Requests for Late Abortions. A report by the Chief Medical Officer. Department of Health, September 2005.

Defiende usted la vida? El caso Morín ouede cambiar la historia del abortion…pero requiere dinero. http://www.religionenlibertad.com/articulo_imprimir.asp?idarticulo=22994. 5 June 2012.

Condenado por abortos ilegales un médico absuelto hace tres años, El País, 17 June 2016.

Visit the website of the International Campaign for Women’s Right to Safe Abortion, where this article was first published on 22 June, for the Annex that lists the 34 articles from El País covering this history from 2006 to 2016. The titles and first lines are in Spanish, translated by me, with the help of SDL Free Translation, into English. The articles are in Spanish.

Footnotes

[1] Some might call it attempted entrapment.

[2] Anonymous, personal communication, October 2011.

[3] This is a direct translation from the Spanish.

[4] “La sentencia tampoco es firme y puede ser recurrida, de nuevo, ante el Tribunal Supremo.”

China: how can the one-child policy and rights-based family planning be reconciled in the face of recently reported abuses?

23/07/2012 Comments Off on China: how can the one-child policy and rights-based family planning be reconciled in the face of recently reported abuses?

Lisa Hallgarten, RHM social media and communications

Marge Berer, RHM editor

Two recent news stories from China have reawakened concern about overzealous enforcement of China’s one-child policy and the emergence of voices critical of the policy and its implementation. Historically, being a country with 25% of the total world population within its borders, China’s population policy has addressed a unique set of social, demographic and political circumstances, and overall, it appears to have had widespread support from the public. However, these two reports have resonated internally and far beyond its shores.

In the United States, the story of Chen Guangcheng ,the Chinese civil rights activist imprisoned and persecuted for exposing and protesting against abuses of women being forced to have abortions against their will, in the name of Chinese government policies, has been co-opted by anti-abortion US activists. Though he has spoken out mainly against the brutality of forced abortions, not abortion per se, he is being used as a poster boy by the US anti-abortion, anti-contraception movement. Stories of forced abortion, and other human rights abuses associated with the one-child policy, are being presented as the logical conclusion of all and any family planning policies.

In one of two recent stories that hit the press due to US publicity, a mother of one was snatched from her home and forced to have an abortion. The procedure went tragically wrong and just hours later the 38-year-old woman was dead.  In another report, a woman who was seven months pregnant was also forced to have an abortion.  The story and pictures of the woman lying beside the aborted fetus were posted on the internet, generating over a million hits on Chinese social media networks. In response, the officials in the second of these cases lost their jobs and were prosecuted  More recently the women was given financial compensation as well.

At the same time, a flurry of anecdotes from other parts of China have started to emerge about the practice of forced abortions: contradicting the official party line that such practices – especially abortions in late pregnancy – are illegal, rare and not countenanced by the government.

A look at the Population and Family Planning Law of China  is instructive. It aims to maximise contraceptive use and minimise population growth by providing local and district officials with financial and other rewards for meeting family planning targets. The motivation this might create for officials to be overzealous in their implementation of the policy is tempered with tepid instructions not to infringe the rights of women and families and to promote family planning using incentives rather than coercion. In one of the cases above, the woman and her husband were threatened with a huge fee if they wished to continue the pregnancy, which they could not have afforded. This raises questions of which incentives and disincentives, if any, are acceptable to the population, how to prevent coercion, what to do when it happens, and what rights women have to redress and compensation when coercion has been shown to take place. Underlying these questions are broader policy issues – whether it is possible to reconcile the need to limit population growth with its attendant targets for coverage of contraception and even abortion.

The Family Planning Summit in London this month said that the funding associated with the new FP Initiative will explicitly NOT be used to support coercive family planning. It did, however, set ambitious targets for contraceptive coverage, though when criticism was raised, the language was changed to read contraceptive access. Whether it will be possible to achieve a huge increase in contraceptive use without incentives and targets, and how this relates to donor expectations with “results-based financing”, remain on the table for discussion. The consequences for informed choice and the right to use or not to use a method hang in the balance. At the same time, given the many barriers to accessing as well as using contraception successfully in the world’s most underserved communities, there will be enormous pressure to prove that the initiative really can give 120 million more women access to contraception.

The anti-abortion, anti-contraception movement would love to discredit the whole programme, as they have sought to do for years in the United States as regards the Chinese policy. Everyone who supports the right to control fertility needs to be committed to ensuring that any new programmes providing contraception will have women’s rights at their heart in practice. If they don’t, this one-off commitment of money may never be repeated.

Also in the news on this issue:
A group of Chinese scholars have written an open letter calling for revision of the one-child policy. They argue that the policy is bad for human rights and also for sustainable economic development.  Some Chinese demographers have said the one-child policy will damage the country as low fertility rates threaten a shortfall in the productive labour force needed to fund the ageing population.

We have no idea whether these statements are typical of public views. The public debate that has ensued inside China since these reports have come out must be multi-faceted and far from one-sided. We would be happy to receive further reports of the many points of viewbeing expressed in this debate, including by the government, as it unfolds within China.

Race, Reproductive Politics and Reproductive Health Care in the Contemporary United States

20/07/2012 Comments Off on Race, Reproductive Politics and Reproductive Health Care in the Contemporary United States

This editorial from the journal Contraception offers an important analysis of population and family planning policy in the USA, both in the context of current politics and also from history, starting as far back as 100 years ago.

Carole Joffe, Willie J. Parker

From: Contraception [Editorial] July 2012 reprinted as a blog with kind permission of Carole Joffe

To paraphrase Leo Tolstoy, who famously wrote that all unhappy families are unhappy in their own way, we can say that all nations confront the thorny issue of demographics, but each in its own, typically controversial, way. Various European countries, for example, have anxieties about a “demographic winter,” which is a below replacement birth rate of the native population, which has led to corresponding fears about rising birth rates among Muslim immigrants. China, driven by worries about overpopulation, has instituted coercive reproductive policies that many observers find unacceptably harsh. The United States, a country marked by extreme stratification on both racial and economic grounds, is a particularly interesting case to consider from a demographic lens because there has been a history both of targeting the birth rates of people of color and at the same time deep political divisions about the provision of reproductive health services — particularly abortion but increasingly, as the current election season reveals, contraception as well.

We, a sociologist and physician, respectively, write here of our dismay about the contemporary state of reproductive politics in the United States and particularly the cynical manipulation of racial themes by the opponents of abortion and birth control. However, we are acutely aware of the mixed legacy of the United States with respect to demographic issues. To name but a few examples, in 1905, President Theodore Roosevelt warned of “race suicide” because of his concern about falling birth rates among white Anglo-Saxon women and the higher rates among immigrants.1 In the 1927 Supreme Court case, Buck v Bell, the Court upheld a statute instituting compulsory sterilization of the unfit, including the mentally retarded, “for the protection and health of the state”.2 In the 1960s, impoverished African-American and Latina women, along with some poor whites, were subjected to coerced sterilizations, often without these women fully understanding to what they had ostensibly agreed.3 When the first federally funded family planning centers were established in the early 1970s, as a result of the passage of Title X, they were disproportionately located in African-American communities, although the language of the legislation did not mention race but rather the income status of the intended recipients.4

Co-existing with these events, however, has been a longstanding reproductive freedom movement in the United States, made up of clinicians and lay activists alike. Starting in the early 20th century, doctors and nurses, along with lay allies, fought for the legalization of first, birth control, and, later, abortion, seeing the particular damage done to the most vulnerable women in the absence of such services. In the 1960s and 1970s, feminist health activists raised an outcry about the sterilization abuses mentioned above; indeed, among the most prominent of the reproductive rights organizations to emerge from the “second wave” feminism of that era was CARASA, the Committee for Abortion Rights and Against Sterilization Abuse, providing a template for the principle that abortion rights should ideally be considered in a broader context that includes the right to have children.5 That generation of feminist activists also severely criticized the then-common practice of testing new contraceptive methods on Third World women. Today, there are numerous reproductive rights/reproductive justice groups hard at work in the United States, a number of them specifically concerned with the situation of women of color.

In short, this very brief recapitulation of reproductive struggles in the United States reveals the truism that the world of sexual and reproductive health services is a complex terrain, always containing both liberatory and coercive possibilities, and always with particular implications for people of color in a white-dominated society. But with respect to present-day conflicts, no figure’s legacy has been more contested than that of Margaret Sanger, the founder of the organization that eventually became Planned Parenthood. Anti-abortion forces for years have accused Sanger of being a racist and a eugenicist. Currently, these groups have pounced upon the high rate of abortion within the African-American community — black women have abortions at nearly four times the rate of white women — and have joined forces with some conservative groups within that community to mount a vigorous campaign against Planned Parenthood in particular and abortion provision more generally. Starting in Atlanta, and spreading to other cities, these groups have sponsored controversial billboards — some proclaiming that “black children are an endangered species” and others comparing abortion to slavery.

As Ellen Chesler, Sanger’s premier biographer, has argued, such accusations are a distortion of Sanger’s record.6 Although Sanger did receive some support from eugenicist organizations (at a time when eugenics was a far more mainstream movement than it is currently), her record cannot be construed as “racist.” Among her supporters were numerous black ministers, leading African-American intellectuals such as W.E.B. Dubois, and prominent community leaders such as Mary McLeod Bethune, founder of the National Council for Negro Women. In 1966, when Dr. Martin Luther King accepted the first Margaret Sanger award from Planned Parenthood, he praised Sanger for “her courage and vision,” comparing her struggle for birth control to the civil rights movement. One of the most effective critiques of the billboard campaign, and against the larger agenda of demonizing Planned Parenthood, has come from Sistersong, a coalition of reproductive justice groups of women of color. As Loretta Ross, the executive director of the group told the New York Times, “The reason we have so many Planned Parenthoods in the black community is because leaders in the black community in the ‘20s and ’30s went to Margaret Sanger and asked for them. Controlling our fertility was part of our uplift out of poverty strategy, and it still works”.7

This manipulation of the history of race and reproduction by those involved in the billboard campaigns and similar efforts obscures the contemporary facts of life faced by the most vulnerable black women. These women experience high rates of unintended pregnancy, low use of the most effective forms of contraception, deep poverty, inadequate educational opportunities, unacceptable levels of intimate partner violence and, very often, lack of support from their churches. It should come as no surprise that these same women would have the highest rates of abortion in this country. Given the conditions, these women need — among many other services — access to comprehensive health care that includes both family planning and abortion. Yet, abortion has long been excluded from most mainstream health care institutions and sources of public funding, and during the current political season, we have watched with dismay the severe attacks on contraceptive coverage as well. The isolation of abortion, in particular, from the rest of health care has contributed to its stigmatization and has helped the development of conspiracy theories, such as we see in the billboard campaign. We decry the inflammatory, false rhetoric of “black genocide” that has been used in this campaign by anti-abortion extremists, and we are hardly the first to point to the hypocrisy of those who oppose contraception and abortion, yet just as fervently oppose any spending for social services.

One of us (WP), speaking from my perspective as a member of the African American community and as a women’s health provider, asserts that this attempt to manipulate my community is made possible by our unresolved issues regarding gender roles and sexuality in a modern context. The failure of our community to promote the agency of our mothers, sisters and partners, and to deal forthrightly with sexual matters, leaves us treating abortion and HIV-related issues as “open secrets.” This evasion results in exorbitant rates for both. To truly confront these issues, our community desperately needs medically accurate sexuality education, improved health literacy and a constructive engagement of religious and spiritual leaders, given the central importance of religion in the African-American community. This type of empowerment effort towards shared reproductive health responsibility is the only effective rebuttal to the mischief occurring with race and reproduction in our community. To paraphrase Dr. King, just as individual wealth is always a function of the commonwealth, thus it too holds true that compromising the reproductive health and rights of individual black women results in jeopardizing the collective well-being of black communities.

If to know is to become responsible, my awareness of black women’s unmet reproductive health needs requires me to provide family planning and abortion care to those most in demand for them. Doing so represents a dual sense of responsibility that I feel as both a women’s health provider and as a member of the African-American community. I join with those in my community who have articulated a vision of reproductive justice, defined as creating a society that enables all women and families to have the children they want, the resources needed to raise them, and the ability to prevent or end the pregnancies that they do not want. I call on my fellow health care providers, of all races, to trust women to make the good and tough decisions about when and whether to expand their families. A fundamental respect for fairness necessitates it, and a respect for human rights demands it.

In conclusion, as already noted, we write in a period of unprecedented political attack on women’s health issues — not just abortion, but also contraception and a range of other reproductive health services. Even the seemingly long settled issue of the importance of programs to combat domestic violence is now being resisted by conservative forces.8 This “war on women,” as it has come to be known, has galvanized a countermovement of health activists, both women and men, who have effectively and creatively protested these developments in a variety of ways. We are greatly heartened by this mobilization, although its eventual impact on elections and restrictive measures is unclear at this time. We close by reminding our readers of what is perhaps obvious: the stakes in this “war” are inevitably the highest for the most vulnerable in our society — those poor women of color about whom we have written in this editorial.

Carole Joffe
Advancing New Standards in Reproductive Health
Bixby Center for Global Reproductive Health
University of California, San Francisco
Oakland, CA

Willie J. Parker
Board member
Physicians for Reproductive Choice and Health
New York, NY

  1. Roosevelt T. On American Motherhood. Available at http://www.nationalcenter.org/TRooseveltMotherhood.html (accessed July 20, 2012).
  2. Buck v. Bell, 274 U.S. 200 (1927). Available at http://www.oyez.org/cases/1901-1939/1926/1926_292 (accessed July 20, 2012)
  3. Schoen J. Choice and coercion: birth control, sterilization, and abortion in public health and welfare. Chapel Hill: University of N. Carolina Press; 2005;
  4. Gordon L. In: The moral property of women: a history of birth control politics in America. Urbana, IL: University of Illinois Press; 2002;p. 289–291
  5. Petchesky R. In: Abortion and woman’s choice: the state, sexuality and reproductive freedom. Boston: Northeastern University Press; 1990;p. 392
  6. Chesler E. Was Planned Parenthood’s founder racist?. Salon. 2012;Nov 2. Available at http://www.salon.com/writer/ellen_chesler/(accessed July 20, 2012).
  7. Dewans S. Antiabortion ads split Atlanta. New York Times. 2012;Feb 5. Available at http://www.nytimes.com/2010/02/06/us/06abortion.html?scp=1&sq=Shaila%20Dewan%20Margaret%20Sanger&st=cse (accessed July 20, 2012).
  8. Joffe C. All common ground lost: the right’s opposition to the Violence Against Women Act. Rhrealitycheck.org. Available at http://www.rhrealitycheck.org/article/2012/03/16/all-common-ground-lost-rights-opposition-to-violence-against-women-act (accessed July 20, 2012).

Family planning and safe, legal abortion go hand in hand

19/07/2012 Comments Off on Family planning and safe, legal abortion go hand in hand

Marge Berer

Editor, Reproductive Health Matters

One in three women in the UK will have an abortion in her lifetime, most of whom will have been using contraception of some kind. Yet since as long ago as the late 1930s, there has been a split in the UK between those who insisted on promoting contraception on its own because they thought abortion was too controversial and would hold back acceptance of family planning, and those who insisted that the two go hand in hand. This split exists in many countries, not just the UK, and also within many organisations with a large membership in different countries, such as the International Planned Parenthood Federation (IPPF). It is reflected most recently in a comparison of the list of 600 groups and individuals who have endorsed the International Campaign for Women’s Right to Safe Abortion this year, and the 1300 that signed a letter circulated by the IPPF supporting the Family Planning Initiative – very different groups are on those lists. Yet all of them support the right to control fertility.

In 1994, the ICPD Programme of Action, a consensus document on the integration of sexual and reproductive health and rights, was only able to be passed if it included a “compromise” clause that called for abortion to be safe only if it was legal. This compromise was and remains a violation of public health principles and women’s human rights. ICPD failed to condemn the often 19th century, often colonial laws on abortion still in place in the criminal code in many countries. However, the Programme of Action did recognise that unsafe abortion was a major public health problem, one which to this day still affects some 22 million women every year, among whom 5 million end up in hospital with complications annually and tens of thousands die (WHO, Guttmacher). And young women, whom everyone wants to be  seen to be supporting these days, are in fact most at risk of unsafe abortion and also have the least access to contraception (Shah & Åhman, RHM, May 2012).

The answer is not to promote contraception in order to reduce unsafe abortion, as the FP Summit did. The answer is to promote contraception to reduce unwanted pregnancy and provide safe abortion to every woman who finds herself with an unwanted pregnancy. That is the way to make unsafe abortion history. Abortion will not go away unless men and women stop having sex with each other or everyone is sterilised. So forget it! The growing number of countries in both the north and south, east and west, where there is 60-80% contraceptive prevalence proves that. Research shows that women and men take up contraception in large numbers if they feel they have the right to control their fertility and have access to the means to do so. There is a huge need for information, because every new generation of young women and men will know nothing about contraception or abortion unless they have access to this information. But there is no need for “demand creation”, a retrograde concept which implies lack of interest. The steadily falling fertility rate globally, falling since the 1970s, proves that, and in every country, abortion is in there, safe or unsafe, reducing the number of births. Forty-four million abortions globally and hundreds of millions of people using contraception and sterilisation prove the huge demand for the means of fertility control. “Unmet need” is more than just lack of knowledge or interest on the part of the women and men who aren’t using contraception, or using it erratically or unsuccessfully.

Women seek an abortion if they have an unwanted pregnancy, legal and safe or not, because it’s too late for contraception. There is no split between contraception and abortion from women’s perspective, they are two sides of the same coin. Even so, many of the biggest supporters of “family planning” refuse to support women’s need for safe, legal abortion. Even worse, they always talk about abortion in negative terms. They mention it along with STIs, as if it were a disease, or treat it as an annoying problem that they wish would go away, and consider it inferior to use of contraception. They even claim that use of contraception will (or should) make it go away. But this is about the realities of people’s sex lives and how sex happens, not just about well-thought-out, planned-in-advance decisions about family formation. Many pregnancies are started without any forethought at all, and all too often as one of the consequences of sexual pressure and coercion.

Campaigns for women’s right to safe, legal abortion have been going on for at least 100 years. Many of us involved in these campaigns are still seen as annoying by people who are supposed to be our colleagues. We’re told it’s sensitive, controversial, difficult, it can’t be put on the agenda, including in the FP Summit. At the same time, many of us who are fighting for abortion rights stopped supporting “family planning” years ago, because of what happened in the past, when coercive programmes put many people off “family planning” and gave it a bad name. Some family planning supporters have blamed ICPD for the neglect of family planning, because it placed family planning in a wider context. But as Gita Sen said at the Summit, ICPD in fact sought to rehabilitate family planning and restore its good name, while the barriers to safe abortion were left in place.

Today’s supporters of family planning would like everyone to forget the coercive programmes of the past, which were target-based. But they may yet become target-based again because of “results-based financing”. So let’s not confuse opposition to coercive family planning policies with being anti-family planning. Yet, it is absolutely true that provision of contraception has been neglected in recent years – and yes, this neglect must stop. At the same time, neglect also characterises how women’s unmet need for safe abortion is treated. What needs to change is that both forms of unmet need should be taken into account – together – starting with donor and national government policies.

For example, although DFID’s development aid policy has long been to fund both family planning services and abortion services, in their roll-out of these policies, funding for family planning is (I am told) separated from funding for safe abortion. That is, it is managed by different people and in different programmes within DFID and in the recipient countries, and these different people may not work closely together or know what each other are doing. Yet DFID did not see a problem in agreeing to a family planning initiative in which funding for abortion is excluded. They fund abortions anyway, they say, so what’s the problem? The problem is that separating abortion from family planning at the programmatic level allows some countries to keep abortion legally restricted and not take responsibility for unsafe abortion.

Then there’s the US, where support for family planning by USAID has been the highest in the world for many years now, while safe abortion services are not funded by them at all. Since ICPD, however, the US has funded post-abortion care, which was invented at ICPD as a way to save women’s lives who had had an unsafe abortion. Unfortunately, the evidence that post-abortion care has in fact saved many women’s lives since ICPD is sparse and not compelling. Yes, the number of deaths from complications of unsafe abortion has fallen a lot, but this may be due to self-medication with misoprostol replacing life-threatening methods.

In fact, once ICPD was over, this so-called post-abortion care should have been rejected as unethical, because it allows harm to be done unchallenged and forces health care providers to clean up the mess without the support of the law. Under US aid policy, even countries where abortion is legal who tried to use USAID funds for safe abortions as well as for contraception and sterilisation, in integrated programmes, had their “family planning” funding stopped. Research has now shown that this leads to higher rates of unwanted pregnancies and abortions in those very same countries, proving how illogical such a policy is/was. Will that evidence, published only recently, lead to a change in USAID policy? Unlikely. Too sensitive. And meanwhile, a violent and fanatical anti-abortion movement flourishes in the US, where some of the most punitive and misogynistic barriers to safe abortion are being implemented with near impunity, in one state after another.

The anti-abortion movement is also anti-family planning. For years, they were very circumspect about this as they feared, quite rightly, that it would lose them support. But the current Vatican has helped to bring anti-abortion opposition to contraception and assisted conception out in the open again. This is evidenced in campaigns to ban emergency contraception and assert conscientious objection to providing contraceptives, e.g. by pharmacists. But still, many in the family planning movement do not support the right to safe abortion.

In light of the Family Planning Summit, it is a good time for abortion rights activists who have ignored family planning to link up with the family planning movement, and help to ensure that services have a rights-based approach. It is also a good time for all family planning colleagues to support the right to safe, legal abortion alongside the right to access contraception and sterilisation – and talk about abortion as a legitimate part of fertility control, a solution to unwanted pregnancy, a public health necessity for women, and a legitimate health care service. All of us should acknowledge the huge unmet need for safe, legal abortion services as well as for contraception and sterilisation services, and ensure that they are provided – and funded – together.

Many effective contraceptive methods, condoms, two types of emergency contraceptive pill and two very safe methods of early abortion – all on the WHO essential medicines list – can and should be provided at primary health care level. This includes medical abortion pills and manual vacuum aspiration for abortions up to 9-10 weeks. Some of these can even be provided during home visits by community-based health workers – the pill, condoms, injectables, emergency contraceptive pills and medical abortion pills for early abortions – as long as there are nurses, nurse-midwives or other mid-level providers who have been trained to do so. The evidence is there– this is all safe and effective. Moreover, the legitimate sort of post-abortion care, i.e. the kind that happens after safe abortions, needs to include information about and provision of contraception, just as post-partum care ought to do. So, even programmatically and clinically, the integration of family planning and abortion makes more sense than ever.

The morning after: the beginnings of an assessment of the FP Summit

16/07/2012 Comments Off on The morning after: the beginnings of an assessment of the FP Summit

Marge Berer
Editor, Reproductive Health Matters

13 July 2012

From a communications point of view, the FP Summit was a raving success. Newspapers, TV and radio all over the world covered it. Around the globe everyone reached by the media heard how wonderful family planning is and how neglected it has been, the Lancet launched a special edition , Guttmacher and others released facts and figures showing the extent of unmet need. Across the women’s health movement the listserves, Facebook and Twitter were full of it. All in all, the day – and many of the messages it gave birth to – had enthusiastic, even missionary, overtones.

On the absolutely fabulous side, Melinda Gates’ challenge to the Pope to acknowledge that contraception is ‘not controversial’ even amongst Catholic women, is likely to rock the foundations of the Vatican’s whole policy on abstinence, condoms and contraception from the grassroots of the Catholic church up. It was God’s gift to Catholics for Choice, who will be promoting Condoms-for-Life and safer sex at the upcoming AIDS conference later this month.

Also on the plus side, there were representatives of governments and many, many others who are making progressive change happen in their countries, and who spoke out about it. These are people who can make a big difference when they get home who did support comprehensive sexual and reproductive health and rights from the podium and the floor of the meeting, and who insisted that family planning services can only be provided within that wider remit. There were people who needed to learn what it was all about, some of whom were too young to have lived the history, but who came with strong pro-choice views.

The media exposure of the value of family planning has a huge potential for good, because it will have reached people who didn’t know family planning existed or whether it’s good for them and safe, and others who have never had a chance to talk about these matters with others. It will also have put fertility control as a public good on the map around the world. And hopefully it will spur those with expertise in sexuality and reproduction to start talking about what they know, and what is and is not true amongst all the hoopla – and to assert that the power of money must not be allowed to take precedence over public health values and human rights principles, or the values of knowledge and truth.

On the oh-God-help-us-no-no-no side, though, Melinda Gates anointed herself as the new saviour of women’s and children’s health, and the press ate it up in both pictures and words. Some of the best people in the field of sexual and reproductive health, were unexpectedly uncritical, singing the praises of this wonderful opportunity. Perhaps not surprising given the historical shortfall in funding for family planning.

A golden moment, the kind that big money and a Tory government are at home in, stage-managed by a slick public relations company called McKinsey (who describe themselves as “the trusted advisor and counsellor to many of the world’s most influential businesses and institutions”). With big pharma, having abandoned contraceptives for many years, talking about the opportunity (“70% of this market is under-served”) to make a profit from family planning needs and then give some of it back to women – as a charitable gift. Patting each other on the back for being so wonderful as to finally have recognised that women have health needs they can exploit. A truly Hollywood event, except this is not entertainment. This is women’s lives.

This golden moment, which had to happen mainly because so many governments have failed to take responsibility for the public health needs of their citizens, for maternal health, family planning, abortion, sexual health, in the only equitable manner that works – by providing publicly funded, well-resourced services.

It was a day that showed the world it was possible for one very well-meaning woman, backed by the power and money of her husband, to direct global policy and claim ownership of the provision of family planning to 120 million women and at the same time, to disparage and stigmatise women’s need for abortion to the entire world – and get away with it without being challenged. She had the courage to challenge the Pope. It is a shame that a summit attended by many of the world’s experts on these subjects could not emulate her bravery and challenge her in return.

She was not the only one who got away with it. The Summit also gave the podium to and applauded politicians from countries where millions of women have the very unmet need for contraception in whose name this Summit was called: women who are still dying from unsafe abortions because their governments are too cowardly to make abortion legal and safe; and women who are dying from complications of pregnancies because they have no access to life-saving maternity care. Countries that since the 1960s have received hundreds of millions if not billions of US dollars for family planning, which have as good as disappeared, or been squandered and misspent.

It included representatives of the very same private sectors whose services and prices for contraceptive methods and safe abortions remain inaccessible to and unaffordable for many in the world’s population who need them, especially young women and men. And not only in low- and middle-income countries, but also in the United States, a country whose health industry has made life hell for Barack Obama for trying to make health care even a little bit more affordable, excluding abortion of course, for millions of disenfranchised people. The United States – a country that has the biggest and most violent and aggressive anti-abortion movement on earth, second only to the Vatican, and some of the highest unintended pregnancy rates in the developed world, especially among poor women.

It was addressed by the Prime Minister of the UK, the Right Honourable David Cameron, who got a standing ovation for a speech about the importance of empowering women, a speech that stank of hypocrisy. A Prime Minister who is responsible for indefensible, swingeing spending cuts that are adversely affecting women, young people and children above all, including cuts in family planning, sexual health services and welfare, at a time when it has never before cost so much to raise a family. Whose Secretary of State for Health is selling off our National Health Service piece by piece, who has wasted public time and at least £1 million in public money harassing some of the real heroes of women’s rights, that is, abortion service providers, for no credible reason. Whose Minister for Public Health put an anti-abortion group on the government’s sexual health advisory group “for the sake of balance” and to propitiate anti-abortion fanatics in Parliament – a Minister who described abortion as a “sensitive” issue, after 45 years of safe, legal abortions (except for women in Northern Ireland, of course).

And now it’s the morning after. How to go on from here and engage in what will happen? It’s a pity about Melinda Gates’ prejudices against abortion. I hope she will reconsider them because it would make her a far more credible ambassador for this cause which, after all, does not belong to her.

An unholy alliance: religion, neo-liberal economics and good old fashioned patriarchy – restricting women’s abortion rights in Eastern Europe

11/05/2012 Comments Off on An unholy alliance: religion, neo-liberal economics and good old fashioned patriarchy – restricting women’s abortion rights in Eastern Europe

A report from guest blogger Charlotte Gage on ‘How much does abortion cost?’ a session organised by ASTRA Central and Eastern European Women’s Network for Sexual and Reproductive Health and Rights at the AWID Forum in Istanbul.

I attended this session where speakers from Poland, Romania, Hungary and Slovakia outlined the economic dimension of sexual and reproductive rights in their countries, and the increasing restrictions on access to abortion.

Provision of abortion and other reproductive health services are under threat from neo-liberal economics which is increasingly restricting state-funded services throughout the region. This is being fuelled, by ideological opposition to abortion from both the Catholic and Orthodox Churches, sometimes with funding and support from US anti-choice organisations which is thought may include the US-based Human Life International and Opus Dei.

Most countries in the region have experienced reforms to health systems following democratic transition from Communism, but the results of these vary. The restrictive abortion laws in countries such as Romania and Albania under Communism were seen as a social experiment to increase the population and provide new generations of workers, and have since been relaxed. More recently however, Ukraine and Russia have tried to implement restrictive laws, to reverse a decline in population.

The influence of religion varies throughout the region. In Poland the Catholic Church still has a strong influence, and as its access to public resources increases, through provision of adoption services, it has a vested financial interest – as well as ideological one to opposing reproductive rights. In other countries it is the influence of, and funding from, the US anti-choice movement that is driving forward an anti-choice agenda.

The increasing reluctance by governments to pay for contraception and abortion services is also having an impact.

In Hungary, an advertising campaign in which images of fetuses asked not to be murdered was funded by PROGRESS EU funding – a fund aimed at supporting equality. The Government was forced to stop the campaign after feminist organisations complained to the European Parliament.

In tandem with ideological tactics aimed at creating attitudinal change, the budget for reproductive health in Hungary, which supported women who could not afford to pay for an abortion, has been significantly reduced with no explanation. Women seeking home birth are subject to unaffordable insurance premiums and in one case a midwife has been imprisoned for supporting a woman to give birth at home. For PATENT – People Opposing Patriarchy these were all cited as examples of the continued repression of women’s reproductive rights in Hungary, patriarchy in action, and the denial of women’s autonomy.

Freedom of Choice, Slovakia,  has campaigned against the lack of unbiased and accurate information on family planning. It also takes on the  influence of the Catholic Church hierarchy which is opposing progressive policies such as inclusion of more information in school textbooks and making contraception more affordable.

The Polish Federation for Women and Family Planning described how in 1993 Poland became the first country in Eastern Europe radically to restrict abortion and is now, regrettably, serving as a model for other  Governments in the region. Official figures show just 600 abortions were performed in Poland in 2010 (compared to 8,000 in 1989), but this figure hides the large number of privately performed abortions and those provided to Polish women abroad.

In many of the countries it is the actual cost of abortion for women that creates the main barrier to accessing services. Women on low wages sometimes pay the equivalent to the average monthly wage for an abortion. In Slovakia, where there are no state controls on the maximum price of contraception, prices are rising and contraception is becoming unobtainable for many women. Moreover, across the region professional resistance to medical abortion combined with high costs means women are denied the option of choosing this extremely safe method of abortion.

An interesting response to the economic and ideological squeeze on abortion access came from a speaker from the Romanian organization European Centre for Public Initiatives (ECPI) which said that Romania has not yet fully learned the lessons from its past. Though the liberalisation of abortion in Romania has led to significant reductions in maternal mortality there have been recent attempts to restrict and limit abortion in Romania, including proposing mandatory (biased) counselling and a three day waiting period before a woman is able to have an abortion.

ECPI believes that calculating the financial benefits of providing reproductive health care may be a powerful tool in opposing further restrictions. To this end, it is attempting to estimate the full cost of unsafe abortion including:  the health care costs following unsafe procedures; social costs including sick leave and disability benefits if the woman is injured; the costs of childcare if the woman dies;  and violence against women services for those who experience violence following abortion.

It may ‘leave a bad taste in the mouth’ to try to put a monetary value on women’s lives, but in the face of ideological opposition to women’s reproductive autonomy, and governments’ focus on cutting budgets, it might be the most powerful argument we can make.

Charlotte Gage

With thanks to Katarzyna Pabijanek – ASTRA Network Coordinator

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