The Guardian, UK

1 February 2013

Constanze Letsch in Istanbul

 

http://www.guardian.co.uk/world/2013/feb/01/turkish-law-abortion-impossible 

 

Draft bill prompts fears that new legislation will ‘dramatically limit availability’ to poorer women and those in rural areas

 

A new law expected to be presented to the Turkish cabinet in the next few days will make it impossible for women in the country to gain access to legal abortions, health professionals and human rights activists have warned.

The government has promised that the new draft bill on reproductive health and child abuse will not touch the legal limit for terminations, which is currently 10 weeks. But while an outright ban seems unlikely, women’s rights activists say the legislation will make abortions impossible in all but a few cases.

 

Under the draft law, abortions will only be permitted if carried out by obstetricians in hospitals, according to reports in the Turkish media. Currently the procedure is also offered by certified practitioners and local health clinics. The new law also introduces the right for doctors to refuse performing an abortion on the grounds of their conscience, and a mandatory “consideration time” for women requesting a termination.

 

“This will dramatically limit availability, especially to women in rural areas and women with few economic resources,” said Selin Dagistanli of the campaign group Abortion Is a Right.

 

“While there is no legal ban, these measures will make abortion de facto unavailable. In many towns there might only be one hospital, and maybe one obstetrician. What if this one doctor then refuses to perform a termination? Many women cannot afford to travel to another city or go to a private hospital,” she said.

 

Deniz Bayram, a lawyer at the Purple Roof women’s shelter in Istanbul, said: “The name of the draft bill puts child abuse and abortion on one level. It criminalises a medical procedure that needs to be available to women.”

 

Abortion in Turkey was legalised in 1983 to reduce the high number of women dying from unsafe, self-induced terminations. According to the Turkish Doctors Union Women’s Health Branch, only 2% of pregnancy-related deaths are the result of unsafe abortion methods today, while the number stood at 50% in the 1950s.

 

“If this new law passes, we will go back to the dark days of backstreet abortions. Women will start dying again,” said Dagistanli.

The prime minister, Recep Tayyip Erdoğan, has repeatedly described abortions as “murder”. Last year, the then health minister Recep Akdağtriggered a wave of protests when he threatened to prohibit terminations.

 

Erdoğan has urged Turkish couples to have at least three children and even campaigned for population growth in other countries. “Ever since the government started to focus on population growth and pro-natalist policies in 2007, obstacles have increased for women wanting an abortion,” said Dagistanli.

 

The draft bill is expected to be presented to the cabinet soon and will then be voted on in parliament. Since the ruling AKP holds the majority of seats, the law is expected to pass once it is put up for voting. Women’s groups fear that it might be passed overnight to avoid protests.

 

Even before the draft has been published, anti-abortion rhetoric from Erdoğan and other government figures has already made it harder for women to obtain terminations, said Bayram. She added that her organisation was receiving an increasing number of phone calls from women who were turned away from hospitals. “Women call us and ask: ‘We were told [in the hospital] that abortion is illegal in Turkey. Is that true?’ These women then often don’t know where to go. We realised that even without a legal abortion ban, it is already largely unavailable in Turkey,” she said.

 

Women are routinely turned away after eight weeks of gestation, when surgery becomes necessary, Bayram said. “We also hear of cases where women are verbally humiliated for wanting an abortion. The psychological pressure on women has increased dramatically.”

 

A full draft of the new law has yet to be published and the Turkish health ministry refused to comment.

 

One doctor at the Turkish Doctors Union Women’s Health Branch, who wished to remain anonymous, said: “This new bill is being drafted behind closed doors, without consulting specialists or women’s rights groups. Health professionals are worried about what it might bring.

 

“The government’s stance is very clear. They do not want to improve the safety of terminations. Abortions are among the safest medical procedures, but it looks like we might lose the right to it now.”

http://www.abortionreview.org/index.php/site/article/1323/

31 January 2013

Dr Carlos Morín, the Barcelona abortion doctor facing a possible sentence of 273 years in prison for practising almost a hundred abortions, has been absolved of all charges. Jennie Bristow discusses the circumstances and broader implications of his trial.

Another 10 defendants also faced heavy prison charges for illegal abortion, forgery, conspiracy and professional intrusion; however, the Barcelona court has ruled the abortions were carried out according to the law, and ‘with the consent and under the express request of the pregnant women’, the Spanish newspaper El País reports (1).

With this ruling, notes El País, ‘the Court of Barcelona has closed today an episode that marked a before and after in the Spanish legislation on abortion’. The Morín case attracted attention across Europe because, as the London Times reported back in 2011, ‘hundreds of women from Britain, Spain and other parts of Europe who were seeking late abortions were treated at the Ginemedex and TCB clinics in Barcelona, which were run by Dr Morín’. (2)

In Spain and beyond, the Morín case highlights some unsettling features of the legal and cultural situation surrounding abortion laws in Europe , and their implications for women and doctors. Above all the case shows how quickly, in a febrile cultural climate, countries can shift from being a haven for desperate women who could not be treated elsewhere in Europe into a hell for the doctors who helped them.

Context

Carlos Morín’s Ginemedex clinic in Barcelona has been the focus of attention by anti-abortion groups and media organisations for several years. In 2004, the British newspaper The Sunday Telegraph conducted an undercover investigation into the practice, by the abortion provider British Pregnancy Advisory Service (BPAS), of giving women the Ginemedex clinic’s telephone number when they were too late in the gestation of their pregnancies to be given an abortion under British law. A ‘supplementary report’ published by the Sunday Telegraph one month later ‘alleged that a general practitioner based in the South Birmingham Primary Care Trust had offered to facilitate the referral of a late abortion to the same clinic’. (3)

In Britain, the maximum ‘time limit’ for abortion (except in cases of fetal anomaly or to save the mother’s life and health) is 24 weeks; and pressure on the ‘late’ abortion services at that time meant that a woman presenting for an abortion at gestations over 21 weeks could not always obtain treatment in Britain. In such circumstances, staff at BPAS would sometimes pass on to these women the telephone number of the Ginemedex clinic, where abortions were conducted up to and beyond the 24-week British limit.

The Sunday Telegraph investigations caused significant fall-out in Britain . The Chief Medical Officer (CMO) conducted a thorough investigation of practices at BPAS, and in a report published in September 2005 (3) concluded that, while some of the advice given to the undercover journalist by staff at the BPAS helpline was unacceptable and that training issues should be addressed, BPAS had not broken any laws and continued to run a good service for women needing abortions at later gestations.

The CMO noted that ‘a woman is entitled to travel to another member state of the European Union for a termination of pregnancy’, and that information received from the Catalan Health Authority at the time of writing his report indicated that ‘there is no evidence of the Spanish clinic having acted outside of Spanish abortion law’.

The CMO’s most significant conclusion, for Britain , was that the circumstances leading to women being given the number of the Spanish clinic indicated broader inadequacies in the late abortion service in Britain , where the lack of provision meant that some women were denied access to the abortions to which they would have been legally entitled. The CMO called for an inquiry in the late abortion service in Britain – to date, this has not been acted upon.

Over in Spain , the campaign against Carlos Morín continued. In 2006, a Danish TV company conducted an undercover investigation of the clinic; this prompted another inspection by the health authorities, which found nothing illegal. The ‘ultra-Catholic’ group E-Christians then lodged a complaint about Morín at the Barcelona doctors’ association, which failed. In 2007, following a legal complaint against Morín by an employee, the clinic was searched, documents confiscated, and Morín arrested.

The puzzling thing to arise from this chronology of events is, what changed between 2006 – when the health authorities were apparently satisfied with Morín’s practices – and 2007, when he was arrested and his practice shut down? Again, it is fruitless to speculate on specific details that may emerge over the course of the case. But given broader developments in the Spanish abortion law from 2007, it is necessary to look at the changing cultural, political and legal context in which the Morín case has developed.

The Spanish abortion law, 2004-2007

As things stood in 2004, abortion was permitted under Spanish law for the following reasons:

• The pregnancy is the result of rape – up to 12 weeks gestation;
• The fetus, if carried to term, will suffer from severe physical or mental defects – up to 22 weeks;
• The abortion is necessary to avoid a grave danger to the life of or the physical or mental health of the pregnant woman – no time limit. (4)

In this respect, the Spanish law was similar to the British abortion law: with the exception of rape cases, abortion was not available on request, but it put the onus on the clinician to interpret it according to the woman’s circumstances. Under British law, abortion is legal up to 24 weeks’ gestation on the grounds that the pregnancy risks damage to a women’s mental or physical health; this is interpreted broadly, so that most of those women with an unwanted pregnancy who are motivated to ask for an abortion are considered to be at risk of psychological damage if the abortion is denied.

In a similar fashion, so the Spanish law came to be interpreted in its least restrictive form, and practiced outside of the national healthcare system. As the CMO’s report noted, in Spain in 2005 ‘Nearly all abortions are carried out in private clinics and 97% of abortions are carried out under the last ground shown above. In 2003, 79,800 abortions were carried out; 1.9% of these were at 21 weeks or more.’

The CMO’s report also cited statistics from the Barcelona newspaper La Vanguardia about the extent of late abortions performed to women from outside Spain: ‘The article also said in 2003, that out of all the patients seen within the 26 centres in Catalunya, 812 patients were foreign and only 14 of these were from the United Kingdom overall. 98.9% of the abortions performed on foreigners were of less than 22 weeks. In three cases it was in the 24th week and in five in the 26th week.’
This detail indicates a number of key points about the legal situation in 2004:

• Abortion in Spain was legal beyond the 24-week British time limit;
• Clinical practice at the Barcelona clinic was above board, in that it was inspected and approved by the Catalunyan health authorities;
• A small proportion of the abortions carried out in Spain were at ‘late’ gestations of only 21 weeks, and an even smaller proportion were carried out beyond the UK time limit of 24 weeks;
• A very small proportion of clients had come from the UK , and most of those were being treated at gestations that were legal in the UK – but presumably, they could not access the procedure here.

In other words, there was no scandal here waiting to be uncovered. The situation in Spain was legal and accepted by the health authorities; and this provided a haven for a small proportion of women travelling from countries where abortion was either illegal or inaccessible. What suddenly seems to have changed in 2007 was not the practice in Spain , but the cultural and political climate in which abortion was provided.

The Spanish abortion law, 2007-date

In 2010, the Sexual and Reproductive Health and Voluntary Termination of Pregnancy Act became law in Spain , replacing the previous legislation. This provides for abortion on request, funded by the state, up until the fourteenth week of gestation; but it is far more restrictive of abortions carried out later on. In this regard, the new Spanish law follows a pattern established in some other European countries, where there has been a ‘trade off’ between liberalisation in the first trimester of pregnancy – abortion on request – against greater restrictions on abortions at later gestations.

The new law seems to have been greeted by abortion providers as a mixed blessing. It was provoked by the bizarre situation in 2007, where a number of abortion clinics were raided by the Guardia Civil, medical records were seized, and clinic staff arrested or investigated. Following this, 40 clinics (over half of those in Spain ) suspended their work because they could no longer guarantee the provision of the service, or the safety of their staff. The situation revealed the fragility of an unclear law in circumstances that can quickly change, and the new abortion law has the merit of clarifying to women what they are allowed to seek, and to doctors what they are allowed to perform.

But at a conference of abortion and contraception providers held in Seville , Southern Spain , in autumn 2010, Eva Rodriguez of the abortion clinics’ association ACAI showed a thought-provoking film examining the new law, and also indicating its negative side. One contributor to the film drew attention to the arbitrariness of the 14-week time limit for abortion on request – why should women be accorded less capacity to decide in week 15, or 20 of their pregnancy? There remained difficulties with the financial and practical aspects of implementing the law, including concerns about regional differences. And of course, for women – in Spain and abroad – who need abortions after 14 weeks’ gestation – things have become that much harder. (5)

This situation indicates a shifting climate of expectation around abortion in Spain . As Ann Furedi, chief executive of BPAS, notes, ‘what has happened in Spain seems less to be a discovery of wrong-doing than a redefinition of wrong-doing’. And it is this notion of wrong-doing that needs to be discussed outside of the court, as a moral and political issue.

The demonisation of ‘late’ abortions

In recent years, and around the world, doctors conducting abortions in later gestations of pregnancy have found themselves in the news headlines, and the reaction is interesting to examine. The murder of the American Dr George Tiller in 2009 shocked those inside and outside the pro-choice movement – it is, thankfully, generally considered to be wrong to murder somebody for going about his lawful business, even if that lawful business is the controversial practice of second-trimester abortion. (6)

On the other hand, the arrest of the rogue Philadelphia doctor Kermit Gosnell in 2010 was shocking to those on both sides of the abortion debate, because of the illegality, brutality and clinically unsound nature of his practices. Those who argue for legal abortion beyond the first trimester do so precisely to protect women – who, when desperate for an abortion, will go to any lengths to obtain one – from charlatans such as these. (7)

As a society – even one like America, which is so polarised around the abortion debate – we set great store by what is legal and clinically safe medical practice, and what is not. This is why advocates of women’s right to abortion seek to make this practice legal, so the woman and her doctors can be safe. It is why the fact that most abortions happen in the first trimester does not mean that women do not need access to abortion beyond that time – as research has amply demonstrated (8), a small proportion of women will always need access to late abortion, and the ‘right to choose’ should not just mean ‘only three months to make your mind up’.

And this is also why abortion advocates and doctors will push for women to have access to safe care to whatever gestation they possibly can within the law. If abortion providers were interested in having an easy life, they a) probably wouldn’t work in abortion services in the first place, and b) would seek to provide women with the cheapest, easiest services they possibly could, even if this meant slamming the door in the face of those women presenting with more challenging conditions or gestations. But they don’t.

The fact is, those who work in abortion services are motivated by the care of women who come to them in difficult circumstances, and it is frustrating – at times heartbreaking – when the service that is provided cannot meet these women’s needs. For this reason, the British Government’s Department of Health should get on with the task its Chief Medical Office set the country back in 2005, which was never taken up: to review women’s access to abortions in later gestations, and find ways of improving the service. (3)

In Britain , abortion is legal on broad grounds up until the twenty-fourth week of pregnancy. But women are not always able to access abortions at this stage. The burden of ‘late abortion’ provision has been taken on by independent sector clinics, which cannot always accommodate women’s needs; also, delays in the care pathway can mean that by the time a woman is referred to an abortion provider, she is already too close to the gestational limit to be helped. There should be greater collaboration between independent providers and the NHS to ensure these women can be helped, and greater acceptance within the health service that women are entitled to the ‘late abortions’ that they need.

In Spain , Carlos Morín should have been able to expect fair treatment from the courts, and the open-minded support of his international colleagues in the pro-choice world. All those negotiating their way around sometimes unclear, and often changing, abortion laws in the current climate should be aware that those prepared to do the most to help women are also often the most likely to attract the ire of anti-abortion campaigners, media organisations, and politicians. In such cases, the first casualty is the woman who needs her abortion.

(1) Absuelto el doctor Morín en el caso de los abortosEl Pais, 31 January 2013
(2) Doctor charged with 101 illegal abortions. The Times ( London ), 16 September 2011
(3) An Investigation into the British Pregnancy Advisory Service (BPAS) Response to Requests for Late Abortions: A report by the Chief Medical Officer. Department of Health, September 2005
(4) Summarised by An Investigation into the British Pregnancy Advisory Service (BPAS) Response to Requests for Late Abortions: A report by the Chief Medical Officer. Department of Health, September 2005
(5) Achieving Excellence in Abortion Care’: Report on the ninth Congress of FIAPACAbortion Review, 25 October 2010
(6) Comment: One family’s tragedy, not a political indicator. By Jennie Bristow. Abortion Review, 2 June 2009
(7) Late abortion: the new clash in the Choice Wars. By Ann Furedi. spiked, 3 March 2011
(8) See for example Second-Trimester Abortions in England and Wales, by Roger Ingham, Ellie Lee, Steve Clements and Nicole Stone, University of Southampton 2007.

Missed Your Period? Don’t Want to be Pregnant? There is an App for That

 

by Karen Gardiner

December 3, 2012

 

http://www.rhrealitycheck.org/article/2012/11/29/missed-your-period-there-is-medication

 

Via www.ipas.org

 

 

“To avoid judgement and fear, it is always useful step into the shoes of another person. I invite you into mine.”

 

So begins the journey of a 19-year-old Mexican named Claudia, protagonist of an inventive computer game.

¿No Te Baja? which translates as Missed Your Period? makes use of bright colors, engaging cartoon characters and relatable, non-technical, language to inform and guide users through the steps they can take to terminate a pregnancy using Misoprostol. The website takes the form of an interactive, Choose Your Own Adventure style game, where users click through to different scenarios that change according to their own personal situation and decisions.

 

Misoprostol, a drug used to treat ulcers, is easily available for purchase throughout Mexico, and, unlike in the United States, does not require a prescription. Use of Misoprostol to terminate pregnancy is widespread in parts of Mexico where abortion is illegal, but pharmacy workers often lack the knowledge of how the drug should correctly be administered — and criminalization means that helpful information is scarce.

 

Although abortion of up to 12 weeks of pregnancy is available on demand in Mexico City, the situation is quite different in the rest of the country. In fact, Mexico City’s 2007 legalization of abortion prompted a backlash from 17 other states, which passed amendments stating that life begins at conception, ushering in a much stricter enforcement of already existing anti-abortion laws.

 

Users of No Te Baja, through the actions of Claudia and her boyfriend, go through each detailed step of the process of self-administering a medication abortion: from the initial pregnancy test to the decision whether or not to involve the partner; the signs and symptoms of an ectopic pregnancy to calculating gestational age to indicate whether or not use of Misoprostol will be effective-and if it will be safe to self-administer.

 

The game advises that Misoprostol can be purchased in most pharmacies and that it may be sold under various other commercial names including Cytotec, Cyrox, and Tomispral.  Users receive detailed information on how to administer Misoprostol through the mouth or the vagina, noting that, in the event of having to seek medical attention, medical personnel would likely be able to detect the remnants of the pills inside the vagina- important information for women living in areas where they can be prosecuted for inducing an abortion.

 

The central Mexican state of Guanajuato, where hospital staff report suspicious miscarriages to the police, is one such place. The Nation described the state’s approach to dealing illegal abortion in a January 2012 article by Mary Cuddehe:

 

“The state has opened at least 130 investigations into illegal abortions over the past decade, according to research by women’s rights groups, and fourteen people, including three men, have been criminally convicted. Given Mexico’s 2 percent national conviction rate during its most violent period since the revolution, that’s a successful ratio.”

 

No Te Baja doesn’t end with the final dosage of medication: users (and Claudia) are informed of what signs to look out for that would require medical attention, and of how to tell if the abortion is incomplete. The final stages of the game offer information on how to avoid another unplanned pregnancy with detailed descriptions of different methods of contraception.

http://www.ipas.org/~/media/Files/Ipas%20Publications/MAMattersNov2012.ashx

 

PERSPECTIVES: ‘It was worth the sacrifice’: Kenya’s Dr. John Nyamu on why he spent a year in prison

 

From: Ipas, Medical Abortion Matters (November 2012)

 

Until 2011, abortion was illegal in Kenya except to save a woman’s life. For years the climate of fear and secrecy surrounding abortion hurt women, their families, and health-care providers. Unsafe abortion in Kenya still causes an estimated 30 percent of maternal deaths and countless other injuries.

 

Now, a newly ratified Kenyan constitution allows for legal abortion on much broader terms-and, when the new law is fully implemented, it stands to dramatically increase women’s ability to exercise their reproductive rights.

 

Ipas’s senior clinical advisor Mary Fjerstad recently sat down with Kenya’s much-respected Dr. John Nyamu to discuss the long and difficult path he and so many other Kenyans have traveled to get where they are today.

 

Mary Fjerstad: Doctor Nyamu, would you tell me what the situation was like in Kenya when abortion was considered a criminal act? [Editor’s note: Before constitutional reform, abortion in Kenya was highly restricted with few legal indications for having the procedure.]

 

Dr. John Nyamu: Most health-care workers were afraid of talking about it openly. Abortion was never performed in government hospitals unless the life of the woman was in real danger. Even then it was very bureaucratic as one doctor could only do the procedure with permission in writing from two other doctors; one doctor had to be a psychiatrist and the other doctor had to be a senior doctor in the hospital. Abortions were performed by D&C or induction. In reality, these legal abortions were provided almost exclusively at Kenyatta National Hospital, provincial hospitals and very rarely in district hospitals. (Kenyatta National Hospital is the major teaching hospital in Nairobi).

T

here were wards in hospitals where women who had unsafe abortions were treated for uterine and bowel damage due to perforations and developed sepsis, brain damage and many women died.

T

here was tremendous secrecy about abortion, women were aborting late. The penalty for a doctor who performed an [illegal] abortion was 14 years [in prison]; pharmacists could be imprisoned for three years for giving abortifacient medicines and women themselves could be imprisoned for seven years for having an abortion.

 

Some private clinics were providing safe abortion. They were harassed regularly by local police, usually by extortion. They were used virtually as the personal ATMs of the police [ATM = Automatic Teller Machine, a banking machine from which you can withdraw cash using a bank card]. A policeman would say, “I’m short of cash, give me your cash or I’ll arrest you.” The entire staff, including nurses, doctors and women seeking abortion could be arrested. Due to the fear, the providers kept servicing [the police] to buy their freedom.

 

Your case was profiled by The Center for Reproductive Rights’ paper in 2010, “In Harm’s Way: the Impact of Keny’s Restrictive Abortion Law.” Can you briefly describe what happened to you that led to this paper?

 

In 2004, [data were shared] which showed worrying trends and consequences of unsafe abortion in Kenya. This was followed by a major crackdown on clinics, hunts for women who had abortions, some clinics were closed and I was targeted. There were 15 fetuses found along a major road with some documents from a hospital I had worked at previously but had since closed. My clinic was raided and two nurses and I were arrested. This appeared to have been very well organized with all the media including print, radio and TV present to report on the matter.  When we were asked to pay bribes, we refused-because we knew the fetuses were not from our clinic and the documents were planted on the road-and we were locked up. [Editor’s note: subsequent pathology examinations found that the fetuses were still-born fetuses, not aborted fetuses.]

 

The three of us were ultimately charged with two counts of murder, rather than an abortion-specific offense. Since murder is a non-bailable offense in Kenya, we had to stay in remand prison pending our trial. We all spent a year in prison. One of the nurses was six months pregnant and delivered while she was in prison. One of the nurses still works for me and the other got her green card and has since immigrated to the United States.

 

A senior doctor, a gynaecologist, was instructed by the Director of Medical Services of the Ministry of Health to accompany the police and inspect the two clinics operated by Reproductive Health Services. The purpose of the inspection was to verify if there was any abortifacient equipment. He gave witness in court that the two facilities had legal equipment normally found in a gynecologist’s clinic and he would be surprised if he did not find it as he uses the same equipment for his work. The police forensic department was asked to look for DNA on the equipment from the clinic. DNA was taken from any instruments or equipment with blood on them-even the couches and lab coats were confiscated. The results from the government chemist found that there was no DNA linkage between the fetuses found on the road and any blood specimens from the clinic. The doctor also found that the clinic was duly registered and all staff had proper and up-to-date licenses.

 

The case was eventually ruled as improper [Editor’s note: They were acquitted of all charges]. With that ruling, the attorney general decided not to pursue prosecution due to lack of evidence.

 

Was it horrible being in prison for a year?

 

Yes, it was horrible, but it was worth the sacrifice. I was held at the Kamiti Maximum Prison, which is where the hard-core criminals are remanded. I was confined in a small cell for a whole year. I really felt persecuted, but as I said, it was worth the sacrifice.

 

Why do you say it was worth the sacrifice?

 

My arrest and imprisonment was in the media virtually every day. The publicity was an opening for people to realize the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public. There are only about 250 OB/GYNs in Kenya; some districts have none. The media sensation from this case galvanized the Kenya Obstetrical and Gynaecological Society (KOGS), the National Nurses Association of Kenya, the Federation of Women Lawyers, human rights advocates, women’s rights organizations and many others to form an alliance of reproductive health rights advocates.

 

This alliance exists to date and is known as the Reproductive Health and Rights Alliance (RHRA). The RHRA is an advocacy platform to agitate for the reduction of maternal mortality and morbidity due to unsafe abortion. This alliance also offers technical support to abortion service providers through Reproductive Health Network (RHN). The public became aware of abortion and the toll of unsafe abortion. The window was open to the public to realize the terrible toll of unsafe abortion in Kenya.

 

This debate extended to the drafting of a new Constitution in 2010. The Constitution says that “every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.” My arrest, imprisonment and [the resulting] publicity generated a public awareness that led to a transformation in the understanding that safe abortion is essential to preventing maternal morbidity and mortality.

 

Is there any further action in your own case?

 

Yes, I have since sued the government for malicious prosecution and subsequent confinement for one year in remand prison. The case has been in court for the last six years without yet being assigned a hearing.

 

What does the expansive definition of health in the new constitution mean in terms of when an abortion is considered legal?

 

Abortion is legal if the pregnancy endangers the life of the woman; as an emergency treatment; or when it endangers health, with health defined broadly: physical, social and mental. If in the opinion of a trained health professional an abortion is provided in good faith (in other words, where the pregnancy jeopardizes the woman’s physical, social or mental health), it is legal. [Editor’s note:Under the new law, a woman can make her abortion decision with one health-care provider; others are not required to be involved or sign off on the decision.]

 

What categories of health-care providers can perform legal abortion?

 

Physicians, nurses, midwives and clinical officers [who have completed training to perform abortion services] can now perform legal abortions.

 

What are the next steps in transforming the policies to establish safe, legal abortion in Kenya?

 

Ipas and other organizations took the lead in writing a document called, “Standards and guidelines for reducing morbidity and mortality from unsafe abortion.” The title is taken from a similar document from Zimbabwe and is brilliant. Kenya, like other countries, wants to achieve the Millennium Development Goal of 75-percent reduction in maternal mortality; this can’t be achieved if safe abortion isn’t available.

 

The other milestone on transformation is the revision of codes of ethics and scope of practice for all the professional associations in Kenya. These have been done and are waiting to be launched.

 

This transformation to legal abortion access in Kenya is a testament to very brave, inspired people dedicated to the common good who have sacrificed a lot. How have all the changes we’ve discussed affected providers of safe abortion and women?

 

Providers are now aware of the enhanced protections that have been offered by the constitution. This in turn has increased access to safe abortion services and thereby enabled women to realize their reproductive health rights. In addition, incidences of provider harassment are now on the decrease.

http://www.guardian.co.uk/commentisfree/2012/nov/14/savita-halappanavar-medically-unnecessary-death

In the worst way possible, a woman refused a life-saving abortion in Ireland has proved ‘pro-life’ advocates wrong

Jill Filipovic for Feministe, part of the Guardian Comment Network

guardian.co.uk, Wednesday 14 November 2012 10.19 GMT

“This is a Catholic country,” was what Irish doctors told Savita Halappanavar after she learned she was miscarrying her pregnancy and asked for an abortion to avoid further complications. She spent three days in agonising pain, eventually shaking, vomiting and passing out. She again asked for an abortion and was refused, because the foetus still had a heartbeat.

Then she died.

She died of septicaemia and E Coli. She died after three and a half days of excruciating pain. She died after repeatedly begging for an end to the pregnancy that was poisoning her. Her death would have been avoided if she had been given an abortion when she asked for it – when it was clear she was miscarrying, and that non-intervention would put her at risk. But the foetus, which had no chance of survival, still had a heartbeat. Its right to life quite literally trumped hers.

US politicians and “pro-life” advocates like Joe Walsh will tell you that there are no circumstances under which women need abortions to avoid death or injury. The Republican platform doesn’t include an exception for medically necessary abortion. And the Republican party is trying to put laws similar to those in Ireland on the books in the United States – laws that would allow emergency room doctors to refuse to perform abortions, even in cases where the pregnant woman’s life or health depends on terminating the pregnancy. The GOP isn’t exactly the most science-friendly or fact-reliant crowd in the world, but to them, women like Savita either don’t exist or just don’t matter. As Jodie at RH Reality Check writes:

“These are the lives of your sister, your mother, your daughter, your aunt, your friends, and your colleagues. These are the lives at stake. These are the very people that the fanatical anti-choice and religious right see as ‘not people’.

They are all Savita Halappanavar.

We are all Savita Halappanavar.

But we do not have to die at the hands of misogynists.

In honour of Savita Halappanavar; in honour of the nearly 22 million women worldwide each year who endure unsafe abortion; in honour of the 47,000 women per year worldwide who die from complications of unsafe abortion and the estimated 10 times that number who suffer long-term health consequences; in honour of the millions of women who do not have access to contraception, who have no control over whether and with whom they have sex or whether or with whom they have children, we can fight back. In honour of the young girls married young and the women forced to bear children long past the point they are able to care for more … for all these women, we must continue to act, to liberalise abortion laws, ensure every woman has access, remove the stigma, and trust women, like Savita, who know when it is time to end even the most wanted pregnancy.”

Just two months ago, a consortium of Irish doctors got together to declare abortion medically unnecessary. They claimed that abortion is never needed to save a pregnant woman’s life, and stated: “We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

I’m pretty sure Savita Halappanavar would disagree. I’m pretty sure she didn’t get optimal care.

SOLIDARITY REQUEST:

 

Protest the death of Savita Halappanavar in Ireland

 

PLEASE SIGN AND SEND THE E-MAIL BELOW TO THE FOLLOWING:

 

To: Taoiseach Enda Kenny (Irish Prime Minister)

cc: Tánaiste Eamon Gilmore (Irish Deputy Prime Minister and Minister of Foreign Affairs)

 

E-mails:

taoiseach@taoiseach.gov.ie

enda.kenny@oireachtas.ie

eamon.gilmore@oir.ie

 

Copy also to the Irish Embassy in your country. Find contact details here: http://www.dfa.ie/home/index.aspx?id=285

   

 

Re: Death of Savita Halappanavar in Galway

 

Honourable Taoiseach,

 

We are writing to you to express our concern about the recent death of Savita Halappanavar, who was repeatedly denied an abortion in Galway. This tragic case demonstrates once again that the prohibition of abortion in Ireland is not just undermining the autonomy of the women across the country, it is leading to unacceptable suffering and even death.

 

Savita Halappanavar made repeated requests for an abortion after presenting at University Hospital Galway on 21 October while miscarrying during the 17th week of her pregnancy. Her requests were refused, and she died one week later after several days in agonising pain and distress.

 

The situation of Savita Halappanavar provides the clearest possible evidence that laws that permit abortion only to save the life of a woman, such as the Irish law, are clinically unworkable and ethically unacceptable. There are numerous clinical situations in which a serious risk posed to a pregnant woman’s health may become a risk to her life, and delaying emergency action only increases that risk. There is only one way to know if a woman’s life is at risk: wait until she has died. Medical practitioners must be empowered by law to intervene on the grounds of risk to life and health, rather than wait for a situation to deteriorate.

 

You will be aware that the European Court of Human Rights, as well as a number of United Nations human rights bodies, have called upon the Irish government to bring its abortion law in line with international human rights standards. Had these calls been heeded before now, the death of Savita Halappanavar would have been prevented.

 

With the death of Savita Halappanavar, Ireland joins the ranks of countries worldwide where abortion is denied to women and leads to their deaths.

 

We call on your government to take urgent and decisive steps to reform the legislation that led to the death of Savita Halappanavar. Until the Irish legal system is reformed the lives, health and autonomy of women across Ireland are in jeopardy.

 

Yours faithfully,

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?