Senegal’s harsh abortion law imprisons women and girls

Senegal’s criminal code completely prohibits abortion, while the Code of Medical Ethics allows an abortion if three doctors agree that the procedure is necessary to save the woman’s life. This is so stringent that the possibility of a legal abortion is very rare.[1] Ultimately, almost no one succeeds, forcing women to turn to unsafe options – carrying risks of complications, imprisonment, and social stigma.

Fatou Kiné Camara, President of the Association des Juristes Sénégalaises (Association of Women Jurists/AJS), who work to promote and extend the legal rights of Senegalese women,[2] stresses: Poor people in Senegal are lucky if they see one doctor in their lifetime, let alone three.”[3]

An estimated 8-13% of maternal deaths in Senegal were caused by complications of unsafe abortion, according to a report by the Fédération Internationale des Ligues des Droits de l’Homme (FIDH).[4] A 2015 study by Gilda Sedgh et al found that 55% of the women who had had abortions experienced complications (range 44% in Dakar to 60% elsewhere). Almost half (42%) did not receive medical treatment.[5]

The FIDH study also found a high prevalence of pregnancy among young girls which were the result of sexual abuse, which was often followed by the refusal of an abortion. In their report, they showed that these pregnancies have terrible physical and psychological consequences for young girls.[6]

Another widespread phenomenon in Senegal is infanticide. Newborn infants are regularly found dead in public places, including in garbage trucks and sewers. Their existence directly reflects the failure of women to obtain an abortion at all, even an illegal one.

There have been numerous attempts to amend the Penal Code. In 2013, the Ministry of Health set-up a multidisciplinary Task Force on safe abortion.[7] The Task Force has brought the subject of abortion, which was previously considered taboo, into the public space. In the first half of 2018, the Task Force plans to formally present a bill to the Ministry of Justice.[8]

Although the number of actual prosecutions has remained low, the number of women in pre-trial detention for suspected infanticide or illegal abortion is remarkably high. In 2014, the two offences of abortion and infanticide accounted for 38% of the female prison population. Infanticide accounts for the second largest percentage of women in detention, at 16%.[9]

In the Senegalese prison system, people held in pre-trial detention stay in the same prisons as those sentenced for a crime. According to a 2015 study carried out by the Regional Office for West Africa of the UN High Commissioner for Human Rights (OHCHR)[10] in collaboration with AJS, of 153 female detainees interviewed in five prisons around Senegal, 72% were in pre-trial detention.[11]

The Center for Reproductive Rights has highlighted the dearth of case reports of prosecutions for abortion in Senegal. In a prison in Thiès, it was reported that in 2017 more than eight women had been found guilty or were in detention for infanticide. Almost all of the ones who agreed to speak to the journalist who interviewed them denied killing their baby.[12]

Overall, the case histories uncovered by AJS indicate an immense failure on the part of the Senegalese justice system to uphold human rights, especially of young girls and women whose pregnancies were not due to any action of their own.

With USAID as the primary donor of funds for maternal health and family planning services since the 1960s, and with abortion still highly stigmatised in the country, Senegal has not taken any steps to allow safe and even limited legal abortion in spite of a statement by President Macky Sall in 2015 that he may eventually support legalisation of abortion in cases of rape and incest.[13],[14]

The determined campaigning of Senegalese feminists and human rights lawyers offers some hope that the law may eventually fulfil Senegal’s regional and international obligations, out of respect for women’s human rights.

 

Read our full-length report on Senegal here.

 

[1] Siri Suh (2014) ‘Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal’. Social Science and Medicine 108, pp.20–33.

[2] http://femmesjuristes.org/

[3] Alex Duval Smith (2014) ‘Senegalese law bans raped 10-year-old from aborting twins.’ The Guardian 4 April 2014. https://www.theguardian.com/global-development/2014/apr/04/sengalese-law-bans-rape-survivor-aborting-twins

[4] Fédération Internationale des Ligues des Droits de l’Homme/FIDH (2014) « Je ne veux pas de cet enfant, moi je veux aller à l’école » La prohibition de l’interruption volontaire de grossesse au Sénégal, p.11 https://www.fidh.org/en/region/Africa/senegal/report-senegal-i-don-t-want-this-child-i-want-to-go-to-school

[5] Gilda Sedgh, Amadou Hassane Sylla, Jesse Philbin and Salif Ndiaye (2015) ‘Estimates of the incidence of induced abortion and consequences of unsafe abortion in Senegal.’ International Perspectives on Sexual and Reproductive Health 41:1 p.1

[6] FIDH Op cit. ref 4

[7] Nafissatou Diop and Fatou Bintou Mbow (2016) ‘I was raped and got pregnant. Abortion is illegal in Senegal. What do I do?’ PowerPoint Presentation. Population Council. http://www.popcouncil.org/uploads/pdfs/2016STEPUP_AbortionSenegal.pdf

[8] Email exchange with Soukeyna Diallo, 18 March 2018

[9] FIDH Op cit. ref 4

[10] Office of High Commissioner for Human Rights (OHCHR) (2015) ‘For a better inclusion of women’s rights in detention in Senegal’. 13 March 2015. www.ohchr.org/EN/NewsEvents/Pages/WomenRightsInDetentionInSenegal.aspx

[11] FIDH Op cit. ref 4

[12] Marame Coumba Seck (2017) « Condamnées pour infanticide, des Sénégalaises racontent » Le Monde 18 September 2017. http://www.lemonde.fr/afrique/article/2017/09/18/condamnees-pour-infanticide-des-senegalaises-racontent_5187443_3212.html

[13] Allyn Gaestel and Ricci Shryock (2017) ‘The Price of Senegal’s strict anti-abortion laws.’ New Yorker 01 October 2017. https://www.newyorker.com/news/news-desk/the-price-of-senegals-strict-anti-abortion-laws

[14] Katherine Drakullic (2016) ‘The Global Politics of Post-Abortion Care in Senegal’. University of Minnesota. https://cla.umn.edu/gwss/news-events/story/global-politics-post-abortion-care-senegal

Legitimising reproductive decisions: a gesture in support of freedom and dignity

by Agustina Ramón Michel, Silvina Ramos, Mariana Romero

Perfil, 18 March 2018

 

Perfil published a report on 18 March 2018 of an opinion poll on abortion by Amnesty Argentina as well as the following blog, which discusses the results. The blog was originally in Spanish. Below is a translation into English of the summary of the blog with the original Spanish summary. The background to this news can be found here, here, and here.

 

The debate on the decriminalisation and legalisation of abortion comes to the Congress at an auspicious moment: a large majority of people have heard news reports on abortion in recent days and more than half know about the imminent legislative debate. There is support for increasing the grounds for legal abortion and taking abortion out of the Penal Code, and more than half of people surveyed agree that abortion should be legal and the woman’s decision.

The results of this survey show that society recognises women’s need to terminate their pregnancies in conditions that do not jeopardise their lives and health. Women in the global North almost never die from abortion, but women in Argentina do. Abortion is safe when carried out in good conditions. Deaths from abortion are not an event of nature against which we are powerless: avoiding the majority of these maternal deaths and risks to health is possible; and reform of the law is key. Let us finish with the high cost of clandestine abortion.

But current support from society for the decriminalisation of abortion is not only a response to the public health reasons. There is something more. Until a few years ago, to call yourself a feminist or make a feminist argument, was seen as something against our culture. Today this is no longer the case, as was shown in the 8th March demonstrations. The feminist spirit was expressed in ideas such as that each person can decide how to live their own sexuality and can decide whether, how and when to have children. Thus, in supporting decriminalisation, the question arises: If it is not each woman’s own decision… who else should be able to decide whether she should continue or terminate her pregnancy? This question is a gesture against an ethic of violence and against the imposition of religious beliefs, fear, ignorance and stereotypes. It is a gesture in favour of freedom and dignity.

The criminalisation and restrictions on access to abortion were a source of much noise, and although it has taken a long time, the debate has finally come to the Congress. We need a law that will legalise the reproductive decisions of those who are pregnant who, as free citizens, assume responsibility for their lives; we also need a bill that provides certainty to health professionals so that they can play their most important roles: to support women’s decisions and promote their well-being, provide timely and good quality care, and contribute to the concrete expression of rights.

 This blog is also available in Spanish here.

How to report on abortion: A guide for journalists, editors and media outlets

The portrayal of abortion in the media can have a major sway on public perception of abortion, and can even influence policy agendas. As such, the Campaign (in partnership with IPPF), has just launched media guidelines for journalists, news outlets and editors who seek to write about abortion.

Our media guidelines intend to aide progressive journalists writing on abortion who we understand face a myriad of challenges. Sisson, Herold and Woodruf (2017)1 interviewed over thirty journalists reporting on abortion in the US, and found that they faced stigmatisation and political polarisation when reporting on abortion. We therefore consider journalists as our co-workers in the campaign for the right to abortion, and our media guidelines hope to assist them in their work.

Accurate reporting can go a long way to confronting abortion stigma and challenging common misconceptions around abortion. Consequently, the guidelines begin by setting out some basic facts on abortion, including how widespread it is and the types of legal restrictions that exist. We dispel the common myths, for instance, by explicating its safety as a procedure when done properly and highlighting that it has no causal connection to mental health. 

Even where journalists are well-meaning, they may unintentionally use incorrect language to describe abortion. Language is powerful, and plays a vital role in stigmatising abortion. Cognitive linguist George Lakoff, has written about the language used in politics and polarising topics, his most well-known book being “Don’t think about an elephant”. He reminds us not to unwittingly co-opt the framing of the right-wing. To prevent journalists from falling into this trap, we have compiled a list of ‘Dos and Don’ts’ when reporting on abortion. For example, we must use terms like ‘pro-choice’ and ‘pregnant woman’, rather than ‘anti-abortion’ and ‘mother’.

In addition, we direct the media on how to use accurate imagery of pregnancy and abortion. Almost every week at the Campaign, we notice examples of positive articles on abortion, but accompanied with an inaccurate image. Often editors include photos of very late pregnancies or images of the fetus as if it is fully formed or independent from the woman. This is misguiding, as most abortions take place in the first trimester or early second trimester of pregnancies. 

Several journalists interviewed by Sisson, Herold and Woodruf felt they must present the anti-abortion argument along with the pro-choice case in order to maintain balance. We therefore explain how to report in a way that represents balance and truth. Indeed, the pro-choice viewpoint is inherently balanced as it respects each individual’s right to decide what’s best for them. Furthermore, journalists frequently desire a personal angle as a powerful way to speak about abortion – hence, we include a section on how to publish personal testimonies of women who want to share their stories.

Along with our media guidelines, the Campaign has also launched a Press Room page on our website which has additional in-depth resources, including the following:

  • A more detailed piece on sharing personal stories
  • Best practice examples of articles and images relating to abortion
  • Lastly, editors often demand a fresh take and do not perceive abortion as newsworthy, so we have started to compile examples of potential abortion hooks for journalists.

As the press officer at the Campaign, I proactively work with journalists, and put them in contact with our members where possible to get their voices heard. Please do get in touch if you are keen to work with me in producing accurate and honest portrayals of abortion.

Nandini Naira Archer

nandini@safeabortionwomensright.org

Research and Press Officer

 

1 Gretchen Sisson, Stephanie Herold and Katie Woodruff (2017) “The stakes are so high”: Interviews with progressive journalists reporting on abortion. Contraception Dec; 96 (6) pp. 395-400https://www.ncbi.nlm.nih.gov/pubmed/28844876

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.

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