The government and legislature of El Salvador have once again shown their blatant disregard for women’s health and wellbeing by adjourning without voting on proposals to weaken the country’s draconian anti-abortion law. El Salvador is one of the remaining five countries in Latin America and the Caribbean to completely ban abortion under all circumstances. The situation is made even worse for women because the law is enforced with exceptional severity and arbitrariness.
In mid-April 2018 the Spanish-language cable network Univision aired a segment on “Primer Impacto” chronicling Salvadoran women’s rights activists’ attempts to get justice for women imprisoned under the law. At least two dozen women who suffered miscarriages or stillbirths late in pregnancy while not under a doctor’s care (in other words, women from the impoverished majority of the population) were initially charged with abortion, a crime bearing a sentence of up to eight years for both the woman and the abortionist. But prosecutors wound up getting the women charged and convicted of aggravated homicide, and they were sent to prison for up to thirty years. Protests by feminist and human rights organizations within El Salvador and throughout the world have succeeded in freeing five of the incarcerated women. But so far the Salvadoran government and judiciary have refused to review most of the cases. Meanwhile, the proposals to grant exceptions to the ban on abortion when the woman’s life is in danger or when a minor is pregnant as a result of rape have once again been stymied.
The bitter ironies in the Salvadoran situation are many. The tiny, densely-populated country has been experiencing an unprecedented upswing in violent criminal activity, in part because of deportations from the U.S. of Salvadoran gang members from Los Angeles, Washington D.C., and elsewhere (young men born in El Salvador but reared and introduced to crime in the U.S.), and in part because of the large numbers of ex-military and ex-paramilitary individuals left unemployed after the end of the U.S.-bankrolled counter-insurgency war against earlier movements for social justice and national liberation. Yet the government seems more concerned with policing women’s bodies and enforcing one of the harshest anti-abortion laws in the world than in trying to control criminal violence.
Another irony: Salvadoran anti-abortion fanatics have had the unmitigated gall to portray supporters of weakening the anti-abortion law as being under the influence of foreigners. The reality is that worldwide most of the funding of the most strident anti-abortionists comes from Catholic or Protestant fundamentalist organizations based in the U.S. The present Salvadoran outright prohibition is only twenty years old and was enacted in 1998 at the instigation of U.S.-based anti-abortion groups. Earlier Salvadoran anti-abortion legislation was not as sweeping, and enforcement was not so vicious.
In the early to mid-1990s it was possible to have discussions of the harmful public health consequences of illegally induced abortion without participants being intimidated and shouted down by anti-abortion zealots. I myself attended conferences in 1993 and 1994 in San Salvador at which speakers addressed the lack of sex education in Salvadoran schools, the horrible consequences for women’s health of abortion under unsafe conditions, the enormous costs to Salvadoran taxpayers, the need for freely distributed contraception, the injustice of safe clandestine abortions being available to affluent but not to ordinary women, and Salvadoran indigenous women’s use of native plants for abortifacient purposes. These conferences were well-attended and well-publicized, and both were co-sponsored by the Salvadoran Women Doctors’ Association. But by the late-1990s throughout Central America the situation had changed. Anti-abortion fanatics, largely funded by U.S.-based organizations, increasingly made it their business to harass legislators, gynecologists, and women’s health clinic personnel. The atmosphere of belligerence and intimidation has deterred many doctors from performing abortions in circumstances in which they would have had no qualms about performing them in the days before the anti-abortion zealots became so threatening. In the words of the independent legislator who proposed one of the bills that would have softened the ban, “There is a lot more tolerance for corruption than there is for discussion on abortion.”
And so the outrage continues. Groups of self-righteous misogynists directed from the U.S. hypocritically and sanctimoniously proclaim their love of (embryonic) life, while Salvadoran women die from clandestine abortions under unsafe conditions, and at least twenty Salvadoran women languish in prison because they couldn’t afford doctors to bear witness to their miscarriages.
These famous words, which Mark Twain attributed (probably erroneously) to British Prime Minister Benjamin Disraeli, have served as a warning that statistics, if used carelessly, can be as misleading as outright lies.
In the mid-1990s I was asked by the United Nations organization UNIFEM to examine cross-cultural statistics on women’s participation in science, technology and medicine (STM). The goal was the compilation of tables for the UN fact book The World’s Women: 1995 .
This being well before the days of easy internet data searches, UNIFEM sent me cartons and cartons of policy papers, data sheets, and women’s organization pamphlets. I poured over the materials for months, trying to contrive tables that would fairly put the status of women in STM in each country in comparative perspective.
I was forced to conclude that the task was impossible. Some data sets only included the percentage of women in STM in tertiary institutions, while others only included women in government research institutes; some collections lumped together women of different ranks or in different scientific specialties, while others meticulously differentiated ranks and subfields; some included even the social sciences and humanities in their definitions of “science,” while others included the physical sciences but not mathematics or engineering. Ultimately, I wrote a piece (the only signed one in the volume) explaining the absurdity of trying to derive meaningful comparisons from such sources.
We find a different sort of methodological morass if we examine the UN’s comparative Gender Inequality Index (GII) (Human Development Report,
United Nations Development Program, 2016). The GII is calculated from three components, one of which is purportedly a measure of reproductive health; it is that component that I’ll discuss here.
The reproductive health component of the GII is computed by combining two indicators: maternal mortality per 10,000 live births and teen pregnancy rates per 1000 women. Once could ask: What about other indicators that in some countries are much more significant than maternal mortality and teen pregnancy rates in assessing the situation? At the very least, the data should include availability of contraception and legality/accessibility of abortion. In the United States one should also track the number of abortion doctors harassed or murdered, the number of clinics and schools intimidated out of offering birth control and abortion information, the number of states with outrageously restrictive TRAP laws, the number of raucous demonstrations at abortion clinics, the number of “Crisis Pregnancy Centers” staffed by anti-abortion zealots masquerading as neutral reproductive health advisers, the decreasing availability of abortion and certain forms of contraception, and so on.
The likely explanation for the UNDP’s use of maternal mortality and teen pregnancy and nothing else is that those are the data that are readily available from most countries of the world with some degree of accuracy (although the ratio of reported teen pregnancy to actual teen pregnancy undoubtedly varies widely from country to country). This is the typical reason why “proxy data” are used: you use the data that’s easiest to get, not the data that would really be most revealing, and you hope that the proxy data at least correlate with what you’re trying to measure.
In the case of the UNDP’s proxy data for reproductive health, what they do correlate with is the overall wealth and level of development of a country. More than anything else, low maternal mortality means a relatively affluent population and a highly developed health care system.
Similarly, the use of teen pregnancy rates skews the results in favor of the wealthier countries, where in fact it’s reasonable to expect that a low teen pregnancy rate signifies widespread availability of birth control as well as adequate sex education in the schools. But note that `teen’ is defined to include 18- and 19-year-olds. In many low-income countries where most men and women do not go to college and a high proportion of the population is rural, early marriage and child-bearing are culturally accepted and not correlated with failure in life. (This was the case in the U.S. until well into the 20th century.) Why then should the GII penalize low-income countries for a high teen pregnancy rate?
Because of what is counted, and equally importantly, what is not counted, there are some curious oddities in the GII rankings. Take South Korea, for example, which ranks tenth in the world in the GII. Because South Korea has a reported teen pregnancy rate of 1.6/1000 (the lowest in the world) and a maternal mortality rate of 1.1/10,000, the reproductive health component of its GII appears close to ideal, and that leads to its high GII ranking. But abortion is almost completely banned in South Korea. Doctors have been prosecuted for performing the procedure, the illegal abortion industry is booming, and there is a large black market in abortion pills obtained illegally over the internet. Women activists have been trying to get the draconian abortion laws revised for years, and have only recently succeeded in convincing the legislature to revisit the issue.
To cite another example, Cuba has a GII ranking of 62 out of 159 countries, while the U.S. ranking is 43. Why does Cuba come out poorly compared to the U.S.? By far the main reason, ironically, is Cuba’s reproductive health component, which is greatly affected by its relatively high teen pregnancy rate of 45.6 per 1000 vs. 22.6 for the U.S. Meanwhile, Cuba has a health care system that is a model for developing countries, and it is the only country of Latin America that has had unconditional reproductive freedom for women for over half a century. (In addition, women constitute 48.9% of the Cuban legislature and 27% of the Cuban Academy of Sciences; the latter figure is the highest percentage in the world.)
My point is not to castigate the UNDP for using statistical methodology that favors the wealthy countries and underrates low-income countries such as Cuba that have progressive traditions in women’s health and women’s rights. Rather, the lesson here is that issues of reproductive health and gender equity are far too complicated to be captured by a single number, especially one that’s computed from proxy data.
I just wrote a review (for a librarians’ journal) of Women against Abortion: Inside the Largest Moral Reform Movement of the Twentieth Century by Karissa Haugeberg, an assistant professor of history at Tulane University. At first, I was put off by the subtitle, because the idea of dignifying anti-abortion zealotry with a term like “moral reform movement” is abhorrent to me. I myself would never use such a phrase for the same reason I never call opponents of abortion “pro-life” — like many feminists, I am sickened by the hypocrisy of that term.
As it turns out, however, one should not judge a book by its cover — or its subtitle. This is a nuanced, sophisticated, and balanced account of three decades of anti-abortion activism in the U.S. on the part of overwhelmingly white, largely working class Catholic and Evangelical women. By the end of the book Haugeberg has made it abundantly clear that there is nothing the least bit moral about the terrorist violence of the anti-abortion movement.
Haugeberg argues against the widespread notion that most acts of violence against women’s health clinic personnel have been committed by white Evangelical men. She demonstrates that women were coordinating violent “rescue” actions (vandalizing and bombing clinics and assaulting and terrorizing staff and clients) “long before Evangelical men joined the movement.” In large part, the Catholic women’s early turn to “rescue” violence was prompted by their frustration with most Catholic priests’ and nuns’ disinclination to actively oppose Roe v. Wade. Juli Loesch, for instance, cut off her relations with a group of Benedictine nuns because of their ambivalence about abortion.
Haugeberg repeatedly notes that most of the (Catholic) women who embraced anti-abortion activism initially went to some effort to portray themselves as seriously interested in women’s welfare. The crisis pregnancy centers (CPCs) were set up by these women supposedly as a more female-centered alternative to the male-led and Evangelical-dominated anti-abortion groups, which were overtly anti-feminist, if not misogynist, and which put fetal personhood at the heart of their rhetoric.
But the CPCs quickly degenerated. Though still employing a discourse of concern for women’s health and wellbeing, the CPCs have unashamedly turned to “deception, coercion, and terror” in their attempts to prevent women from accessing abortion. CPC personnel routinely lie to women about how long they’ve been pregnant (thus moving them past the time limit for legal abortion in many states). CPC staff show fabricated abortion videos, make outrageously inaccurate claims about abortion hazards, intimidate and terrorize women seeking abortions, and publish confidential information about them and their families.
Haugeberg’s book is fascinating and well written. But it is not an easy read. She uses their own words as much as possible in chronicling violent anti-abortion fanatics such as Shelley Shannon (attempted murderer of Dr. George Tiller and intimate friend of the killers of Dr. Tiller, Dr. David Gunn, and others). Those words are smug and self-righteous, and it takes a strong stomach to read the sanctimonious justifications of their violent attacks.
Haugeberg criticizes the distinctions often made by scholars and the media between supposedly peaceful arms of the anti-abortion movement such as the CPCs and the terrorists who over three decades have killed eleven people, attempted to kill another 26, and committed close to 2000 acts of arson and vandalism. Violent anti-abortion activists move freely among the various factions of the movement, and their terrorism is virtually never condemned by the national organizations. The actions of female anti-abortion terrorists have met with tepid response by state and federal officials as well. All too often, their repeated violent acts do not lead to criminal charges and rarely result in jail time.
Recently I came across a 6/2/14 blog post from Melinda Gates extolling her foundation’s emphasis on reproductive, maternal, newborn, and child health (they use the acronym RMNCH). Gates was bothered by the fact that many commentators see RMNCH issues as inextricably linked with abortion access/legality. She insisted that abortion should be discussed separately from other reproductive health issues, and she proudly announced that the Gates Foundation has no intention of funding abortion. Gates’ blog post drew protest from some feminists, including Daily Beast writer Sally Kohn, who posted “A Plea to Melinda Gates: Stop Stigmatizing Abortion.” Kohn pointed out that the Gates Foundation’s head-in-the-sand policy on abortion comes at a time when, according to World Health Organization figures, each year approximately 20 million women resort to unsafe abortion and at the barest minimum 68,000 women worldwide die from the consequences.
Provision of effective contraception could certainly reduce these numbers, but it is absurd to act as if contraception will eliminate the need for abortion altogether. Contraceptives fail. Women’s circumstances change. A partner can leave or become abusive. A loved one might suddenly require intensive care. Any of a score of events could mean that a pregnancy, even one that was desired at one time, cannot be allowed to continue without hardship. And the fact is that once a woman has decided that continuing a pregnancy is not in the best interests of herself and her family, she is likely to terminate it by whatever means necessary, even possibly attempting the procedure on herself.
Gates is regrettably (if unconsciously) following in the footsteps of Margaret Sanger, the founder of Planned Parenthood. Sanger is often eulogized as the mother of modern birth control. However, as I discuss in Sex and Herbs and Birth Control (pages 182-188), in the first decades of the 20th century Sanger promoted “modern” contraceptives (which at the time consisted of ill-fitting diaphragms or spermicidal jellies) as the logical replacement for abortion. But these methods were unreliable, as Sanger knew. Moreover, a study in Sanger’s own clinic indicated that most women who discovered their condition when they came in requesting birth control did not carry their pregnancy to term but rather found some medical excuse for termination (doctors would often approve medical termination of pregnancy for the affluent) or else disappeared into the abortion underground. But Sanger refused to recognize the implications of these findings. Unlike more progressive feminists of the time, such as Drs. Marie Equi and Madeleine Pelletier (both of whom gave abortions to poor women themselves) and Mary Ware Dennett, Sanger stubbornly insisted that contraception could eliminate the need for legal abortion entirely. This was wrong then, and it’s wrong now. Melinda Gates is making the same mistake.
Gates appears to be avoiding the abortion issue for a couple of reasons. She herself is a Catholic and does not want to challenge the Church’s stance as many Catholics (for example, the group Catholics for Choice) have done. In addition, like Margaret Sanger, Melinda Gates seems to feel that by stigmatizing abortion her Foundation can avoid controversy and position itself in the mainstream. This approach worked for Sanger, in that she was able to attract some fairly conservative donors who would have balked at being associated with a “leftist” demand such as legalized abortion. (The infant Soviet Union immediately legalized abortion in 1918, so calls for legalization in the West were often branded as “communist.”)
But Gates is deluding herself. Abortion access is integral to any RMNCH strategy worthy of the name. And promoting abortion stigma, as Gates does, is not helpful to anyone who is truly interested in women’s reproductive health and wellbeing.
Occasionally athletes make the headlines because of their visible and vocal commitment to progressive political causes. In 1967 Muhammad Ali refused induction into the U.S. army, saying that he had no quarrel with the Vietnamese people; he was vilified in the press and (temporarily) stripped of his heavyweight boxing title. In 1968, runners Tommie Smith and John Carlos, winners respectively of Olympic gold and bronze medals in the 200-meter dash, drew the ire of conservatives by raising their fists in the Black Power salute during the award ceremony. In 2016, quarterback Colin Kaepernick and later several other U.S. football players began kneeling during the national anthem (which is played before U.S. sporting events) to protest racist violence and show their support for the organization Black Lives Matter.
The most recent example of people in the sports world taking a courageous stand on principle concerns the fight to maintain women’s access to reproductive health care. As discussed in previous blog posts, in the U.S. there have been massive and increasing attacks on women’s reproductive health. Misogynist Republicans at the state and federal levels have been assiduously working to defund Planned Parenthood, despite the fact that for many low-income women, the organization provides their only access to health screening exams. In the face of this concerted assault, the Seattle Storm, a professional women’s basketball team which is one of the very few sports teams owned by women, has announced a pathbreaking formal partnership with Planned Parenthood.
On July 18, 2017 the Storm will have a “Stand With Planned Parenthood” rally before their game with the Chicago Sky. Five dollars from the sale of each ticket will go to Planned Parenthood of the Great Northwest and the Hawaiian Islands, and there will be a fundraising auction as well.
Interestingly, the Storm ownership group does not think that their action will be particularly controversial among their fans. In an interview with The New York Times, co-owner Dawn Trudeau noted that the team owners, their audiences and their players share a progressive outlook. Trudeau sees the partnership with Planned Parenthood as a way to “make a meaningful impact on the national health care debate.” According to the Times article, reaction among coaches and players on other professional women’s basketball teams has been very positive. Chicago Sky player Imani Boyette noted that “Planned Parenthood is vital for women who don’t have access to standard health care. I was a P.P. patient in high school because I didn’t have health insurance. Taking a stand for things that affect the underprivileged, as a league and [as] women of privilege, is how change happens.”
As readers of Sex and Herbs and Birth Control know, I am not uniformly positive about Planned Parenthood’s role historically or internationally. Margaret Sanger, the founder of Planned Parenthood, often consorted with racists and eugenicists in her efforts to get funding, and International Planned Parenthood often acts in culturally inappropriate ways. But at present in the United States, Planned Parenthood plays a crucial role in women’s health, and efforts to defund the organization must be resisted. As Boyette notes, Planned Parenthood is often the only recourse for women without health insurance, and is their best option for obtaining mammograms, Pap smears, STD-screening, and low-cost contraceptives.
The May 11, 2017 New York Times carried a brief letter from Father Michael P. Orsi that is worth quoting here. Orsi objects to an earlier column (“A Christian Abortion Doctor” by Nicholas Kristof, The New York Times, May 7) that said that Thomas Aquinas’ theology allowed for abortion. Orsi writes:
“In the Summa Theologica, his magisterial opus, the saint never writes directly on abortion but speculates on ensoulment for the fetus, which did not challenge the traditional prohibition [against abortion].
“Although there is no direct condemnation of abortion in the Bible or by Thomas, he was certainly aware of the scriptural roots of the anti-abortion teaching, as well as in the teachings of the church fathers, who unanimously condemned the practice.”
At first glance, Father Orsi’s remarks seem clear and straightforward. Aquinas and other leading Catholic theologians “unanimously” condemned abortion. End of story.
At least Orsi was honest enough to admit that the Bible does not prohibit abortion — a fact that most anti-abortion zealots persistently refuse to acknowledge. But Father Orsi implies that Aquinas’ speculations on ensoulment of the fetus have nothing to do with questions of abortion; this is far from the truth. Virtually all Catholic theologians before the 19th century were interested in the question of ensoulment (the point at which a human soul enters the body of a fetus, usually thought to coincide with quickening) in large part because of its relationship to the question of abortion. For most of its history the Catholic church condemned termination of pregnancy only after ensoulment/quickening, but not before. In fact, most theologians didn’t even use the word “abortion” for the ending of pregnancy prior to quickening.
The use of the term “abortion” by early Catholic theologians was very different from the modern use. In fact, the vast majority of abortions in the U.S. today would not have been considered abortions by them, because they occur before quickening.
Several prominent clerics, nuns, and saints, including Thomas Sanchez, Albertus Magnus, Pope John XXI, Hildegard of Bingen, and Elizabeth of Hungary, themselves wrote positively of emmenagogues and early-stage abortifacients. Peter of Spain (later Pope John XXI) compiled a long list of abortifacients in his Book of the Poor, and Hildegard of Bingen promoted the abortifacient properties of tansy, which had not previously received scholarly attention.
The fact is, for close to 1900 years the majority of church writers and Canon lawyers accepted early abortion (approximately first trimester) under most circumstances and all abortion under some circumstances (such as when the life of the woman was threatened). Contrary to Father Orsi’s claim, Thomas Aquinas paid attention to ensoulment precisely because the timing of ensoulment was intimately tied to the question of when termination of pregnancy is an actual abortion. The later ensoulment was thought to occur, the longer the window for ending pregnancy without incurring religious censure.
In the chapter of my Sex and Herbs and Birth Control titled “A Little Bit Pregnant,” I discuss the diversity of opinions on termination of pregnancy among Catholic commentators through the ages. I note that present-day opponents of abortion are completely mistaken in their claims that the Church has implacably opposed all abortion at all stages of pregnancy from the time of Christ until now. But I say that the confusion is in some sense understandable, since definitions of abortion used in the past and at present are not the same, and the average anti-abortion zealot misstates the history out of ignorance rather than deliberate deception.
Father Orsi, however, is an eminent theologian who has written numerous books and articles on bioethics, Catholic family law, and related topics. He is not ignorant of the complex and nuanced stances of his predecessors. He must know full well that his Church did not categorically condemn all abortion under virtually all circumstances until 1869. One is forced to conclude that Father Orsi’s misleadingly worded letter is deliberately misstating the history of Catholic proscriptions on abortion. Father Orsi’s letter is, in fact, an excellent example of sophistry, that is, how to lie without lying.
My last post was cautiously optimistic about the state of women’s reproductive rights in the U.S., since the Supreme Court had just struck down Texas’ most extreme TRAP laws. Unfortunately, because of the blatantly undemocratic system of indirect voting in the U.S. (that is, the Electoral College), Donald Trump, who received 2.84 million fewer votes than the “losing” presidential candidate Hillary Clinton, is destined to enter the White House in January 2017. Trump is an unrepentant misogynist who has boasted about forcing himself on women and groping their genitals.
Trump was supported by sexist, racist, homophobic fundamentalists who have taken his supposed victory as a signal to rush into law a barrage of measures limiting women’s rights over their own bodies. Take the example of Ohio, whose state legislature just passed a bill banning abortion after a fetal heartbeat has been detected (this generally occurs between six and eight weeks’ gestation — before many women even know they’re pregnant). Numerous other state legislatures are contemplating similar bans, and at least four states have “trigger bans” in place. These bills automatically criminalize abortion as soon as a Trump-skewed Supreme Court overturns Roe v. Wade (and thus leaves decisions about the legality of abortion to the individual states).
Trump has committed himself in writing to putting anti-abortion judges on the Supreme Court, passing a national ban on abortion after 20 weeks, eliminating federal money for Planned Parenthood, and making the Hyde Amendment (passed annually by Congress to ban taxpayer-funded abortions) permanent. The potential results of this wave of fanaticism are appalling, and as always, the effects will disproportionately fall on women of limited economic resources and women of color.
Polls continue to show that the majority of the U.S. population supports the legalization of abortion affirmed in Roe v. Wade. Moreover, if we add the popular votes cast in November for Hillary Clinton to those for Gary Johnson and Jill Stein (the two leading third-party candidates, who, like Clinton, strongly oppose increased restrictions on abortion), we find that they received a total of 71.5 million votes as opposed to Trump’s 62.9 million. A sizable majority of voters are opposed to the Trumpist misogyny being promulgated by legislators on the state level.
Some pundits are predicting that Trump’s disregard for anti-corruption laws will get him impeached sooner rather than later. But his removal would in no sense help women because the Vice President-elect Mike Pence is even more rabidly anti-reproductive justice than Trump is.
In many ways the U.S. is a pariah of human rights on the international stage. Domestically as well, the country seems destined to enter a dark age of human rights abuses of women — unless a resistance movement can gain force.
Over the past few days, the news media as well as social media platforms such as Facebook and Twitter have been abuzz with news of the U.S. Supreme Court’s 5-to-3 decision in the Whole Women’s Health v. Hellerstedt case. The court struck down the Texas state legislature’s 2013 restrictions on abortion clinics; these restrictions had already caused half the abortion clinics in Texas to close, and threatened many more. A June 27 article in The New York Times called the decision “the court’s most sweeping statement on abortion since Planned Parenthood v. Casey in 1992, which reaffirmed the constitutional right to abortion established in 1973 in Roe v. Wade.”
People interested in women’s reproductive health have heralded the decision as signaling the likely end of most of the so-called TRAP laws (targeted restrictions on abortion providers) so beloved by right-wing state legislators all over the country. Indeed, anti-abortion forces view Whole Women’s Health v. Hellerstedt as a shocking defeat. (The Washington Superior Court ruling against the Skagit County hospital district for failing to provide abortions that I was so pleased about last week seems like very small potatoes in comparison.)
I have to admit that when I first heard of the Court’s decision, I was as ecstatic as anyone else, and did not particularly cavil at the descriptions of Whole Women’s Health v. Hellerstedt as being a death-blow to the U.S. anti-abortion movement. Upon reflection, however, my enthusiasm has become more measured. Such court decisions are welcome, of course. But history has shown us that one cannot rely upon the courts to ensure fair treatment. After all, the Miranda v. Arizona court decision of 1966 (which limited police powers and required that arrested persons be informed of their right to a court-appointed lawyer) has not notably resulted in equal justice for the poor. And anyone who knows anything about the recent history of abortion in the U.S. is well aware that neither Roe v. Wade nor Planned Parenthood v. Casey ensured access to abortion for women of scarce resources outside of certain major metropolitan centers.
Anti-abortion zealots are already regrouping, and strategizing about what their next moves will be. Their onslaught against the health rights of women over the past few decades has been unceasing, and there is no reason to assume that they will view Whole Women’s Health v. Hellerstedt as anything other than a temporary setback. The TRAP laws have certainly been an effective tactic. But women are also denied access to abortion through intimidation of health care professionals and patients at the doors of clinics, cuts in funding to clinics that provide reproductive health services to the poor, and the failure of more than a handful of medical schools to require their students to learn procedures to terminate pregnancy.
It is, of course, far better for abortion to be legal than illegal. But that is not the end of the story. Sometimes a place where abortion is illegal can have better access than certain other places (such as many rural regions in the U.S.) where it is legal. Take, for example, the South American country Uruguay, which in 2012 became the second country in Latin America and the Caribbean (after Cuba) to legalize abortion under a broad range of circumstances. Interestingly, already for a decade or so before legalization, Uruguay had succeeded in drastically reducing maternal mortality from unsafe abortions by means of “before” and “after” appointments for poor women at the public hospital. Physicians would see women contemplating illegal abortions to instruct them in the correct administration of misoprostol/Cytotec, though they would not provide information on how to acquire the drug (which in any case was freely available over the internet). After the women self-aborted chemically, Uruguayan physicians would confirm completeness of the procedure and if necessary perform a uterine aspiration if there were any complications. This subtle skirting of Uruguay’s abortion prohibitions has come to be known as the “Uruguay Model,” and has been informally adopted by doctors in other countries with restrictive abortion laws, such as Uganda, Tanzania, and elsewhere. See the article by Patrick Adams in The New York Times.
Anyone who is concerned about reproductive health issues has had plenty of bad news in the past few years. In Latin America and the Caribbean the menace of the Zika virus has caused governments to warn women against becoming pregnant, in most cases without loosening restrictive anti-abortion laws or providing increased contraceptive options. Despite problems of access, Guttmacher Institute scientists estimate that women of the region have about 6.5 million abortions per year (https://www.guttmacher.org). Most are illegal, many are performed under unsafe circumstances, and at least 750,000 women per year experience post-abortion complications.
In the U.S. more and more state legislatures have enacted so-called “TRAP” laws (targeted regulation of abortion providers) (http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap) making it difficult if not impossible for many abortion providers to continue to offer the procedure. And Planned Parenthood clinics are under constant threat of losing state and federal funding despite the fact that most offer a full range of women’s health services (including cancer screening, in vitro fertilization, and sex education) that would not otherwise be accessible to women of scarce resources.
The U.S. is not a monolith, however. TRAP laws and other threats to women’s reproductive health do not affect all parts of the country equally. Take, for example, the Pacific Northwest. In 1991 voters in the state of Washington sent a clear message when they acted to limit Christian fundamentalists’ ability to curtail women’s abortion rights. By means of a direct popular vote, Washington residents enacted the Reproductive Privacy Act (RPA), which bars the state legislature from passing abortion restrictions, requires the state to finance abortions for poor women, and mandates that any public hospital that offers maternity services must also provide abortion services.
In 2015 the American Civil Liberties Union of Washington sued the Skagit County public hospital district on the grounds that Skagit County was referring women desiring abortions to Planned Parenthood clinics rather than offering the service themselves. The county claimed that their hospitals had no physicians willing to provide abortions and cited the RPA provision allowing individual doctors to opt out of doing abortions. But Skagit County Superior Court Judge Raquel Montoya-Lewis has ruled that the hospital district is required to find someone willing to provide abortions since they provide maternity services, and that the individual opt-out provision of the RPA cannot be employed at the county-wide level. The victory is a small one, of course, and it remains to be seen whether Skagit County will appeal the court decision. But at least the case has served to remind people in Washington State of the RPA and its provisions.
Another intriguing battle being waged right now concerns Washington Senator Patty Murray’s efforts to get the federal government to pay for reproductive assistance for injured U.S. veterans. For example, it would pay for in vitro fertilization for a couple who could not conceive in the normal way because of battle wounds (such as shrapnel in the uterus or testes). Her measure has passed the Senate, but is being obstructed in the House of Representatives. According to a June 22, 2016 editorial in The Seattle Times, opposition is being spearheaded by the conservative Family Research Council on the grounds that in vitro fertilization could result in the destruction of fertilized eggs (which is tantamount, in the eyes of Catholic and Protestant religious fundamentalists, to abortion). Senator Murray has noted the outrageous ironies of the situation: the U.S. claims that it is sending young people to the Mideast with the purpose of fighting Islamic religious fanatics who seek to impose their will on the population at large. But after U.S. soldiers are wounded in the course of that struggle they come home to fall victim to Christian zealots who impose their extremist views on the majority of Americans who do not share their fanaticism.