Abortion: the Decision that Needs to be Made, Not Blocked

The current debates and actions for legal abortion in Ireland may have been triggered by the death of Savita Halappanavar, who died from complications following a miscarriage after being refused a clinical abortion, even though she had been told her fetus was not viable. But the issue of abortion urgently needs to be addressed in Ireland, and other countries where it is currently illegal, and not just in situations where the mother's life is at risk either.

As it is not possible to legislate against the circumstances which lead to people requiring an abortion, it is necessary to legislate about whether they should be entitled to a safe abortion. If safe abortion is available, a decision can be made about whether to have one, where a need has arisen. If safe abortion is not available, which is usually the case where abortion is illegal, people have to take other steps, which can put them in very serious danger. But making abortion illegal denies them the opportunity to make decisions that could protect them against injury, and even death. Banning abortion is refusing to make a decision about the lives of those who have a need for an abortion, and simultaneously denying them the possibility of making a decision themselves.

Holding that life begins at conception is a similar refusal to make a decision that could protect those who have need for an abortion. These are hard decisions to make, and in the case of some of the philosophical problems involved, humanity has yet to come to any solid conclusions. But we can not ask those with a need for an abortion to wait till we decide on some issues that have dogged us since civilization began. The need for access to safe abortion and for protection against unsafe abortion is too urgent to postpone making a decision on, as we in Ireland, and many other countries, have done for so long.

The issue of abortion is far more extreme in countries like Kenya and Uganda because maternal and infant morbidity and mortality rates are very high. Safe abortion is only one vital health service that people are denied. Safe healthcare of any kind is denied to most people in most developing countries. Banning abortion has resulted in women taking huge risks with their health, many having suffered terrible consequences, social as well as health-related; many have died. Far from making a moral choice about safe abortion, a choice has been made to block people from making a decision about something so vitally important.

Ireland is (or has been) very heavily influenced by the Catholic Church, which does not have a great history when it comes to the rights of human beings, Catholic or otherwise. Why Irish people still allow this institution to wield such an influence is difficult to understand. Other countries, such as Kenya and Uganda, also seem to be influenced by various Christian churches (that themselves appear to be overwhelmingly American). The reputations of powerful states such as the US, and various Christian churches, is not much better than that of the Catholic Church. So it is perplexing to be accused of breaking moral laws by institutions that preach about moral behavior, but don't always practice it.

Rather than invoking some kind of authority that goes beyond us as human beings, we need to address the issue of abortion ourselves, in terms we can understand. Political and religious leaders do not have the moral high ground they seem to assume they hold. People can not wait for decisions to be made in their name by those who are no better qualified than they are themselves. Invoking a higher authority is also a refusal to make a decision, a means of hiding behind what amounts to no more than a wish that difficult decisions didn't have to be made, a wish that things were different.

Kristof on Poverty, Climate Change & Conflict: Birth Control is the Answer

Nicholas Kristof really knows how to pack the largest amount of conservatism into the one article. The presumptuousness of the title continues throughout the article, as well: 'The Birth Control Solution'. Kristof holds the rather naive view that underdevelopment exists because some people in some countries have too many children. The 'solution' to climate change, poverty and civil wars, and to underdevelopment in general, is birth control to limit population growth.

One result of overpopulation, according to Kristof, "is that youth bulges in rapidly growing countries like Afghanistan and Yemen makes them more prone to conflict and terrorism". All those who have spent long hours wondering why terrorism erupts in some countries should look at rapidly growing countries, with a high proportion of young people. These areas are 'prone' to conflict and terrorism, apparently.

Such populations also contribute to global poverty, we are told, and make it impossible to protect virgin forests or fend off climate change. Well that's quite a revelation to me. I always thought the biggest pressures on climate change come from rich countries. What does Kristof think virgin forests are being cut down for? To build mud huts? I am happy to let him know that the bulk of carbon emissions don't come from mud huts or from people wearing out the soles of their sandals in developing countries. There is no global shortage of food either, just a lot of people who can't afford prices that have been inflated by Western economic measures.

Kristof cites evidence that family planning works, but that is not in doubt. What's in doubt is that if you get family planning right, everything else will follow. His evidence is from India and Mexico in the 1950s and 60s. So now all Indians are rich and Mexico is peaceful? Family planning, birth control, even sexual and reproductive health, are just part of the health of a population. They need to be put into perspective.

Surprisingly, Kristof notices that the 'unmet need' for contraception is only one of many unmet needs, but he seems to think others are limited to those relating to family planning. Does he not know that there is an unmet need for access to healthcare, clean water and sanitation, education, social services and adequate infrastructure? There's nothing wrong with contraception, nor with providing more contraception, but it is just not at the top of everyone's list. It is buried inside some of those far more pressing needs.

The first thought of people planning a family (or just having a family, without any particular plans) is to have children. Then there needs to be some consideration of how to raise them. Some may wish to limit the number of children they have, but that might not come till later. What seems unlikely is that people will use contraception in order to reduce the possibility of their having an abortion. Aside from the fact that people don't think that way, abortion is illegal in many developing countries. It is just not an option. Reducing abortions is a secondary outcome of increased use of family planning methods, it is not a 'selling point'.

And those who worry about the world running out of resources tend to be those who are able to use far more of them than they need, not those who barely have access to them in the first place. Kristof seems to be thinking of his skin, and the skins of other rich Westerners. There is widespread poverty because most of the world's wealth and resources are in the hands of a few, civil wars are often fuelled by external influences (as any American journalist should know) and climate change is a result of the overconsumption of the minority world, not the sheer size of the majority world.

Sexually Transmitted Infections Can Also Be Spread By Unsafe Healthcare

When patients are found to have been exposed to HIV or other viruses as a result of the care they received, so called 'nosocomial' infections, they are usually recalled for testing and treatment, as required. This certainly happens in many rich countries, but not always, it seems.

A doctor operating in Philadelphia illegally aborted fetuses in their third trimester and then killed them by severing their spinal cords with scissors. Many women have been seriously injured as a result of this doctor's treatment and some have died.

The doctor has been convicted of murder and the fact that so many people were affected over such a long period of time has been put down to a 'complete regulatory collapse'. The case is so horrifying that it is probably difficult for those reading about it to concentrate on anything but what should happen to the perpetrators and how this sort of thing can be prevented from happening again.

But what about all the women who have been treated in the appalling conditions described in the article? They have been exposed to all sorts of things, some of which will make them very sick, some of which will eventually kill them. They need to be screened and treated, if it's not already too late.

The issue is not just how authorities should have done their job in the first place, that's the concern of relevant institutions and regulatory bodies. But for the women concerned, their immediate need is for proper health care, albeit belated. Lives may be saved, illness averted and even mental trauma may be relieved.

Other articles I have seen involving unsafe healthcare mentioned the actions that were taken to limit the damage to those who were still alive. But I have yet to find out if all previous patients have been traced in this instance. Is this because no effort has yet been made to trace them, or is it that the sheer horror of the case has distracted attention from the victims?

A number of other employees in the same clinic were also indicted with various crimes and the clinic, which appears to have concentrated on late term abortions, was operating for 16 years. There is no telling what risks the patients faced over the years.

The circumstances surrounding the case are almost beyond belief and my question is not about the fact that so many warning signs were ignored for so long; rather, I'd like to know if it is true that most of the clientele attending this clinic were poor and/or non-white.

The chances of non-white, especially black, Americans becoming infected with HIV are far higher than the chances of white people becoming infected. Similar remarks apply to sexually transmitted infections (STI). But high prevalence of STIs doesn't merely indicate high levels of unsafe sexual behaivor. It could also indicate low levels of health care provision, especially sexual and reproductive health care.

The jury in the case of the clinic doctor, Dr. Kermit Gosnell, concluded: "Bureaucratic inertia is not exactly news. We understand that. But we think this was something more. We think the reason no one acted is because the women in question were poor and of color, because the victims were infants without identities, and because the subject was the political subject of abortion." And apparently white clients were treated quite differently.

Many women who attended this clinic were infected nosocomially with sexually transmitted infections. Being sexually active, poor and non-white, it would probably have been assumed that they were infected sexually. Nosocomial infection appears to be of interest in other cases of unsafe healthcare, but not in this one. Not so far, anyhow.

Punishing Victims; Protecting Perpetrators

Several Christian organisations and churches in Kenya are claiming 'victory' because the draft constitution has been rewritten to specify that life begins at conception. They threatened to sabotage the whole constitution if this was not done. As a result of their threats, other clauses have also been removed. Kenyans will not now have a right to health care, in particular, reproductive health care. Also, the clause stating that no one may be refused emergency medical treatment has been removed. And there is a phrase that specifically rules out abortion unless the life of the mother is in danger.

Abortion is already illegal in Kenya, but this has not prevented several hundred thousand woman and girls seeking abortion every year. The majority of these abortions, an estimated 800 per day, are unsafe, being carried out in insanitary conditions by untrained personnel. Those who go through these unsafe abortions are less likely to seek professional medical attention and less likely to receive it. As a result, over 2000 die every year, adding considerably to the thousands of maternal deaths that occur.

In what sense have these Christian groups achieved a victory? They don't appear to be opposed to the fact that rape and forced sex often goes unpunished because it is carried out by the more powerful against the powerless. It is carried out by adults against young people, even children. Those who should protect the victims, church leaders, political leaders, teachers, police and others, are often the perpetrators.

If, as Christians are so fond of claiming, life is sacrosanct, why are the lives of certain people so unimportant? Why are human lives so unimportant as to be denied the right to health and the right to make their own reproductive decisions? Women should be able to choose when to have children, under what conditions and with whom. Where these rights have been denied, why should they be made to pay for someone else's crime?

Nothing that these Christians have done will reduce the incidence of unsafe abortions, of seriously compromised reproductive health for women, of women suffering and dying unnecessarily. Nothing that these Christians have done will reduce the incidence of rape and forced sex. Victims of crime should be entitled to protection, not punishment. Perpetrators of crime deserve punishment, especially when those perpetrators are in a position that gives them a level of power that they subsequently abuse.

One priest has said 'we should not victimise the innocent unborn children' but what about the woman or girl who has already been victimised and is now to be punished, perhaps for the rest of her life? Kenya is in dire need of good leadership and the interference of interested parties, whether they be political, religious, commercial or whatever else, is frustrating this need. The country also needs good health care and equal rights for all people, regardless of gender, sexual orientation, tribe, wealth and anything else. But some of the Christian churches clearly have other ideas.

Kenyans Don't Need Rights, Especially if They Are Women

The Kenyan MPs reviewing the draft constitution have decided that women will not have equal rights to men in marriage. They don't at present, so no change there. And a big missed opportunity in the fight against domestic violence, family impoverishment and indeed, the spread of HIV and other sexually transmitted infections (STI), along with unplanned pregnancies, including those among women who are HIV positive.

These extremely well paid MPs have decided to exclude much in the constitution that relates to rights and the role of civil society. This includes religious groups (and the Kenyan National Commission on Human Rights), so I'm sure the MPs will be persuaded to change their minds about the former! But Kenyans certainly, these MPs feel, don't need rights to water, housing or food (or social security, health, founding a family, safe environment, access to quality goods or efficient administrative action). It could be wondered what rights Kenyans are deemed to be entitled to by these (Kenyan) MPs.

One of the reasons that the use of condoms for reducing the spread of HIV, STIs and unplanned pregnancies has not been too successful is that women say they don't have the option to refuse to have unprotected sex with their husbands or partners. Effectively, they don't have the option to avoid becoming pregnant, even when they don't want more children or when they know they or their partners are HIV positive.

The Christian churches, the ones whose part in running the country may or may not be threatened by this constitutional review, of course, object to the use of contraception. The fact that it could prevent all sorts of social problems, such as the ones mentioned above, is irrelevant. Harm reduction will probably never cut any ice with Christian dogma. But it is unlikely that women's rights will fare any better in the ultimate male dominated institution.

However, on the insistence of the same Christian churches, the controversial paragraph that mentions the right to life without stating when life begins has been altered to stipulate that life begins at conception. Are all Kenyans Christians? Clearly not, but some vocal sectors of the civil society that these MPs seem to want to silence appear to have a lot more say in the new constitution than others.

Abortion is already illegal in Kenya. With very few exceptions, the hundreds of thousands of abortions that take place in Kenya every year are, therefore, unsafe. These unsafe abortions contribute to the maternal death rate of 30% and an estimated 2000 women die every year from unsafe abortions.

So the Christian churches are interested in the right to life of the unborn, but they don't seem to be so interested in the right of women to choose whether to become pregnant or even to choose who can make them pregnant or when. Women who know their partner or husband is HIV positive do not have the right to refuse to have sex or to insist on the use of a condom. Why are these Christian churches not as concerned about the rights of the very women who are expected to carry, give birth to and raise children where they do not choose to, perhaps because they or their partner is HIV positive?

A canon who was interviewed about this matter said that 'pregnancy is God's design' and that men and women are 'responsible to control themselves and engage in sex as a husband and wife', which, if you are a Christian, may well be true. But is the canon not aware that a lot of sexual activity doesn't take place between husbands and wives, that a lot of people have sex with people other than their husbands and wives, that some people don't get to choose when, where and with whom they have sex? The Christian churches, of all churches, should be aware of things like this.

If the Christian churches wish to oppose the use of contraception and a woman's right to choose, they need to pay some attention to the rights that women are currently being denied. Because it is in part the denial of these rights that is giving rise to huge numbers of unplanned pregnancies in the first place. If they sincerely want to reduce unplanned pregnancies, transmission of HIV and other STIs, sexual and gender based violence and other social problems, they would need to reconsider their position on contraception, for a start. If they are unable or unwilling to do that, these churches will find their relevance to the majority of Kenyans, especially poor Kenyans, diminishing as quickly as it has done in Western countries over the past few decades.