Northern Ireland: Mass Civil Disobedience in North Illuminates Role Of States In Abortion Discussion

http://www.wsm.ie/c/mass-civil-disobedience-abortion-northern-ireland

Workers Solidarity Movement

Mass Civil Disobedience in North Illuminates Role Of States In Abortion Discussion

Date: Mon, 2013-03-11 12:21

In an act of mass civil disobedience directly challenging the legitimacy of the state to regulate women’s reproduction against their own will, over 100 people in Northern Ireland under the banner Alliance for Choice have signed an open letter declaring they have taken, or supported others to take, a pill to induce an abortion.

The political action is designed to coincide with a vote in Stormont tomorrow that, if passed, would make it illegal for women to receive abortions in private clinics in the north. The proposed amendment to the Criminal Justice Bill is being pushed by fundamentalists within what’s traditionally described as “both communities.” The proposal to change the law was tabled by the DUP’s Paul Givan, who chairs the Stormont Justice committee, and the SDLP’s Alban Maginness both of whom will never get pregnant. The Alliance party and Sinn Fein will oppose the amendment.

The act of civil disobedience itself is interesting from many perspectives, not least the way in which a coherent analysis within the letter makes apparent the links between women’s reproductive autonomy and the social/political policies of austerity that function to increase poverty and social inequality within national borders. That analysis is shared by the Pro Choice movements in the south.

Its also throws into stark relief one of the ambiguities of public discussion around abortion in the south. Whilst looking northwards, mainstream media seems to have little problem in conflating religious, social and political perspectives with the function of the state itself. Its one I and other anarchist share, and the contested nature of political identity and structural oppressions that gave rise to both to the civil rights movements as well as the provos make help illuminate that. That the state itself is an ideological entity is a given and assumed, even as the workplace practices of contemporary journalism give little reward or encourage for this to be untangled and explored. Neither is the tactic of civil disobedience in examined beyond the word ‘protest’.

For example this act of civil disobedience forces the northern state – via its police force and criminal justice system – to act or not act in a public fashion. The political act of disobedience is calculated to illuminate and educate about unjust structures of social/political/economic power as well as forcing the state to act in ways that regardless of the specifics, all actors know the state will itself be judged upon by the wider public.

However when looking closer to home, this Irish state seems to be continually framed – and likes to present itself as – ideologically neutral, as if it were a paternal independent arbitrator between two opposing positions. But this self image is patently false and can only be sustained under a social imagination that separates out abortion from the state’s historical role in the systemic abuse of women. But that’s simply not tenable to an increasingly political literate population, nor is it to the growing feminist movements on the island. The state is patriarchal in so far it has continually reproduced social conditions of inequality against women.

The Catholic Church has seen a massive diminishing of it social power, a direct result of the breaking of silence surrounding the systemic brutality that enforced its cultural weight in Irish society. Its “socially conservative” (read deformed, sexually repressive and violent) dogmatism, simultaneously anti-women, anti-homosexuality, is being challenged by an increasingly counter-hegemonic discourse. Woman in the pro choice movements are no longing pleading for control over their own bodies from a church and state nexus which have previously deemed itself the only legitimate authority that can dispense or renege on that autonomy. Many are, quite sensibly, demanding complete autonomy for themselves and each other.

Also the narrative that ‘abortion debate’ revolves around two opposing yet valid abstract moral positions is itself a mispresentation. There is no emotional or intellectual equivalency between the positions of “I dont want to be forced to remain pregnant against my will” and “You should be forced to remain pregnant against your will because I think abortion is ‘bad’”. I have yet to hear a anti abortion argument that doesn’t relegate women’s existence to forced birthing factories. Appeals to God and a paradigm of ethics and morals founded upon his (yes of course his) existence can of course can be made – and as an anarchist I support the freedoms that facilitate that – but they should be given no greater intellectual weight that the musings of Thomas the Tank engine or other fictional entities.  The function of suppressing women’s right to bodily integrity and reproductive choices does need a meta philosophy to justify itself. It is not to role of critically thinking, emotionally literate human beings to do that however.

If you align yourself to the Catholic Church you need to get used to the idea that many people see this as reason enough to reject the idea that you are an ethically coherent and emotionally literate human being. You have some ground to make up given our collective history. Likewise if you are a member of a political organisation that oversaw generations of state sanctioned abuse. And indeed this is also the case if you “believe” in unending economic growth on a planet of finite resources and growing inequality and social injustice. You simply come with too much baggage and too much incoherency to expect your ideas be deemed valid or socially useful merely because you hold them.

What come from this is the basis of a position that makes coherent arguments against state coercion in all its forms, but that also recognises that the state itself is deeply ideological itself, rather than an arbitrator. The tactic of mass civil disobedience has yet to be used within this wave of feminist struggle for social justice in the south. However when that happens, the state itself will be forced to act, and in doing so illuminate part of itself that so far has remained invisible in mainstream media narratives

Heres the letter

Open Letter

We, the undersigned, have either taken the abortion pill or helped women to procure the abortion pill in order to cause an abortion here in Northern Ireland.

We represent just a small fraction of those who have used, or helped others to use, this method because it is almost impossible to get an NHS abortion here, even when there is likely to be a legal entitlement to one.

We know that Stormont Ministers and the Public Prosecution Service are aware that such abortions have been taking place in the region for some years, but are unwilling to prosecute for a range of reasons, at least partly to do with not wanting an open debate around the issue of when women here should have a right to abortion.

We are publishing this letter now because of the Givan/Magennis amendment to the Criminal Justice Bill which we believe is aimed at closing down the debate on abortion here, as much as it is about closing down Marie Stopes.

We want to emphasise that medical abortions happen in Northern Ireland on a daily basis but without any medical support or supervision. We were delighted when Marie Stopes came to Belfast as it meant that women who are unwell, and therefore eligible for a legal abortion, can access a doctor to supervise what we have done or helped others to do without medical help.

We live in the only part of the UK that still does not have a childcare strategy. We face huge cuts in children’s living standards if the Assembly passes the Welfare Reform Bill without major amendment. If our politicians showed as much zeal in protecting the lives of children who are already born, perhaps we would have fewer women seeking abortion because of poverty.

Signed

Christiane McGuffin, Derry
Bronagh Boyle, Belfast
Goretti Horgan, Derry
Judith Cross, Belfast
Siusaidh Laoidhigh, Belfast
Roisin Barton, Derry
Virginia Santini, Belfast
Julia Black, Derry
Natalie Biernat, Derry
Adrianne Peltz, Bangor
Elizabeth Byrne McCullough, Belfast
Naomi Connor, Belfast
Catherine Couvert, Belfast
Caitlin Ni Chonaill, Belfast
Helen McBride, Armagh
Wendy McCloskey, Derry
Alice Lyons, Bangor
Maev McDaid, Derry
Janet Shepperson, Belfast
Mary Breslin, Derry
Anita Gracey, Belfast
Grainne Boyle, Belfast
Catherine Rush, Derry
Yvette Wilders, Limavady
Deirdre Kelly, Derry
Sarah Wright, Belfast
Sharon Meenan, Derry
Shannon O’Connell, Bangor
Ciara Smyth, Belfast
Shannon Sickels, Belfast
Jason Brannigan, Belfast
Connor Kelly, Derry
Claire Hackett, Belfast
James Doherty, Derry
Jill Letson, Derry
Noella Hutton, Derry
Glen Rosborough, Derry
Ann Harley, Derry
Ryan McKinney, Belfast
Kieran Gallagher, Derry
Jeanette Hutton, Derry
Julie Rogan, Derry
Matt Collins, Belfast
Pat Byrne, Derry
Susan Power, Derry
Aisling Gallagher, Belfast
Betty Doherty, Derry
Mel Bradley, Derry
Edward Gary Hill, Belfast
Sha Gillespie, Derry
Abby Oliveira, Derry
Joanne Butler, Derry
Majella Keys, Derry,
Gerard Stewart, Belfast
Maisie Sharkey, Derry
Orlagh Ni Leid, Belfast
M. Campbell, Derry
Tiarnan O Muilleoir, Belfast
Laura McFeely, Derry
Brenda Graham, Derry
Janet Shepperson, Belfast
Donna McFeely, Derry
Daisy Mules, Derry
Malachai O’Hara Belfast
Eileen Webster, Derry
Véronique Altglas, Belfast
Dianne Kirby, Derry
Helen Quigley, Derry
Sadie Fulton, Belfast
Aaron Murray, Derry
Aoife McNamara, Co.Down
Eileen Blake, Derry
Diana King, Derry
Paula Leonard, Killea
Kitty O’Kane, Derry
Sara Greavu, Derry
Eve Campbell, Derry
Katherine Rowlandson, Derry
Justine Scoltock, Derry
Eamonn McCann, Derry
Catrin Greaves, Belfast
Anita Villa, Derry
Caolan Brown, Derry
Asha Faria-Vare, Belfast
Chrissie Kavanagh, Derry
Elaine Power, Derry
Maria Caddell, Belfast
David Stewart Campbell, Lisburn
Ellie Drake, Belfast
Lisa Byrne, Derry
Siobhan Doherty, Derry
Stella Green, Belfast
Jim Collins, Derry
Guy Hetherington, Belfast
Amos Gideon, Belfast
Stephen Connolly , Belfast
Catriona Acherson, Belfast
Timothy Lavety, Belfast
Ellen Wilson, Belfast
Richard Bailie, Belfast
Manuela Moser, Belfast

The letter contains signatures of 100 individuals from Northern Ireland who have accessed or helped women to access illegal (under Section 58 of the Offences Against the Persons Act 1861) abortion pills, such as those available from Women on Web (WoW).

Update

Since the letter was published, the following names have been added:

Emma Campbell, Belfast
Judith Thurley BA (Hons) RGN, Belfast
Lynda Walker, Belfast
Claire McCann
Lily Hendron, Coleraine
Nick Ní Fhéasóg
Claire Molloy, Belfast
Peter McCormack, Belfast
Áine Jackman, Belfast
Seanín Ní Connalláin, Belfast
Ruth Wilson, Belfast

 

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

In Spanish, but here is a Google translation in English

 

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

Líneas telefónicas promueven el aborto seguro en Sudamérica

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

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

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

TENGO UN GRAVE PROBLEMA

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

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

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

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

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

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

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

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

LARGA DISTANCIA INTERNACIONAL

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

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

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

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

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

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

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

HORIZONTES

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

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

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

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

El número de la línea en Chile es 889 18 590

+ INFO:

www.womenonwaves.org

Por Cristóbal Cornejo

El Ciudadano

 

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

. . . . . . . . . .

 

Morocco: Women on Waves Will Visit Morocco Next Week

Abortion Ship Will Visit Morocco Next Week.

For immediate release: “Abortion Ship Will Visit Morocco Next Week”
MALI ( Alternative Movement for Individual Freedoms ) has invited the Dutch organization Women on Waves to come to Morocco with the abortion ship. The ship can provide women with legal medical abortions under Dutch law after sailing to international waters.

Abortion is illegal and taboo in Morocco, but approximately 600 to 800 women still have an abortion every day. While wealthy women can afford safe abortion access, women of low socio-economic-status must often resort to unsafe methods that can result in morbidity and death. Therefore, access to safe abortion is fundamentally an issue of social justice. According to the World Health Organization (WHO), unsafe abortion methods cause 13% of pregnancy-related deaths.

MALI has invited Women on Waves to support the movement for legalization of abortion. To support legalization of abortion in Morocco, people can sign the petition.

In another press release will be send next Wednesday, October 3 th, the place, date and time of arrival of the ship will be announced.

http://www.petitions24.net/legalisation_de_lavortement_au_maroc
For more information please call:

MALI- Ibtissame Betty LACHGAR +212610177421
WoW- Rebecca GOMPERTS +31652052561

 

USA: Idaho Abortion Ruling States Pregnant Women Can’t Be Prosecuted For Having Abortion

http://www.huffingtonpost.com/2012/09/11/idaho-abortion-ruling_n_1875283.html

by
Laura Bassett

An Idaho law that bans the use of medication to induce abortion cannot be used to prosecute a woman who took the pills to abort her pregnancy, a U.S. appeals court decided on Tuesday.

Bannock County prosecutors brought a case against Jennie Linn McCormack in 2011 after she used medication that she obtained online to induce her own abortion. McCormack, a single mother of three, claims that she could not find a licensed abortion provider in Southeastern Idaho, so she had to violate a state law that requires abortions to be performed at a hospital or medical clinic.

An Idaho federal judge dismissed the charges against McCormack in September 2011 on the grounds that the law cannot be enforced. McCormack then challenged the law itself, arguing that it imposes an undue burden on women’s access to abortion in Idaho.

The Ninth Circuit Court of Appeals ruled Tuesday that the law is likely unconstitutional because the burden of having to adhere to criminal abortion statutes should fall on the physician rather than the pregnant woman.

“There can be no doubt that requiring women to explore the intricacies of state abortion statutes to ensure that they and their provider act within the Idaho abortion statute framework, results in an ‘undue burden’ on a woman seeking an abortion of a nonviable fetus,” Judge Harry Pregerson wrote in his opinion.

The ruling, however, does not mean that other pregnant women can now break the law without fear of being prosecuted, Pregerson said. Until the law is struck down, prosecutors can legally continue to enforce it.

 

Devil in the detail: abortion drug [misoprostol] banned in Turkey

by Stratos Moraitis | July 16, 2012   The Globe Times/Advocating Human Rights   http://www.theglobetimes.com/2012/07/16/devil-in-detail-abortion-drugs-banned-in-turkey/   Pursuant to a month of heated discussions, Turkish government stated that they will not amend the existing laws on abortion in Turkey and restricted their changes to the subject of making caesar sections more difficult to implement. Social media whirled about a few days, press immediately forgot about the issue, but the snake never slept.   Since the debate was bipartisan and centered around the poles of who said what and belonged to which group, a subject so complicated and without a widespread consensus ended up being imprisoned within the walls of daily agenda. No real public discussion was enabled; the opinion makers yelled and gagged and powers to be let it go on while preparing for their real scheme.   Since the leader of the governing party made it clear that their “religious and vindictive” new youth should increase in numbers, abortions and family planning should be abolished. This author is fully aware of the fact that his rhetoric is exactly that and nothing more. But in reality AKP government and the state machinery need ignorant, scarcely educated majority to increase as a percentage of total population to guarantee their political and social existence. Since level of education and economical wealth has an inverse relationship with the number of kids in households, their “3 children minimum for each family” motto will evidently succeed only in undereducated and ill-informed population, increasing their vast numbers even more.   So while arguing publicly that the government has no immediate plans to ban abortion, Ministry of Health banned all drugs containing misoprostolused in medical abortion on July 9th with instructions by Turkish Medicine Informations Network. World Health Organisation declares that misoprostol can be used safely to induce an abortion up to nine weeks of pregnancy and places the substance on the List of Essential Medicines. In Turkish pharmacies medicine containing the banned substance-misoprostol; Arthrotec (used in osteoarthritis and rheumatoid arthritis treatment) and Cytotec (used in peptic ulcer and Gastroesophageal reflux disease treatment) are banned now. Turkish government is simply preventing ulcer and arthritis patients’ access to affordable treatment with no literature or explanation behind their decision to prevent medical abortions. No other drugs enabling medical abortions that contain Misoprostol or Mifepristone are available in Turkey.   Public fury started after Turkish Prime Minister’s mention that abortion is an equivalent of mass murder in a public speech. Turkey experienced historically very high death rates in pregnant women prior to the legalization of abortion in the early eighties. However, being a country with feudal traditions death rates among young women due to family feuds and sexual issues are still relatively high. With the influence of the rise of conservative values in the society death rates among women increased 1400% during the last seven years according to the Justice Department. Women’s Rights is a severe issue in Turkish society where women even when they are economically independent, are frequently abused by men due to the social and traditional factors. Even according to the existing abortion law, the right to undergo the operation is dependent on husband or father’s approval.   In Turkish politics devil is always hidden in detail. Rhetoric and reality does not usually match. The love story between engineering of the society and the ruling elite does not seem to fade away any time soon. While managing the public euphoria and the demands of society at large, the officials follow an unwritten strategy of oppression based on the changing needs of time. As we go through the commercialization of everyday life in Turkey with increasing number of shopping malls and conservatism on the rise, it has been the management strategy of the new elite to blackmail the society with economic growth: “obey, become one of as and prosper.” This strategy helped limit the fight for human rights to ethnic and religious minorities that refuse to join conservative ranks.   And with new pressures applied on freedom of women, religious, ethic or sexual minorities everyday, another “modern” era of assimilation is underway.   The state as a supplier of amenities decides who shall receive the charity and who is to be shunned. In a country which calls itself a democracy that is unthinkable. But then again, when you have a closer look, and feel how the Sunni Muslim elite takes on daily issues, the devil’s shining golden teeth grins between each golden ornament in the framework. With gratitude to Duygu Kara and Rebecca Gomperts for their insight.

 

Fabulous comment on the recent situation in Ireland

www.irishexaminer.com/opinion/columnists/colette-browne/reluctant-politicians-need-to-get-real-and-change-law-on-abortion-191633.html

Reluctant politicians need to get real and change law on abortion

By Colette Browne

Wednesday, April 25, 2012

IF Labour is wondering why its support has suffered a vertiginous drop since last year’s election it need only look to its TDs’ shameful contributions to last week’s Dáil debate on abortion for answers.

One by one they got to their feet and waxed lyrical about their sympathy for women who find themselves forced to travel abroad for an abortion, fulminated about the appalling failure of successive governments to do anything to resolve the legal quagmire that enmeshes this most controversial of issues, declared their unwavering support for legislation to finally give effect to the X Case judgment — and then promptly voted against a Bill that would do just that.

Now, let’s get a few things straight. It may come as a surprise to hear this but women in this country have had a constitutional right to an abortion, if their lives are at risk, for nearly 30 years, since the constitutional amendment was passed in 1983.

A High Court judge, in the X Case in 1992, said the failure of government to enact legislation to give legal effect to that right was “inexcusable”. Six years later another judge, in the C case, said she didn’t want the High Court to become a “licensing authority” for abortion — vulnerable women constantly forced to mount costly legal actions to determine their right to an abortion.

The response of government, in 2002, was to try to pass a constitutional amendment that would have removed the right of suicidal women to an abortion. They would rather have let them die. Thankfully, the Irish people rejected that amendment.

In 2010, the European Court of Human Rights (ECHR) said the State’s failure to implement a framework to allow a woman unambiguously determine her right to a lawful abortion was a breach of her human rights.

The judgment is binding and while the court could not tell the State how to comply with its obligations under international law it did pointedly note that Ireland is almost alone in the Western world in not having enacted legislation to clearly define in statute the conditions governing access to abortion.

Remember, this is not abortion on demand. Or even abortion for health reasons — no matter how serious those health issues may be. The ECHR ruled that the State’s preferred practice of exporting desperately ill women for abortions was perfectly fine. The only thing this ruling relates to is access to an abortion when that abortion will save the life of the mother.

Still, the Government felt compelled to create yet another stumbling block before legislation could even be contemplated and long-fingered action by creating an expert group to discuss how best to bring itself into line with the court’s judgment.

The reasons for this are purely political and have nothing to do with women or their best interests. TDs are simply too craven to accept the implications of the ECHR ruling so they have outsourced the decision to a quango that will be cynically used to deflect criticism when it eventually reports back and recommends legislation.

Then , of course, there will be another endless delay before legislation is drafted and, if the Government manages to get around to it before the end of its term, it may be enacted.

Incredibly, last week was the first time in the history of the State that an abortion Bill was debated in the Dáil, but TDs like Michelle Mulherin still insisted that those supporting it were moving too fast — as if a 30-year delay wasn’t long enough.

The faux controversy surrounding the Bill, the only purpose of which was to grant women an abortion if one was required to save their life, was truly horrifying and reveals the naked contempt with which women are treated by the body politic.

Imagine if politicians had been debating a Bill that offered life-saving treatment for diabetics, or asthmatics or cystic fibrosis patients and it had been defeated in favour of waiting an indeterminate length of time for a report and subsequent identikit legislation? There would have been outrage, deservedly so, but because the debate concerned women, and their right to an abortion, politicians were too cowardly to act.

It really was nauseating but the behaviour of Labour TDs, only one of whom, rebel TD Patrick Nulty, supported the Bill, was particularly odious.

At least those TDs implacably opposed to abortion didn’t betray their conscience. They opposed this abortion Bill and they’ll oppose the next one. It was Labour TDs, with their mealy-mouthed words of support and their patronising extensions of thanks to the proposers of the Bill for raising the issue, who abandoned their principles when they casually torpedoed it.

Support for last week’s Bill, a highly restrictive piece of legislation that would have required the opinion of two doctors before an abortion could be performed to save a woman’s life, is a no-brainer. The real debate we need to have in this country is extending that right to women whose physical or mental health is seriously harmed by their pregnancy.

Currently, most Irish women cannot avail of a medical abortion, a pill taken over the course of a number of days, because of the logistics of travelling abroad. They have to opt for a day procedure, a surgical abortion, which, for safety reasons, cannot be performed as early as a medical abortion.

So, women are forced to wait for up to two months, while their pregnancy progresses, before they can leave the country for a much more invasive procedure. They are also less likely to access vital after-care services, once they return to Ireland, because of the stigma attached to their decision to travel for a procedure that, if performed here, could result in a conviction and a life-sentence.

THEN there are the women who discover, much later in their pregnancy, that the foetus has a genetic condition that means it will not survive the birth. They too are told, tough, to continue with the pregnancy and endure the birth. Why? Because a succession of male-dominated governments have presumed to tell women how they should react to that devastating news and feel perfectly content removing any vestige of personal autonomy from one of the most difficult decisions they will ever have to make.

This isn’t an area in which the State should be meddling at all. It is a personal medical decision that should be taken by women in conjunction with their partners and their doctors. Instead, women are reduced to the status of insentient incubator and instructed to grin and, literally, bear it by the self-dubbed pro-life lobby — whose concern for life doesn’t seem to extend past the moment of birth.

The 4,500 women who are unwilling or unable to comply with this diktat every year are shipped, out of sight and out of mind, beyond our puritanical shores — their silent sacrifice deemed an acceptable price to maintain the State’s illusory veneer of moral rectitude.

The abortion law on the statute books is 151 years old while the constitutional ban was introduced when a prescription was required to buy condoms and homosexuality and divorce were illegal. Ireland has changed. It’s time the law did too.

 

WomanCare Global to Distribute Mifepristone inEurope and Africa

WomanCare Global announced today that mifepristone has been added to their reproductive healthcare portfolio.

Through an agreement with Linepharma, WomanCare Global will provide sales, marketing, provider training and distribution of mifepristone in seven European and seven African countries. Linepharma’s mifepristone is labeled for use as a single 200mg tablet of mifepristone to perform medical abortion in conjunction with a prostaglandin, in compliance with the World Health Organization’s recommendation.

Linepharma’s mifepristone is manufactured in Europe and is currently approved in five E.U. countries. The planned distribution of mifepristone by WomanCare Global in 14 countries will ensure that close to 55 million women will have another safe, quality product to manage their reproductive health.

Please read the entire press release at http://ow.ly/8W2Wz

 

Sri Lanka: Misoprostol and women’s health

www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=31532

August 2, 2011, 5:53 pm 

by Ramya Kumar
The absence of safe abortion services in the public sector has obvious implications for both gender and class. First abortion, a health service required only by women, continues to be criminalized and second “safe” abortion services are currently only accessible to women who can afford them in the private sector. With the clamp down on Marie Stopes clinics that had provided abortion services at relatively low cost for more than 20 years, medical abortion has become an alternative that women in Sri Lanka have begun to explore. The drugs used for medical abortion, mifepristone and misoprostol, are reportedly available in private hospitals and pharmacies across the country at exorbitant prices. Both of them are currently unregistered for use in Sri Lanka although misoprostol was recently considered for registration. Their use in Sri Lanka is therefore technically illegal. Further, since Article 303 of the Penal Code states that abortion is permitted only to save a woman’s life, the use of these drugs for medical abortion (except to save a woman’s life) is unlawful in Sri Lanka. Why are these drugs not registered although widely available? And why is there no public debate on abortion law reform in Sri Lanka today?
Swarna: a forgotten statistic
The case of a woman, who I will call Swarna, illustrates some of the social problems associated with unsafe abortion. Swarna was admitted to the Surgical Intensive Care Unit (SICU) of a provincial hospital where I worked as a medical officer. Swarna, a resident of the Uva province, had three children, was poor and could neither read nor write. She had been transferred from a base hospital where she was suspected to have had a reaction to blood transfusion. While family planning services were provided free of charge through the public sector to Swarna, her social situation made her vulnerable to an unintended pregnancy. Criminalized abortion and the fear of law enforcement prevented Swarna from accessing post-abortion care until she was very ill and when she did she strongly denied having had any such intervention. The consultant obstetrician who had seen a similar clinical picture in other women who were admitted after unsafe abortion, decided Swarna should undergo a lifesaving surgical procedure in spite of her denying that she had had an induced abortion. Swarna remained in the SICU for two weeks with multi-organ failure and was lucky to have survived. Swarna and other such women who face the consequences of unsafe abortion are not included in the tally of deaths from unsafe abortion because they survive. When we talk about low mortality from unsafe abortion in Sri Lanka, the stories of Swarna and many others like her are overlooked or forgotten.
Global abortion politics
Abortion is a contentious issue globally. Intergovernmental organizations like the United Nations and the World Health Organization (WHO) are restricted in their dealings with the issue due to strong pro-life lobbies in powerful countries like the United States that impose funding restrictions on providing abortion services. The International Conference on Population and Development Programme of Action (1994) that was endorsed by Sri Lanka and many other countries incorporated a rights perspective on population issues including reproductive health. Although it was considered a watershed for reproductive rights, this document did not address abortion in any significant way. While its focus is on the prevention of unintended pregnancies and implementation of post-abortion care, it states that safe abortion services should be provided in countries where abortion is not against the law. This leaves women in countries like Sri Lanka, where abortion laws are very restrictive, with limited options.
Situation in Sri Lanka
Sri Lanka is doing extremely well in terms of maternal health. We have been able to achieve reductions in maternal mortality without addressing unsafe abortion. In fact our maternal mortality rate is the lowest in the South Asian region. Research shows that there is a high prevalence of abortion (a 1998 estimate suggests 650 abortions per day) and that most women resort to abortion to limit or space their families. In 2006, unsafe abortion became the second highest cause of maternal mortality in the country. While unsafe abortion was identified to be a problem on a review on maternal mortality published by the Ministry of Healthcare and Nutrition in 2009, the strategies they recommended included improving access to family planning and improving post-abortion care. There was no recommended strategy for abortion law reform. It is perhaps surprising that a government that shows much commitment to providing healthcare would leave unsafe abortion off the health agenda. Why does abortion law reform remain on the backburner? And could the potential use of misoprostol for medical abortion have influenced the recent decision on misoprostol registration?
Medical abortion and misoprostol
The WHO recommended regime for medical abortion includes two medications: mifepristone and misoprostol. While the combined regime has a success rate of over 95% in the first 9 weeks of gestation, misoprostol has been used alone for medical abortion in many settings with success rates roughly between 85 and 90%. Although less effective, it is used alone for medical abortion because it is cheaper and also because in many countries misoprostol is registered and freely available while mifepristone is not. The WHO does not recommend misoprostol alone regimens for medical abortion claiming the evidence for such a recommendation is inadequate.
Misoprostol is listed in the WHO Essential Medicines List (EML) for many indications. In 2005, misoprostol was listed for labour induction and with mifepristone for medical abortion, where legal and culturally acceptable (other drugs on the WHO EML do not include notes on cultural acceptability). In 2009, the EML listed misoprostol for incomplete abortion and this year in May for post-partum hemorrhage. Since misoprostol was initially developed for the treatment and prevention of gastric ulcers in 1988, it had been registered without controversy in many countries before its use for medical abortion was discovered. Therefore, today it is widely used by women for abortion in countries where it is registered but abortion laws restrictive. Such use without access to information could result in incorrect dosing with adverse consequences such as increasing rates of incomplete abortion and the occurrence of birth defects in fetuses that are not aborted.
Registration of misoprostol in Sri Lanka
Why was misoprostol, a drug with several obstetric indications, not registered in Sri Lanka? In my study, I focused on the misoprostol policy because it is the only policy related to abortion currently under review. Ten medically qualified experts engaged in women’s health policymaking and four women’s rights advocates with expertise in the social sciences and law were interviewed for this study.
Misoprostol (and mifepristone) is available although unregistered in Sri Lanka and is being widely used in the private sector. An application to register misoprostol was submitted to the National Drug Regulatory Authority (NDRA) by a pharmaceutical company in 2010. The decision to approve a drug for registration lies with the Drugs Evaluation Subcommittee of the National Drug Regulation Authority (NDRA) which consists of medical specialists from various fields and pharmacists. The misoprostol situation was described by one participant to be “tricky” because obstetricians have access to the drug through representatives of pharmaceutical companies who supply the drug to them directly. The drug is also believed to be smuggled into the country from India and Pakistan in “suitcases”. The NDRA wished to register the drug for regulatory purposes and quality assurance because it was known to be widely available in the country. The obstetricians probably wanted it registered so that they could use it legally in their obstetric practice.
The NDRA sought the opinion of the Sri Lanka College of Obstetricians and Gynaecologists (SLCOG) on registering misoprostol due to a conflict of opinion within the Drugs Evaluation Subcommittee. In November 2010, the SLCOG recommended misoprostol be registered with restrictions to be used only in the public sector. However, when the Drugs Evaluation Subcommittee met a month later, they could not reach a consensus on registration due to opposition from within the subcommittee. While complications of misoprostol (specifically maternal deaths from using misoprostol for labour induction) had been discussed at the meeting, the potential for using misoprostol for medical abortion had not come up for discussion. Eventually it was decided to keep the decision pending and the decision is still pending today.
Implications on health policymaking
The policy decision on misoprostol appears to have been a result of an undemocratic process based on obscure social values held by a few members of the Drugs Evaluation Subcommittee at the NDRA. Under these circumstances, it seems unlikely that misoprostol will be registered anytime soon.
It would be unfair to say that this policy making process exemplifies health policymaking in general in Sri Lanka. The controversial nature of this drug is likely to have influenced the process. But note that this was a closed process with little input from nonmedical experts. Even the recommendation of the SLCOG, the professional body of obstetricians and gynaecologists in the country, was overlooked. There was no contribution from women’s advocacy groups to the decision making process. Many policymakers in the sample believed that the policy decision on misoprostol was influenced by its possible use for medical abortion.
I would argue that the reason misoprostol registration became controversial in Sri Lanka was because both the NDRA and the SLCOG wished to register the drug for different reasons. Health policymaking is controlled by the Ministry of Health; the public has little access to information on who and how these decisions are made.
Implications for abortion policy
The Ministry of Health’s strategy to address unsafe abortion focuses on preventing unintended pregnancies and providing post-abortion care (PAC). Arguably, this narrow focus may be justified given the restrictive abortion legislation in Sri Lanka. Under these circumstances, one would expect a dynamic family planning programme and accessible sexual and reproductive health education and services. One would also anticipate the institution of effective PAC. However there is no evidence to show that this is happening.
Participants expressed concerns about contraceptive services targeting only married women and the absence of a state sponsored comprehensive sexual and reproductive health education program for adolescents. There is in fact a complete silence on sexual health in existing policy documents. Further, participants expressed concerns about the inadequacy of existing PAC services and the stigma and discrimination experienced by women who seek PAC. The interviews also demonstrated gaps in research on unsafe abortion, specifically current prevalence and groups most vulnerable to the problem. Significantly, Ministry of Health has not taken an official position on the need for abortion law reform in their policy documents. To compound the situation, in 2007 the government closed down clinics that were providing abortion services or “menstrual regulation” to a less well-off clientele while turning a blind eye on less affordable abortion services provided in private hospitals. All this suggests that addressing unsafe abortion even within the existing legal framework has not been prioritized in state policy. Addressing issues of health equity and gender/class based discrimination are clearly not on the health agenda.
Given this situation, leaving unsafe abortion to be addressed as a policy level debate restricted to the Ministry of Health is unlikely to be effective. The issue of unsafe abortion will not be addressed unless the debate becomes far more broad based than it is now. We need to advocate abortion law reform and the registration of abortion medicines now instead of reinforcing the silence by pretending that abortion does not take place in Sri Lanka. In reality women will access abortion services if they need them whether we like it or not. Decriminalization and registration will only make existing services cheaper and safer.
Ramya Kumar, MBBS is a graduate student in Public Health. This article is based on a presentation she made at the International Centre for Ethnic Studies, Colombo on July 13, 2011.

 

Czech Republic: Morning-after pill made available over the counter

Emergency contraception pill was made available over the counter in Czech Republic . While before it was necessary to present a prescription to buy the pill, now it will be sufficient to present the ID. The data of the person who purchased the pill will be stored in database. The emergency contraception won’t be available for minors of 16 years.

Source: http://www.novinky.cz/domaci/249447-postinor-se-bude-v-cr-prodavat-bez-receptu.html
http://relax.lidovky.cz/postinor-bude-nove-v-lekarnach-bez-predpisu-feh-/ln-zdravi.asp?
c=A111103_132801_ln_domov_rka