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.

It’s Not an Emergency, it’s in Kenya

If Ireland, my country of birth, had a HIV epidemic like Kenya's, there would be 173,250 HIV positive people there, instead of 5,500. HIV prevalence in Kenya is estimated to stand at 6.3%, in Ireland it's 0.2%. Instead of having one HIV positive person for every 818 HIV negative people, Ireland could have one for every 26. Then it would not be unusual for every person and every family to know or be related to at least one HIV positive person, as is the case in Kenya.

Nyanza province, in the South West of Kenya, has a prevalence of 13.9%, twice that of the next highest prevalence, Nairobi, at 7%. But the Luo tribe, consisting of only around three million people, has the highest prevalence of any tribe in Kenya. At 20.2%, it’s over two and a half times the next highest tribe, the Maasai, at 7.9%. If Ireland had an epidemic like that of the Luo, there would be 555,500 HIV positive Irish people. Think of the dependency ratio and the health care bill.

I like to think that if that number of Irish people were infected with a chronic, life threatening illness, it wouldn't take long before it was established how people were becoming infected and measures were taken to ensure that transmission be reduced to as small a number as possible. I would like to think that the epidemic would be seen as an emergency far more significant than foot and mouth, bird flu, H1N1 and BSE all put together.

555500 is probably similar to the number of World Cup visitors currently in South Africa. The total number of HIV positive people in Kenya is about three times that number, or a third of the population of Ireland. And Kenya doesn't even come close to having the worst HIV epidemic in the world. South Africa itself is estimated to have well over 5 million HIV positive people. And prevalence in some countries, such as Swaziland, is even higher than that found among the Luo tribe.

But imagine if Ireland were to have such an epidemic, what would the government and various international health institutions say and do? Would they say that the epidemic was caused by promiscuity and that Irish people need to have less, or even no, unsafe sex? Would they say or imply that it was due to vague 'cultural' or 'tribal' practices? Or would they say it was due to low levels of circumcision? After all, circumcision levels in Ireland are low, as they are in all European countries.

And if many Irish people, either infected with HIV or affected by it, were to deny that they were promiscuous or careless, would they be believed? Would the government and various international health institutions investigate their claims and try to find out how they could have been infected if they were not infected sexually? If large numbers of infants and young children were HIV positive and their mothers were HIV negative, would that be seen as a possible indication that many of them, perhaps all of them, were infected by unsafe medical procedures or by some other non-sexual route?

A friend pointed out to me that the latest figures show that 53% of married HIV positive women in Kenya have HIV negative husbands. How did they become infected? Would the relevant authorities in Ireland, under similar circumstances, say or imply that these women were promiscuous, give them condoms and drugs and tell them to be careful in case they infect their husbands? Would they circumcise all their husbands as a priority?

Perhaps you would object and say that the scenario I present is futile and that the questions I raise are meaningless. Well, I'm tempted to agree. It seems brutal to ask if the world would be indifferent to the plight of such huge numbers of people, of whole nations, of a whole continent. Could health, economic and political professionals be so inhumane as to humiliate sick people and refuse to protect those who are, as yet, uninfected?

The number of people newly infected with HIV every two years globally is about the same as the population of Ireland. HIV has been recognised for nearly three decades. Since it was first identified, it was clear that it was transmitted, not just sexually, but also through contaminated blood and bodily fluids and by mothers to their infants. After HIV was identified, various measures were taken to reduce transmission, whether transmission was sexual or non-sexual.

But now, people here in Kenya seem almost unaware of any threat aside from that of unsafe sex. Many people, on finding they are HIV positive, assume they must have been infected sexually because that's what they are told, over and over again. They have not been told how to protect themselves from unsafe medical or cosmetic practices, only that they should abstain, be faithful and wear a condom, three things that will never protect them from non-sexually transmitted HIV. It's no wonder people think they must have been infected by mosquitoes or by someone putting a curse on them.

Perhaps the eminent people of UNAIDS, CDC, WHO and other institutions would like to tell the president of the US that many members of his father's extended family and fellow tribespeople are HIV positive and that this is so because most of them are extremely promiscuous and that they need to stop having sex, start using condoms and get circumcised if they are male. Because that’s what they are telling Obama’s father’s people. So perhaps this is what they would say to Irish people under the scenario I mention above.

I would like to think that this would not be their reaction, but what evidence is there that their reaction would be different? Because I don't believe that there has ever been a sexually transmitted disease that has spread like HIV is said to have spread among the Luo people or among the Swazis. I'm not sure if such a sexually transmitted disease is even possible, I certainly hope not. But if HIV prevalence among the Luo and among other populations exceeds our worst nightmares, why is it not considered to be the emergency that it clearly is? I'm not asking why HIV spreads as fast as it does but why it spreads so fast among some people and not among others. And please don't tell me that it's because Luos are 100 times more promiscuous than the Irish.