What Happens to Women Who Are Denied Abortions?

http://www.nytimes.com/2013/06/16/magazine/study-women-denied-abortions.html?pagewanted=1&_r=1&hp&pagewanted=all&

By JOSHUA LANG

Published: June 12, 2013 807 Comments

S. arrived alone at a Planned Parenthood in Richmond, Calif., four days before Christmas. As she filled out her paperwork, she looked at the women around her. Nearly all had someone with them; S. wondered if they also felt terrible about themselves or if having someone along made things easier. She began to cry quietly. She kept reminding herself that she felt secure in her decision. “I knew that that was going to be the right-wrong thing to do,” she told me later. “I was ready for it.”

After S. urinated in a cup, she was led into a small room. She texted one of her sisters, “Do you think God would forgive me if I were to murder my unborn child?” It was the first time anyone in her family knew she was pregnant.

“Where are you?” her sister asked. “Are you O.K.?”

“I’m at Planned Parenthood, about to have an abortion.”

“God knows your heart, and I understand that you are not ready,” her sister texted back. “I think God will understand.”

The pregnancy had crept up on S. She was a strong believer in birth control — in high school she was selected to help teach sex education. But having been celibate for months and strapped for cash, she stopped taking the pill. Then an ex-boyfriend came around. For months after, she had only a little spotting, but because her periods are typically light, she didn’t think much of it at first. Then she started to worry. “I used to press on my stomach really hard thinking maybe it would make my period come,” she said.

Around Thanksgiving in 2011, S., then 24, took her first pregnancy test — a home kit from Longs Drugs. S. (her first initial) lived alone, with her dog and her parrot, and it was late at night when she read the results. She stared into space, past the plastic stick. She’d never been pregnant before. “I cried. I was heartbroken.” Her ex had begun a new relationship, and she knew he wouldn’t be there to support her or a child. She was working five part-time jobs to keep herself afloat and still didn’t always have enough money for proper meals. How could she feed a baby? She kept the news to herself and made an appointment at Planned Parenthood.

At the clinic, a counselor comforted S. and asked her why she had come, if anyone had coerced her into making this decision. No, S. explained, she was simply not ready to have a child. The woman asked how far along she thought she might be. S. estimated that she was about three months pregnant.

In the exam room, a technician asked her to lie down. She did an ultrasound, sliding the instrument across S.’s stomach: “Oh . . . it shows here that you are a little further along.” She repeated the exam. S., she estimated, was nearly 20 weeks pregnant, too far along for this Planned Parenthood clinic. S. felt numb: “I was thinking, If it is too late here, it is probably too late other places. . . . And I was like, Oh, my God, now what?”

Planned Parenthood gave S. a packet of information, including two pieces of paper — one green, for adoption, and one yellow, for other abortion providers. S. still wanted to have an abortion. She called a clinic in Oakland and took the first available appointment, just after Christmas. “I was a ticking time bomb, running out of days,” she told me. On the Internet, another of S.’s sisters also found a place called First Resort, which provided abortion counseling. S. didn’t know that First Resort’s president once said that “abortion is never the right answer.” (A spokeswoman for First Resort says that while the organization “takes no public stand on legalized abortion,” it “does not provide abortions or abortion referrals.”)

S. went to First Resort the day before her appointment in Oakland, unsure what to expect. It provided a free ultrasound. The nurse asked S. if she wanted to see the baby and turned the monitor toward her: “Look! Your baby is smiling at you.” S. was shaken, convinced she also saw the baby smiling. The nurse told her that she was at least a week further along than the Planned Parenthood estimate (ultrasound estimates can be off by several days either way). S. sobbed all the way to her car and called the clinic in Oakland, giving it the First Resort estimate. If it was correct, they told her, she would be past its deadline. S. never made it to the Oakland clinic and in a matter of days gave up looking for another clinic that could perform a later procedure. She was out of gas money, hadn’t eaten a decent meal in weeks and resigned herself to the fact that, no matter what she wanted or how it would affect her life, she was going to have a baby.

When Diana Greene Foster, a demographer and an associate professor of obstetrics and gynecology at the University of California, San Francisco, first began studying women who were turned away from abortion clinics, she was struck by how little data there were. A few clinics kept records, but no one had compiled them nationally. And there was no research on how these women fared over time. What, Foster wondered, were the consequences of having to carry an unwanted pregnancy to term? Did it take a higher psychological or economic toll than having an abortion? Or was the reverse true — did the new baby make up for any social or financial difficulties?

“It’s not that the study was so hard to do,” Foster says. But no one had done it before. Since Roe v. Wade was decided in 1973, the debate over abortion has focused primarily on the ramifications of having one. The abortion rights community maintains that abortion is safe, both physically and psychologically — a position most scientists endorse. Those on the anti-abortion side argue that abortion is immoral, can cause a fetus pain and leads to long-lasting negative physical and psychological effects in the women who have the procedure. There is no credible research to support a “post-abortion syndrome,” as a report published by the American Psychological Association in 2008 made clear. Yet the notion has influenced restrictive laws in many states. In Alabama, women who seek an abortion must have an ultrasound and be offered the option to view the image; in South Dakota, women must wait at least 72 hours after a consultation with a doctor before having the procedure. “The unstated assumption of most new abortion restrictions — mandatory ultrasound viewing, waiting periods, mandated state ‘information,’ ” Foster says, “is that women don’t know what they are doing when they try to terminate a pregnancy. Or they can’t make a decision they won’t regret.” Lost in the controversy, however, is the flip side of the question. What, Foster wondered, could the women who did not have the abortions they sought tell us about the women who did?

Most studies on the effects of abortion compare women who have abortions with those who choose to carry their pregnancies to term. It is like comparing people who are divorced with people who stay married, instead of people who get the divorce they want with the people who don’t. Foster saw this as a fundamental flaw. By choosing the right comparison groups — women who obtain abortions just before the gestational deadline versus women who miss that deadline and are turned away — Foster hoped to paint a more accurate picture. Do the physical, psychological and socioeconomic outcomes for these two groups of women differ? Which is safer for them, abortion or childbirth? Which causes more depression and anxiety? “I tried to measure all the ways in which I thought having a baby might make you worse off,” Foster says, “and the ways in which having a baby might make you better off, and the same with having an abortion.”

Foster began by gathering data locally. She ran the study out of her office at U.C.S.F. (I am a student in the U.C. Berkeley-U.C.S.F. Joint Medical Program but did not know Foster before reporting this article.) When the counselors at a nearby abortion clinic received a woman who was too far along to terminate her pregnancy, they called Foster, who would run over and arrange to interview the patient. Given the stigma attached to seeking an abortion later in pregnancy, Foster expected that many women would be reluctant to be part of her study. But four out of five women agreed to participate. “Sometimes, if you tell them that their experience is valuable, that it might help other people in their situation, they will come through,” she says.

Initially, Foster’s study was confined to women whose pregnancies were in a narrow band of time on either side of this particular clinic’s gestational limit — two weeks under or three weeks over. (In California, state law allows an abortion up to what a physician considers viability, but clinics can set their own limits.) Eventually Foster received multiple foundation grants that allowed her to hire additional staff and recruit more subjects. The study, which is ongoing, encompasses 30 clinics from 21 states across the country. The clinics’ gestational limits vary from 10 weeks to the end of the second trimester, with a vast majority falling in the second trimester, typically defined as Weeks 14 to 26 of pregnancy. Women turned away from these “last stop” clinics had no other options within 150 miles. Of some 3,000 women who were asked to participate, 956 have completed a baseline interview and agreed to follow-up interviews every six months. Of those women, 452 were within two weeks of their facility’s cutoff and received an abortion, and 231 missed the cutoff by up to three weeks and were turned away. About 20 percent of the turnaways received an abortion elsewhere. Foster compared the remaining women who carried their pregnancies to term with the near-limit abortion patients. (The 273 other women in the study received a first-trimester abortion and acted as a control group. In the United States, 88 percent of abortions occur in the first 12 weeks, and Foster wanted to be sure that the near-limit abortion patients did not differ significantly in their outcomes from first-trimester abortion patients.) Of the turnaways in Foster’s study who gave birth, 9 percent eventually put their children up for adoption.

There are many reasons women are turned away from an abortion clinic — lack of funds (many insurance plans don’t cover abortion) or obesity (excess weight can make the procedure more complicated) — but most simply arrive too late. Women cite not recognizing their pregnancies, travel and procedure costs, insurance problems and not knowing where to find care as common reasons for delay. These are the women for whom “society has the absolute least sympathy,” Foster acknowledges. While a majority of Americans (53 percent) agree with Roe, many of those who support abortion rights draw the line at later stages of pregnancy. And the law reflects this view. Roe v. Wade guarantees a woman’s right to abortion only up to the “viability” of a fetus, with exceptions for danger to a woman’s health. (Viability varies depending on the medical expert you ask, typically at 23 weeks or more.) But the widespread discomfort with abortions near viability is reflected in recent bans on so-called partial-birth abortions. And many clinics, reacting to state law, set their own gestational limits — often 20 to 22 weeks — making later-term abortion more difficult to find in some states than in others. (In the U.S., 87 percent of counties have no abortion provider at all.)

“Usually the only difference between making it and not is just realizing you are pregnant,” Foster says. “If you’re late, abortion gets much harder to find. All the logistic concerns snowball — money, travel, support.” Women who seek abortions tend, in general, to be less well off than those who don’t, and those seeking second-trimester abortions tend to be “particularly vulnerable,” given the difficulties of finding an appropriate clinic and the higher cost of a later procedure.

As the argument that abortion harms women gains political traction, it is especially critical to look at how turnaways fare. “All past studies of women denied abortion in the United States have been hospital-specific and local, focusing on a brief amount of time, without a control group,” says Roger Rochat, former director of the division of reproductive health at the C.D.C. and a professor of global health and epidemiology at Emory University. “Foster’s turnaway study had a sample across the United States that she followed over a long period of time. It is the best science we have ever done on the subject. ”

Foster’s study does have a precedent — of a sort. In 1957, Czechoslovakia liberalized its abortion laws, while maintaining significant restrictions. Women were required to apply to an abortion commission and could be denied for a host of reasons — if they were past 12 weeks’ gestation, presented “false or insufficient” reasons or had had an abortion too recently. Women denied by the first commission could appeal to regional review boards. Some were denied twice and thus carried their pregnancies to term.

An eminent American psychologist, Henry David, took note of this and embarked on a pioneering study. Between 1961 and 1963, 24,989 Czech women applied for abortions; 638 of the applications were denied after initial application and appeal. With a team of Czech colleagues, David enrolled 220 of the women who were twice denied the abortion they sought and 220 women who never pursued an abortion. For the next 35 years, he followed their children, making regular inquiries and comparisons between the two groups.

The first results examined the children at age 9. David reported that the children born of unwanted pregnancies had significant disadvantages. They were breast-fed for shorter periods; were slightly but consistently overweight; had more instances of acute illness and lower grades in Czech. They seemed less capable in socially demanding situations; they were less popular among peers and teachers and even, if sons, with their own mothers. David concluded that “the child of a woman denied abortion appears to be born into a potentially handicapping situation.” After David published his first round of data, Czechoslovakia made first-trimester abortion available on demand.

In the course of interviewing the mothers about their children, David’s research suggested that whether the mother wanted the child was a significant predictor of the child’s future negative qualities, independent of the effect of the mother’s personality. But he did not have a proper control group to determine if a child’s unwantedness rather than a poor family environment was the source of the trouble. David called it “the Achilles’ heel” of his work.

Foster’s study, by contrast, seeks to isolate the impact of abortion by comparing two groups of very similar women: there are few differences in their educational and socioeconomic backgrounds, and they all sought an abortion. Only 6.6 percent of near-limit patients in the study and 5.6 percent of turnaways finished college (18 percent of adult American women have a bachelor’s degree). One in 10 were on welfare, and approximately 80 percent reported not having enough money to meet basic living needs. A majority, in both groups, already had at least one child.

Foster hoped that their similarities would allow her to answer more fully how abortion affects women’s mental health and emotional states. The A.P.A. report from 2008 concluded that, among adult women with unplanned pregnancies, the “relative risk of mental-health problems is no greater if [women] have a single elective first-trimester abortion than if they delivered the pregnancy.” But it did not go beyond the first trimester. It also noted the “complexity of women and their circumstances” and suggested that further study was needed to “disentangle confounding factors and establish relative risks of abortion compared to its alternatives.”

Foster saw that most abortion studies failed to acknowledge that women seeking abortions are likely to have mixed emotions — regret, anger, happiness, relief. They also often failed to separate the reaction to pregnancy from the reaction to the abortion. She has designed her study to do both, relying on a series of questions and periodic interviews, and initial results, to be published in the fall, show that the emotion that predominates right after an abortion is relief.

When she looked at more objective measures of mental health over time — rates of depression and anxiety — she also found no correlation between having an abortion and increased symptoms. In a working paper based on her study, Foster notes that “women’s depression and anxiety symptoms either remained steady or decreased over the two-year period after receiving an abortion,” and that in fact, “initial and subsequent levels of depressive symptoms were similar” between those who received an abortion and those who were turned away. Turnaways did, however, suffer from higher levels of anxiety, but six months out, there were no appreciable differences between the two groups.

Where the turnaways had more significant negative outcomes was in their physical health and economic stability. Because new mothers are eligible for government programs, Foster thought that they might have better health over time. But women in the turnaway group suffered more ill effects, including higher rates of hypertension and chronic pelvic pain (though Foster cannot say whether turnaways face greater risk from pregnancy than an average woman). Even “later abortions are significantly safer than childbirth,” she says, “and we see that through lower complications and low incidence of chronic conditions.” (In the National Right to Life’s five-part response to preliminary findings of Foster’s study, which were presented at the American Public Health Association conference last year, the group noted that the ill effects of abortion — future miscarriage, breast cancer, infertility — may become apparent only later. Reputable research does not support such claims.)

Economically, the results are even more striking. Adjusting for any previous differences between the two groups, women denied abortion were three times as likely to end up below the federal poverty line two years later. Having a child is expensive, and many mothers have trouble holding down a job while caring for an infant. Had the turnaways not had access to public assistance for women with newborns, Foster says, they would have experienced greater hardship.

Though S. is not part of Foster’s turnaway study, she is in many ways typical. The same month that she realized she would be having her baby, she was confronted with a host of financial hurdles. She couldn’t move in with her parents because they’d lost their home to foreclosure. By late March, S., exhausted by the pregnancy, had stopped working. Everyone moved into her older sister’s house — a three-bedroom, one-bathroom — where now seven people would be living. There was a family meeting. S. and her baby would take one room; her sister’s daughter would move into the small playroom; the parents would move into the garage. Their parents brought 20 years of belongings with them; S. sold, gave away or threw out everything she could but brought her parrot and her dog.

S., who had never seriously considered adoption, was overwhelmed when Baby S., a healthy girl, was born in May 2012. “It was like, whoa!” S. recalled. “That first night was terrible. I was tired, and she was so hungry, and she had a very loud cry. They don’t tell you how hard it is to nurse your baby. You don’t know how painful it is for something to eat off you, and it’s pulling your skin.” She developed plugged ducts, a condition in which the breasts become painfully engorged with milk.

It’s not unusual for new mothers to have trouble breast feeding, but S. felt overwhelmed in other ways too. “This baby is such a crybaby, and I didn’t know what was going on,” she said. “I felt like she didn’t love me, like maybe she was mad at me.” S. watched bitterly as her family members held a contented Baby S. When S. held her, the baby would begin to cry. It went on like that for weeks. S. sometimes buried her head in her pillow, crying, when the baby cried. “Her tone was negative,” one of S.’s sisters remembers. “She would become angry, saying she wished the baby would shut up.”

S. wanted to be a good mother, so she kept trying to nurse even when she began to develop sores on her breasts. Perhaps because of S.’s difficulty breast-feeding, Baby S. wasn’t gaining weight. Her physician threatened to call social services. Through a federal program — Women, Infants and Children (W.I.C.) — S. found a lactation consultant, who rented her a breast pump and provided her with information on baby formula. Once she stopped breast-feeding, Baby S. began to gain weight.

One day, when Baby S. was nearly 3 months old, S. left her on a pillow at the center of her bed while she went to the bathroom. She was gone for about a minute. When she came back, Baby S. was on the floor, lying face up, whimpering softly. S. and her mother took the baby to the hospital. It turned out nothing was wrong, but like many new parents in that situation, S. was terrified. The thought of losing Baby S. made her sick. From that point on, she no longer buried herself under the pillow when her baby cried. She didn’t let Baby S. out of her sight.

S. now says that Baby S. is the best thing that ever happened to her. “She is more than my best friend, more than the love of my life,” S. told me, glowingly. There were white spit-up stains on her green top. “She is just my whole world.”

When I told Foster S.’s story, she wasn’t surprised that S. ended up bonding with her baby. “That would be consistent with our study,” Foster said. “About 5 percent of the women, after they have had the baby, still wish they hadn’t. And the rest of them adjust.” S.’s experience is also consistent with one of the most striking statistics from Henry David’s Czech study. David found that nine years after being denied abortions, 38 percent of women said they never sought one in the first place.

Some would use these data as justification to further restrict abortion — women rarely regret having a child, even one they thought they didn’t want. But as Katie Watson, a bioethicist at Northwestern University’s Feinberg School of Medicine, points out, we tell ourselves certain stories for a reason. “It’s psychologically in our interest to tell a positive story and move forward,” she says. “It’s wonderfully functional for women who have children to be glad they have them and for women who did not have children to enjoy the opportunities that afforded them.”

Yet it is still true that being denied an abortion resulted in some measurable negative effects for S. She had to give up work and her apartment, and her precarious finances became more precarious. When women seek abortion, you have to ask yourself, Foster says, what is the alternative they are trying to avoid? And how might the life of a turnaway look if she’d had the abortion she sought? “You would need to look at the people who managed to get the abortion and find whether a woman who started out similarly is now in school, building a stable relationship, career or, possibly, that later she had a baby she was ready for.”

Talking with Foster, I was reminded of a woman I met at a “last resort” clinic in New Mexico. J., as I will call her, lived in Kansas with her partner and teenage son. She was 38, one of the long-term unemployed, and struggling to support the child she had. She thought she was too old to become pregnant. When she missed her period, she and her partner drove to a nearby abortion clinic, in Oklahoma, knowing that they couldn’t afford another baby. The clinic estimated that J. was five weeks pregnant, but when they tried to perform an abortion, the procedure was not successful.

Two weeks later, J. and her partner went to a more specialized clinic in Tulsa and were told that J. was actually 23 weeks pregnant, past the clinic’s gestational limit. J. cried in the parking lot. She and her partner drove to Texas, where she missed the gestational limit again. Finally, in New Mexico, J. was able to terminate her pregnancy. A month later J. got a job operating heavy machinery at a manufacturing plant for $15 an hour. She had been applying for the past six months. If she had had the baby, she said, she wouldn’t have been able to take the job. “They wouldn’t have even looked at me.”

Given some of the negative outcomes for turnaways, Foster’s study raises an uncomfortable question: Is abortion a social good? Steven D. Levitt, a University of Chicago economist and co-author of the book “Freakonomics,” famously argued that the passage of Roe v. Wade led directly to a sharp drop in crime during the early ’90s: women who were able to plan their families gave birth to better-adjusted children. The study was widely criticized, but the extent to which it was discussed shows the intensity of the desire to understand abortion’s effect on society. “It’s offensive,” Foster said of the Levitt study. “Let people have abortions or they will breed criminals?” If there is a social good to abortion, Foster prefers to frame that good in terms of positive alternatives. “Maybe women know what is in their own and their family’s best interest,” she said. “They may be making a choice that they believe is better for their physical and mental health and material well-being. And they may be making a decision that they believe is better for their kids — the kids they already have and/or the kids they would like to have when the time is right.”

S.’s baby turned 1 on May 13. She still qualifies for W.I.C. benefits and is still living with her sibling and parents, working two days a week. Of her living arrangement, S. says: “We have had family talks and pretty much come to the conclusion that we are trying to move by the end of the year. But we haven’t really found a place to go.” What will happen when she leaves her sister’s house and she has to support herself and her baby? And what about Baby S.? Will Henry David be right that being “born unwanted” is a predictor of poor development?

There is a chance, of course, that S. and her baby will thrive. How Foster’s turnaway subjects will be affected long-term is still unclear. In assessing how women like S. and J. fare over time, Foster plans to look at several variables: mother-child bonding; whether women who carry unwanted pregnancies to term face lasting economic difficulties; how the children of turnaways compare with children who are born later to women who once had abortions. The purpose of Foster’s study is not to set policy by suggesting new or uniform gestational limits. She notes, however, that there are ways to reduce the number of women seeking abortion at an advanced gestational age by improving access to reproductive health care. But Foster sees herself as a scientist, not an advocate. She did not set out, she says, to disprove that abortion is harmful. “If abortion hurts women,” she says, “I definitely want to know.”

Joshua Lang is a student in the U.C. Berkeley-U.C.S.F. Joint Medical Program.

Editor: Sheila Glaser

A version of this article appeared in print on June 16, 2013, on page MM42 of the Sunday Magazine with the headline: Unintentional Motherhood.

 

France’s free abortion law takes effect

 

   

http://www.huffingtonpost.com/2013/04/02/france-free-abortion-law_n_2998962.html  

   

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.

 

Inter-American Human Rights Commission to hold landmark hearing on abortion rights

 

 

3 March 2013

 

Ipas News

 

Inter-American Human Rights Commission to hold

landmark hearing on abortion rights

 

On Friday, March 15th, the Inter-American Commission on Human Rights will hold a landmark hearing on the negative impactof criminal abortion laws. It is the first time the IACHR will hear testimony on theharmful effects these laws have on the lives of young girls and women and their families in Argentina, Bolivia, Brazil and Peru.

 

Ipas and Ipas Bolivia, in collaboration with Women’s Link Worldwide, ISER/Brazil, Promsex/Peru, Argentina, the Special Rapporteurship on the Right to Sexual and Reproductive Rights/Dhesca Brazilian Platform and Asociación por los Derechos Civiles/Argentina, will present findings from legal research on the impact of abortion criminalization on women’s lives, health and criminal justice systems. These findings indicate that states are systematically violating women’s rights to health, equality and non-discrimination, privacy and due process of law. The organizations will present recommendations to the IACHR on measures to be taken by states to respect and protect women’s human rights.

 

Legal indications for abortion are extremely limited throughout Latin America, and several countries-Nicaragua, El Salvador, the Dominican Republic and Chile-have outlawed abortion entirely, even when necessary to save a woman’s life. Previous regional human rights decisions have called on states to ensure access to abortion in narrow circumstances-such as when a pregnancy threatens a woman’s health or if she’s been raped. This hearing will address the broader social and legal impact of criminal laws.

 

The hearing will be take place 11:30 a.m. at the IACHR’s Rubén Darío Room (8th floor), 1889 F Street, NW, Washington, DC. It will also be webcast live on IACHR’s web site. It will be conducted in Spanish, with translation available.

 

Chile: Abortion Hot Line Is in Legal Gray Area

Taking Calls on Abortion, and Risks, in Chile  

 

By Aaron Nelsen   

Published: January 3, 2013  

http://www.nytimes.com/2013/01/04/world/americas/in-chile-abortion-hot-line-is-in-legal-gray-area.html?pagewanted=all&_r=1& 

  

Roberto Candia for The New York Times

Volunteers for the Safe Abortion Hot Line in Chile routinely wear masks when showing support in public for the organization in a country where abortion is illegal under any circumstances.

 

SANTIAGO, Chile – Every time the phone rings, Angela Erpel feels her nerves swell. Sometimes it is a scared teenager on the other end, or a desperate mother of three. There are the angry ones, too, with callers playing the sounds of crying babies or sending text messages with pictures of aborted fetuses.  

 

Then Ms. Erpel, 38, a sociologist who volunteers at Chile’s Safe Abortion Hot Line, gathers herself and settles into a familiar dialogue on the use of misoprostol, a drug that will induce a medical abortion.

 

“We don’t give them a moral guide or advice; we only provide information,” she said.

 

Since the hot line began in 2009, volunteers spread across this long, thin country have taken turns answering tense calls from women seeking information about abortion every evening from 7 p.m. to 11 p.m. There have been more than 12,000 calls so far, and they continue rolling in at a steady clip.

 

In a country where abortion is entirely illegal, even in cases of rape or when a woman’s life is in danger, the hot line is a risky endeavor. Operating in a legal gray area, volunteers face a daunting prison sentence if a conversation veers too far from a lawyer-approved script. The hot line already has had three lawsuits brought against it, though all were eventually dropped.

 

According to the law, having an abortion carries a penalty of 5 to 10 years in prison, depending on the circumstances, while doctors and others who perform an abortion or assist with one could face up to 15 years, prosecutors say. In practice, however, fewer than 500 cases have been prosecuted over the last several years.

 

“I think there is a certain sensitivity to the social conditions behind these abortions, such as poverty or rape or teenage pregnancy,” explained Paula Vial, a lawyer and former public defender in Santiago.

 

Beyond the legal consequences, the 30 hot line volunteers are keenly aware of the social ramifications of taking an active role in such a polarizing issue. They wear masks when promoting the hot line at public gatherings, and are often vague about the details of their volunteer work in their daily lives. Many fear losing their jobs or driving a wedge into personal and family relationships. Indeed, Ms. Erpel was the only volunteer willing to go on the record about her work with the hot line, and even she is usually circumspect about it.

 

“It’s complicated,” she explained. “I’m open about being in an organization, but not necessarily that I work directly with abortion.”

 

Abortion was not always a clandestine affair in Chile. The current law that strictly bans it was one of the final acts of the dictatorship. In 1989, shortly before relinquishing power, Gen. Augusto Pinochet ended a tradition of legal abortion dating to 1931, in which a pregnancy that threatened a woman’s life, or a fetus that was not viable outside the womb, could be terminated. Chile’s law now is one of the strictest in the world.

 

By contrast, Uruguay legalized abortions in the first trimester for any reason last October, joining Guyana and Cuba as Latin American countries with broadly legalized procedures. Abortion is also legal in Mexico City. But Chile has remained a socially conservative country, after 20 years of economic growth and the election in 2006 of a woman as president.

 

“The hierarchy of the Catholic Church has had a very strong influence in public policy,” said Claudia Dides, a spokeswoman for the Movement for the Legal Interruption of Pregnancy.

 

In a pivotal case in 2008, Karen Espíndola, then 22, learned in her 12th week of pregnancy that her fetus had holoprosencephaly. Fetuses with the condition have a single-lobed brain, and most die before they are born. It is a common reason for terminating a pregnancy.

 

Ms. Espíndola sought an abortion, appealing to the president and setting off a national conversation over abortion. In February 2009, Ms. Espíndola gave birth to Osvaldo, who died in 2011.

 

“In reality he was never conscious he was alive,” she lamented. “He fought to breathe; he was fed through a tube. We all suffered a lot. Nobody here is a winner.”

 

Chile has witnessed a swell of liberal social movements in recent years, with gay men and lesbians pressing for the country’s first hate-crime legislation, environmentalists stalling dam-building projects in Patagonia, and students pushing for an overhaul of the education system.

 

Advocates contend that abortion rights sentiment bubbles near the surface as well, but the government has pushed back.

 

After criticizing the abortion hot line in the news media, the Ministry of Women started a hot line of its own. It is attended by psychologists and social workers who answer calls from men or women looking for information or support when facing what the ministry calls an “abortion situation” or “post-abortion syndrome.”

 

“Maternity, one of the most satisfactory experiences in the life of a woman, can go through difficult and desperate moments,” Minister Carolina Schmidt said at the time the government hot line began.

 

Other influential anti-abortion organizations offer to guide women considering abortion away from the procedure.

 

“If you help that person define what is troubling them and making them think of an abortion, and together you find a solution, in the end the person decides for life and her child,” said Victoria Reyes, director of assistance for Foundation Chile United. “We are convinced the second victim of abortion is the woman; the woman who has an abortion carries that guilt.”

 

The government reported several hundred adoptions in 2011, but it estimates 120,000 abortions, in a country with a population of about six million women from 15 to 64 years old.

 

Misoprostol, sold under the brand name Misotrol in Chile, has changed the way many of those abortions are performed. The drug was originally developed as an ulcer medication, and its warning label advised that, in excess, misoprostol would cause a woman to miscarry. Before long, women in countries with little or no access to safe abortions were using the drug to do that very thing.

 

Misoprostol “is a revolution for women,” said Rebecca Gomperts, founder of the Dutch organization Women on Waves. “Even where abortion is illegal and women don’t have a doctor, or they are poor, they still have a way to do a safe abortion.”

 

The abortion hot line is Ms. Gomperts’s creation. A medical doctor and former Greenpeace activist, she realized in 1999 that it was possible for a ship sailing under a Dutch flag to take women from countries where abortion is illegal to international waters to administer misoprostol.

 

Before departing Chile, Women on Waves helped set up the abortion hot line, training volunteers how to discuss misoprostol according to World Health Organization guidelines.

 

There are now five abortion hot lines in South America: in Argentina, Chile, Ecuador, Peru and Venezuela.

 

Misoprostol was taken off pharmacy shelves in Chile under Michelle Bachelet, the former president who now runs the United Nations’ agency for women’s advancement, so access to the drug is almost entirely a black market transaction.

 

Dozens of Web sites offer misoprostol at exorbitant prices, and sometimes of dubious quality.

 

One 29-year-old lawyer who became pregnant a few months ago said she paid $300 for the necessary 12 pills.

 

“To meet someone in a clandestine place, hoping they aren’t a police officer, wondering if they are even giving you the right pills, knowing that you could go to prison when all you want to do is exercise your right as a woman is horrifying,” the lawyer said on the condition of anonymity to avoid prosecution.

To its volunteers, the Safe Abortion Hot Line stands as a simple equation – 30 women and a single cellphone that gets passed among them. This month, they expanded: they released an abortion manual on using misoprostol.

 

Occasionally, women call back the hot line after a successful abortion, but more often the volunteers never know the outcome.

 

“That’s always the hardest part,” Ms. Erpel said.  

 

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.

 

Chile: Líneas telefónicas promueven el aborto seguro en Sudamérica / Telephone lines promote safe abortion in South America

In Spanish, but here is a Google translation in English

 

http://www.elciudadano.cl/2012/11/10/59785/lineas-telefonicas-promueven-el-aborto-seguro-en-sudamerica/

Líneas telefónicas promueven el aborto seguro en Sudamérica

Hartas de las restricciones impuestas a los cuerpos femeninos, colectivas e individualidades sudamericanas han optado por la acción directa a través de líneas telefónicas autogestadas que guían a las mujeres a tener un aborto seguro con pastillas. Otra estrategia para llegar a la ansiada y necesaria despenalización total.

La Organización Mundial de la Salud (OMS) calcula que anualmente en el mundo se practican cerca de 20 millones de abortos de alto riesgo y que el 99,9% de la mortalidad materna por aborto en condiciones de ilegalidad ocurre en los países no desarrollados. Por esta razón, cada 28 de septiembre miles de mujeres americanas y caribeñas se manifiestan por su despenalización, que en la región suma cuatro millones de casos al año, en un marco de legislaciones restrictivas y criminalizadoras.

Desafortunadamente, Chile, junto a Nicaragua, El Salvador, Honduras y República Dominicana, son los únicos países latinoamericanos que prohíben el aborto en cualquier circunstancia. Otros aceptan la interrupción del embarazo por razones terapéuticas o de violencia sexual, pero concretarlo implica superar todos los obstáculos impuestos por la burocracia médica, los sectores políticos conservadores y la iglesia.

TENGO UN GRAVE PROBLEMA

Según la propia OMS, el misoprostol (o misotrol) es la manera más segura para quienes deseen abortar sin complicaciones hasta las doce semanas, aunque su uso original es la prevención y tratamiento de las ulceras gástricas. Como potencial abortivo, en nuestro país se vende con receta, pero el mercado clandestino es amplio.

Por esta razón, en 2009, la agrupación Feministas Bio Bio replicó una inédita experiencia en estas tierras: la Línea Aborto Información Segura (LAIS), un servicio autogestionado de telefonía donde llaman mujeres que necesitan orientación para abortar de manera segura con misotrol. Rápidamente, fue necesario congregar más gente y el proyecto se hizo extensivo a Iquique, Valparaíso, Santiago, Temuco y Valdivia, lugares desde donde se contesta actualmente el teléfono.

“Decidimos responder con algo concreto y más radical, ya que no se ha avanzado nada desde la legalidad y se ha retrocedido en la concepción que tiene la gente sobre el aborto. La línea, además, es una estrategia para avanzar hacia la despenalización”, explica Zicri Orellana, de Lesbianas y Feministas por el Derecho a la Información, agrupación que hoy se hace cargo de la línea en la capital penquista, y que también realizan talleres y se aprontan a sacar un par de publicaciones relativas al tema.

“Apuntamos a que el aborto deje de ser un crimen, que no es lo mismo que la legalización, porque eso implica que el Parlamento defina bajo qué condiciones las mujeres pueden abortar. A nosotros nos interesa abortar cuando se nos de la gana: en nuestra casa, con nuestras amigas, de manera autónoma”, agrega.

Las telefonistas son voluntarias y están capacitadas para responder las dudas. Contestan desde las 7 de la tarde a las 11 de la noche, ya que todas son trabajadoras o estudiantes. “Informamos sobre cómo usar las pastillas, una vez que ya se han conseguido; no las vendemos. Por lo mismo, también ayudamos a identificar si son falsas”, explica.

No preguntan nada, sólo entregan información. Los datos entregados espontáneamente por las 10 mil llamadas acumuladas en sus tres años les permiten identificar un perfil: llaman mujeres desde 18 hasta 40, estudiantes y trabajadoras, madres, inmigrantes; a veces llaman sus parejas, pero no se entrega la información a hombres.

Zicri explica que ha habido 3 o 4 intentos de criminalizar la línea, pero no han fructiferado: “buscaban saber si vendíamos pastillas y si damos la información a menores de18 años, lo que no hacemos. También se intentó acusarnos de asociación ilícita, de inducción al aborto y de apología al delito, pero ninguna de estas denuncias fue admitida”.

Sin embargo, el Estado chileno si ha criminalizado a una niña de 15 años de la Octava Región, quien tras ocultar un embarazo producto de incesto, de violaciones y abusos sexuales, tuvo un parto adelantado en el que murió el feto. Hoy se encuentra esperando un veredicto judicial que manchará sus papeles de por vida y estigmatizada como infanticida por los medios de comunicación masivos.

LARGA DISTANCIA INTERNACIONAL

Pero la línea nacional tiene sus raíces en la experiencia ecuatoriana nacida en 2008. En la actual Constitución de ese país, vigente desde 2008, los casos de aborto no punibles son en caso de que el embarazo ponga en peligro la vida o salud de la mujer, y cuando este sea producto de una violación a una mujer demente o idiota. Datos de la OMS indican que en el país hermano cada cuatro minutos aborta una mujer.

Esta alarmante cifra inspiró la creación de la línea Salud Mujeres Ecuador, “ante la necesidad de que las ecuatorianas puedan acceder a información sobre aborto seguro, frente a la inoperancia del Estado en tratar este tema”, indican desde la Coordinadora Política Juvenil por la Equidad de Género. La dinámica y los horarios de atención son casi iguales a los de Chile.

Sus estadísticas muestran que el 35% de mujeres que llamaron a la línea tenían entre 18 y 22 años, siendo el promedio de edad de las mujeres que llamaron 20 años.

En Septiembre de 2010, la línea fue suspendida por orden de la Fiscalía, quien había recibido una denuncia y una orden de investigación por parte de la Comisión de Salud de la Asamblea Nacional. Las activistas buscaron otro número, que sigue funcionando, y la denuncia quedó en nada.

Además de talleres, trabajan con otras organizaciones y pertenecen al Frente Ecuatoriano por los Derechos Sexuales y Derechos Reproductivos, “desde donde hacemos lobby en la Asamblea Nacional, para presionar en el tema coyuntural que es el Aborto por Violación”.

En el caso argentino la línea “Aborto: más información, menos riesgos” surge en 2009 “para facilitar la independencia de las mujeres, ante la mirada hegemónica médica que se cubre detrás de una ley, para establecer un doble discurso que les de ganancia económica. También para politizar el lesbianismo desde un lugar diferente al del matrimonio igualitario y la maternidad”, señalan sus coordinadoras.

Datos del Ministerio de Salud cifran entre 500 mil y 600 mil el número de mujeres que abortan al año en ese país, lo que quiere decir que toda mujer, en promedio, aborta dos veces en su vida.

HORIZONTES

Los contactos internacionales y los números de las tres líneas son similares: entre 10 mil y 15 mil llamadas desde su funcionamiento; 10 a 15 llamadas por día. Sin embargo, las perspectivas van más lejos. “Nuestro trabajo como colectiva va encaminado a la despenalización total del aborto, legal y socialmente. Queremos que el Estado garantice el acceso a todas las mujeres a un aborto, legal, gratuito y seguro en los hospitales públicos, lo que va de la mano con una educación sexual integral y con real acceso a métodos anticonceptivos”, explican desde Ecuador.

“No queremos hacer educación sexual porque no nos corresponde, aunque podemos aportar con nuestra experiencia. Lo que nos interesa es informar que el aborto se puede prevenir si los hombres usan condón, y si siendo mujer, eres lesbiana”, indica Zicri Orellana de la línea chilena.

“Buscamos que el misotrol se incluya gratuitamente en la provisión estatal y se promueva la investigación científica para mejorarlo”, dicen desde Argentina.

Para todas ellas el cómo abortar debiese ser un contenido mínimo de la educación, porque hoy el nivel de información es muy precario. “Hay mujeres que llaman a la línea diciendo que quieren abortar porque la noche anterior tuvieron una relación sexual y no se cuidaron. Es decir, ni siquiera saben que existe la “pastilla del día después”. Hay mujeres que no tienen idea de nada y eso no puede seguir pasando”, concluye Zicri Orellana.

El número de la línea en Chile es 889 18 590

+ INFO:

www.womenonwaves.org

Por Cristóbal Cornejo

El Ciudadano

 

Chile: Safe Abortion Hotline – Assisting Women With Illegal, But Safe, Misoprostol Abortion

by Emily Anne, Lesbians and Feminists for the Right to Information

 

The phone buzzes insistently and I scramble to answer it. Nervously, the woman on the other end explains that she has six pills of misoprostol, and wants to know how to use them to induce an abortion. I explain that according to the World Health Organization (WHO) the recommended dose is 12 pills spread over nine hours, dissolved under the tongue. I explain the symptoms, and how to recognize problematic bleeding or infection. But I can’t say much more, or ask her any questions about her health, because helping a woman to get an abortion is illegal in Chile, and if we were caught openly discussing it, both of us could be arrested.

After I finish explaining, there’s a long pause. Finally, she asks if there’s a doctor she can call if there’s a problem. This is perhaps the biggest concern for women who have abortions in Chile: a misoprostol abortion is very safe, but if something does go wrong, women may hesitate to seek treatment because they face up to three years in prison if they’re reported to the police. I assure her that as long as a woman puts the pills under her tongue, she’s safe—in an emergency room, a misoprostol abortion looks exactly like a miscarriage.

As part of Chile’s only abortion hotline, most of my conversations with women are like this. I have to follow a lawyer-approved script that keeps us just on the right side of the law. While it’s impersonal, it’s the only way we can actually reach women without putting our callers and ourselves at risk.

Chile is estimated to have one of the highest abortion rates in all of Latin America, but it has one of the strictest anti-abortion laws in the world. Abortions are banned under all circumstances, including saving the woman’s life. Naturally, this has forced women to seek abortions outside of the law—with varying levels of safety.

That’s why the Chilean safe abortion hotline was launched in 2009. It’s run by a national network known as Lesbians and Feminists for the Right to Information. The hotline is open 365 days a year, for four hours a day, on a completely volunteer basis. Women call from all over Chile, and they are offered information on the correct dosage and administration of misoprostol, its contraindications and side effects, as well as information on abortion law and legal rights. Since its launch, it has received more than 10,000 calls, up to 15 a day.

There are five hotlines like ours in Latin America (Chile, Argentina, Ecuador, Peru and Venezuela), and others around the world. Some are independent, and others work closely with organizations such as Women on Waves, which uses tele-medicine  to provide medical abortions to women in countries where it’s illegal.

Of the five Latin American hotlines, Chile’s faces the most constraints. We do have the right to share public information with the women who call us—but that’s about it. That means addressing women in the third person (“According to the WHO, a woman can….”), and not asking any questions. Cell phone minutes are expensive, and sometimes women run out of minutes before we finish explaining the procedure. If the line does go dead, we have no way of knowing if we’ll ever be in touch again. We also can’t provide any kind of counseling, and there’s not much we can do to address the social stigma of abortion. And as far as the pill itself is concerned, women are on their own.

Some women who call are already very informed about misoprostol, and looking for answers to very specific questions. Some are surprising: one woman called to ask if she could eat watermelon during the abortion (answer: yes!). Others have never even heard of misoprostol. Some have the full support of their partner, a family member, or a friend. But others call us in the midst of the abortion, because they are alone and are terrified that something will go wrong.

Some women are confident and matter-of-fact about their decision. Others call in tears, explaining that they can’t have a baby because they are already mothers, or are students, or have no support from their partner. Those are the calls that stick with us, because although we may believe that any reason not to have a baby is a legitimate reason, we can’t remove a lifetime of stigma and guilt in a five-minute phone call.

We can offer the information we do because it’s already available online from organizations such as the WHO, International Consortium for Medical Abortion,Ipas, and Women on Waves. Of course, for most women it’s not obvious where to find it, and there’s no guarantee they’ll understand the medical terms if they do. As an organization we have much more access to these resources. Some of us have been trained in misoprostol use by these international organizations. Some of us are health professionals. Some are involved in extensive activist networks, and have been able to share information and strategies with women around the world. These experiences allow us to take this public information, and present it in a way that’s accessible to as many Chilean women as possible.

Each of us has our own reasons for joining the hotline. Some of us have personal experiences with abortion—both good and bad. One hotline member saw her roommate hospitalized—and then jailed for two years—after an abortion with a TV antenna. Another woman watched her cousin be denied an abortion after discovering that the fetus had severe genetic defects, only to give birth and watch her child struggle to survive for more than a year before dying. Others are lifetime activists, who were frustrated with the lack of progress in decriminalizing abortion. But whatever our motivations for joining, once we do, few think of quitting. Answering the hotline is a radicalizing experience. It’s impossible not to listen, night after night, to the injustice that these women face, and not be moved to take action.

Misoprostol has indeed revolutionized the way women have abortions—especially illegal abortions. Throughout history, women have had their methods for inducing abortion, some safer than others. Likewise, throughout the world there have probably always been networks of women to help each other get abortions (the Jane Collective in Chicago in the early seventies is a famous example).

But for the first time, a safe method is available for women to use themselves, in the privacy of their own homes. Originally invented as an ulcer drug, today misoprostol is used around the world (including the United States) to provide first trimester abortions, along with the drug mifepristone (RU-486).  Although the mifepristone-misoprostol combination is more effective, misoprostol alone is also recommended by WHO, as a safe alternative where mifepristone is not available. In Latin America, misoprostol use for self-abortion care was first documented in Brazil in 1986; today, in Chile it’s sold on the black market for about $250 for the full dose of 12 pills.

Unlike an illegal surgical abortion, a woman doesn’t have to put herself at the mercy of an illegal abortionist- who is likely someone she doesn’t know, may or may not be trained, will probably charge her exorbitant amounts of money for what is a relatively simple procedure, and may submit her to verbal or sexual abuse. The lack of training of many illegal abortion providers not only puts women’s health at risk, but also their security in an emergency room, a badly preformed surgical abortion is very easy to identify, which increases the chances of being sent to prison. And even in cases where the practitioner is well trained, the additional people that may be involved- the practitioner themself, assistants and contact persons—also may make it more likely to get caught.

But with misoprostol, the practitioner is often the woman herself. She doesn’t have to put her life in the hands of a total stranger. She can choose when, and where, to have the abortion, and she has much more control over who knows about it. A woman in an abusive relationship doesn’t have to tell her partner. A teenager doesn’t have to tell her parents. An emergency room doctor doesn’t need to know she used misoprostol, because the treatment for complications is identical to the treatment for miscarriage.

Perhaps most importantly, illegal misoprostol abortion is inherently safer than illegal surgical abortion, because there are fewer things that can go wrong. Since no foreign objects are introduced into the vagina, there is very little chance of infection, and therefore little chance of long-term consequences such as infertility. Problematic bleeding is uncommon. Uterine rupture (often incorrectly cited as a risk) is extremely rare, even in second trimester abortions when the uterine walls get thinner. Because no technical skills are needed, it is very easy to learn to do a misoprostol abortion; essentially, one must learn the timing of misoprostol administration, and what warning signs to look for.

For women who use misoprostol, information is key; it can be the difference between a safe abortion, and one that ends in an emergency room, or in jail. If they do have to go to a hospital, women who don’t know their rights may be pressured to confess by hospital staff. And there are plenty of myths about misoprostol use, some of which come from doctors themselves. Because there are no circumstances in which they can legally perform abortions, Chilean doctors only receive training on post-abortion care, not abortion itself, and will often prescribe the wrong dose. The problem is that misoprostol dosage is very counterintuitive—the further along the pregnancy is, the lower the dosage that is needed. So 12 pills may seem like a lot, both to women, and to doctors who are used to using smaller doses of the drug (for example, in induction of labor).

Many people don’t realize that in a legal medication abortion, the actual abortion takes places in the woman’s home. According to clinical guidelines published by the WHO, ICMA, and Ipas, the practitioner (who may be a doctor, nurse, midwife, or physician’s assistant) begins by confirming the length of the pregnancy and ruling out contraindications, of which there are few.  Next, the women is told how to take the pills and how to recognize signs of hemorrhage and infection, and then sent home to take the pills at her convenience. She would need to return to the clinic in two weeks, and if the abortion was incomplete it can be taken care of at that point; unless there are signs of infection, an incomplete abortion is not a life threatening situation.

So in a country like Chile- where almost 90 percent of the population lives in urban areas, with easy access to hospitals and post-abortion care, women are able to mimic clinical procedures, and safely induce their own abortions. Chilean reproductive health specialists have publically stated that misoprostol use hasgreatly reduced the number of abortion complications they see in their practice, a phenomenon that has been documented in other countries as well.

Unfortunately, most press coverage of illegal misoprostol use is sensationalist and misinformed. The image of a woman taking pills in the privacy of her home is quite different from what most people imagine that illegal abortion is like. The image of a “back-alley” abortion is a powerful one for Americans and Chileans alike. Gruesome images, such as that of Geri Santoro, dead in her hotel room 1973, played an important role in the struggle to legalize abortion in the United States. But they don’t accurately represent the reality of illegal abortion today.

In today’s United States, we have women Jennie Linn McCormack, an Idaho woman who bought the abortion pill over the internet because she didn’t have the money to obtain a legal abortion in Salt Lake City, three hours from her home. She underestimated the length of her pregnancy, and was surprised by the size of the fetus. When she called a friend for help, the friend’s sister called the police. McCormack had no complications, and her case was later dismissed, but she still had to suffer abuses at the hands of the police, media attention, and ostracism by her neighbors.

Of course, McCormack’s case represents a huge failure on the part of the US healthcare system. Even though she lives in a country where abortion is a constitutional right, a safe abortion was no more accessible to her that it is to her Chilean counterparts. It’s unclear how often American women have to resort to inducing their own abortions. But in other countries, stories like hers are all too common.

Chile is one of 5 countries in the world with a total abortion ban; the others are El Salvador, Nicaragua, Malta, and the Vatican. There are no reliable statistics that tell us how many abortions there are in Chile each year, and even less information on the number of misoprostol abortions. Estimates range from 60,000 to 200,000  abortions per year, in a country of 17 million people.

So-called “therapeutic” abortion, permitted only if the woman’s life or health is in danger, was legal from 1939 to 1989. It was legalized in part to bring down the high maternal mortality rate. Its prohibition was one of dictator Augusto Pinochet’s last acts in office.
Pinochet’s 17 year reign ended not with a counter-coup, but rather a plebiscite. In exchange for a bloodless “transition to democracy,” the country maintained the dictatorship’s constitution and many of its legislators. Because of this and related social processes, there have been no changes to the abortion law since 1989. The most recent bill, which would restore the therapeutic abortion law, was proposed in March of this year, but Congress refused to even open discussion.

For many Chileans, abortion is a non-issue. It is rarely even mentioned in the press, and when it is, coverage is invariably anti-choice. As in most countries with restrictive laws, there is little political will among the legislators. That may be in part because most come from the upper class, and safe abortion has always been available to those who can pay for it. Some thought that the government of Michelle Bachelet—a female, socialist, physician who was president from 2006-2010—would make more progress. But in fact, it was during her government that misoprostol was pulled from pharmacies (where it had been available with a prescription), leaving women to try their luck on the black market.

Another reason may have to do with Chile’s low maternal mortality rate. Abortion has long been established as an important cause of maternal mortality, and in many countries where some form of abortion is now legal, legislators were moved to lift the abortion ban because they wanted to protect women’s lives. But Chile has one of the lowest rates in Latin America– 26 per 100,000 live births, comparable to the US rate of 24 per 100,000.  There are probably many reasons why maternal mortality has declined, but some of the most important factors are likely government subsidized birth control and post-abortion care, and access to safer illegal abortions using misoprostol.  But increasingly safer abortions means there hasn’t public outcry to remove the ban.

In 22 years of democratic government, there has been zero progress towards decriminalizing abortion. Another 20 years could easily pass before any action is taken at the national level. Chile has shown itself incapable of protecting women’s reproductive rights. And if current trends are any indication, the United States is not much better. But meanwhile, women still need abortions. So we have no other choice than to organize ourselves, and empower women to have the safest, most positive abortion experience they can. Someday, women in the United States and Chile alike will have access to affordable, legal abortion offered by a trained practitioner. But until then? We’ll be here. Give us a call.

 

. . . . . . . . . .

 

Nicaragua: Pregnant Girls Forced to Become Mothers

http://www.ipsnews.net/2012/08/pregnant-nicaraguan-girls-forced-to-become-mothers/

By José Adán Silva Reprint

MANAGUA, Aug 22 2012 (IPS) – Carla lost everything when she got pregnant at the age of 13: her first year of secondary school, her family, her boyfriend, and her happiness. She spent a year panhandling on the streets of the Nicaraguan capital before she was taken in by a shelter for young mothers.

Her life fell apart in December 2006, when her mother discovered that she was three months pregnant as a result of being raped by one of her primary school teachers. Her mother gave her a savage beating with a belt and threw her out of the house, saying she couldn’t afford another mouth to feed.

Carla’s* baby died at birth due to respiratory problems. During the pregnancy, a neighbour let her sleep in her house, but did not give her meals. So she sold homemade sweets and begged for small change at bus stops, where she suffered continuous sexual harassment from men who offered her money, drugs or food in exchange for sex.

She was initially taken in by Casa Alianza, the Latin America branch of the New York-based Covenant House, an international child advocacy organisation. But at the age of 15 she went to stay at a school shelter, where she took cosmetology and beauty courses. Now 19, she works in that field, and is also a volunteer motivator in the centre for young mothers, which she said saved her life and taught her that she had human rights.

The case of Carla, with whom IPS was put in touch by a non-governmental organisation that works with at-risk children and adolescents, illustrates a phenomenon that takes on alarming proportions in this Central American nation, one of the few countries in the world where abortion is illegal under all circumstances.

In this country of 5.8 million people, one of the poorest in Latin America, there were 1.3 million births in the public health system in the last 10 years. Of that total, 367,095 births were to girls and adolescents, including 172,535 to girls under the age of 14, according to a Health Ministry statistical report covering the period 2000-2010, released in July.

That means girls and teenagers accounted for 27 percent of all births in public health institutions. And 47 percent of these youngsters were between the ages of 10 and 14 – representing 13 percent of the pregnancies attended in the public health services.

Dr. Osmany Altamirano, an adviser on sexual and reproductive rights with the Nicaraguan office of the global children’s charity Plan International, told IPS that the problem was serious but improving.

“In the year 2000, adolescent mothers were 31 percent of the total. The teen pregnancy rate has gone down, although it is still the highest in Latin America, and one of the highest in the world,” he said.

A 2007 study by the Latin American and Caribbean Demographic Centre reported that Nicaragua was the country with the highest adolescent birth rate in Latin America.

Nicaraguans of child-bearing age (10 to 49) represent 65 percent of the total female population, and 37 percent of that portion are between the ages of 10 and 19.

Altamirano said the phenomenon of teenage pregnancy in Nicaragua forms part of the cycle of poverty in which most of the young mothers have lived.

“Pregnant girls reproduce the cycle of poverty, because they become mothers before they are biologically mature – in other words, they are underweight mothers who suffer from chronic malnutrition and give birth to low birth-weight, short-stature babies,” he said.

He also said that 47 percent of pregnant girls and teenagers do not complete primary school, effectively losing their right to an education.

“Many are forced to look for work in disadvantageous conditions, because they don’t have experience or training in a profession or trade, others are thrown out on the streets, and many end up as the victims of sexual exploitation,” he said.

According to World Health Organisation (WHO) statistics from 2009, 16 million girls between the ages of 15 and 19 years old give birth every year, accounting for 11 percent of all births worldwide.

Karla Nicaragua, with the Quincho Barrilete Association, told IPS that in a study carried out in 2011 among teenage girls in Managua, 60 percent admitted to being pressured or induced to have sex with relatives, classmates, neighbours or even their fathers.

The phenomenon is explained, among other things, by a social fabric “that sees pregnancy as something normal” and “by a legal system that forces women to give birth, even under conditions of medical risk,” said Nicaragua, whose association is dedicated to the protection of street children in Managua and to preventing violence against children.

Since 2006, this Central American nation has been one of the few countries in the world where abortion is illegal in any circumstances, and is punishable by prison – even if the pregnancy is the result of rape or incest, or the mother’s life is in danger.

“The lack of scientific, accurate sex education in school and in the family, sexual harassment and abuse, peer pressure among adolescents, poverty and overcrowding, along with a permissive justice system, are all factors that influence the high teen pregnancy rate,” she said.

Lorna Norori with the Movement Against Sexual Abuse (Mcas) said that sexual violence is hidden behind the statistics on teenage pregnancy.

Nicaragua’s penal code establishes that sexual relations with a child under 14, even with the consent of the minor, amounts to rape, and is punishable by 12 to 15 years in prison, the activist for the human rights of women said.

Norori accused the state of Nicaragua of complicity in the public policy of forcing young pregnant girls to give birth, despite the fact that the law clearly states that they are victims of rape.

Around 40 percent of victims of rape in Nicaragua have no access to justice, according to the study “Indignación: datos sobre violencia sexual en Nicaragua 2011″ (Indignation: Statistics on Sexual Violence in Nicaragua 2011), carried out by Mcas.

For the study, the organisation compared the records of the government forensic institute (IML) and of the National Police office of women and children (the Comisaría de la Mujer y la Niñez).

The study points out that while the IML reported a total of 4,409 forensic medical examinations of rape victims in 2011, the Comisaría de la Mujer y la Niñez only recorded 3,047 cases handled by the office of the public prosecutor.

The IML records show that more than 85 percent of the forensic exams were carried out on underage girls. Of them, 36.5 percent were adolescents between the ages of 13 and 17 and 49 percent were girls under the age of 12.

* Not her real name.

 

 

Poland: Abortions generate $95 million a year for Polish doctors as women use illegal private sector

www.medicalxpress.com/news/2011-05-abortions-million-year-doctors-women.html

May 17, 2011 in Health

New analysis published by the UK journal Reproductive Health Matters shows that the criminalisation of abortion in Poland has led to the development of a vast illegal private sector with no controls on price, quality of care or accountability. Since abortion became illegal in the late 1980s the number of abortions carried out in hospitals has fallen by 99%. The private trade in abortions is, however, flourishing, with abortion providers advertising openly in newspapers.

Women have been the biggest losers during this push of abortion provision into the clandestine private sector. The least privileged have been hardest hit: in 2009 the cost of a surgical abortion in Poland was greater than the average monthly income of a Polish citizen. Low-income groups are less able to protest against discrimination due to lack of political influence. Better-off women can pay for abortions generating millions in unregistered, tax-free income for doctors. Some women seek safe, legal abortions abroad in countries such as the UK and Germany.

“In the private sector, illegal abortion must be cautiously arranged and paid for out of pocket,” says Agata Chełstowska, the author of the research and a PhD student at the University of Warsaw. “When a woman enters that sphere, her sin turns into gold. Her private worries become somebody else’s private gain”. The Catholic Church, highly influential in predominantly Catholic Poland, leads the opposition to legal abortion.

Since illegality has monetised abortion, doctors have incentives to keep it clandestine, “Doctors do not want to perform abortions in public hospitals,” says Wanda Nowicka, Executive Director of the Federation for Women and Family Planning. “They are ready, however, to take that risk when a woman comes to their private practice. We are talking about a vast, untaxed source of income. That is why the medical profession is not interested in changing the abortionlaw.”

In several high profile cases, women and girls have been denied legal abortions following rape or because of serious health conditions and have been hounded by the media for seeking them. The 2004 case of a young pregnant woman who died after being denied medical treatment is currently under consideration at the European Court of Human Rights.

Other articles in this issue of Reproductive Health Matters focus on many aspects of health privatisation worldwide and includes studies from Bangladesh, Turkey, Malawi, India, Madagascar and South Africa.

More information: doi:10.1016/S0968-8080(11)37548-9

 

List: Sexual Health Services Worldwide

Women on Waves     Sexual Health Services Worldwide   Women on Waves maintains a list of sexual health services worldwide at:   http://www.womenonwaves.org/en/page/926/sexual-health-services-worldwide   For almost every country we have listed some family planning, women’s health, and abortion rights organizations.   We would like to keep it up-to-date and accurate.   If you have information about additional services in any countries or corrections to the current listings, please send this information to:info@womenonwaves.org. Thank you!