Class and Poverty

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.

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

Women on Waves



Sexual Health Services Worldwide


Women on Waves maintains a list of sexual health services worldwide at:


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

Thank you!

by ALIYA HAQVERDI | The Institute for War & Peace Reporting

Posted  18 July 2012

BAKU, Azerbaijan – Women’s rights activists in Azerbaijan are worried about a proposal to ban abortions. The proposal was introduced by Hadi Rajabli, chairman of the Azerbaijani parliament’s social policy committee and a member of the governing Yeni Azerbaijan party.

“In many countries of the world, including China, Iran and Islamic states, abortion is regarded as murdering a human being. The destruction of unborn infants in their mothers’ wombs is not justified on humanitarian or religious grounds,” he said. “We therefore believe that such a ban could be introduced in Azerbaijan.”

Under current law, abortion is legal up to the 12th week of pregnancy, and under exceptional circumstances, until the 22nd week.

Azerbaijan, along with Armenia and Georgia, has historically had some of the highest abortion rates in the European region, according to the World Health Organization. Meanwhile, the use of modern contraceptives is low in these countries. This can be traced back to when Azerbaijan was part of the Soviet Union and contraceptives were not widely available. In fact, abortion was the most common form of birth control during the Soviet era.

Women’s rights advocates say that many women here are still unfamiliar with various means of contraception.

Matanat Azizova, head of the Women’s Crisis Center, believes the proposed ban would be disastrous. “There will be illegal abortions, causing death, sterility, various illnesses and so on,” she said. “It will also be a good way of fostering corruption, pregnant women will be able to pay doctors for a document stating that abortion is necessary on health grounds.”

The debate here has also been fueled by the issue of using abortion as a means of sex selection. The practice of terminating female fetuses has led to a significant imbalance in the country’s population, with 112 live male births to every 100 live female births. Azizova acknowledges that the problem exists, but says a blanket ban on abortions is no way to deal with the issue.

“International organizations have urged Azerbaijan to address the selective abortion problem which unfortunately exists here. But they (national authorities) have decided that the easiest route to fixing this is a ban, just so that they don’t have to think about it,” she said.

Ulviya Mammadova, a scholar at the Women’s Human Rights Training Institute in Azerbaijan and a well-known rights activist, also opposes a ban. “In practice, it will just create new problems, given the lack of social protections for women and low wages earned by young mothers,” she said. “Corruption and the lack of an effective health-care system will lead to illegal abortions at sky-high prices, with no way of holding doctors to account. There will be more abandoned children, and maternal mortality will increase.”

Only 20 of the 135 members of Azerbaijan’s parliament are female, and right activists like Mammadova worry that the concerns of women will not get a proper hearing if Rejebli’s proposal is adopted.

On the other hand, some young women, like Jamila Mammadova, 20 and a university student, are in favor of imposing a ban. “Termination of a pregnancy is a terrible sin,” she said. “I can’t see how this law will run into any problems with our customs and traditions.”

Islam, which plays a major role in Muslim-majority Azerbaijan, strictly forbids abortion. But some religious leaders, like Haji Ilgar Ibrahimoglu, imam of Baku’s Friday mosque and chairman of the Center for the Protection of Freedom of Conscience and Confession, say they are better ways of dealing with the issue than an outright ban.

“In countries like ours, bans are counterproductive and often result in the opposite of what was intended,” he said. “It will create an even greater tolerance of corruption, a rise in primitive forms of termination, an underground abortion industry, and protection rackets surrounding it.”

On July 1st, Mississippi becomes the first state in the country with no abortion clinic.

The Mississippi Department of Health is forcing Jackson Women’s Health Organization, the last remaining abortion clinic in the state, to immediately comply with a new law requiring doctors to have admitting privileges at local hospitals.

To date, none of the highly qualified doctors who regularly provide abortions at the clinic have been granted those privileges.

This unreasonable law puts women’s lives in danger and deprives them of their constitutionally-protected right to decide whether and when to carry a pregnancy to term. The Center filed a legal challenge against the law on June 27, 2012 in an effort to block the state’s unconstitutional attack on women’s health.

Right now, thousands of women travel from all corners of the state, and beyond, to reach the clinic. Even if Jackson Women’s Health Organization has to shut down, women won’t stop seeking abortions. Instead, they’ll be forced to travel out of state to the nearest clinic or they’ll turn to unsafe options putting their health and even their lives at risk.

But the lawmakers responsible for this callous law don’t care about women or the resulting hardships. In fact, State Representative Sam Mims, the sponsor of the law, was quoted by the New York Times saying, “If this abortion clinic is closed, I think it’s a great day for Mississippi.” Gov. Phil Bryant similarly said, “If [the law] closes that clinic, then so be it.”

More infos:

BY REBECCA BOONE   08/31/11 09:41 PM ET   AP

BOISE, Idaho — An eastern Idaho woman has filed what is believed to be the first lawsuit in the nation to directly challenge the constitutionality of a so-called “fetal pain” abortion ban.

Jennie Linn McCormack filed suit in federal court against Bannock County’s prosecuting attorney, contending Idaho’s new law banning abortions after 20 weeks of pregnancy violates the Constitution.

Idaho is one of six states that have enacted such bans in the past two years. The bans are based on the premise that a fetus may feel pain at 20 weeks.

McCormack, who was briefly charged with having an illegal abortion, is seeking class-action status in her lawsuit against prosecutor Mark Hiedeman. The suit also challenges other parts of Idaho abortion law.

McCormack was charged with a felony in June after police said she took pills to terminate her pregnancy last December. Police found the fetus in a box at McCormack’s Pocatello home Jan. 9, and an autopsy determined it was between five and six months gestation. Police said McCormack told them she didn’t have enough money to go to a licensed medical professional, so her sister helped her access abortion-inducing drugs online.

A judge later dismissed the criminal case without prejudice for lack of evidence. That means the prosecutor may refile charges if he chooses, unless the federal courts stop him from doing so.

In the lawsuit, McCormack challenges the lack of access to abortions for women in her region, as well as the ban on abortions after 20 weeks.

She notes there are no elective-abortion providers in southeastern Idaho, forcing women seeking the procedure to travel elsewhere.

McCormack was unmarried and unemployed at the time of her pregnancy – with an income of $200 to $250 a month – and already had three children. She couldn’t afford the time or money it would take to travel to Salt Lake City to get an abortion, the lawsuit says.,abortion,lawsuit%3A,jennie,linn,mccormack,challenges,state,fetal,pain,law,politics

If McCormack prevails, it will be a win for women across the region, said her attorney, Richard Hearn of Pocatello.

“If we’re successful, they’ll be able to access legal and safe abortions in southeastern Idaho,” whether performed with medicine or surgically in a clinic, Hearn said Wednesday.

Hiedeman could not be immediately reached for comment.

Idaho law bars women from getting abortions from anyone but licensed Idaho physicians, and requires that second-trimester abortions be performed in a hospital. Women who purposely cause their own abortions, or who get abortions from unlicensed physicians, face up to five years in prison and up to a $5,000 fine.

McCormack is asking a judge to find that those criminal sanctions are unconstitutional, in part because they wrongly burden women in regions like southeastern Idaho that lack abortion providers.

Another Idaho law, passed during the 2011 Legislature, bans abortions once a fetus has reached 20 weeks on the belief that fetuses begin to feel pain at that stage. Idaho was one of five states – along with Kansas, Alabama, Indiana and Oklahoma – that enacted bans modeled after a fetal pain bill passed in Nebraska in 2010.

McCormack says the new law violates the Constitution because it doesn’t contain an exception allowing for abortions if necessary to preserve the mother’s health, and because it prohibits some abortions even before a fetus has reached viability. Roe v. Wade barred states from prohibiting abortions done before the age of viability, and other legal rulings have since determined viability occurs at 22 to 23 weeks gestation.

That contention echoes an opinion written by Idaho Attorney General Lawrence Wasden’s office, which advised state lawmakers that the fetal pain bill could be found unconstitutional under the 14th Amendment.

It’s not the first time Idaho lawmakers have passed abortion laws that they were warned likely would be found unconstitutional. In the past decade, Idaho has spent more than $730,000 to defend restrictive abortion laws that ended up being struck down by courts. Those costly rulings prompted legislative leaders in recent years to require that abortion-related legislation be reviewed by the Idaho attorney general’s office.

Republican state Sen. Chuck Winder, who sponsored Idaho’s fetal pain legislation, didn’t immediately return a phone call seeking comment.

The National Right to Life Committee said Wednesday it believes the law will be upheld.

“Unborn children recoil from painful stimuli, their stress hormones increase when they are subjected to any painful stimuli, and they require anesthesia for fetal surgery,” the group’s legislative director, Mary Spaulding Balch, said in a statement. “We are confident that the Supreme Court will ultimately agree and will recognize the right of the state to protect these children from the excruciatingly painful death of abortion.”

Janet Crepps, director of the U.S. legal program for the Center for Reproductive Rights, said laws like fetal pain bills are both unconstitutional and bad policy. They also are “demeaning to women and their doctors” because they don’t take into account how each woman’s situation is different, she said.

“When you think about all the regulations that are piled onto abortion, it just clearly becomes impossible for doctors to provide them and women to receive them in a situation like McCormack’s,” Crepps said. “It’s a really sad situation.”

Great article about the blind spots and prejudices on abortion research

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

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

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

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

The worst study ever done on abortion

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

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

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


The questions that science can’t ask 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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