Open Letter to the Committee on the Rights of Persons with Disabilities

 

CORRECTION:This Open Letter was mistakenly addressed to the Special Rapporteur on the Rights of Persons with Disabilities and well as the Committee on the Rights of Persons with Disabilities. The recommendations to the UK were made by the CRPD Committee, not by the Special Rapporteur. We apologise for the error. Anyone who wishes to reprint this letter is welcome to do so but must use this revised version.

 

Open Letter To:

Committee on the Rights of Persons with Disabilities

c/o crpd@ohchr.org

RE: “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)

9 November 2017

Dear members of the Committee on the Rights of Persons with Disabilities,

I am the International Coordinator of the International Campaign for Women’s Right to Safe Abortion and an abortion rights advocate for more than 35 years, living in the UK. I am writing to you in a personal capacity regarding the “Concluding observations on the report of the UK to the Committee on the Rights of Persons with Disabilities”, as above.

Your recommendations to the UK overall are absolutely fair and just, but I am writing to take issue with those related to abortion, and to explain why. These are as follows:

Equality and non-discrimination (art. 5)

  1. The Committee is concerned about perceptions in society that stigmatize persons with disabilities as living a life of less value than that of others and about the termination of pregnancy at any stage on the basis of fetal impairment.
  2. The Committee recommends that the State party amend its abortion law accordingly. Women’s rights to reproductive and sexual autonomy should be respected without legalizing selective abortion on the ground of fetal deficiency.

My concerns regarding these recommendations are threefold: the first is to do with your definition of “a person”. The second is to do with the reasons why women have abortions vs. how different laws address and codify reasons for abortion as legal or illegal grounds. The third is that I believe including any ground for abortion in the law whatsoever – apart from permitting abortion at the woman’s request – is a mistake because it serves to restrict women’s autonomy and decisions over their own bodies.

  1. The definition of a person

Re the definition of a person in regard to human rights and discrimination, I offer the abstract from a paper by Rhonda Copelon, Christina Zampas, Elizabeth Brusie and Jacqueline deVore, which was published in the journal Reproductive Health Matters in November 2005:

In the Universal Declaration of Human Rights, the foundation of human rights, the text and negotiating history of the “right to life” explicitly premises human rights on birth. Likewise, other international and regional human rights treaties, as drafted and/or subsequently interpreted, clearly reject claims that human rights should attach from conception or any time before birth. They also recognise that women’s right to life and other human rights are at stake where restrictive abortion laws are in place. This paper reviews the International Covenant on Civil and Political Rights, the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination Against Women, the European Convention for the Protection of Human Rights and Fundamental Freedoms, the Inter-American Human Rights Agreements and African Charter on Human and People’s Rights in this regard. No one has the right to subordinate another in the way that unwanted pregnancy subordinates a woman by requiring her to risk her own health and life to save her own child. Thus, the long-standing insistence of women upon voluntary motherhood is a demand for minimal control over one’s destiny as a human being. From a human rights perspective, to depart from voluntary motherhood would impose upon women an extreme form of discrimination and forced labour. (http://www.tandfonline.com/doi/abs/10.1016/S0968-8080(05)26218-3)

If you accept this interpretation of international human rights law, then it is surely a contradiction in terms in your recommendations to the UK, or indeed to any State party, to call 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 which abortions are acceptable and which are not 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.

I believe that the focus on “legal grounds/indications for abortion” per se has boxed us into a corner in almost every country in the world. Abortions on the ground of fetal anomaly, just like abortions on the ground of fetal sex, have been described as “selective” abortions. That is, unlike abortion based on a risk to the woman’s health or based on her social circumstances, these grounds seem to allow abortion on the basis of a condition(s) of the embryo/fetus. Abortion following rape or incest might also be considered to be “selective”, since the pregnancy arises from the violence of the man responsible for engendering it.

However, to accept this picture in each of these instances makes the woman’s  response invisible by shifting the locus of decision-making about the pregnancy away from her and its effects on her life. It also leads to new forms of “discrimination”. Thus, it implies, for example, that a male embryo/fetus has fewer rights than a female one, if only female fetuses are protected, or that an embryo/fetus without any identified anomalies has fewer rights than one with identified anomalies, if only fetuses with anomalies are protected, as you are proposing. Such outcomes are also and equally unacceptable.

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. This may mean any baby whatsoever or it may mean a baby that is male or female, or one with or without an identified fetal anomaly, or one that is the product of sexual violence or of wanted sex, or one that is unwanted from the start or becomes unwanted during the course of the pregnancy – in short, no matter what the reason may be.

Furthermore, and most importantly for this discussion as I see it, fetal anomalies and disability are not the same. An embryo/fetus has no “abilities” of its own. Its life and development are utterly dependent on the woman carrying it. Disability (and ability) are conditions that come into existence only after birth. Disability may arise from fetal anomalies present before birth or from events and illness after a baby is born, which may occur throughout the life course.  I have never heard this distinction made, but I believe it must be.

Your text uses the phrase “fetal deficiency”. No one working in fetal medicine today would use that term. 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, as Copelon et al say in the abstract above, “to depart from voluntary motherhood would impose upon women (my emphasis) an extreme form of discrimination and forced labour”.

It was therefore a great relief to me that our government, in its initial response to you on 3 October 2017, did not accept your recommendation to change our abortion law. I think you should know that groups in the UK Voice for Choice coalition, of which I am a member, will be opposing any such change in the law. Instead, we are working for decriminalization of all abortions.

One of the most concerning issues about your stance on this topic is that it is so out of line with the recommendations on making all abortions safe by the CEDAW and other OHCHR Committees, and those of the Special Rapporteurs on the right to health and against torture, as well as those of the Working Group on all forms of discrimination against women in law and practice.

I therefore feel it is very important that more people are aware of your recommendation to the UK on this subject. I will be publishing this Open Letter in the newsletter of the International Campaign and sharing it with colleagues.

In closing, I should like to express my respect and admiration without reservation for all of your efforts in opposing discrimination on the grounds of disability. I hope you will discuss this matter with others in the OHCHR community and reconsider your stance.

With kind regards,

Marge Berer   (writing in a personal capacity)

International Coordinator,

International Campaign for Women’s Right to Safe Abortion

London, UK

E-mail: info@safeabortionwomensright.org

Web: www.safeabortionwomensright.org/

Giving her, the woman, life: Dismantling the damage abortion stigma does to young people and communities

 

In this Inroads blog, Akosua Agyepong, a 20-year old, third year student and youth activist in Ghana, lays out her hunger to see the eradication of stigma which leads to unsafe abortions within her country.

She describes her journey to understanding the dynamics of abortion stigma and explains how religious and traditional leaders seek to dictate what women do with their bodies and sexuality. Akosua ends with a call to her communities which she says must wake-up and realise that young people are sexually active, that they could get pregnant in the process and some of them would want to terminate the pregnancy.

“Abortion stigma stems really from the hypocrisy of society. The pretense of our lawmakers, cultural custodians, religious leaders and community leaders. To abort a foetus is wicked, sinful, uncultural and with whatever contempt they describe abortion with. They live in a false consciousness that young people must and are all abstaining from sex. That those who do not, would eventually give birth and would marry whoever got her pregnant or better still suffer for their sins.”

 

Read the full blog here.

 

PHOTO: Inroads

 

Response to an Australian woman convicted for attempting to terminate her pregnancy

Jenny Ejlak, President of Reproductive Choice Australia responds to the case of a woman in New South Wales, Australia, who was recently convicted of attempting to terminate her own pregnancy. This entry was originally posted as a Facebook post.

Firstly it is important to recognise we only know what has been reported in the media and the courts and none of us know the full extent of this woman’s circumstances. Our comments below are based solely on information that has been made public.

Failures in the healthcare system in NSW

As far as we can tell this woman was simply turned away from health services when she should have been referred onto counselling, family violence services, a social worker or at least pre-natal care services. If she was not, this demonstrates that the NSW health service system has gaps and vulnerable women are suffering as a result.

Anyone seeking termination of pregnancy that far into the second trimester will be experiencing significant and complex life circumstances which need to be addressed by a multi-disciplinary health and social services team, she should never have been left to fend for herself.

If the woman herself didn’t want the pregnancy it is most likely she would have tried to terminate in the first trimester – the reporting makes it sound like she was only trying to terminate at her partner’s behest.

The fact that she seemed to be coerced by her boyfriend so late into the pregnancy is not an abortion issue, it’s a controlling, abusive relationship issue and should have been dealt with as such.

The law in NSW

This remains an extremely rare case of post 20wk termination and the fact that abortion providers would not provide a service at this stage demonstrates that the medical community already exercises judgement on later-term gestation pregnancies and no additional laws are needed to further restrict their practice.

The current criminal law in NSW is outdated and inappropriate for dealing with situations such as this. The woman in this case has clearly been through significant trauma and is possibly still under the influence of a controlling partner. The last thing she needs on top of that is a criminal record. She needs assistance and support not punitive laws.

Buying abortion pills from overseas

An unknown number of women in Australia access abortifacient medication online from overseas destinations, without knowing whether the pills they receive are genuine, often without advice on how to take them and without having had appropriate medical tests such as an ultrasound to confirm the pregnancy is below the recommended gestation for medical abortion, and is not ectopic.

Women do so because they cannot access affordable, timely services in their local community, however they fall foul of the law in most states and territories and risk prosecution as this woman has.

Governments need to improve health and social support to women experiencing problem pregnancy, not prosecute them with punitive nineteenth century laws.

Sources for further information:

https://www.buzzfeed.com/amphtml/ginarushton/an-australian-woman-has-been-convicted-after-taking

http://www.reproductivechoiceaustralia.org.au/

Making Abortion Illegal Doesn’t Stop It From Occurring

By Michael Okun Oliech, Naya Kenya Youth Advocate 
 

According to article 26 of the 2010 Kenyan constitution,  Abortion is not permitted in Kenya unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.

Despite this strict law against abortion, women and adolescent girls are still having abortions in the country. According to the Ministry of health over 500,000 abortions are procured every year in Kenya and three quarters of these abortions are unsafe. Moreover, over 25,000 women go to government hospitals with complications due to unsafe abortion and more than 2,600 women die annually from unsafe abortion here in Kenya.

Making abortion illegal does not stop it from occurring but instead it drives it underground forcing women to seek unsafe and risky abortion procedures which are often performed by untrained providers and many even try to perform abortions on themselves. The consequences of this can be horrific. Unsafe abortion may lead to serious and permanent injuries and eventually death. Unsafe abortion is the leading cause of maternal death in Kenya.

The best way to reduce abortions in this country is not by outlawing it but by helping women avoid unintended pregnancies in the first place through investing more in contraception and family planning. By doing so, unintended pregnancies would decline, we will have fewer abortions and most importantly thousands of women lives will be saved.

It is estimated that even where there is high contraceptive use, there will always be a need for abortion. By legalizing and offering safe abortion services including post abortion care, many lives could be saved.

It’s a basic right for each and every woman to make her own decision about whether and when to have a child without putting her health or life at risk.

Denying women the ability to choose to end an unwanted pregnancy under safe and legal conditions is a violation of human rights and flies in the face of the empowerment agenda. Empowerment means full-participation, autonomy, and equality. It means destroying the barriers that prevent women from achieving their full potential. Women will not be equal until they can control if, when and how many children they have.

It’s time for Kenya to make that right a reality by investing in contraception/family planning and legalizing safe abortion

_____________

KENYA SOLIDARITY REQUEST – we are calling on all Campaign members to sign and share this petition. 

Educating a New Generation of Pro-Choice Advocates

by Hannah Thi Minh Nguyen

It’s a typical spring evening at Stanford University, and I am huddled around a conference table with twelve classmates at the Medical Center’s Department of Obstetrics and Gynecology. We frantically jot down notes as our professor, Dr. Paul Blumenthal, draws a uterus on the whiteboard, and with his marker, demonstrates how a sharp curette could accidentally perforate the organ. We all suppress a collective wince, but not even the gory details of surgical abortion are enough to keep us from being completely mesmerized by the lecture.

For the past ten weeks, I’ve had the privilege of taking a class entitled “Perspectives on the Abortion Experience in Western Fiction” with Dr. Blumenthal, a Professor at Stanford and Director of Division of Family Planning Services and Research here. Before entering the classroom, I wasn’t entirely sure what new information I would gain from the seminar. I had already been passionate about reproductive justice for years and worked as a counselor in my school’s sexual health peer counseling center where we had covered abortion as part of our training curriculum. While I knew that the class would be entertaining, I figured I would already be well-versed in the topics that we would cover.

Of course, after our first lecture, my expectations were blown out of the water.

The course took a unique approach to broaching the subject of abortion, focusing on the concept of “narrative medicine” which emphasizes the role of storytelling and the personal experiences of patients in promoting effective healthcare. By using depictions of abortion in popular media to transition into meaningful class discussions, this class was a comprehensive look at the technical, ethical, social and legal aspects of reproductive healthcare as a whole.

Indeed, candid conversations and logical, realistic explanations behind abortion procedures helped to debunk common pro-life arguments, thus strengthening my resolve in the pro-choice movement. Most memorably, we learned about the steps involved in a second-trimester dilation and evacuation, which involves the removal of pregnancy tissue with forceps. In this class, however, Dr. Blumenthal explained that although the procedure may not be “aesthetic,” or visually appealing, it is far less agonizing, and more expeditious than the alternative:  induced labor that takes eight or more hours. We concluded that if the outcome of either method of abortion is the same, physicians should prioritize the health and safety of the woman by using the safest, most reliable procedure available.

Furthermore, we analyzed ethical considerations around abortion in novels written at different time periods. The first of our three readings was My Notorious Life (2013) by Kate Manning, a story based on a famous abortion provider in the 19th century, Madam Restell. For our first essay prompt, we investigated the portrayal of different rationales behind abortion and engaged critically with pro-choice rhetoric. One of the highlights of the class occurred when Kate Manning visited us and explained in person her creative decisions and the development behind each of her characters and their motivations. I had never been able to speak with an author in such an intimate setting, and found the book even more enjoyable after discussing it with her.

In addition to My Notorious Life, we read A Case of Need (1968) by Michael Crichton and Protect and Defend (2001) by Richard North Patterson. For both novels, we examined different aspects of the abortion debate. A Case of Need follows the story of a pathologist whose friend is arrested for performing an illegal abortion and his journey to find the actual culprit. While reading this novel, we analyzed the ways in which the portrayal of and arguments for abortion have changed over time. Meanwhile, Protect and Defend, which focuses on a controversial abortion case brought before the Supreme Court, began a class discussion on second trimester abortions and legal barriers to obtaining the procedure safely. Each novel that we read vividly illustrated anxieties surrounding abortion at the time and sparked fascinating conversations amongst ourselves and with Dr. Blumenthal.

Having obtained a strong understanding of the mechanical aspects of abortion as well as rhetorical arguments surrounding it, we were then able to confront the social stigma associated with terminating a pregnancy. Sociologist Dr. Gretchen Sisson from Advancing New Standards in Reproductive Health (ANSIRH) gave a guest lecture on modern depictions of abortion in the media and explained how television and film can be powerful tools to either reinforce or disprove prevalent misconceptions about abortion.

We discussed how certain representations of abortion may risk bolstering stereotypes around the procedure, such as those in Scandal, E.R., and Grey’s Anatomy. In each series, characters terminate their pregnancies in intimidating hospital operating rooms while swells of music and voiceover monologues heighten the drama of the scene. Furthermore, in shows like Reign, stylistic decisions frame the abortion provider as a terrifying antagonist. While these shows don’t overtly oppose a woman’s right to choose, they present abortion as a highly dramatic, dangerous surgical procedure which may deter women from considering abortion entirely.

However, we also saw positive portrayals of abortion that served to destigmatize and normalize the procedure. We watched a clip of the first Latina woman to have an abortion on a television show in Jane the Virgin, and saw the value of humor and levity when discussing abortion, such as in Please Like Me and Bojack Horseman. Following Dr. Sisson’s presentation, we brainstormed different scenarios that we wished to see more represented in the media: for example, medical abortion, and people of varying ages, marital and socioeconomic statuses, and races terminating their pregnancies.

Since taking Dr. Blumenthal’s class, I not only have a stronger resolve to be an effective abortion provider in the future but also the foundations to practice compassionate healthcare in general. By reading about the lives of abortion providers, I recognize the challenges that those who perform abortions must face, but also see the dire need for health professionals  able to supply this service. Furthermore, by examining myriad perspectives through different forms of media, I can more fully understand and appreciate why an individual may or may not choose to terminate a pregnancy. Social, legal, and health-related factors all contribute to this complicated decision that must be respected. Demonstrating empathy, rather than judgement, was a central theme to this course and a lesson I will carry with me as a future healthcare provider.

In an article published in the NWSA Journal, Natalia Deeb-Sossa and Heather Kane investigated the discomfort that teachers experience when trying to discuss abortion with their students, citing the caustic political environment as a key factor. However, they also emphasize the importance of education in the fight to dismantle the “culture of fear” that has sprung up around abortion. By having the opportunity to learn about abortion in an informative, comprehensive and engaging manner, I strongly agree that candid discussions of abortion and a narrative medicine approach are essential for equipping the next generation with the knowledge and willpower to fight for our reproductive freedoms.

Education key to women’s access to abortion

by Sophie Cousins

A school physical education textbook in India recently came under fire on social media for defining 36-24-36 as the ‘best body shape for females’, claiming that it was ‘why in Miss World or Miss Universe competitions, such type of shape is also taken into consideration’.

While the textbook wasn’t widely circulated (and local media reports say the government will take action against the publisher of the book as it wasn’t approved for use in schools) it nonetheless highlights a common problem in India: the lack of education on the inner workings of the female body, rather than just its appearance.

The sexual and reproductive health needs of adolescents across India are grossly overlooked by the education system, not understood by the healthcare system and considered so taboo in all areas of society, including among parents and politicians, that they are rarely discussed publicly.

The consequences of a lack of appropriate and adequate sex education along with commonly reported negative healthcare worker attitudes towards teenage sex can have dire consequences and presents myriad barriers to the effective delivery of services to millions of adolescent Indians of reproductive age.

In fact, when a sex education curriculum was promoted by the government in 2007, it was fiercely opposed with many arguing that it was a western construct that would corrupt youth.

The result has been a ban of sex education in numerous states. Other states meanwhile allow private schools to run their own version of sex education with varying degrees of sufficiency while states like Haryana run more liberal education classes in state schools that address sex, contraceptives and “natural urges”.

I recently worked on a piece about India’s small yet declining use of modern contraception and the need for India to educate its youth and move away from its reliance on female sterilisation.

As part of the piece I met a young, vivacious and thought-provoking woman who works in sexual health. She told me she’d never talked about sex or contraception with her mother until her mid-twenties. She’d basically flown blind, she told me.

“In the end, women only access services when they’re pregnant,” she said.

And with this inevitably unwanted pregnancy is included.

While India’s abortion laws are considered liberal compared with elsewhere in the region, a lack of awareness of the laws, a lack of women’s agency, stigma and healthcare worker attitudes are major barriers.

Such barriers can have devastating consequences. In fact, it’s estimated there are more than 6.4 million abortions in India every year, a stark contrast to the official figure of 395,495 recorded between 2015-16.

The wide discrepancy between the estimated number of abortions and the official figure is because government figures only count abortions that are registered by accredited public and private facilities, which is a legal requirement.

But given that two-thirds of abortions in India take place outside accredited healthcare institutions by unregistered healthcare providers or “quacks” or by women who opt for medical abortion tablets which are available over-the-counter, the official figures don’t accurately represent the situation on the ground.

It’s not surprising to learn that complications from unsafe abortion in India are not decreasing, but are actually increasing, according to the executive director of the Population Foundation of India, Poonam Muttreja.

Another barrier is the limits of the Medical Termination of Pregnancy Act 1971, which stipulates that getting an abortion on the grounds of contraception failing is only available for married women. What about the rights of unmarried women? And what services are then available for the youth of India who are increasingly becoming more sexual explorative and rejecting early marriage?

While draft amendments to the Act have been tabled which would include allowing an unmarried woman to legally seek an abortion up until 12 weeks,

and another which would allow abortions up to 24 weeks in grounds of serious fetal anomalies, these have yet to be incorporated into the Act and it’s unclear whether or when such changes will be realised.

On this note, I recently met Amrita whose sister, Deepti, got pregnant out of wedlock. She sought an abortion in New Delhi but the doctor refused, asking relentless questions about her boyfriend, her parents and where she lived.

Fearful of being beaten by her family, she had no option but to leave home, marry her boyfriend and continue her pregnancy. In the end, she was jailed for taking part in an illegal marriage and she gave birth in prison.

“Only if I had had the knowledge of contraception and law,” she said at the end of a short film made about her story.

How does one even begin to understand what it would be like to be rejected by your own family because you’d never had the opportunity to understand what contraception is?

I can’t imagine how many young girls like Deepti there must be across India and elsewhere in the region. India’s youth hold the key to the country’s future. But if its youth are going to flourish to their best ability then girls’ and women’s sexual and reproductive health and rights must be realised to their full potential.

 

Image: Front cover of Our Bodies Ourselves, published by the Boston Women;s Health Book Collective

Challenges to implementing safe, legal abortion in Rwanda

 by Christopher Sengoga, Human Rights Officer, Health Development Initiative, Rwanda

23 May 2017

The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol) is the main legal instrument for the protection of the rights of women and girls in Africa and the most comprehensive on women’s rights globally.[1] The Protocol went into effect in November 2005, after the minimum 15 of the then 53 African Union member countries ratified it. Today, 49 countries have ratified.

Rwanda signed and ratified the Protocol in 2004 but placed a reservation on Article 14.2.C, which stipulates that countries should “protect the reproductive rights of women by authorizing medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus. It subsequently lifted the reservation in 2012, making Rwanda fully committed to the Protocol.[2]

The Penal Code, revised in 2012, in Articles 165 and 166 exempts women from criminal liability for having an abortion;  (i) if the pregnancy is a result of rape, (ii) incest (iii) forced marriage, (iv) when the continuation of pregnancy seriously jeopardizes the health of the fetus or that of the pregnant woman.[3] (Original text in French: (i)a femme est tombée enceinte à la suite d’un viol; (ii) la femme a fait l’objet d’un mariage forcé; (iii)  la femme est tombée enceinte à la suite d’un inceste jusqu’au second degré; (iv) la poursuite de la grossesse met en péril grave la santé de l’enfant à naître ou de la femme.)

The exemption from criminal liability under items (i), (ii) and (iii) in this article shall be permitted only if the woman who seeks abortion submits to the doctor an order issued by the competent Court recognizing one of the cases under these items, or when this is proven to the Court by a person responsible for providing abortion.[4] The Court where a petition for abortion is filed shall hear and make a decision as a matter of urgency.[5] A medical doctor must state that continuation of the pregnancy would seriously endanger the health of the woman or that the unborn child cannot survive.

Health Development Initiative (HDI) together with other civil society organizations and partners have been engaged in advocacy since 2010 for the decriminalization of abortion in Rwanda.[6] The reform of the Penal Code responded to some extent to our voices, but certain restrictions remain or were included in ways that meant the intention of the Maputo Protocol was somewhat disregarded. Moreover, despite the enactment of the Penal Code, women and girls in Rwanda continue to suffer from unsafe clandestine abortions. The law remains largely unknown to most Rwandans, and the rights enshrined in it are not fully enjoyed by the women and girls who are meant to benefit from it.

The Protocol refers to rights for “women” to mean the female sex, which specifically includes both girls who are minors and women of majority age. In the Penal Code of 2012, however, although it also talks about “women”, it implicitly means women of majority age – excluding girls. This is indicated where the Penal Code says that rape is one of the conditions that should be exempted. Rape in the Rwandan legal context means “forced sexual intercourse with a woman of majority age”. The term “defilement” is the term used in Rwanda to refer to forced sex with a minor. This has led to confusion in the courts. Some prosecutors and judges have understood this interpretation to mean that they must deny minor girls the right to have an abortion, as rape includes women but not girls, and defilement is not included as an exception in the Penal Code.[7]

According to a report by the Rwandan Biomedical Center, an institution working under the Ministry of Health, 84% of sexually abused women in Rwanda are minors aged 13-18 years. The report further stresses that a retrospective review of data from 2012-2014 found that some 84 women got pregnant as a result of rape, incest or forced marriage, only four sought a court order for abortion and none was permitted by a health centre or hospital to have an abortion.[8]

Currently, Health Development Initiative, Ihoreremunyarwanda and the Great Lakes Initiative for Human Rights and Development have prepared a policy brief in support of ongoing advocacy of this matter. The draft of the Penal Code is still in the Law Reform Commission, but we hope that it will be submitted to the Cabinet after the presidential election, which will take place on 3-4 August, 2017.[9]

“In 2012, approximately 18,000 Rwandan women required treatment for complications resulting from unsafe abortion, costing an estimated $1.7 million. The finding comes [from] The Health System Cost of Post-Abortion Care in Rwanda, by researchers at the Guttmacher Institute, the University of Rwanda’s School of Public Health and the Rwandan Ministry of Health. The cost of treating complications from unsafe procedures was approximately 11% of total public spending on reproductive health, representing a significant drain on the country’s scarce health resources.”[10]


[1] African Commission for Human and Peoples’ Rights. http://www.achpr.org/instruments/women-protocol/ratification. Accessed 10 May 2017.

[2] Ibid.

[3] https://www.unodc.org/res/cld/document/rwa/1999/penal-code-of-rwanda_html/Penal_Code_of_Rwanda.pdf.

[4] Ibid. Art 165 (5).

[5] Ibid.

[6] http://eng.imirasire.com/news/all-around/in-rwanda/article/hdi-rwanda-boosts-advocacy-for. 24 July 2015.

[7]Case N0 [RPA 0787/15/KIG ] http://www.womenslinkworldwide.org/files/571deb06d7b4b_gjua_judgment_en.pdf.

[8] Rwandan Biomedical Center. Retrospective record review data (1 July 2012 to 30 June 2014).

[9] Health Development Initiative. http://hdirwanda.org/our_work/advocacy-accountability/advocacy. Accessed 23/05/2017.

[10] Quote and photograph at: http://www.freedomofresearch.org/article/2014-05-30-170000/treating-complications-unsafe-abortion-drains-scarce-health-resources, 30 May 2014. Accessed 23/05/17.

Where are we now? Bit by bit, abortion decriminalization advances in Chile

 

By Erin Becker

Chile’s Senate voted January 25 to consider the Ley Tres Causales, legislation that would overturn a 1990 law and decriminalize abortion in three limited circumstances: fetal non-viability, to save the life of the pregnant woman; and for pregnancies resulting from rape.

Senators were given until early April to suggest modifications (see a recent Safe Abortion Women’s Right newsletter for more details on the Senators’ suggestions). Now, the legislation is being discussed in the Senate Health and Constitutional Commissions.

The Ley Tres Causales has been one of the major legislative priorities of Chilean president Michelle Bachelet, who served as head of UN Women between her first and second terms. But with Bachelet’s presidency coming to a close at the year’s end, it remains to be seen whether the administration will achieve its goal.

While legislators debate, women in Chile continue to seek abortions. Precise statistics on abortion in the country are hard to come by, but estimates range from 60,000 to 300,000 procedures each year. Chile is a major and quite high-tech market for the medical abortion drug misoprostol, with vendors running sleek ads on Instagram and communicating with potential clients via WhatsApp. Yet black-market misoprostol is an imperfect, stop-gap solution in a country lacking access to safe, legal abortion. Some vendors are unscrupulous; the drugs can be difficult to access for those who live outside the capital; and prices prove expensive or even prohibitive for middle- and lower-income Chileans.

Access to surgical procedures is also fraught with inequalities. Helia Molina, a former Chilean minister of health, was forced out of her post after implying that wealthy Chileans had access to safe, discreet abortions in expensive clinics, while their poorer counterparts did not. Yet her taboo statement spoke to the lived reality for women in Chile under the current law. As Molina said, upper-class Chileans have the resources to seek out safe abortions, either in Chile or abroad, while those living in poverty continue to feel the law’s full weight.

Despite popular opinion siding with the Ley Tres Causales––seventy percent of Chileans see a need for legislation addressing abortion access in the three cited circumstances––there has long been vehement legislative and religious opposition to any pro-choice measures in the country. The Catholic church holds significant political and cultural sway in Chile. An ultra-conservative prelature, Opus Dei, has been one source of the anti-choice resistance. Opus Dei owns a large university and hospital in Chile’s capital city, and counts five current legislators amongst its members.

The abortion ban itself has its roots in Catholic doctrine. Though Chile’s abortion laws have always been highly restrictive, therapeutic abortion was permitted from 1931 to 1990. In certain hospitals, this provision was at times applied quite liberally, especially during the presidency of Salvador Allende. In the late 1980s, naval admiral José Toribio Merino, member of the military junta and the ban’s primary architect, was encouraged by the Vatican to craft legislation that would ban abortion outright, including when necessary to save the life of the pregnant woman.

Merino was a firm believer in Christian law, which he called perfect, unmalleable, and unchangeable. But a total ban on abortion seemed extreme, even within General Augusto Pinochet’s right-wing regime. Still, Merino persisted, writing a letter to his colleagues waxing poetic about the grave responsibility God had bestowed upon them. Three and a half months later, abortion under any circumstances became punishable by law.

Since Chile’s return to democracy in 1991, activists, legislators, and NGOs have been trying to overturn this legislation. Yet it has proven one of the dictatorship’s most enduring legacies: the Ley Tres Causales marks Chile’s 29th attempt to pass legislation weakening the ban. Though far from ideal, the law will be groundbreaking for Chile if it succeeds. Supporters of women’s rights should keep a close eye on the Chilean Senate to see what happens next.

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Erin Becker is a writer living in the south of Chile.

Disability, sex selection and the right to choose

Alice Finden

International Campaign for Women’s Right to Safe Abortion

18 April 2017

There have been a number of articles written recently debating ideas of sex selection and disability and their relation to abortion. The first one that may come to many minds in the UK is a recent BBC documentary and article by actor Sally Phillips. Phillips asks us whether we really want a world without Downs syndrome. She worries that a new screening method called the Non-Invasive  Prenatal Testing (NIPT) in the UK will lead to a “world without Downs”. Her concerns follow the results of the widespread use of this method in Iceland, which saw 100% of Downs syndrome pregnancies terminated.

When explaining her stance on screening for Downs Syndrome, Sally Philips makes a simplistic link between prenatal screening, abortion and disability, in which she implicitly suggests that abortion is discriminatory and ableist, and that everyone who has an abortion following a Downs Syndrome diagnosis must hate people with disabilities.

Philips’ opinion is one that has been moulded around her love for her son, who has Downs syndrome. She is keen to “make people aware of the fact that a Down’s syndrome child does not need to be in the ‘defect’ category”. Challenging social stigma around disability is an immensely important thing to do. However, Philips neglects to consider the intersectional lives of people with disabilities. She does not consider that some women are disabled, and some disabled people are women, all of whom have the same right to claim ownership over their own body and choice. And some of whom will have had or will have an abortion after a diagnosis of fetal abnormality, thanks to prenatal screening methods. In fact, by conflating fetuses that carry Downs syndrome, and real people living with the disability, Philips blurs the line between fetus and human being, and feeds into anti-abortion rhetoric that claims life and rights begin at conception.

In doing this, Philips’ argument holds abortion rights or women’s rights and disability rights in opposition to each other. It claims that you are a bad person, a person who does not care about disabled people, if you choose to abort your pregnancy because it has been diagnosed with a disability. This argument further does nothing to uncover or challenge the structures of society that shame women for having abortions at the same time as shaming people with disabilities. Meanwhile, Philips is “keen to emphasise that she is pro-choice”…

In actuality, it is social stigma and shaming of disabled people that Philips (and all of us) should decry, not abortion. This is shown in a 2012 journal article by Annelies Kusters. The article charts the reaction to a 1975 law introduced in the village of Adamorobe in Ghana, that said deaf people, who were the majority of people in the village, could not marry each other. The rule was introduced explicitly in order to lower the chances of women having more deaf children. Kusters describes how it was the stigma from people living outside the village of Adamorobe that influenced attitudes towards deaf people in the village, and led to the eventual criminalisation of marriage between deaf people in the village. Access to abortion provided deaf villagers with agency: it allowed them to defy the law and continue to marry other deaf people, without giving birth to a deaf child. Furthermore, deafness was not interpreted as a disability within the community of the village until outsiders’ social stigma informed the way deafness was thought about. Prior to that, deaf and non-deaf community members found their own means of communication that avoided exclusion.

Similarly, in regard to sex selection, it is social stigma and discrimination against girl children and women that activists should be trying to decry, and not abortion. Professor Wendy Savage was recently hounded by the press for supposedly condoning sex selective abortion: again, her comments come from the right to choose abortion, no matter what the circumstance. It is societal structures that have a problem with disability and gender discrimination from the outset, it is not abortion and it is not prenatal screening, and it is certainly not the individual who chooses to abort.

The problem with the view that prenatal screening will lead to the abortion of fetuses with abnormalities, and that that in turn will reduce the number of disabled people, is that it creates rifts between women and disabled people, when what we actually need is to work together to challenge societal stigma. This is exactly the same argument as applied to sex selection. What ties debates on sex selective abortion and abortion based on a diagnosis of fetal anomaly together is that they have a preconceived idea of the moral standing of a person who chooses to abort their pregnancy for these reasons. It is this that allows people to say ‘I am pro-choice… but only in these circumstances…’. In reality, being pro-choice should not derive from stipulations of when and why; the only thing that matters is the right to choose.

Other sources used:

https://www.theguardian.com/society/2016/oct/01/downs-syndrome-screening-jane–fisher-expert-criticises-sally-phillips-bbc-documentary

Northern Territory Australia’s new abortion law: a great victory despite a few caveats

Marge Berer

International Coordinator, International Campaign for Women’s Right to Safe Abortion

4 April 2017

The new Northern Territory (NT) Australia abortion law was a great victory and its supporters were celebrating their achievement last week. Now, the analysis will begin. Here is mine:

The news reports mention that three women members of the NT Parliament who supported the bill all shared stories of deciding to have an abortion during the debate, which was described in one news report as emotional and in another as passionate. Telling personal stories in a parliamentary debate on abortion has only happened one other time I’m aware of, in Ireland in July 2016, where one woman member of Parliament spoke about her personal experience of needing an abortion for fetal anomaly and having to travel to England. The law wasn’t changed in that instance, but the tenor and reporting of the debate were affected considerably.

This is highly unusual, to say the least, and creates a new challenge to parliamentarians who may be opposed to making abortion safe and legal, especially when the parliament in question has 50% women as in NT. It would take quite some nerve to discount such stories if in the future more women parliamentarians put their personal experience into the debate.

The bill has some praiseworthy clauses that will support providing most abortions. Thus, it removed the requirement for all abortions to occur in a hospital, especially as there are only a few hospitals in a territory that is 1.4 million sq km, that is, over 6 times bigger than the UK.

Previously, only surgical abortion was available. Now, both surgical and medical abortion will be made available and in non-hospital clinical facilities. However, this is only up to nine weeks of pregnancy, which is disappointing. Moreover, according to one local news report, the initial clinical guidelines may “only allow medical terminations within two hours drive of a hospital”.[1] However, the clinical guidelines have not been finalised, let alone published, so hopefully this will not turn out to be true. If it is true, however, such a restriction has not been applied since the introduction of medical abortion in Great Britain in 1991, where it was never found to be necessary.

The WHO Safe Abortion Guidance (2012)[2] says vacuum aspiration abortion can safely be provided at primary care level to 12 weeks and with a bit of extra training up to 14 weeks, while the US FDA approved medical abortion use up to 10 weeks of pregnancy in 2016. Their guidance isn’t comprehensive either, so it’s not surprising that the NT bill is also out of date even before it’s been signed and sealed.

Medical abortion is still new in Australia. Mifepristone was only approved in 2012 and at a reasonable price only in 2013.[3] In many parts of the country they still call it RU486, its ID number in France in the 1980s at Roussel-Uclaf, where it was first developed. Let’s hope best practice from countries like France, Norway and Sweden, who allow nurse/midwife provision due to ease of use and safety is taken fully on board. The very good news is that the new law should allow the Tabbot Foundation, who provide medical abortion consultations by phone and send women medical abortion pills by post all over Australia, except to Northern Territory up to now, to promote their services in NT too, after the new law is published on 1 July 2017. (Personal communication, Lynette Shumack, Tabbot Foundation, March 2017).

In addition, the new law applies to “a woman of any age”; hence, it is thought adolescents no longer need the consent of their parents to decide on abortion. That’s in line with the best thinking about the evolving capacity of adolescents to make decisions about their own lives, a concept introduced by the UN Convention on the Rights of the Child.

The legislation also mandates safe access zones 150m around abortion clinics, where it will be an offence to harass anyone entering or leaving. By the end of November 2015, three Australian jurisdictions – Tasmania, ACT and Victoria – had introduced safe access zones around abortion clinics.[4] Northern Territory has become the fourth, in line with best practice in Australia.

The new law also allows conscientious objection to abortion, but requires health care providers to refer patients to a doctor who doesn’t. Sometimes that works; often it doesn’t, however, and to women’s detriment. Yet, conscientious objection is permitted in most laws on abortion today, with the exception of Sweden, Finland, Bulgaria, Czech Republic and Iceland.[5] The basis for allowing it is that the health care provider gets first choice – i.e. not to provide an abortion. The basis for not allowing it, according to the Swedish Association of Midwives, is that the health professional always has a choice (s/he can choose another profession); the patient’s choice must always come first. This is a conflict of interest that, like the wider fight for women’s rights, has a long future ahead of it.

One of the two places where the new law falls down most, however, is in requiring the approval of one doctor for abortions up to 14 weeks (instead of two as previously), while it retains the approval of two doctors between 14 and 23 weeks of pregnancy. Although one doctor is of course better than two, this firmly maintains doctors’ control over the abortion decision, which is a lost opportunity. I think it is past due time for doctors to refuse to act as gatekeepers with the power over women’s access to abortion and for lawmakers to stop using them to control women’s decisions. Hopefully, NT will at least allow nurses and midwives to take over providing all but the most complicated abortions, as per WHO guidance,[6] and will also allow home use.

The other really disappointing bit is that the law only allows abortions up to 23 weeks of pregnancy unless the woman’s life is at risk. At the very least, it should have allowed abortions after 23 weeks in cases of serious risk to the woman’s health, pregnancy due to rape or incest, and where fetal anomaly has been diagnosed later, and also for those women and girls who have been unable to find an abortion earlier There are so few of them, and they are all in a highly vulnerable state. Make exceptions, damn it. Have a heart!

Equally problematic, the law contains criminal penalties of up to 7 years in prison for anyone who is “unqualified, who causes an abortion”. This might be worth imposing in a country like South Africa where abortion has been legal on broad grounds for 20 years but where illegal and unsafe clinics are still flourishing. But whose fault is that? In South Africa, it’s the government and health system who are responsible for not making abortion services universally accessible, which is the only way to make illegal clinics disappear. But in Australia? It seems the fear of full decriminalisation of abortion runs deep, and that’s not just in NT.

On the other hand, regarding criminal penalties, the new law explicitly says it does not apply to “a woman who consents to, or assists in, the performance of a termination on herself”. Hence, it does not criminalise self-use of medical abortion pills. This is a major positive step for other countries to emulate.

Which allows me to end on a very high note: Heartfelt congratulations to all those who put so much time and energy into making this bill into law.

[1] NT News 24 March 2017, quoting Darwin GP Dr Jacqueline Murdoch.

[2] World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems. Geneva: WHO; 2012. http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf

[3] Sifris R. State by state, ‘safe access zones’ around clinics are shielding women from abortion protesters. The Conversation, 30 November 2015. 

[4] Sifris, op cit, ref 2.

[5] Heino A, et al. Conscientious objection and induced abortion in Europe. See comment in PubMed Commons belowEur J Contracept Reprod Health Care 2013;18(4):231-3. doi: 10.3109/13625187.2013.819848

[6] Health Worker Roles in Providing Safe Abortion Care and Post-Abortion Contraception: WHO, 2015

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