African health ministers agree to tackle unsafe abortion

 

By Nyasa Times Reporter

July 3, 2013

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

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

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

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

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

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

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

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

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

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

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

 

http://www.nyasatimes.com/2013/07/03/african-health-ministers-agree-to-tackle-unsafe-abortion/

 

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

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

22 Mar 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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.

 

Canada: The benefits of decriminalizing abortion

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

By Joyce Arthur

| January 4, 2013

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

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

History: Previous laws and one Doctor’s civil disobedience 

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

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

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

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

Reaping the benefits of decriminalization 

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

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

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

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

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

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

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

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

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

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

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

Having no laws is not enough 

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

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

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

The moral high road: Decriminalizing abortion

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

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

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

 

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

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

 

 

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.

 

Costa Rica – Call to action to help Aurora

via http://www.colectiva-cr.com/node/180

Aurora is a 32-year old Costa Rican woman. She has a university degree, a job that she likes, a good relationship, and after months of trying, she is finally pregnant.    However, at 8 weeks of pregnancy, the doctors informed her that the fetus has multiple severe malformations that would not allow it to survive outside the uterus, including severe scoliosis, decreased level of amniotic fluid, and a complete absence of abdominal wall which leaves the internal organs such as the liver and intestines outside of the body. She has had many more exams since, which have all confirmed the original diagnosis of a nonviable pregnancy. 

A little after her first appointment, Aurora started experiencing strong abdominal and back pain that prevent her from working. The circumstances of the pregnancy are seriously affecting her physical and emotional health. Aurora has indicated that “in addition to the physical pain, the stress and suffering resulting from the news have provoked constant sadness, depression, severe stress, insomnia, nightmares, constant tears…”

 

Aurora is now about 25 weeks pregnant. We demand that she be given immediate access to a therapeutic abortion.

On multiple occasions, Aurora has requested that they end her suffering.  However, the medical professionals and medical authorities in Costa Rica have repeatedly denied her right to a therapeutic abortion. This, despite the fact that the medical recommendation points toward pregnancy termination and that some of the professionals who are treating Aurora have indicated that the pregnancy would be terminated in more “advanced” countries. Therefore, Aurora is being forced to carry the pregnancy to term, despite the serious physical and emotional damage that this causes her. 

Therapeutic abortion is allowed in the Costa Rican law. Article 121 of the Costa Rican Criminal Code signals that abortion is not criminalized when practiced with the consent of the woman, a doctor, or an authorized obstetrician, when it is practiced to avoid danger to the life or health of the woman and cannot be avoided by other means.

 

Aurora’s case is not an isolated situation. In 2007 A.N., another Costa Rican woman, suffered a similar situation. A.N. was a 27-year old woman who was forcet to carry to term an anencephalic pregnancy (severe cerebral malformation of the fetus). After 7 hours of labor, she gave birth to a dead baby girl. To this day, as a result of this experience, A.N. is fighting depression, anxiety attacks, chronic diarrhea, and social inhibition.

 

There’s a petition here to show your support.

 

 

Send messages to the following individuals:
Dra. Ileana Balmaceda, Presidenta Ejecutiva de la CCSS

Dra. Daisy Corrales, Ministra de Salud.

Dra. Sisy Castillo, Viceministra de Salud.

Dra. María Eugenia Villalta, Gerente Médica de la CCSS.

Dra. Flory Morera González, Presidenta de la Asociación de Ginecología y Obstetricia de Costa Rica (AOGCR).

 

SAMPLE LETTER:

Dear XXX:

The press has reported in recent days on a woman who has been refused a therapeutic termination of pregnancy. This woman’s pregnancy is not viable as severe malformations have been identified.

I believe that compelling this woman to carry her pregnancy to term is an act of cruelty and torture, and a violation of her human rights. Therefore, I am writing to demand that she is offered the option of a therapeutic abortion, pursuant to article 121 of the Costa Rican Penal Code. 

Sincerely,

 

Video: The Secret History of Sex, Choice and Catholics

The Secret History of Sex, Choice and Catholics

“The Secret History of Sex, Choice and Catholics,” a new documentary-style filmproduced by Catholics for Choice, sets the record straight about Catholic social teaching on issues related to sex and sexuality. Catholic bishops the world over have politicized the pulpit, seeking to drown out the voices of Catholics who disagree with them. This film offers a straightforward explanation of what Catholic social teaching really is on the controversial issues that drive the news cycle-and it’s not simply the dictates of the bishops. “Contrary to popular opinion, there is more to Catholics’ beliefs than what the hierarchy espouses,” said Jon O’Brien, president of Catholics for Choice. “We put together this film with some of the top theologians in the world to get at the heart of Catholic teaching: that people become Catholics through their baptism and are given both a free will and a conscience to make important decisions. We hope that anyone seeking to discuss ‘what Catholics think,’ how they vote or, most importantly, what Catholics believe, will consider this film.” Please watch the movie, share it with your family and friends, and let us know what you think via e-mail or on our Facebook page.

Watch the Film

http://www.catholicsforchoice.org/SecretHistory.asp

 

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

 

An unmet need for the world’s women: safe second-trimester abortion

by Jennifer Daw Holloway, Ipas

11 October 2012 

http://www.rhrealitycheck.org/article/2012/10/11/an-unmet-need-world%E2%80%99s-women-provider-stories-second-trimester-abortion

 

If you work in reproductive health or public health you often hear people talking about the “unmet need for contraception” in a certain country or region. But here’s an unmet need that never gets discussed outside of small circles: second-trimester abortion.

 

Millions of women die or are disabled every year from unsafe abortion. Two-thirds of the women who suffer or even die are those who had an unsafe second-trimester abortion. No one really wants to talk about it but second-trimester abortions are often a medical emergency. And if they’re performed unsafely, women die. But with appropriate provider training, we can save women’s lives.

 

In the United States, most women who end up seeking a second-trimester abortion are disproportionately young and poor. They may not recognize signs of pregnancy early on, or they may delay seeking care for financial reasons. And then there are health reasons for later abortion, such as in cases where a wanted pregnancy goes horribly wrong and either fetal abnormalities or the woman’s health make the procedure necessary.

 

In the rest of the world, the picture is much the same. There is one difference, however: As many barriers to safe second trimester abortion as exist in the United States, barriers are that much greater in the global south. Many women facing complications from unsafe procedures have nowhere to get follow up care. And many women don’t make it.

 

At the World Congress of Obstetrics and Gynecology (FIGO 2012), now underway in Rome, Italy, Ipas and the FIGO Working Group on the Prevention of Unsafe Abortion sponsored sessions on second-trimester abortion in low-resource settings. In Nepal, for example, where safe abortion-including second-trimester abortion-is integrated into the national health system, providers have to turn some women away for various reasons… only to find that despite warnings and counseling, the woman sought an unsafe procedure and was seriously injured or even killed. Providers remember these women’s faces and their stories; they recall the woman’s fear and emotional pain like it was just yesterday.

 

Dr. Alfonso Carrera, a Mexican gynecologist, says in the last year he has seen 160 second-trimester abortion cases. Why? The health system failed these women. Some have been raped, he says. Some are just teenagers. With few options and few resources, they come to him because other health facilities won’t see them. “One woman said if I couldn’t help her she would kill herself,” he says with tears in his eyes.

 

Another doctor in Africa says he only knows of a handful of providers in his country who will perform a second-trimester abortion-and all are in a major city, hundreds of miles from women in rural provinces.

 

In Ethiopia, 20 to 40 percent of women seeking abortion are second-trimester cases. In South Africa, roughly 25 percent of abortions are performed in the second trimester. Like in other countries, despite the law allowing for abortion up to a certain point in second trimester, some facilities set their own guidelines, shortening the time period during which they’ll perform a second-trimester abortion. Providers are often reluctant to perform these abortions because of stigma. A nurse in South Africa said “other professionals call you a murderer.”

 

And don’t forget the stigma women face. In Colombia, women are sometimes given the fetal remains in a plastic bag, or are put in the labor ward-seemingly as punishment for their decision to terminate a difficult pregnancy.

 

But, second-trimester abortion services are achievable even in low-resource settings. Providers need clinical and networking support from colleagues. In Nepal, providers have developed an exchange program with providers in Ethiopia, another country where second-trimester abortion care has been improved with legal reform and buy-in from the government. The World Health Organization’s most recent safe abortion guidance includes recommendations on abortion after 12 and 14 weeks.

 

Providers around the world who are willing to perform second-trimester abortion care all agree: The challenges and barriers are great. They call for more training, particularly for whole-site training to sensitize all staff, even those working in reception or in janitorial positions.

 

For both women and providers, this is no easy decision. As advocates for women’s sexual health and rights, should we dismiss this population’s rights? Safe abortion is part of the spectrum of reproductive health care. How can we ignore this unmet need for safe second-trimester abortion services?

 

Evidence-Based Advocacy: Expanding Our Thinking About “Repeat” Abortions

http://awid.org/News-Analysis/Issues-and-Analysis/Evidence-Based-Advocacy-Expanding-Our-Thinking-About-Repeat-Abortions

Source: RH Reality Check

 

18/10/2012

About 1.2 million abortions are performed in the United States every year, and of women seeking abortions, about half have had an abortion before.

Women who have had more than one abortion are often targets of public-health interventions designed to increase women’s use of post-abortion contraception, or, to put it another way, to prevent them from having another abortion. Instead of seeing these women as “repeaters,” it’s time we viewed each abortion as a unique experience with its own set of complex circumstances.

Tracy Weitz and Katrina Kimport, sociologists with Advancing New Standards in Reproductive Health (ANSIRH), analyzed the interviews of ten women who’d had multiple abortions (full disclosure: I interned at ANSIRH this summer). Their research was part of several larger studies. The women interviewed varied in age, race, and geographic location, although most were from the Northeast or the West Coast. Together, they’d had a total of 35 abortions. Weitz and Kimport examined how these women thought about each abortion experience. Were they similar or different from each other? How did the circumstances of each abortion affect women’s emotional outcomes?

The researchers found that women talked about their abortions as separate events. Each abortion came with its own set of unique emotional and social circumstances, some more difficult or easy than others. In other words, a woman who’s had three abortions wasn’t repeating the same experience each time. Health interventions and policies that target women who have had more than one abortion should take into account that each abortion —and the circumstances of that pregnancy—may reflect a different emotional experience.

Weitz and Kimport argue, “It is important to recognize that some abortions can be emotionally easier or harder; it is problematic to instead think about abortion as being harder or easier for some women.” That is, just because a woman has had multiple abortions does not mean that each one was a product of the same circumstance. In fact, women reported that they wanted different types of support based on the circumstances of each abortion.
Similarly, providers should not assume that a woman with a history of multiple abortions will have the same emotional or contraceptive needs after each abortion. In fact, Weitz and Kimport found that some women avoided going to the same provider for each abortion because they feared being judged for having multiple abortions or having to hear the same contraceptive-counseling script. Providers should not make assumptions about their patients’ needs based on the number of abortions they’ve had.

Even our so-called pro-choice allies place judgments on women who have had multiple abortions. Mainstream pro-choice organizations often shy away from acknowledging that some women have more than one abortion. Instead of worrying that discussing multiple abortions will rile up the anti-choice movement, we should focus on de-stigmatizing the experience of abortion, no matter how many times a woman needs to access this service.
Women who have had multiple abortions should not be viewed as a separate class of people from women who have had one abortion. Indeed, it may be that the women who have only one abortion over an average of 35 years of trying not to become pregnant, are the rarer ones. Instead of targeting just the women who have had multiple abortions for public-health interventions, the researchers suggest that we offer emotional support based on the context of each abortion.
We should understand women who have had multiple abortions through their individual life experiences rather than judging them on their pregnancy history. If we want to better meet women’s emotional needs around abortion, we can start by using the phrase “multiple abortions” instead of “repeat abortions,” and moving away from policies that seek to prevent “repeat abortions.” To support women who have had multiple abortions, we need to acknowledge that some abortions may be more difficult than others.