IRELAND: The new abortion law – Protection of Life during Pregnancy Bill 2013 – just released

 

http://cdn.thejournal.ie/media/2013/04/protection-of-life-during-pregnancy-bill-plp-30-04-13-10-30.pdf

 

Summary and comment, Marge Berer, Reproductive Health Matters

 

This bill manages to allow abortion if a woman’s life is at risk while at the same time protecting the life of the fetus, as required in the Irish Constitution, and at the same time, meeting the conditions laid down by the European Court to legislate clearly on matters arising from previous court cases.

 

The bill allows abortion“only if there is a real and substantial risk to the life of the mother”, for example arising from a physical illness. It says that it is “not necessary for medical practitioners to be of the opinion that the risk to the woman’s life is inevitable or immediate, as this approach insufficiently vindicates the pregnant woman’s right to life”. However, it repeats often that there must be a real and substantial risk to the life of the mother.

 

It also says: “In circumstances where the unborn may be potentially viable outside the womb, doctors must make all efforts to sustain its life after delivery. However, that requirement does not go so far as to oblige a medical practitioner to disregard a real and substantial risk to the life of the woman on the basis that it will result in the death of the unborn.”

 

This appears to take particular account of what happened to Savita Halappanavar, as does the name of the bill.

 

It creates separate conditions for what to do if the woman is threatening suicide, including requiring at least three medical opinions as to whether to allow an abortion on this ground.

 

It makes it clear that legal abortion will be very rare. It allows a woman to appeal a decision against her but makes it extremely difficult to do so.

 

It allows for conscientious objection by individuals but NOT by institutions, which is important, and requires anyone objecting to find another medical professional to refer the woman to.

 

The bureacracy for medical professional control of the decision to allow an abortion is prodigious and possibly even unworkable in practice if a woman’s life is at risk. It potentially requires many medical professionals to be involved to agree an abortion is legal, far more than in any other country. The numbers required to agree to an abortion in case of a threat of suicide appear to say it is hard to believe any woman would actually commit suicide and so she must be examined by many to prove it. It requires any abortion to take place in an obstetric hospital unless it is a medical emergency, which also has specific conditions attached.

 

It makes it very clear that there is no restriction on travelling to another country for an abortion where it is legal. It almost invites women to continue doing so rather than go through this process.

 

Last, and not least, it says that anyone found providing or having an illegal abortion will be subject to punishment of up to 14 years in prison. This is very serious. In my opinion, it is perhaps the worst aspect of this bill from Irish women’s point of view.

 

I believe this bill is extremely successful at doing exactly what the European Court required, to clarify the law when a pregnant woman’s life is at risk, and not a step further. For all the easy criticism we can make of every word of it, it is a gift to the politicians who must have felt (no matter what their personal views) that their political lives were not worth having this fight. They can now say “We did exactly what we were told to do by the European Court” and no more. It will be impossible to oppose it – in those terms – from any point of view. The person/people who drafted it deserve a gold star for compliance with the political necessity involved.

 

El Salvador: woman denied life saving medical intervention

REQUEST FOR SOLIDARITY

 

El Salvador: woman denied life saving medical intervention

 

From: Amnesty International, 15 April 2013

 

http://www.refworld.org/docid/5177d9574.html

 

Beatriz is a 22-year-old woman with a high risk pregnancy who is being denied access to

life saving medical treatment that she urgently needs in El Salvador. Her life is at risk and

she is suffering cruel, inhuman and degrading treatment.

 

Beatriz suffers from health problems that put her life at risk while she is pregnant. She has a history of lupus, a

autoimmune disease in which the body’s immune system attacks the person’s own tissue. She also has other

medical conditions, including kidney disease related to the lupus, and she suffered serious complications during

her previous pregnancy. Beatriz has been diagnosed as being at high risk of pregnancy-related death if she

continues with the pregnancy. Three scans have confirmed that the foetus is anencephalic (lacking a large part of

the brain and skull). Almost all babies with anencephaly die before birth or within a few hours or days after birth.

 

Beatriz has been requesting the recommended medical intervention for over a month. Beatriz wants to live and has

requested an abortion. She is now 4 and a half months pregnant. The medical professionals have not acted in

accordance with her wishes as yet because they feel unable to terminate her pregnancy without the express

assurance from the Salvadoran government that they will not be prosecuted for administering the life saving

treatment she needs. Abortion is criminalised in all circumstances in El Salvador. Under Article No. 133 of the

Penal Code, anyone who provides, or tries to access, abortion services can face lengthy prison sentences.

 

The health professionals responsible for Beatriz’s care have requested permission from the authorities to proceed

with the treatment. As yet no response has been given. Anxiety and suffering increase for Beatriz and her family

every day as concerns for her survival grow. Beatriz has a one year old son. The physical and mental anguish she

is experiencing is contributing to her health condition.

 

Please write immediately in Spanish or your own language:

·           Calling on the authorities to prevent any further denial of treatment and ill-treatment and order the immediate

unfettered access by Beatriz to the life saving treatment she needs, in accordance with her wishes and the

recommendations of medical staff;

·           Urging them to immediately ensure that the health professionals are enabled to provide the treatment necessary

to save Beatriz’s life without the threat, risk or fear of criminal prosecution for doing so in accordance with Beatriz’s

wishes.

·           Urging them to decriminalise abortion in all circumstances and ensure safe and legal access by women and

girls to abortion services necessary to preserve their life or health, or if they are pregnant as a result of rape.

 

PLEASE SEND APPEALS BEFORE 27 MAY 2013 TO:

Minister of Health

Dra. María Isabel Rodríguez

Ministerio de Salud

Dirección postal: Calle Arce No.827,

San Salvador, El Salvador

Fax: +503 2221 0991

Email: mrodriguez@salud.gob.sv

Salutation: Dear Minister/Estimada

Ministra

 

President

Mauricio Funes

Presidente de la República de El

Salvador

Dirección postal: Alameda Dr. Manuel

Enrique Araujo, No. 5500,

San Salvador, El Salvador

Fax +503 2243 6860

Salutation: Dear Mr/ Estimado Sr

 

And copies to:

The Citizens Group for the

Decriminalisation of Therapeutic,

Ethical and Eugenic Abortion

Fax: +503 2226 0356 (say “tono de fax”)

Email: agrupacionporladespenalizacion@gmail.com

 

Also send copies to diplomatic representatives accredited to your country.

 

New website www.doctorsforchoiceireland.com

The website www.doctorsforchoiceireland.com has just gone live.

Doctors for Choice is an alliance of independent medical professionals and students advocating for comprehensive reproductive health services in Ireland, including the provision of safe and legal abortion for women who chose it.

We believe that women should be supported to make their own decision regarding their sexual and reproductive health and to manage their own fertility, with doctors and nurses providing expert advice and care without judgment, recourse to the law or fear of criminal sanction.

We welcome your support. If you are a doctor or a medical student we will gladly welcome you into membership. You can contact us at doctorsforchoice@gmail.com

Follow them on Twitter and Facebook.

 

e: doctorsforchoice@gmail.com

t:  @doctors4choice

f:   Doctors For Choice Ireland

w:  www.doctorsforchoiceireland.com

 

Suicide in Pregnancy is much rarer now ‘thanks to legal abortion’

http://www.nwci.ie/news/2013/03/22/suicide-in-pregnancy-is-much-rarer-now-thanks-to/

22 Mar 2013

Dr Peadar O’Grady, Doctors for Choice speaking at seminar “Abortion – The Lives and Health of Women”

Article by Dr Peadar O’Grady, Consultant Child and Adolescent Psychiatrist and member of Doctors for Choice

It is important in discussing the relevance of suicide in the current abortion debate that good medical practice does not come second place to legal arrangements for certification. Maternal mental health matters because of the effects on the mother of mental distress, self-harm and the catastrophe of a completed suicide, but also because of the devastating effects any and all of these can have on any children involved. It is often observed that during pregnancy the incidence of mental health problems and suicidal ideas is high but the risk of completed suicide is lower than usual for comparable women. Even so, because the total of maternal deaths in pregnancy is low, suicide is still one of the top 4 causes of maternal deaths in developed countries.

Groups at higher risk of suicide are those with an unwanted pregnancy, particularly teenage mothers and those on low incomes. In its 2009 report on Maternal Mental Health, the UN’s World Health Organisation (WHO) has highlighted the increased risk of mental health problems in, “unintended pregnancy especially among adolescent women”. The WHO emphasises the further risk from factors such as poverty and lack of support, “in contexts in which there are strong, gendered role restrictions on women including lack of reproductive rights”. ‘Reproductive rights’ for women means the right to decide whether or not they want to have children and, if so, how many and when.  To be vindicated this right requires access to abortion services but also access to good quality obstetric, contraceptive and STD services as well as sex education and information. In his 2011 journal article ‘Suicidal Mothers’, Salvatore Gentile agreed that maternal suicide attempts during pregnancy were increased where there was: “teen age, unplanned pregnancy, unmarried status or recent divorce, unemployment, and difficult access to safe abortion service(s).”

It has also been observed that suicide in pregnancy (and the year after delivery, known as the ‘puerperium’) has become much less common with access to legal abortion services. Professor Robert Kendell summarised this conclusion in the title of his 1991 review in the British Medical Journal: ‘Suicide in pregnancy and the puerperium, much rarer now: thanks to contraception, legal abortion and less punitive attitudes’. It is therefore clear from the WHO and peer-reviewed research that restricting access to abortion, that is, denying women ‘the right to choose’, raises the risk of suicide in pregnancy.

Despite this the opposing notion that choosing an abortion increases the risk of mental health problems, and even suicide, persists. This false conclusion is a misreading (often deliberate and repeated) of the fact that there is often a higher incidence of mental health problems found in people who have had abortions than among those giving birth. However ‘correlation is not causation’. When previous mental health and unwanted pregnancy are taken into account there is no higher rate after an abortion. This makes abortion a ‘risk indicator’ rather than a ‘risk mediator’. As we have seen the likely mediators are unwanted pregnancy and previous mental health problems. It is also well known that, following abortion, mental health problems are more common where the woman has had a negative attitude to abortion before and a negative reaction after, especially when she has been under pressure to have an abortion. The ‘right to choose’ must be without pressure to choose a certain way. Good counselling and practical support before and after this decision is the key to supporting women with unwanted pregnancies.

A similar example of prejudice clouding judgement is the observation that LGBT individuals are at higher risk of mental health problems. One conclusion (by many of the same fundamentalist Christians who populate the anti-choice lobby) is that homosexual or transgendered people should be ‘cured’ from this presumed ‘disease’. The modern psychiatric approach, based on evidence, has been to reject the notion of homosexuality or transgender as diseases by identifying the high incidence of bullying and discrimination as causative factors, or ‘risk mediators’, for mental health problems in this group.

When the allegation, that abortion leads to mental health problems or suicide, is systematically investigated, it is found to be false. In the US the American Psychological Association in 2008 found there was no credible evidence that choosing to have an abortion raised the risk of mental health problems. In the UK the National Collaborating Centre for Mental Health’s review in 2011 reached the same conclusion. Where there the choice of legal abortion services is available there is no increase in suicide (or mental health problems) caused by choosing an abortion with informed consent.

Anti-choice proponents have emphasised that ‘Abortion is not a treatment for suicide’ and ignored the fact that there is no such narrowly-defined thing as a ‘treatment’ for suicide. However, abortion, for those who choose it with proper supports, can be as much a ‘treatment’ for the risk of suicide as blood pressure tablets are a ‘treatment’ for the risk of a heart attack. Both can be preventive, lowering the impact of a relevant risk factor; that is, the distress of an unwanted pregnancy and high blood pressure respectively. The ‘treatment’ for unwanted pregnancy is ‘non-directive counselling’ and the ‘treatment’ for suicidal risk in unwanted pregnancy is ‘risk-reduction’, which includes facilitating the choice of accessing abortion services.

In Ireland, abortion, and even access to information on abortion, is heavily restricted with a criminal sanction, confirming the ‘punitive attitude’ Prof Kendell referred to over 20 years ago. Women are forced to travel, usually alone or with a very restricted support network because of the costs of travel. As a result, in this Irish context, the restriction of access to abortion services is mediated by restrictions on travel. The following groups, whose ability to travel is compromised, are therefore at an increased risk of restricted access to abortion and hence at an increased risk of suicide:

• Women too sick to travel
• Adolescents and young women
• Women with young children
• Migrant women
• Women with Disabilities
• Women with no or low incomes
• Women whose pregnancy, involves a fatal foetal malformation
• Women pregnant as the result of rape or child sexual abuse.

The obvious solution to these risk factors is to end the unnecessary, dangerous, and, for the most part, ineffective legal restrictions on abortion services. This is the very successful approach taken in Canada for the last 25 years. Abortion there is subject to healthcare guidelines and not criminal law; just like every other medical service. It is an ongoing absurdity that pregnant women are in some way considered to be exceptions to the usual rules of capacity to make a decision.

It seems likely however that, instead of the Canadian model, emergency legislation in Ireland will deal only with the risk to just some of those whose ability to travel is restricted. The ‘need’ to distinguish between, and medically certify, a risk to the life, as opposed to the health, of pregnant women has put an emphasis on suicide that shows little concern for either crisis pregnancy or suicide.

In summary, in terms of mental health concerns, it is important to stress that unwanted pregnancy and previous trauma or mental health problems are the most relevant risk factors for mental health in pregnancy and that women on low incomes and child and adolescent mothers are at particular risk; the focus should be on care and support. Restriction of access to abortion increases suicide risk and supported choice reduces suicide risk. While there is no medical need for aspecial legal framework for abortion, doctors are perfectly capable of certifying the need to support a woman’s choice of abortion services to reduce her risk of mental health problems and suicide.

Doctors for Choice is an organisation of doctors who wish to promote choice in reproductive healthcare. This means advocating for informed consent as the basis for decision making within the doctor-patient relationship. The NWCI and Doctors for Choice recently organised a Seminar on “Abortion – The Lives and Health of Women”, see presentations from the seminar.

 

US aid ban on abortions for women raped in war

Source: http://www.guardian.co.uk/global-development/poverty-matters/2013/feb/12/us-aid-ban-abortions-rape-victims

 

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

 

Canada: The benefits of decriminalizing abortion

http://www.rabble.ca/columnists/2013/01/benefits-decriminalizing-abortion

By Joyce Arthur

| January 4, 2013

On January 28, 2013, Canada will celebrate 25 years of reproductive freedom. Since our Supreme Court struck down Canada’s abortion law in 1988, our country’s experience is proof that laws against abortion are unnecessary. A full generation of Canadians has lived without a law and we are better off because of it.

Canada is the first country in the world to prove that abortion care can be ethically and effectively managed as part of standard healthcare practice, without being controlled by any civil or criminal law. Our success is a role model to the world.

History: Previous laws and one Doctor’s civil disobedience 

In the 1988 Morgentaler decision, the Supreme Court of Canada ruled that our criminal law on abortion violated the constitutional right to “security of the person” under our Charter of Rights and Freedoms. One justice, Bertha Wilson, also found that women’s rights to life, liberty, conscience, privacy, and autonomy were compromised by the law. She stated that every individual must be guaranteed “a degree of personal autonomy over important decisions intimately affecting his or her private life. Liberty in a free and democratic society does not require the state to approve such decisions but it does require the state to respect them.” 

The struck-down law was a liberalized one that passed in 1969, replacing a strict ban on abortion. The 1969 law required women to apply for permission from a hospital committee, which would decide if a woman’s health or life was at risk. The law obstructed access for women because most hospitals did not even establish committees, while some that did refused to approve most or all applications. In practice, access to abortion was spotty and unfair. Long delays at hospitals also increased the health risks for many women. Abortion clinics were illegal. 

Dr. Henry Morgentaler had begun performing safe — but illegal — abortions in his private office in Montreal in 1968, a year before the new law passed. In 1967, he told a Parliamentary committee that women had a right to abortion on request without having to state a reason. After the 1969 law passed, he continued to break the law because he knew that sending women to a committee for approval was a discriminatory barrier that increased medical risks to women.

During his 20-year battle, Dr. Morgentaler challenged the law by opening illegal abortion clinics in three cities and inviting media coverage of his safe abortion services. Police raided the clinics several times, resulting in repeated arrests and trials that eventually led to the historic Supreme Court victory on January 28, 1988.

Reaping the benefits of decriminalization 

The evidence now vindicates Dr. Morgentaler’s perspective and Canada’s legal position. After 25 years with no legal restrictions on abortion whatsoever:

- Doctors and women handle abortion care responsibly.
- Abortion rates are fairly low and have steadily declined since 1997.
- Almost all abortions occur early in pregnancy.
- Maternal deaths and complications from abortion are very low.
- Abortion care is fully funded and integrated into the healthcare system (improving accessibility and safety).
- Further legal precedents have advanced women’s equality by affirming an unrestricted right to abortion. 
- Public support for abortion rights has increased. 

Responsible abortion care: Since 1988, the Canadian Medical Association (CMA) has successfully managed abortion just as it does for every other medical procedure — by applying policy and encouraging medical discretion for doctors, subject to a standard code of ethics.

Doctors abide by CMA policy and guidelines, and follow best medical practices based on validated research and clinical protocols. Criminal laws are inappropriate and harmful in medicine because they constrain care and negatively impact the health of patients. 

Low and declining abortion rates: Canadian women had 93,755 abortions in 2009 – the last year for which reliable numbers are available. This translates to an annual abortion rate of 14 per 1000 women of childbearing age, approaching the lowest rates in the world. Incidentally, the annual abortion rate in the United States has also declined significantly in the last decade, and now sits at 15 abortions per 1000 women of childbearing age. 

Although western European countries and the U.S. enforce various legal restrictions on abortion care, their declines in abortion rates are not attributed to the effect of laws, but largely to more effective and increased use of contraceptives. The evidence is clear that contraception and family planning services are key to reducing unintended pregnancy, which is the main cause of abortion. In countries where abortion is legal and contraceptive use improves over time, abortion rates decline predictably and often dramatically. This pattern has repeated itself countless times around the world, including in Canada, where our abortion rate has declined by at least 14 per cent since 1997, and by 29 per cent amongst teenagers. 

Earlier abortions: At least 90 per cent of abortions in Canada are now performed on request in the first 12 weeks. The procedure is very safe and 97.6 per cent of terminations (in hospitals) have no complications. Less than 2 per cent of abortions occur after 20 weeks (again in hospitals only), and these are performed only in cases of severe fetal anomaly or under compelling maternal life or health circumstances. A similar situation exists in every country independently of any laws — the majority of women seeking abortions will present early, while a small number of women will always need later abortions because of exceptional circumstances. 

Low complication and death rate: About half of abortions are now done in private clinics in Canada, virtually all by 16 weeks of pregnancy. Since early abortions are safer than later abortions, and hospitals handle the later and more complex cases, our hospital statistics likely overestimate the number of later abortions, as well as maternal deaths and complications from abortion. Statistics Canada reported that in 1995, less than 1 per cent of abortions in Canada resulted in any complication at all, whether minor or more serious. Further, Canada has one of the world’s lowest maternal mortality rates from legal abortion. Between 1976 and 1994, the mortality rate was estimated to be 0.1 deaths for every 100,000 abortions – about one every ten years — compared to a rate of 0.7 in the U.S (from 1988 to 1997). Maternal death from legal abortion remains virtually unheard of in Canada today. 

Funding and integration into healthcare system: Abortion care has become better integrated into the Canadian healthcare system, partly because it was already being done in hospitals and funded as “therapeutic abortion” before 1988. However, between 1988 and 2006, the pro-choice movement successfully challenged provincial governments to also fund all procedures done at private clinics. Today, only the province of New Brunswick refuses to pay for abortions at one private clinic, in defiance of federal law. (The Canada Health Act guarantees funding and equitable access for all “medically required” treatment, which includes abortion.) Full government funding for abortion is essential to protect women from discrimination, facilitate early access, ensure acceptable standards of care, and prevent the service from becoming marginalized or further stigmatized.

Further legal precedents: Subsequent court rulings have solidified the Morgentaler decision, which has been widely cited in other rulings due to its advancement of women’s constitutional rights. The Supreme Court appears to have adopted Justice Wilson’s broader approach to such rights, recognizing for example that the right to liberty includes the autonomy to make decisions of fundamental personal importance. Our federal Criminal Code states that the legal status of “human being” accrues only after exiting the birth canal alive, a definition validated by several Supreme Court decisions that established that fetuses are not legal persons and that women’s rights must prevail. In a 1999 decision, Dobson v. Dobson, the Supreme Court ruled that: “A pregnant woman and her foetus are physically one, in the sense that she carries her foetus within herself. The physical unity of pregnant woman and foetus means that the imposition of a duty of care would amount to a profound compromise of her privacy and autonomy.” 

Increased public support: Strong public support exists for abortion rights in Canada, despite lingering social stigma against abortion that is continually reinforced by anti-choice propaganda. Even though half of Canadians appear to want some restrictions on abortion, this anti-choice article on polling shows a gradual increase in pro-choice support since the 1980′s. A 2012 poll revealed that 49 per cent of Canadians support abortion on request at any time, while only 6 per cent want a total ban. (In comparison, 30 per cent of Americans want it fully legal while 15 per cent prefer a total ban.) 

Having no laws is not enough 

Of course, the lack of restrictive laws alone does not guarantee access or availability of services. Canada still has problems with access because of ongoing abortion stigma, inadequate training in medical schools, reluctance of politicians to implement improvements, and simple geography — abortion is much easier to access in larger cities than in Canada’s vast rural areas and North, where women often must travel to find abortion care. However, another benefit of decriminalization is that we have been able to focus our time on addressing these issues instead of struggling against restrictive laws. 

Key to understanding the incidence of abortion is that it can never be eliminated. We will never live in a perfect world — contraception is far from 100 per cent effective, people are human, and continuing inequality means that disadvantaged women will experience higher rates of unintended pregnancy. The lowest possible abortion rates — the rates of 6 to 7 per 1000 women of childbearing age that were achieved in the past by Holland and Belgium – require a sustained commitment and dedicated resources in areas such as family planning and reproductive health services, comprehensive sex education, and doctor training. The other key element in reducing abortion is to advance women’s status and equality so they are more empowered to avoid unintended pregnancy. 

Vigilance is also required due to the endless tenacity of the anti-choice movement. Since 1988, Canada has seen 45 attempts to recriminalize or restrict abortion through the introduction of Private Members Bills or Motions in Parliament. Not one has passed, and nor is one likely to pass. Despite the loud voices and campaigning power of anti-choice activists, women’s rights are well established in Canada and sexual and reproductive health is understood as a vital facet of overall health. 

The moral high road: Decriminalizing abortion

The rest of the world is catching up to Canada. Two Australian states have also successfully decriminalized abortion in recent years. And in 2011, a groundbreaking report to the United Nations boldly called on all states to decriminalize abortion. The UN’s Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health described laws restricting abortion as an abuse of state power. Such restrictions “infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity.” 

Looking at Canada, concerns that other countries may have about eliminating punitive laws on abortion are clearly unfounded. Even with our remaining issues, our outcomes are exemplary. We can all thank Henry Morgentaler for that. 

The Canadian pro-choice movement will do all it can to ensure that Canada never goes back, and we encourage other countries to embark upon a similar journey. When women can make their own reproductive decisions without interference from the state, society takes the moral high road — one that saves lives, raises women’s status and potential, and ultimately benefits everyone. 

 

Joyce Arthur is the founder and Executive Director of Canada’s national pro-choice group, the Abortion Rights Coalition of Canada (ARCC), which protects the legal right to abortion on request and works to improve access to quality abortion services.

The author would like to thank Jane Cawthorne for contributing to this article.

 

 

Philippines: Leave no woman behind: Why we fought for Reproductive Health Bill

By Miriam Defensor Santiago, Special for CNN

December 31, 2012

Supporters of the RH Bill celebrate, as lawmakers pass the landmark birth control legislation on December 17.

Editor’s note: Miriam Defensor Santiago is in her third term as a member of the Philippines Senate and a co-sponsor of the Reproductive Health Bill. She is also the founder of People’s Reform Party. Last year she was selected to be a judge in the International Criminal Court, though she has still to take office.

Manila, Philippines (CNN) – We were like David against Goliath. We fought long and hard, and in the end we prevailed.

After 14 long years in the dustbins of Congress, mainly due to strong opposition from the Catholic Church, the Reproductive Health (RH) Bill was approved by both the Senate and the House of Representatives on Monday, 17 December 2012.

Indeed, there is no force more powerful than an idea whose time has come. And the time for a Philippine reproductive health law is now.

Read: Philippines leader signs divisive bill

The Philippines remains one of the poorest countries in the world because, among other things, for a long time, it refused to acknowledge what could easily be seen when one glances out the window: the country desperately needs a reproductive health law.

Not having a reproductive health law is cruelty to the poor. The poor are miserable because, among other reasons, they have so many children. Providing reproductive knowledge and information through government intervention is the humane thing to do. It can help the poor escape the vicious cycle of poverty by giving them options on how to manage their sexual lives, plan their families and control their procreative activities. The phrase “reproductive rights” includes the idea of being able to make reproductive decisions free from discrimination, coercion or violence.

Read: A14-year fight for birth control

Many poor women do not receive information on how to receive reproductive health care. Our underprivileged women have to accept standards lower than what they need, want, or deserve. According to the Department of Health, the mortality rate for Filipino mothers increased to 221 per 100,000 live births in 2011 from 162 per 100,000 live births in 2009. But not only do the women suffer, the children do, too. The children remain undernourished and undereducated because their parents are ignorant about reproductive health care and choices.

In short, the bill merely wants to empower a Filipino woman from the poorest economic class to march to the nearest facility operated by the Department of Health or the local government unit, to demand information on a family planning product or supply of her choice. The bill, at the simplest level, wants to give an indigent married woman the freedom of informed choice concerning her reproductive rights.

If the bill is highly controversial, it is not because it is dangerous to humans or to the planet. It is not subversive of the political order. It is not a fascist diktat of a totalitarian power structure. The reason this bill is emotionally charged is because of the fervent opposition of the Catholic Church in the Philippines and those who wish to be perceived as its champions.

Yet the majority of Catholic countries around the world have passed reproductive health laws, even Italy where the Vatican City is located. Other nations include Spain, Portugal, Paraguay, Mexico, Guatemala, Ecuador, Colombia and Argentina.

Apart from the Catholic Church, all other major religions in the Philippines support the RH Bill. Other major Christian churches have not only officially endorsed the bill but have published learned treatises explaining their position. Support also comes from the Interfaith Partnership for the Promotion of Responsible Parenthood, the National Council of Churches in the Philippines, the Iglesia ni Cristo and the Philippine Council of Evangelical Churches.

The position of these Christian bodies is supported by the most authoritative body of Islamic clerics in the Philippines, the Assembly of Darul-Iftah of the Autonomous Region of Muslim Mindanao. These constitute the top-ranking ulama, deemed to have the authority to issue opinions on matters facing Islam and Muslims. In 2003, they issued a fatwah or religious ruling called “Call to Greatness.” It gives Muslim couples a free choice on whether to practice family planning.

The Filipino people, regardless of religion, are in favor of RH. In June 2011, the Social Weather Stations, a survey group, reported that 73% of Filipinos want information from the government on all legal methods of family planning, while 82% say family planning method is a personal choice of couples and no one should interfere with it. An October 2012 survey among young people aged 15 to 19 years old in Manila shows that 83% agree that there should be a law in the Philippines on reproductive health and family planning.

This is the will of the Filipino people; it is the democratic expression of what the public wants from government. The anti-RH groups are mute on this ineluctable fact.

Reproductive health care is a human right. The people are entitled to demand it from their government and the government is obligated to provide it to its constituents.

 

Abortion deaths wildly underestimated

http://www.salon.com/2012/12/13/how_many_savitas_have_there_been/

Thursday, Dec 13, 2012 6:36 PM UTC

It was worldwide news when a woman died in Ireland after being denied an abortion. She was hardly the only tragedy

By Irin Carmon

By now, many have heard the name of Savita Halappanavar, whose death in a Galway hospital this fall was a chilling reminder of how abortion bans can be deadly.

That case had the benefit of a vocal and angry person to speak on the dead woman’s behalf — her husband, Praveen. He has said she requested a termination that may have saved her life — but was told, “This is a Catholic country.” (An official inquiry by the hospital has yet to be released, and Praveen Halapannavar isappealing to the European Court of Human Rights.) But for every Savita, there are thousands of women whose names we don’t know, women who aren’t even counted.

The most commonly cited statistic suggests that complications from unsafe abortions led to approximately 13 percent of maternal deaths worldwide. That’s a World Health Organization figure first arrived at in 2000, which hasn’t been re-evaluated. Every year, when WHO says how many women have died from unsafe abortions, they’re simply taking the same percentage of the global maternal mortality figure — 56,000 in 2003, or 47,000 in 2008. But one epidemiologist, Caitlin Gerdts, wondered if that number wasn’t a potentially vast understatement.

A few years ago, Gerdts was planning to write her dissertation about maternal mortality at a hospital in Zanzibar, Tanzania. “From the data we were able to gather I was sure that we had missed a number of women who had died likely from unsafe abortion,” she told Salon. Even in the original WHO report, she said, the authors “talk about how unsure they are about that estimate, and how they have the aggregate data, and how the data that they did have from countries where abortion-related mortality is the highest were of the poorest quality. They say directly, this is the best number we can come up with –  but we think it’s an under estimate.”

And a lot has changed since 2000, in both directions: Some countries, including in sub-Saharan Africa, have liberalized their laws; others, notably in Central America, have toughened their bans. Meanwhile, misoprostol, a pill which can induce a miscarriage identical to a spontaneous one, has become more widely distributed across the developing world. “There has been so much happening in the last decade,” said Gerdts, who is now affiliated with Advancing New Standards in Reproductive Health at University of California, San Francisco. “It’s impossible that the number has stayed the same.”

She eventually proposed a statistical model that would take into account what the researchers were getting at but not naming: Stigma. Specifically, women who were coming into hospitals seeking post-abortion care and would be reluctant to attribute the bleeding to a self-induced abortion because they feared social and criminal consequences. And, said Gerdts, “Doctors aren’t going to record it because they’re afraid of repercussions. Or maybe the woman hasn’t even told her family she was pregnant or that she had induced abortion.”

Gerdts and her colleagues canvassed 300 women treated for post-abortion or miscarriage care in that Tanzanian hospital, and found that only seven of them admitted they had induced abortion. But over 85 percent of these women said they were “unsure or unhappy” about their pregnancies, suggesting that not all of them had spontaneous miscarriages. And that’s not even counting women like Halappanavar, who may have been eligible for what life-saving exceptions sometimes do exist on the books but who died out of physician reluctance to test the boundaries of the law.

If these women hemorrhaged to death or died of sepsis because they couldn’t access a safe termination, few, if anyone, would have known that it was no ordinary miscarriage — or that it could have been prevented.

 

Ireland: State settled with (now deceased) cancer patient who was denied abortion

http://www.irishtimes.com/newspaper/ireland/2012/1122/1224326952282.html

 

The Irish Times - Thursday, November 22, 2012

PAUL CULLEN, Health Correspondent

The State has paid substantial compensation to a woman who was forced to travel to Britain for an abortion despite being terminally ill with cancer.

The case was settled in just three months, her solicitor, Michael Boylan, said yesterday.

Michelle Harte, Ardamine, Co Wexford, sued for violation of her human rights last year after a hospital ethics forum had decided against authorising an abortion on the basis that her life was not under “immediate threat”.

“This was resolved very, very quickly, which is unusual in my dealings with the State,” Mr Boylan said. Ms Harte, a former nurse from London, has since died of her cancer.

In 2010, after she became unintentionally pregnant while suffering from a malignant melanoma, doctors at Cork University Hospital advised her to terminate her pregnancy because of the risk to her health.

Mr Boylan said her obstetrician was willing to perform a termination but was “hamstrung” by legal issues. The issue was referred to the hospital’s “ad hoc” ethics committee.

Appalling delay

He said there was an absence of clear guidelines about what to do and an “appalling delay” ensued. After the committee refused the termination, there were further delays because Ms Harte did not have a passport.

“I couldn’t believe the decision [to refuse an abortion in Ireland] when it came,” Ms Harte, who was then 39, told The Irish Times in December 2010. “Apparently my life wasn’t at immediate risk. It just seemed absolutely ridiculous.”

Her condition worsened significantly during this time and she was not able to receive cancer treatment because she was pregnant. She eventually travelled to Britain for an abortion; she had to be helped on to the aircraft due to a deterioration in her condition.

Mr Boylan of Augustus Cullen Law then sued the State on her behalf for infringing her rights under the ABC case, in which the European Court of Human Rights ruled that Ireland had breached the human rights of a woman with cancer who had to travel abroad to get an abortion.

In that case, the woman – “C” – had a rare form of cancer and feared it would relapse when she became unintentionally pregnant. However, the woman said she was unable to find a doctor willing to make a determination as to whether her life would be at risk if she continued to term.

Ms Harte’s lawyers served a statement of claim in May 2011 against the HSE, Ireland and the Attorney General. It was settled by July 2011. Mr Boylan declined to specify the amount but said it was substantial. Ms Harte died that November.

Mr Boylan said his client, a mother of one, was delighted not to have to go through the trauma of a court case and was pleased some compensation was available for her family.

 

What the Death of Savita Halappanavar and Canada’s Attitude to Abortion Have to Teach Us

http://www.xojane.co.uk/issues/what-the-death-of-savita-halappanavar-and-canadas-attitude-to-abortion-have-to-teach-us

Savita Halappanavar’s life ended because medics put the life of her unborn child – who they knew would die anyway – before hers, and because those medics were prevented by law from performing a procedure that would have saved her.

 

This week I’ve been thinking a lot about the tragic death of Savita Halappanavar, the 31 year old dentist who passed away in a Galway hospital last month, after being refused an abortion that could have saved her life. By the time this goes live, I’m sure the controversy will have reached Frankenstorm proportions.

Halappanavar was admitted to hospital miscarrying at 17 weeks. However, abortion is illegal in Ireland, and because the foetal heartbeat was still beating, medics refused to perform the medical abortion she needed and begged for. She miscarried days later, but not before she’d contracted the septicemia that would go on to kill her.

Anti-choice campaigners may rabbit on about the provision under law that states that abortion can be provided when there’s a direct threat to a woman’s life, or claim that the medics looking after Halappanavar should have induced labour in order to save her life.

The reality, as we’ve now seen, is that abortions are just not performed. And as for their suggestion that medics should have induced the birth of her unborn, but dying foetus? It would have been both cruel and totally unnecessary when the foetal heartbeat could have been stopped as the first step of the abortion Halappanavar repeatedly asked for.

The fact is, her baby, sadly, was not going to survive no matter what course of action her doctors took. So why not opt for the one that would have saved her?

Last week, I was contacted by Joyce Arthur, who is the Executive Director of the Abortion Rights Coalition of Canada (ARCC). Arthur emailed members of the British media wanting to talk about Nadine Dorries’ recent attempts to reduce the time limits on abortions in Britain.

She explained that abortion had been fully decriminalised in Canada in 1988 because it was felt that the application of either civil or criminal laws to medicine was inappropriate.

Abortions are seen as a matter for women and their doctors, not law-makers and politicians, and the overall impact has been positive – abortion rates had fallen. Arthur also felt that Dorries, and her strategies, were ‘misguided.’

Happy to talk to anyone who describes Nadine Dorries as ‘misguided,’ I contacted her for an interview.

Who are the Abortion Rights Coalition of Canada, and what do you do?

The Abortion Rights Coalition of Canada is a national advocacy group for abortion rights so we do lobbying and education. We act on various issues, working with MPs, to protect the abortion rights that we have and also try and improve access to abortion in different ways.

What abortion services are freely available in Canada? Are they available on the Canadian National Health Service for free?

We do have universal healthcare [an equivalent to the NHS] so it is fully covered. In 1969, abortion was decriminalised to allow women to go before a therapeutic approval committee of three doctors to get approval before an abortion.

Abortions were available at some hospitals but it turned out that the committees were very arbitrary in how they made decisions so that law was completely struck down by our Supreme Court in 1988.

After that, access improved. Before 1988 abortions were funded [by the health service] and that continued. We had a fight over the next ten years of getting private abortion clinics, which had previously been illegal, funded.

In your email to me you said, “Parliamentary debate led by MP Nadine Dorries on reducing the time limit for abortion is misguided since criminal or civil law is inappropriate in medicine.”

Can you explain to us how the laws surrounding abortion in Canada works?

We don’t actually have any laws. Basically, abortion care is delivered just like any other healthcare. We don’t use civil or criminal law in healthcare normally. Healthcare is delivered by the medical profession and they have their internal policies, they have a code of ethics for doctors around informed consent, all the normal stuff like that.

Really what it comes down to is a decision between a woman and her doctor, and the doctor has discretion over what’s appropriate for each patient and what their own limits are, and so on and so forth. They decide whether they want to perform abortions, to what gestational length and all that kind of thing.

The Canadian Medical Association passed a policy around the time of the Morgenthaller decision in 1988. Briefly, the policy is on induced abortion. It says:

“Abortion on request is recommended up to twenty weeks, and after that under exceptional circumstances.”

It doesn’t really go into [what these “exceptional circumstances” might be]. It just leaves it up to the Doctor’s discretion.

In practice what happens is that very, very few Doctors in Canada perform abortions after twenty weeks. It’s obviously a more complex procedure – it’s more skilled, so not many doctors are trained in it to begin with, meaning it’s only available at a few centres.

In almost all cases, what usually happens, especially later on in pregnancy, an abortion is sought because of lethal foetal abnormalities, where the foetus can’t survive the birth. Other cases most often involve serious health or life endangerment problems for women.

And sometimes a late abortion might be performed in especially socially compelling circumstances, which would be at the discretion of a doctor. For example, if a very young girl was in denial about her pregnancy, or a sexual assault or a domestic abuse survivor sought an abortion. In situations like that though it’s on a case-by-case basis according to the Doctor.

How has the full decriminalisation of abortion affected women in Canada?
The overall effect was that abortion was kind of incorporated into a regular part of healthcare, and even though we also had stand-alone clinics doing abortions, hospitals still were doing the bulk of abortions at the beginning.

They still do almost half so I think having that hospital-based service is important for integrating abortion care into regular healthcare instead of having it so isolated the way it is in the United States, for example.

I think it’s also shown that it’s working – we’ve gone for 25 years without law and nothing bad has happened – women are not presenting for 9 month abortions so they can fit into their prom dress, and so on.

—-

Back to Ireland. Performing or procuring an abortion in Ireland is a criminal act, with persons found guilty of either risking life imprisonment.

Savita Halappanavar’s life ended because medics put the life of her unborn child – who they knew would die anyway – before the life of the woman in front them. Because those medics were prevented by law from performing a procedure that would have saved her, and because the politicians who have the power to legislate so that no woman ever has to go through this again have refused to.

On Wednesday, hundreds of people gathered in protest outside the Dail (Dublin’s equivalent to the House of Commons), to express outrage at this tragedy and, once again, demand the government decriminalize abortion in this country.

Surely this time, now that Ireland and its abortion laws are under international scrutiny, something has got to give.

I’m tweeting angrily about Savita, Dorries and the state of reproductive rights in Ireland @AlisandeF

To make donations to ARCC or show your support, check out their website, or follow them on Twitter @abortionrights.