Funding and Foundation


By Nyasa Times Reporter

July 3, 2013

Health ministers from several African countries have vowed to tackle the high number of deaths of women due to unsafe and crude abortion by among other efforts, expanding the provision of safe abortion services.

The commitment was made by ministers of health and gender and senior government officials from Ghana, Liberia, Kenya, Malawi, Mali, Nigeria, Sierra Leone, Tanzania, Uganda and Zambia at a regional meeting of ministers on unsafe abortion and maternal mortality in Africa.

The meeting took place on June 18-19, 2013 in Nairobi, Kenya and Malawi was represented by the then deputy ministers of health and gender Halima Daud, and Agnes Mandevu Chatipwa respectively, Lastone Chikoti, the Reproductive Health Officer in the ministry of health and Elsie Tembo the Second Principal Secretary in the ministry of gender.

“We note that unsafe abortion constitutes between 13-30 percent of the unacceptably high rates of maternal deaths in our countries, and acknowledge that concrete and urgent action must be taken to address this challenge if maternal death and injuries are to be effectively reduced.

“We additionally recognize that unsafe abortion constitutes a violation of women’s human rights, and affirm the link between protection, promotion and realization of women’s human rights to the improvement of sexual and reproductive health outcomes for women and girls in our countries,” reads the communiqué by the minister in part.

The ministers mentioned other countries which are providing safe abortion services and simultaneously reduced their maternal mortality rates.

The ministers thus committed themselves to individually and collectively as countries tackle the problem by examining laws, using evidence to raise awareness on issue.

“We will try to integrate evidence and advocacy on the issue of unsafe abortion into the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) and in other efforts to reduce maternal mortality and morbidity in our respective countries.

“We will also encourage our governments to include the issue of unsafe abortion as part of the issue of maternal health in Cooperation Frameworks with donor countries and development partners,” said the ministers.

According to a 2010 ministry of health study called Abortion in Malawi: Results of a Study of Incidence and Magnitude of Complications of Unsafe Abortion, 70,000 Malawian women have abortions every year, which is 24 abortions for every 1000 women aged 15-44. 31,000 Malawian women are treated for complications of unsafe abortion annually.

Approximately 17 percent of maternal deaths in Malawi are attributable to unsafe abortion, making it one of the primary causes of maternal mortality. 30percent of all admissions in country’s gynecological wards are due to unsafe abortion.  


Abortions in France are now effectively free , as a law that requires the nation to reimburse the full cost of the procedure took effect April 1, France 24 reports.

The French law greatly expands access to abortions and also offers free and anonymous birth control to teenagers ages 15 to 18. France’s National Assembly passed the expansive abortion bill in October, and the legislation was approved by the Senate shortly thereafter.


The new law seeks to make abortion more easily attainable and offer free contraceptives to cut down on unwanted pregnancies. According to the French Directorate for Research, Studies, Evaluation and Statistics, 225,000 abortions were performed in France in 2010.


As Radio France Internationale notes, free access to birth control includes first and second generation contraceptive pills, along with contraceptive implants and sterilization. However, the law will not include other contraceptives, such as condoms.  


President Francois Hollande first promised to pass the free abortion measure during his 2012 campaign. At the the time, the presidential candidate also proposed adding specialized centers for the procedure to all hospitals, according to Le Monde.


Before the law was passed, France only offered to cover up to 80 percent of [the cost of] procedures to terminate pregnancies. Contraception costs were also partially refunded with reimbursements set at 65 percent. France provides remunerations for abortions and contraceptives through its social security funds.


Abortion was first legalized in France in 1975.



Prohibiting the use of foreign aid to provide access to safe abortions has repercussions far beyond US borders


US aid policy still denies women access to abortion if they are raped in war. Photograph: Carolyn Kaster/AP

Over many years, I have visited conflict-affected states where I have met women who have suffered the agony of rape, and where sexual violence is the shocking and specific consequence of conflict.

These women are often traumatised, stigmatised and ostracised by their families and communities. When they are pregnant as a result of rape, these consequences are compounded.

While there is welcome attention focused on the plight of women and girls raped in war, there are still significant gaps in the international response to this global scourge.

One of those critical gaps is the routine denial of access to safe abortion services for rape survivors, which violates their rights under international humanitarian law. The reality is that these women are entitled under the Geneva conventions “to receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition”.

I remember meeting three women in the Democratic Republic of the Congo who had been gang-raped the day before as they walked home from the market. I will never forget them, and I have often wondered what would have happened if they were pregnant, because abortion is illegal in Congo .

What we do know is that, often when women in such situations are denied access to safe abortion services, they resort, in desperation, to unsafe methods that can result in serious harm or even death. And this happens even though several international bodies, including the committee against torture and the human rights committee, have found that the denial of abortion to rape victims can be defined as “torture and cruel, inhuman and degrading treatment”.

So what exactly are the obstacles and restrictions facing them, when it is already clearly defined that when rape is used as a weapon of war, in armed conflict, women have an absolute right to non-discriminatory medical care under the Geneva conventions?

The blame for these draconian restrictions lies at the door of the US and the International Committee of the Red Cross (ICRC), whose largest single donor is the US . The US imposes a “no abortion” ban on its foreign aid, which in practice means that the EU, the UK , the UN and the ICRC neither talk about nor provide abortions.

ICRC is the Department for International Development’s (DfID) partner of choice and receives the largest amount of DfID funding made to humanitarian organisations. This means that the UK is severely compromised by restrictions that it apparently doesn’t support, and which allow for a situation where life-saving abortion is being denied, even to very young girls raped in conflict.

This clearly flies in the face of international humanitarian law. In a recent statement, DfID said: “In conflict situations where denying an abortion in accordance with national law would threaten the mother’s life or cause unbearable suffering, international humanitarian law principles may justify performing an abortion”.

Does that mean that when the suffering of an impregnated war rape victim is “bearable” she can be denied an abortion? And how does she prove that her suffering is unbearable?

DfID says it talks to Norway , a country that is showing real leadership and has asked the US to lift the abortion ban as a matter of compliance with the Geneva conventions. Why doesn’t the UK join Norway in the stand it is taking?

And isn’t it time that the UK stood up for the rights of women and girls who have been raped to have the same access to medical treatment as other war victims?



Stephanie Johanssen

Legal Counsel for European and UN Affairs

Global Justice Center


The French government announced in the last week of September 2012 that all terminations of pregnancy would be reimbursed in full by the Social Security insurance from 2013. The  procedure will therefore be free of cost for women. This was a commitment made by François Hollande during the presidential election campaign in France earlier this year.


Each year in France, there are about 225, 000 abortions and 54% are medical abortions. The cost varies from 200 to 450 Euros, depending on the method and is currently reimbursed by the state at 70% for medical abortions and 80% for surgical abortions.


España: La única clínica de la Comunitat que práctica abortos de segundo trimestre convoca un cierre patronal por los impagos

(The only clinic that provides second trimester abortions in Valencia and Castellón on strike and planning to subvert any government restrictions on abortion)

Los trabajadores llevan 4 meses sin cobrar por la deuda de 500.000 euros del Consell

(Clinic staff have worked without pay for 4 months due to non-payment of fees for 7 months for women referred by public hospitals who refuse to do second trimester abortions)


21 September 2012


English summary:

At a press conference on Friday at noon, Josep Carbonell, director of the Mediterranea Medica clinic in Valencia announced that the clinic is going on strike tomorrow Monday for one week, because for 7 months the regional administration has not paid for abortions provided to women referred by public hospitals who refuse to perform abortions. Because of the outstanding payments of  €500,000, workers at the clinic have worked without pay for 4 months and suppliers cannot be paid either. During the strike, minimal services will be maintained so that women seeking abortions do not have to wait until they are over the legal time limits for abortion.


With the closure, the clinic also wants to protest against the intention to restrict the 2010 abortion law announced by the Minister of Justice Gallardon. Dr Carbonell warned that if Gallardon persists in these restrictive reforms and wants to force abortion back underground, he will launch: “a clandestine network of free clinics to ensure the rights of women. They will have to put many of us in jail ,” he said.


and in Spanish: Las direcciones de las clínicas Mediterránea Médica de Valencia, la única en la Comunitat Valenciana que practica abortos de segundo trimestre, y Deiá Médica de Castellón, realizarán un cierre patronal del lunes 24 al próximo día 30 de septiembre ante los impagos del Consell, que asciende a 500.000 euros, y que han provocado que los trabajadores lleven casi cuatro meses sin cobrar. No obstante, harán servicios mínimos para que ninguna mujer sobrepase el límite legal.


El vocal de la Asociación de clínicas Acreditadas para la Interrupción del Embarazo (ACAI) y director de clínicas Mediterránea Médica de Valencia, Josep Lluis Carbonell, ha explicado en rueda de prensa que el Gobierno valenciano sólo ha abonado el 65 por ciento de 2010 y 2011 y lleva siete meses de este año sin pagar, lo que supone una deuda de 415.000 euros para Valencia y de otros 100.000 para el centro de Castellón.


Carbonell ha detelaldo que el 80 por ciento de las interrupciones que práctica son de mujeres remitidas por centros dependientes de la Conselleria de Sanidad, lo que supone unos 120 abortos mensuales, y el 20 por ciento son casos privados, principalmente de dos hospitales de gestión privada y de Murcia. Así, ha expuesto que si hasta ahora se han podido mantener han sido por estas casos privados, pero que desde hace dos meses los dos hospitales de gestión privada que les remitían pacientes también han dejado de pagar….


Contra la reforma de Gallardon

Por otra parte, ha informado de que con este cierre también quiere protestar contra la reforma de la Ley del Aborto anunciada por el ministro de Justicia, Alberto Ruiz-Gallardón, que “condena a las mujeres a parir un feto malformado”. “Es una crueldad sublime para las mujeres”, ha constatado y “más cuando se han suprimido los fondos para el ciudadano de la dependencia”.


Además, ha señalado que con la presente ley se ha conseguido disminuir y que casi desaparezcan los abortos del segundo trimestre que “antes eran tan numerosos, al poder abortar de forma gratuita en la red pública”. Por ello, ha advertido de que si Gallardón persiste en esta reforma y quiere volver a llevar la práctica de abortos a la clandestinidad, pondrá en marcha “una red de clínicas gratuitas clandestina para garantizar este derecho de las mujeres”. “Nos tendrán que meter a la cárcel a muchos”, ha señalado.


Full text in Spanish:

By Sarah Ditum

WeNews correspondent

Thursday, May 31, 2012

Polls show most U.K. citizens support a woman’s right to choose abortion. But U.S.-style anti-choice tactics are picking up speed and fostering an aggressive activism movement marked by website hacking and clinic vigils.

BATH, England (WOMENSENEWS)–The United Kingdom may be a pro-choice nation in polling data, but U.S.-style anti-choice tactics are being used to attack that consensus.

Seventy percent of U.K. citizens polled in 2011 said it was a woman’s right to choose whether she continues her pregnancy.


But this pro-choice majority has long been opposed by vocal anti-abortion groups, such as the London-based Society for the Protection of Unborn Children, founded in 1966. And now U.S. anti-choice groups have expanded into the U.K., bringing more aggressive tactics that overshadow the homegrown movement.


One such organization is 40 Days for Life, founded in College Station, Texas, in 2004. The group’s self-proclaimed tactic is what they call peaceful prayer outside abortion clinics. (Its name refers to the length of the biannual vigils the group conducts.) However, employees of the British Pregnancy Advisory Service have reported that members of one vigil approached women attending the Bedford Square in London clinic. The Guardian has also reported that clinic workers accused 40 Days activists of filming people entering the clinics.


A second group, Abort67, is the English offspring of the Center for Bio-Ethical Reform, an anti-choice lobby group with headquarters in Lake Forest, Calif. The group, founded by Greg Cunningham, a former advisor to President Ronald Reagan, has more extreme tactics than 40 Days. Primarily active in Brighton and London, they display graphic images of late-term fetuses outside clinics in protest.


This type of graphic protest, fairly uncommon among British anti-choice groups, has proven to be an effective scare tactic. A rape victim, who walked through a protest by Abort67 to enter an abortion clinic, told her local paper it left her feeling “intimidated… panicky and judged.”


Website Hacking

Beyond protests, the criminal hacking of an abortion provider’s website here also had U.S. ties. In April, James Jeffrey was convicted of attacking a British Pregnancy Advisory Service website and stealing the personal information of 10,000 women who had registered with the site. He was also convicted of vandalizing the site with slogans referring to the “abortion industry,” a term with roots in U.S. anti-abortion rhetoric.


Following Jeffrey’s conviction, the BBC reported 2,500 attempts to hack the British Pregnancy Advisory Service’s website again, with more than half of those attacks originating in the United States.


Parliamentary efforts are also taking a harder anti-choice line. Conservative Member of Parliament for Mid-Bedfordshire Nadine Dorries has twice attempted to introduce legislation to lower the legal limit for abortion in the U.K. to 21 weeks from 24 weeks.


After these attempts failed, Dorries began casting aspersion on abortion providers. She criticized counseling provided by clinics as “biased” during a parliamentary debate on National Health Service practices in September last year.


The charge – common in the U.S. anti-choice movement – implied that providers were financially motivated profiteers. It has since gained currency within mainstream right-wing papers in the U.K., such as the Daily Mail and the Daily Telegraph.


This is despite the fact that the vast majority of U.K. abortions are provided either by not-for-profit bodies (mostly Marie Stopes and the British Pregnancy Advisory Service) on behalf of the National Health Service, or by the National Health Service itself. Just 4 percent of abortions are privately funded, according to the Department of Health.


Committee Established

Although Dorries’ amendment was defeated, Anne Milton, the parliamentarian under secretary of state for health, said during the September debate that she was sympathetic to Dorries’ aims. She established a committee to discuss the possibility of independent abortion counseling. Dorries is on that committee, which was due to submit a report at the end of April that hasn’t been published yet.


Pro-choice M.P. Diane Abbott resigned from the committee in January, calling it a front for anti-abortion ideology.


In the face of these attacks, U.K. pro-choice activists are becoming increasingly organized. In Brighton and London, where 40 Days for Life has been most active, an initiative called “40 Days of  Treats” delivered cakes and biscuits to the affected clinics for every day of the 40 Days for Life’s vigil.


When the Society for the Protection of the Unborn Child held roadside vigils to mark the anniversary of the 1967 abortion act–which legalized abortion in cases where a woman’s health or life is at risk or if a child is likely to be born with a serious mental or physical disability–pro-choice activists throughout the U.K. held counter-protests.


Local groups have offered leadership in the pro-choice cause. The Bloomsbury Pro-Choice Alliance in London and the Brighton Feminist Collective have been particularly engaged in organizing direct action and producing literature to refute alarmist claims of anti-choice groups.


On May 16, a pro-choice parliamentary meeting organized by the Abortion Rights Campaign brought activists, journalists, abortion providers and parliamentarians together to discuss how best to resist attacks on the right to choose.


But these groups are now clearly on the defensive.


In March, Health Secretary Andrew Lansley ordered inspections of every abortion clinic in the U.K., following a sting operation by the Telegraph newspaper. Doctors who provide abortions say this has left them feeling attacked and demoralized.


Clare Murphy, head of public policy at the British Pregnancy Advisory Service, said in an article for the Independent in March that there is a worrying possibility that doctors will be deterred from training to perform abortions at all.


Sarah Ditum lives in Bath, England. She is a freelance journalist on politics, family and health.

Great article about the blind spots and prejudices on abortion research

Why don’t we know more about the long-term effects of abortion?

Though abortion is one of the most contested medical practices in U.S. history, we know shockingly little about how this simple outpatient procedure affects women. There are almost no scientific studies on what happens to women who receive abortions, and even fewer on what happens to women who are unable to get them. The American government regulates access to abortion, but rarely funds studies on the procedure through the National Institutes of Health (NIH) or the Centers for Disease Control (CDC). That means that most abortion policies in the U.S. are not based on scientific evidence from medical studies.

To find out why, we talked to the University of California at San Francisco’s Tracy Weitz, who for the past decade has run a program at UCSF called Advancing New Standards in Reproductive Health (ANSIRH). The group, funded entirely by private donors, has done some of the only comprehensive studies in the U.S. about abortion in the medical system. Weitz told us what she and her colleagues have found.

ANSIRH was founded at the medical school in 2002 for scientists and doctors who wanted to research abortion and other reproductive health issues. They publish all their results specifically to help policy makers base regulations on rigorous, scientific studies.

The worst study ever done on abortion

In several states, including Kansas, Michigan, Nebraska, North Carolina, South Dakota, Texas, Utah and West Virginia, “informed consent” laws require health care providers to tell women seeking an abortion that the procedure can lead to mental illness. These laws are based in part on a 2009 study by psychology researcher Priscilla Coleman, who found a higher incidence of depression and other psychological disorders among women who had abortions.

Since that time, many scientists — including Weitz herself — have published papers showing how Coleman’s research methods were flawed. She made the basic “correlation equals causation” error, said Weitz. “You may have higher rates of depression in the population of women who choose abortion, but that’s part of why they choose abortion. You can’t make a causality argument, but that’s what these studies try to do.”

To combat poorly-designed studies like Coleman’s, ANSIRH has just completed a five-year study on the long-term health effects of abortion on women. They’re currently analyzing their data, and will have results to report later this year.


The questions that science can’t ask 

There are no studies on what happens to women’s health when they want abortions but are denied them. Weitz says that’s partly because gathering that data would be almost impossible. Women can be denied abortions in multiple ways. “It could be health care providers denying it to them,” she said, or it could be that they go to an abortion clinic but their pregnancies are so far along that the clinic says it can’t handle the procedure.

“The only way to do it would be to track a general population and ask them what their experience was when they sought abortions,” she mused. But even that would be difficult, because often women aren’t willing to admit they wanted abortions. Besides, Weitz added, women’s perspectives on unwanted pregnancies change once they’ve actually had their children. “It was unintended, they didn’t want it, but then the child is there and they love their children,” she said. It would be hard to ask women in that position about having an unwanted child, since they have ultimately come to want it.

“Another question we’re interested in is how many women don’t even contemplate an abortion because the social stigma is so great in their communities,” Weitz said. “If they lived in a different world, would they have had an abortion?” Again, this is a question that’s almost impossible to answer.

But there is one data set that gives us hard numbers on how much social environment affects whether women will get an abortion.

How many unwanted babies are born when abortion is taken away?

In North Carolina, researchers can track very precisely what happens to women when access to abortion is taken away. That state separates medicaid funds for abortion into its own special fund, and the fund has been cut off at various points over the years. So researchers can pore over data that shows how many abortions women get when money is available for them versus when it isn’t. For many women, coming up with $500 to get an abortion in time (ideally, the first 3 months of pregnancy) is impossible. So lack of funding means lack of access, period.

In a scientific analysis of the data, researchers found that “3 out of 10 pregnancies that would have been terminated were carried to term among low income black women” who were the main recipients of the medicaid funds. Those are fairly extraordinary numbers. They suggest that 3 out of 10 women who were already struggling financially are now saddled with the additional expense of rearing children.

While we don’t have data on what happens to women who are denied abortion, we do have a great deal of data on what happens to people in the long term when they struggle financially. Their health suffers tremendously, and they are prone to depression.

Why don't we know more about the long-term effects of abortion?How should abortion fit into health care?

Questions around how abortion should be funded are part of a larger issue: How does abortion fit into the medical system? This sounds like an odd question, but it’s what doctors have to ask about any procedure that’s more complicated than taking your blood pressure. Who can do the procedure, and under what conditions? Is abortion such a difficult medical undertaking that it needs to be done by a specialist at an abortion clinic? Currently, most states say yes. In California, for example, only doctors are allowed to perform abortions and most often they’re done at specialized clinics.

Placing all these limitations on who can do abortions and where means that women often don’t have access to abortions in time. As Weitz put it, every week that a woman waits to get an abortion — whether because she needs a doctor’s appointment, is raising $500, or has to travel to a far-away clinic — makes the operation more difficult.

But what if women could get safe abortions in their primary doctor’s offices, from nurse practitioners? This would certainly help women get abortions in time far more often. ANSIRH did a 4-year study in California asking this very question. They gathered data on the feasibility of training physicians, nurse practitioners, and even midwives to conduct abortions. As a health service, Weitz explained, abortions are relatively simple — from a purely medical standpoint, a first term abortion is roughly equivalent to having your wisdom teeth pulled. ANSIRH’s researchers found that a variety of healthcare providers could be trained relatively quickly to provide abortions, and that this would be a very cost-effective way to provide safer abortions to a greater number of women. Their research is currently being used by policy makers in California to evaluate a law that allows a greater range of clinicians to give abortions.

What should scientists really be researching if they want to understand how abortion affects women?

Weitz has spent much of her career researching questions that most scientists and funding organizations won’t touch. But there is a lot more she’d like to know.

“I think the real question of interest is what social and economic resources do women need to make the child bearing decisions they want,” she said. She continued:

Some women don’t want to be pregnant because it’s not the right time in their lives, and that’s a very affirmative decision. Then there are women [at abortion clinics] because they don’t have enough money, they don’t have a place to live. Those women are not making an affirmative choice — they’re making a survival choice. [In the context of social justice] we need to be asking more than, “Did they get the abortion?” but “What kinds of policies could be in place to help women make the decision they truly want?” We’ve forgotten to think about that group of women because this is so politicized. But what would allow women to make a genuine choice, to have the families they want and to parent their kids in healthy communities? In a rational society, that’s what we’d be asking.

Weitz gets to the heart of what “choice” really means for women. In our current political climate, pundits lump “choice” in with “abortion.” But understood rationally, as Weitz would have it, choice means setting up a social system where women never have to terminate pregnancies for survival reasons. They shouldn’t fear living on the streets, without resources, just because they want children.

One of the greatest investments women make, both financially and emotionally, is in their kids. But we live in a nation that provides almost no assistance to low-income women who want to be mothers. As long as this is the case, women will never truly be making a free choice about whether to give birth.

Deaths in childbirth would drop further if the bank cut fees and expanded grants in its spending on reproductive health

Every minute of every day, one woman dies somewhere in the world due to preventable complications in pregnancy or childbirth. That’s a total of 1,000 women dying each day, or 365,000 dead each year, from pregnancy-related causes. Despite research that shows an overall decrease in worldwide maternal mortality since 1980, millions of women and girls still face a staggering risk of death or disability during pregnancy and childbirth.

The World Bank boasts that it has positioned itself as a “global leader” in reproductive health, especially for youth and the poor, having committed $96m to reproductive health projects in 2011. However, the bank fails to mention that this total represents just 0.2% of its $43bn budget for the financial year ending 2011. The bank also overlooks the fact that almost half of its reproductive health projects in Sub-Saharan Africa — where women have a one in 16 chance of dying during pregnancy or childbirth — are funded by loans. These loans leave poor countries indebted and threaten to divert domestic spending away from vital public health services. Such spending cuts are devastating for poor women, who not only suffer directly from reduced access to healthcare but are responsible for the health of their households.

There is a striking mismatch between countries’ maternal mortality rates and the bank’s spending on reproductive health. While Sierra Leone (where women face a one in 21 risk of dying in pregnancy and childbirth over their lifetime) receives the greatest amount of reproductive health funding per person at $7.43, Rwanda (where the risk of dying is one in 35) receives just $0.38 per person. Women in Niger, Liberia and Somalia face an average lifetime one in 17 risk of maternal death, yet these countries receive no reproductive health funding from the bank at all.

While the World Bank’s approach to reducing maternal mortality responds to many leading causes of maternal death, such as haemorrhage, infection and obstructed labour, its investments virtually ignore the risk of maternal injury and death that stem from unsafe abortion.

Globally, unsafe abortions account for 67,900 (13%) maternal deaths each yearapproximately half occur in Sub-Saharan Africa. Although the bank’s Reproductive Health Action Plan acknowledges the severe risk of maternal death and injury due to unsafe abortion, particularly for adolescents, the majority of bank-funded reproductive health projects do not include any interventions to address it.

For example, the bank’s Health System Performance projectin the west African country of Benin, which allocates about $5m to reproductive health, acknowledges that infections stemming from unsafe abortion are the second leading cause of maternal death at four of Benin’s referral hospitals. However, none of the project activities directly addresses this alarming statistic. Although four of the bank’s 39 current reproductive health-related projects in sub-Saharan Africa include interventions to reduce maternal death from unsafe abortions, none include indicators to measure if these interventions are actually carried out.

Also troubling is the fact that many of the World Bank’s current reproductive health projects promote healthcare user fees, despite overwhelming evidence that such fees drastically reduce women’s healthcare access, exacerbate poverty and undermine efforts to reduce maternal mortality.

For example, the World Bank’s $4.3m reproductive health vouchers in western Uganda project, which ended in December 2011, required women to purchase $2 vouchers that entitled them to prenatal and postnatal care, treatment for sexually transmitted diseases, and facility-based delivery. This is a prohibitive amount in Uganda, where half the population lives on less than $2 per day.

The World Bank must re-evaluate its strategies for reducing maternal mortality if it is ever going to live up to its claim of being a “global leader” in improving reproductive health. The bank must increase the number of grants it provides to expand access to reproductive and maternal healthcare — including post-abortion care — and eliminate any fees attached to these vital services.

Catholic Hospitals Expand, Religious Strings Attached

Published: February 20, 2012

As Roman Catholic leaders and government officials clash over the proper role of religion and reproductive health, shifts in health care economics are magnifying the tension. Financially stronger Catholic-sponsored medical centers are increasingly joining with smaller secular hospitals, in some cases limiting access to treatments like contraceptionabortion and sterilization.

Catholic hospitals have a broad mission for medical care, says Sister Carol Keehan, president of the Catholic Health Association.

In Seattle, Swedish Health Services has offered elective abortions for decades. But the hospital agreed to stop when it joined forces this month with Providence Health & Services, one of the nation’s largest Catholic systems.

In late December, Gov. Steve Beshear of Kentucky turned down a bid by Catholic Health Initiatives, another large system, to merge with a public hospital in Louisville, in part because of concern that some women would have less access to contraceptive services.

And in Rockford, Ill., there is resistance to a plan by OSF HealthCare, run by the Sisters of the Third Order of St. Francis, to buy a hospital because of new restrictions that would require women to go elsewhere if they wanted atubal ligation after a Caesarean section.

About 20 such deals have been announced over the last three years, by one estimate, and experts expect more as stand-alone hospitals and smaller systems with no Catholic ties look to combine with larger and financially stronger institutions, in part because changes under the federal health care law are forcing all hospitals to become much more efficient.

There is already considerable tension between Catholic-run medical institutions and the Obama administration over insurance coverage for contraception for employees. The cultural divide over reproductive health is playing out on the campaign trail as candidates debate hot-button issues like abortion and contraception.

But while the growth of Catholic-run hospital networks is a testament to their long history and operational skill, local and state officials, doctors and advocates in many communities are concerned that some procedures that run counter to Catholic doctrine may no longer be available or will be much more limited. Some doctors fear they may not be able to do what’s best for patients, forced to wait to treat a woman who is miscarrying, for example, or to send arape victim elsewhere for an emergency contraceptive.

The restrictions at any given hospital may not be clear. “Women simply don’t know what they’re getting,” said Jill C. Morrison, senior counsel in health and reproductive rights at the National Women’s Law Center.

The confusion is likely to increase.

“We are starting to see what was rare in the past,” said Lisa Goldstein, who follows nonprofit hospitals for Moody’s Investors Service and predicts more such partnerships. The institutions themselves are grappling with how to remain true to Catholic doctrine and serve a broader community. About one-sixth of all patients were admitted to a Catholic hospital in 2010. In many smaller communities, the only hospital within miles is Catholic.

“That is a constant challenge,” said Sister Carol Keehan, president of the Catholic Health Association of the United States, which represents the nation’s roughly 600 Catholic hospitals. “It’s a challenge we take very seriously.”

Being a Catholic hospital means adhering to the church’s religious directives about care, Sister Carol said, but she says hospitals also see their mission much more broadly, including caring for those who are less fortunate and treating patients with respect.

At the Seton Healthcare Family in Texas, a unit of Ascension Health — the nation’s largest Catholic system and largest nonprofit system — officials say partnerships with struggling community hospitals are integral to their mission. Seton’s first partnership, in 1995, was to operate Brackenridge, a public hospital in Austin, because Seton was “not doing enough to care for the poor and vulnerable in central Texas,” said Charles J. Barnett, an Ascension executive.

In that case, Mr. Barnett says the system never agreed to provide services like elective abortions and sterilizations, and public officials and hospital administrators initially struggled to find a compromise. Although another system eventually offered sterilizations on a separate floor of the hospital, complete with a separate elevator, another hospital now provides those services.

One large system, Catholic Healthcare West in San Francisco, announced in January that it was severing its formal ties to the church to better work with hospitals that did not share its faith. The system, renamed Dignity Health, operates 25 Catholic hospitals, which will remain Catholic, and 15 non-Catholic hospitals. While none of Dignity’s hospitals will provide elective abortions or offer in vitro fertilization, the non-Catholic hospitals will not have to adhere to the church’s religious directives.

Dignity officials declined interview requests.

Even as Catholic Healthcare West, however, the system was not without controversy. One of its Catholic hospitals performed what it considered a life-saving abortion in 2009, but the local bishop in Phoenix disagreed, and the nun who allowed the procedure was excommunicated.

In many communities, like Rockford, the question is an intensely practical one: How will patients, particularly women, use services barred by the church? Because none of the city’s three hospitals perform elective abortions, the debate has largely focused on whether a woman who has a C-section can have her tubes tied afterward.

“It would just be an inconvenience to the patient and the physician, who has to make life-and-death decisions,” said Dr. Ronald Burmeister, a retired obstetrician in Rockford who is concerned about the merger.

The merger itself was prompted by the increasing need for hospitals to combine. Despite the federal government’s concern about possible antitrust implications, many believe the city can support just two hospitals. “Rockford needed a strategic partner,” said Andrew K. Bachrodt, a managing director for Kurt Salmon Associates, which advises nonprofit hospitals. OSF already owns a Rockford hospital, OSF Saint Anthony Medical Center.

OSF says Rockford needs fewer hospitals and wants to expand its network to better serve the area. “It’s all about how to deliver care, coordinated and efficient care,” said Robert C. Sehring, an executive at OSF.

OSF has already developed an arrangement in which affiliated doctors can prescribe birth control pills through a separate practice.

A woman who wanted a tubal ligation immediately after a C-section would be able to go to a competing hospital, if her insurance plan allowed. “It’s not like we’re eliminating female sterilization procedures,” said Kris L. Kieper, the chief executive of the YWCA in Rockford, who serves on an advisory committee for the OSF hospital there.

In Louisville, the debate focused on contraceptive services, like elective sterilizations, that had been provided by the University of Louisville Hospital, one member of a planned three-party merger that would have created a large statewide system. There was considerable uncertainty over whether University Hospital would be required to follow Catholic policies, according to a report by the Kentucky attorney general. Officials initially said the hospital would follow Catholic directives but then focused on certain procedures.

“While this evolving explanation may represent an accurate description of the proposed legal structure of the consolidation, it has cast a cloud of vagueness and skepticism over the issue in the public eye,” the report concluded.

Asking women to go across town to another hospital for services is not a solution, said Dr. Peter Hasselbacher, a retired university official who follows health policy in Kentucky. And while women in Louisville generally have a choice of hospitals, women in rural communities may not, he said, adding that many of Catholic Health Initiative’s Kentucky hospitals are the only hospital available.

Catholic Health says there was never a possibility that University Hospital would be allowed to perform services like elective sterilizations. “Our position around the ethical and religious directives never changed. How we communicated that evolved and changed over time,” said Paul Edgett, a senior vice president at the system.

Mr. Edgett says the system will consider future partnerships with non-Catholic hospitals, including University Hospital, as it seeks to position itself as a stronger system as health care evolves. “We all have to adopt and adapt,” he said. But, he added, “we’re not going to compromise our values in the process.”

Russia has just defunded most abortions – a dangerous and discriminatory act that will harm vulnerable groups of women the most. If anyone is interested in arguments about why all abortions must be fully funded, here’s a piece written for the Canadian situation but much of it could apply anywhere:


The Russian Health Ministry has cut the list of social grounds that allow women to have a free abortion, which leaves sexual assault as the only excuse for women to abort their pregnancy.

“A pregnancy which occurs after sexual assault, is a social reason for a woman to have an abortion,” the Health Ministry said in a statement.

Other social factors that would have qualified a woman for a free abortion were; if there was a court decision to relieve a woman of her parental rights, if a woman was in jail, or if a father became disabled or died during a woman’s pregnancy.

Among the medical factors that give Russian women the right for a free abortion are AIDS infection, oncology, an active form of tuberculosis, grave genetic diseases and other health problems threatening a woman’s life.

There are both state-run and commercial clinics that carry out abortions in Russia. The former offer free services in case a woman has social or medical factors that need to be taken into account, while the latter allow women to have an abortion even if they do not qualify for a free one.

Russia argues that abortion makes the ongoing demographic crisis in the country even worse. This kind of propaganda to distract from the governments responsibilities for social and economic problems can be found in more and more eastern european countries. Forcing especially poor women in having babies wont make the problem of poverty go away.

The parliament may soon pass a new anti-abortion bill that could limit access to abortion services and toughen criminal punishment for doctors who carry out illegalized abortions.

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