Melinda Gates Makes the Same Mistake as Margaret Sanger


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Melinda Gates

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.

Professional Women’s Basketball Team Takes a Stand for Women’s Reproductive Health


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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.

Black Power salute at the Mexico City Olympics, 1968.

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.

How to Lie without Lying


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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.

Saint Thomas Aquinas

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.

The New Face of Misogyny in the U.S.


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President-Elect Trump

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.

Cautious Optimism after a U.S. Supreme Court Decision


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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.”


Justices Sotomayor, Ginsburg, and Kagan. There was a gender gap in the 5-to-3 decision. The women justices voted 3-to-0 to throw out the Texas TRAP law; the men voted 3-to-2 in favor of the Texas restrictions.

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.

News from Washington State: Hope on the Abortion Front


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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 ( 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) ( 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.

U.S Senator Patty Murray of Washington State

U.S Senator Patty Murray of Washington State

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.

Zika and Abortion


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The spread of the Zika virus is causing consternation and alarm in many countries. The symptoms of the mosquito-borne virus are generally quite mild, to the extent that many victims don’t even know that they are ill. Recently, however, it has become clear that, when contracted by women in the first trimester of pregnancy, Zika can cause birth defects such as microcephaly, brain damage, deafness, and paralysis. The World Health Organization has stated that as many as four million people in the Americas could be infected in 2016, and the U.S. Centers for Disease Control are cautioning pregnant women not to travel to certain countries in Latin America and the Caribbean where the virus outbreak is becoming severe.

The Central American country of El Salvador has been particularly hard hit, and the government has taken the unprecedented step of warning women not to become pregnant until 2018. This advice is bizarre. El Salvador is a poor country. Many women face barriers, both practical and cultural, to contraceptive use. Moreover, abortion — even when the fetus is known to be severely deformed — is illegal, and the punishments are severe.


The sign says “Stop Criminalizing Women.” The woman belongs to a protest movement in Chile, which, like El Salvador, has draconian laws that criminalize women who terminate their pregnancy. In both countries abortion is illegal under all circumstances, even if necessary to save the life of the woman. In El Salvador the exception that allowed abortion when the mother’s life is in danger was removed in 1998; in Chile it was removed under the military dictatorship in 1989.

An effective government strategy to combat the epidemic of birth defects would consist of three components: widespread sex education and cheap and easily available contraception; widely available prenatal screening for birth defects (amniocentesis); and safe, legal abortion. Since El Salvador has none of these, women in large numbers will inevitably get pregnant, and some will deliver babies with severe abnormalities.

Note that the government’s admonitions are not directed at men, as if they didn’t realize that men share responsibility for pregnancy. Rather, the clear implication is that women and women alone will be blamed for the expected public health catastrophe. A 25 January 2016 article in The New York Times about the Zika threat in El Salvador aptly describes the Salvadoran government’s pregnancy warning as “the equivalent of a Hail Mary pass that, to many here, only illustrates their government’s desperation.”

In this article the word “abortion” is conspicuous by its absence. This is a peculiar oversight by The New York Times, since the illegality of all abortion in El Salvador is one of the principal obstacles to an effective response to the public health crisis.

Also omitted from the coverage in The New York Times is any discussion of U.S. culpability for the deplorable situation in that country. During the years 1979-1992 the U.S. gave billions of dollars in financial and military aid to the right-wing government that committed large-scale atrocities during a civil war in which an estimated 80 thousand people died. After the war the huge quantity of weapons and the large number of demobilized and unemployed former soldiers set the stage for an epidemic of violent crime. In addition, in the mid-1990s the U.S. deported several thousand Salvadoran pandilleros (gang members, mainly from Southern California), who brought their criminal gangs back with them to El Salvador. Current estimates of the number of gang members in El Salvador (a country having 1/50 the population of the U.S.) range from 30 to 60 thousand. At present El Salvador has the highest homicide rate in the Americas.

The pandilleros are not the only U.S. export to cause havoc in El Salvador. Over the past two decades religious fundamentalist groups based in or funded from the U.S. have given rise to anti-abortion fanaticism on a level that was virtually unknown before. In 1994 the Kovalevskaia Fund (of which I am director) and the Salvadoran Women Doctors’ Association convened an international conference in San Salvador to discuss the medical consequences of illegally induced abortion. El Salvador’s Vice-Minister of Health attended, and topics included the use of herbal abortifacients and menstrual regulators by the indigenous peoples of El Salvador, the actions of RU-486, the efficiency of vacuum aspiration as an abortion technique, the work of South American abortion clinics and their education programs for midwives and obstetricians, and so on. There was a sprinkling of anti-abortion people among the 300 doctors and medical students in attendance, but discussions were wide-ranging and respectful. Yes, that is not a misprint. The abortion opponents in El Salvador listened to the discussions of these topics with interest and respect.

Now, however, such an event would be virtually impossible to organize because religious fundamentalists have become much more visible, violent, and well-funded than they were in the mid-1990s. Medical personnel are prevented from performing abortions even in cases of ectopic pregnancy or other life-threatening conditions. In such circumstances it is not surprising that the Salvadoran government fails to mention abortion in connection with the Zika crisis. That The New York Times fails to mention abortion in its own coverage is harder to explain.

Postscript (added 4 February 2016) Although the article on the response in El Salvador to the Zika virus did not mention abortion at all, a 3 February editorial in The New York Times did: “In Latin America, where many nations outlaw abortion, some governments have advised that pregnancies be delayed, which can create only greater anxiety for women who have sadly limited control over such decisions…. Immediate responses, like increasing access to birth control and abortion, face stiff legal and cultural resistance in the affected region.” The New York Times also carried an article “Surge of Zika Virus Has Brazilians Re-examining Strict Abortion Laws”.

Second postscript (added 8 February 2016) Today’s The New York Times has an excellent op-ed on the situation in Brazil by Debora Diniz, a professor of law at the University of Brasilia.

A Strange Taboo about Abortion: What I Love and Hate about Amazon


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There are many aspects of Amazon’s business model that deserve praise, the outlandish claims and baseless accusations of some large publishing conglomerates and their famous authors notwithstanding. Amazon favors presses that keep their prices reasonable and gives a greater percentage of gross to those which keep e-book prices under $10.00. This benefits all readers, and is particularly good for college students, whom most publishers have traditionally treated as captive audiences and cash cows. The cost of textbooks has been rising outrageously and now constitutes a sizable fraction of college expenses. The University of Washington, for example, estimates average annual textbook costs at $1200.


The purchase of appropriately priced e-books can significantly reduce this. After all, there is no reason why students should be called upon to subsidize the publishers’ bloated bureaucracies and the huge royalties for textbook authors (who generally write the books while receiving full-time salaries as professors). There is in fact no reason why any publisher should charge more than $10.00 for an e-book, so Amazon is completely justified in attempting to rein in the cost.

Amazon offers an astonishing array of e-books at low prices, and an amazing number of quality titles are available free to Kindle Unlimited subscribers. The collected works of Dostoevsky, Pushkin, Turgenev, and many others cost under $3.00 each, and many of the classics of science fiction (one of my favorite genres) can be read for free. It can be argued that Amazon has democratized reading in new ways, not only by potentially lowering the cost of textbooks and other e-books, but also by making books (hard copy as well as electronic) easily available to anyone within reach of the internet.

There is another aspect of Amazon’s business model that is of immense value to those who might want to work outside the narrow confines of what is considered acceptable by the mainstream presses, including university presses. Namely, Amazon facilitates the distribution of books by tiny, independent specialty publishers, giving us access to readers on an unprecedented scale.

I speak from experience. My book, Sex and Herbs and Birth Control, had a long and tortuous path to publication. Along the way two presses broke contracts with me, and the head editor of one prominent university press said the book was “outside our comfort zone” and advised that I should tone down my criticisms of the Vatican. Ultimately, I decided to publish the book through the Kovalevskaia Fund, a small non-profit foundation for women in science, technology and medicine of which I am director. But in all but name the book was produced by an experienced small independent publisher named Aqueduct Press that is known for its high quality feminist science fiction. L. Timmel Duchamp, Kathryn Wilham, and Tom Duchamp, the motive forces behind Aqueduct Press, kindly worked with me to ensure a professionally produced book. Recently Sex and Herbs and Birth Control won the 2015 Transdisciplinary Book Award of Arizona State University’s Institute for Humanities Research, beating out twenty-six other entries including books published by Oxford, MIT, Indiana, and other distinguished presses.

The book is not exactly selling well. But the fact that it is selling at all is due in large part to Amazon. Amazon is a godsend for small independent presses. The company does not disadvantage the tiny. On the contrary, Amazon encourages presses that keep their book prices low. And Amazon has the reputation of paying more promptly than other booksellers—a circumstance of some importance to a small press. All in all, it is safe to say that without Amazon it would have been difficult if not impossible to distribute Sex and Herbs and Birth Control effectively.

This does not mean, however, that Amazon is perfect. It is a huge corporation, and like any huge corporation in our capitalist world it can be accused of many things, including worker exploitation. What concerns me here, however, is Amazon’s peculiar taboo against allowing the word abortion to be used as a keyword for a sponsored advertising campaign.

Among the useful tools that Amazon offers—and one that is especially welcome to small presses with small budgets—is the possibility of creating a mini-ad campaign tailored to a specific audience. One can “bid” on keywords, with bids as low as two cents per click, and specify a low maximum budget. Amazon keeps track of the number of “impressions” (how many viewers see the page on which the sponsored link or ad is featured) and charges based on the number of clicks to the ad itself. If there are not many ads linked to a given word or term, or if one’s bid is higher than those of other sellers, then one’s ad is nicely placed at the bottom of the first page of search results.

Given the modest cost and the possibility of stopping at any time, we put in a two-cent bid on several terms: birth control, fertility control, women’s herbs, and abortion. All but abortion were accepted, and links to Sex and Herbs and Birth Control appear when viewers search these terms. Mystified by the absence of ads for the book under “abortion,” we upped our per-click bid to a whopping fifty cents. Still nothing.

Email with a sales representative revealed that abortion is in all likelihood a taboo ad word for Amazon. In fact, an abortion word search yields no ads or sponsored links on those pages at all. This seems bizarre and more than a bit disturbing. After all, a search for “Confederate battle flag” yields six sponsored links on the first page, four of which are to sites which sell that reviled symbol of racism and oppression. Why should Amazon have no qualms about allowing advertising for Confederate (or indeed, for Nazi) regalia, yet shy away from permitting relevant links on a word search for a legal women’s health-related procedure like abortion? There seems to be no rational reason for Amazon to spurn ads and sponsored links on its abortion word search pages. In fact, the action appears to smack of censorship of a particularly perplexing and troubling variety.

Postscript (added 1 February 2016): Amazon seems to have recently changed its policy, and sponsored links have begun to appear with abortion word searches.

In the Heart of Africa


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I recently saw a fascinating website called EmGender: Malawi Gender Justice Research Network, created by Sarai Chisala, who is a Malawian expert on human rights law, especially relating to gender, HIV/AIDS, and race. Inspired by the #16 Days of Activism movement (that publicizes actions for progressive social change worldwide), Ms. Chisala provides portraits of some ordinary and extraordinary people fighting for gender equity and other aspects of social justice in Malawi. Among those she highlights are the Honorable Jessie Kabwila and other members of the Parliamentary Women’s Caucus who are advocating the reform of abortion laws. Malawi at present has extremely restrictive anti-abortion laws, and even the exception to save the life of a pregnant woman is interpreted narrowly. As in many countries with restrictive abortion laws, illegally induced abortion under unsafe conditions is common. The procedure accounted for 17% of maternal mortality in 2009, and about 30,000 women are treated for complications of septic abortion each year.

Other women mentioned on the EmGender site include sports stars, clothing designers, diplomats, judges, journalists, entrepreneurs, and a transgender activist. Their achievements are impressive, and Sarai Chisala hopes they demonstrate that Malawian women do not have to look outside the borders of their country for inspiration.

To follow in the footsteps of these role models, however, Malawian girls need education and training — things that were denied to the vast majority during the last decades of the 20th century. So-called structural adjustment policies (SAPs) mandated by international agencies such as the World Bank, the International Monetary Fund and USAID decreed that the government sector must drastically reduce expenses, and this meant, among other things, that primary schools had to impose fees. Those institutions were responsible for holding back the education of millions of girls throughout Africa.

I have only been in Malawi once, in 1997, but it was a memorable trip. Once, while my husband and I were approaching the village of Chembe on the shores of Lake Malawi (a choice destination for snorkeling enthusiasts such as us at the time) our car got stuck in the mud, and the children of Chembe gathered to talk to the tourists and watch them try to get their car out. I was struck by the fact that, while the boys spoke English and were in school, the rural girls (for whom the boys interpreted) were not in school — although they said they wanted to be. As in many places, parents often view girls’ education as less of a priority and in times of economic hardship are more likely to pull their daughters out of school than their sons.


This photo and the following caption are from
“According to UN statistics, although 27% of Malawi’s girls enroll in secondary school just 13% attend. Only a fraction of that 13% actually finish 4 years of secondary school and even fewer will pass their national final examinations that effectively qualify them as ‘graduates.’ [This means that] less than 7% of the women have attained a high school education.”

The effects of internationally-imposed SAPs were disastrous, and their complex consequences continue to be felt to this day. By the early 2000s the outcry from the Global South was too deafening to be ignored even by bureaucrats at the World Bank and USAID, who are normally arrogant and impervious to criticism. The Western “aid” establishment finally devoted some efforts to encouraging the education of girls.

But it turns out that repairing the damage done by decades of neglect of African girls is not so easy. Even when girls’ parents do pay the fees so they can attend school, they sometimes find a hostile environment where they are subject to discrimination, sexual harassment, and even rape by teachers and male pupils. Families often expect girls to continue to contribute to household income, something girls occasionally do by finding an (older) man to defray family expenses in exchange for sexual favors. Reliable birth control is expensive and not always available, so pregnancy is a constant concern and has derailed the ambitions of numerous African school girls. (My colleague Heather Switzer writes about these and other issues facing Maasai school girls in Kenya; similar worries face young women in many parts of the continent.) That is one reason why the work of the Parliamentary Women’s Caucus, EmGender, and other activists is so important. Getting girls into school is all well and good, but one must also provide the means for them to study in an environment conducive to their success.

Because anti-abortion laws are fundamentally misogynist, they are usually part of a whole complex of neglect and abuse of women and girls. That is true in the U.S., and it is also true in Africa. We should view the struggle for women’s reproductive rights as inextricably linked with other feminist campaigns, as Ms. Chisala does in her website.

Reproductive Justice a Theme of Conference in Puerto Rico


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Recently I attended the National Women’s Studies Association meeting in San Juan, Puerto Rico. Among the dizzying array of panel presentations were two of particular interest to me. One focused on women of color creating organizations to support non-medicalized birthing options for poor women. The organizations, Birth Justice Project and Black Women Birthing Justice, sponsor classes for pregnant women in the California state prison system with the goal not only of obtaining better outcomes for their pregnancies but also training them to become doulas (informal birth assistants) after their release. The same panel featured a well-known Puerto Rican midwife, Rita Santiago, who was largely responsible for the resurgence of midwifery on the island. Historically midwives had handled virtually all births and most of the health needs of women and children in Puerto Rico. But when the U.S. assumed the colonial mantle of the Spanish at the beginning of the 20th century, the government and medical profession initiated a concerted campaign against midwives and in favor of hospital births attended by (largely male) physicians. These interventions had disastrous results for women’s health. Even now, Puerto Rican women have high Caesarian rates—approximately half of all babies on the island are delivered by Caesarian. These rates are well above the levels deemed acceptable by the World Health Organization. By comparison, Santiago noted that Cuba’s rates are low; about 8% of Cuban births are surgically managed, yet their maternal and infant mortality statistics are far better than those of Puerto Rico.

Another fascinating panel was organized by the Chicago Abortion Fund (CAF). CAF began thirty years ago with the goal of providing money for low-income women to obtain abortions after the Hyde Amendment cut off federal funds for the procedure. But they have branched out and adopted a reproductive justice (RJ) framework for their activism, which situates abortion access in the context of general health equity for low-income women and women of color. According to a CAF brochure, the broader orientation is necessary because “The mainstream reproductive rights movement has, in some instances, …been elitist and has ignored the needs of women of color and low-income women.” CAF has developed an abortion access toolkit that is widely used by other RJ-oriented activists around the country.

A poignant aspect of the abortion issue was brought to light in the discussion that followed the presentations. A young Latina woman in the audience asked how one deals with feelings of guilt about having an abortion. She is a high school student in a state that mandates so-called abstinence-only sex education, and she said that this, combined with the religious proscriptions drilled into them by Catholic and fundamentalist Christian parents, renders her and her peers unable to easily access birth control, terrified and uncertain where to turn when pregnancy results, and obsessed with the notion that they are betraying their culture or committing an unforgivable sin if they attempt to get an abortion.

The panelists were sympathetic, and CAF’s Latina intern said that she had suffered the same guilt when she terminated her own pregnancy. The advice offered by her and other panelists went along the lines of: remember that it’s your body and your life; you’re the best judge of what is right for you at this time. Certainly these statements are reasonable and can go some way toward assuaging guilt. However, I suggested an additional line of reasoning that might have some effect, especially on the young woman’s Catholic peers and (possibly) on their families. Namely, I pointed out that restrictions on abortion are relatively recent. Until 1869, when the Catholic Church banned the procedure, the Church had a flexible attitude toward abortion. I noted that Catholic saints and theologians (for example, St. Bridget, Hildegarde of Bingen, and Thomas Sanchez) and even a Pope (Peter of Spain, who became Pope John XXI) tolerated abortion, and some developed abortifacients themselves. I don’t know how much this information helped the young woman. But I am convinced that a significant component of making women of similar backgrounds more comfortable with their reproductive decisions is the disseminating of information on the wide acceptance of abortion in many cultures and circumstances both now and in the past.