Tuesday, 8 May 2012

It's women's lives stoopid

Many people will be whooping at delight that Melinda Gates is defying the hierarchy of the Catholic Church to promote and fund provision of contraception to women around the world. I’m whooping myself because we all know that women of all faiths and cultures want access to modern contraceptive methods and there is currently a massive global unmet need for them. It’s great that she has presented her view on this as one of social justice and interesting that she has linked this to the ethos of her convent education. We know that nuns are not always uncritical mouthpieces for the Vatican. In fact US Bishops have recently been ordered by the Vatican to whip their nuns into line for focussing on ‘radical feminist themes’. Historically, there is even evidence of nuns providing women with safe abortion. It’s a shame that Gates’ teachers never taught her this bit too.

Because the thing that is significantly missing from Gates’ pronouncements on contraception is a recognition that abortion too is a matter of women’s health and of social justice? While Gates hopes to generate $4bn to fund family planning services, no money is going to go towards provision of safe abortion or advocating for governments to reform restrictive abortion laws. For Gates, abortion is a step too far morally. Maybe she hopes that with good contraceptive coverage this problem will disappear, but we all know this is wishful thinking. Maybe she thinks that if she doesn’t mention abortion she can hold back the rage of the Catholic establishment –even win them round. Both of these are wishful thinking too. 

By ignoring abortion or presenting it as morally distinct from contraception - as she does - it reinforces a separation that serves women badly. It undermines the efforts of those who are trying to reform restrictive laws in their own countries, it marginalises those who do provide abortions, and maintains the invisibility of the ordinary women who have abortions each year (44 million in 2008).  It even risks limiting contraceptive options for women, as the anti-choice lobby draws our energy into debates about which drugs are abortifacient as opposed to contraceptive. We know that women everywhere have abortions - whether they are poor women in rural areas with no access to contraception, or middle class women in Europe whose contraception has failed. Catholic women are no more immune to the dilemma of an unintended pregnancy than any other women. Like all women when they know that they simply cannot continue a particular pregnancy, they will defy their religious leaders and the law of the land. They will risk excommunication, prison, and even their lives to get the abortion they have decided is the right thing for them. For some reason these women, their bodies and their lives are not a legitimate focus of social justice.

The same ear-covering ‘la la la la la I can’t hear you’ attitude is often on display in the maternal health field. Despite that fact that 13% of maternal deaths are due to unsafe abortion – a higher proportion in some regions – many in the maternal health field don't address this cause. Despite many of the women dying from pregnancies they would rather have ended, some funders and policy makers in maternal health field avert their eyes. Even as doctors pick up the pieces of unsafe abortions around the world and families bury their dead, abortion remains, at best, peripheral to the maternal health agenda.

It is only when we join up all the dots, that we will really start to improve and save women's lives. That means advocating for, and funding, comprehensive and accurate sexual health education for all young people; access to the full range of modern contraceptive methods and sexual health services for all; safe, legal and accessible abortion as a necessary safety net when things go wrong; and comprehensive ante-natal, maternity, emergency obstetric and post-partum care. Separating these things out or picking and choosing which to address to accommodate the personal morality or preferences of law makers and funders, or hoping that doing so will minimise the opposition will mean that women continue to die wholly preventable deaths.

So please funders, don’t leave out abortion  - it’s women’s lives stoopid.


  1. Dear Eucation for Choice

    The Gates family planning summit will raise money to fund contraception, including hormonal contraceptions: pills, injections, implants, patches, IUD etc. Each of these, as hormonal methods, have the potential to act abortifaciently i.e. cause an abortion, by preventing the implantation of the human embryo. As such, abortion is not off the agenda.

    DFID, MSI, IPPF, and other stakeholders who will be attending the summit all have longstanding positions of promoting and performing abortion. It is very likely that money will be used to promote and perform abortion, especially as abortion is so often presented as part of family planning (the comments of Hiliary Clinton are an obvious example). another example is the use of so called "menstural regulation" which is used to circumvent abortion laws in developing countries.

    The claim that 13% of all maternal deaths are cause by unsafe abortion is highly disputed. There is no doubting the difficulty of acurately recording deaths in the developing world in the first place, never mind the specifics of cause of death. Even the study you link to admits the difficulty, so all there is left is large estimates. Often induced and spontaneous abortion is counted together, which is obviously a problem.

    A research paper by the UNFPA and WHO (2005) listed abortion as the 9th cause of maternal deaths at 3.9%, both induced and sponteneous for Africa. simialr results were given for Asia. that's nowhere near 13%, even as an estimate.

    Dr. Elard Koch, Dr. Irvine Loudon, and Professor Owen Drife FRCOG have each show how maternal deaths have rapidly declined over the last century thanks to the improvements in medicine generally, and specific improvements in maternal and newborn health, all well before the widespread legalisation of abortion. The evidence is showing us that contraception and abortion doesn't save lives, and the lack of does not lead to maternal deaths. 4 billion would be better spent on proper healthcare, water, and food for mums and children under 5.

  2. Hi anonymous, you have brilliantly demonstrated the reason that those of us who think contraception is a good thing are concerned by explicitly excluding abortion from this funding pot. As we said 'It even risks limiting contraceptive options for women, as the anti-choice lobby draws our energy into debates about which drugs are abortifacient as opposed to contraceptive', which is exactly what you have done here.

    It is true that deaths from unsafe abortion are falling globally and this is something we should celebrate. We also need to acknowledge why this is. It is not because women are choosing to continue unwanted pregnancies, it is because in those countries where abortion remains illegal, women are increasingly able to access safer abortion methods such as using Misoprostol - a drug that is used in the UK and elsewhere to induce abortion and to manage miscarriage safely.

    There is also increasing training for health professionals to quickly manage the complications of unsafe abortion and encouragement for women to seek that help without fear of legal consequences.

    'Menstrual regulation' is a formulation which allows health services to end potential pregnancies by providing abortion medication or procedures for women, after they have missed their period, but normally before pregnancy is confirmed. It has diverted thousands of women from unsafe backstreet abortion and doubtless saved lots of lives in countries that were previously devastated by the high number of deaths from abortion.

    There are three camps we might occupy here:
    1. Supporting total criminalisation of abortion and accepting the high levels of maternal mortality and morbidity as sad but inevitable as long as women choose abortion(as I suspect 'anonymous' does)or even seeing the deaths as an appropriate punishment for the sin of abortion as some real extremists might believe.
    2. Supporting total decriminalisation and open access to abortion as part of comprehensive state health and welfare services which would also provide good quality contraceptive care, ante-natal care, labour management and post-partum care, and ongoing financial, educational and health provision for children - which means women really feel supported to continue pregnancies in difficult situations(which we support)
    3. The status quo in which many countries still forbid or restrict access to abortion, but women are increasingly able to manage their abortions safely alone with medication, or with the help of health professionals who are able to 'circumvent' the law in order to save lives, or take timely action to help women who are injured in the backstreets. Inadequate a compromise as this is it appears to be saving lives.

    Finally, we have no argument that more investment needs to be made into maternal and newborn health care. Hundreds of thousands of women are dying preventable deaths because of lack of investment in this area and improvements that have been made have largely been for women in urban areas and excluded poorer women and rural women. Attempts to reduce infant mortality too have been inadequate with most success for those babies that have made it through their first few weeks and have benefited from vaccination programmes etc, and little progress at getting more babies to survive labour and the first few days of life.

    We are the first to argue that all these things are linked and that fundamentally they are about valuing women: women's choices; women's bodily autonomy; women's equality; women's health and lives; and women's value to their families, communities and countries. When the anti-abortion movement starts investing in mothers, babies and children or promoting their rights to safe and fulfilling lives and stops wasting its time and vast resources on trying to stop abortion maybe they will be taken more seriously.