Launching of Aunty Jane Hotline in Malawi

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Aunty Jane Hotline has been launched in Malawi. Centre for Girls and Interaction (CEGI) organized the launching at Mimosa Court Hotel in Mzuzu northern of Malawi.

Aunty Jane Hotline is an Interactive Voice Response system, meaning women and girls can access information 24 hours a day, 7 days a week in English and Chichewa. Aunty Jane Hotline gives information on PPH prevention, contraception, unwanted pregnancy and abortion, among other sexual and reproductive health topics. Because abortion is a very stigmatized topic, the launch of this public hotline is an important step forward. Callers can leave a message or sms and get a call back from a trained operator if they have specific questions or want to speak with someone

0884 773 300  or text 0884 773 310

Great article in the Argentine newspaper Pagina 12, about a network of women, called Pink Rescue, who accompany other women in the use of misoprostol for safe abortion. They give information, advise about risks and help make sure the women get a checkup afterward.

Articulo excelente sobre Socorro Rosa servicio de acompañamiento de mujeres que están usando el misoprostol para abortar con seguridad. Dan información, consejan sobre los riesgos y ayudan a segurar que la mujer haga un examen de control despues.

http://www.pagina12.com.ar/diario/suplementos/las12/13-7899-2013-03-16.html

Mon, 25 Feb 2013 11:18 GMT

Source: Trustlaw // Anastasia Moloney

An activist dressed as a nun holds a placard that reads “they decided on your body” above pictures of the parliamentarians who are against abortion, during a rally outside a church in support of legalisation of abortion in Valparaiso city, about 121 km (75 miles) northwest of Santiago, September 28, 2012. REUTERS/Eliseo Fernandez

By Anastasia Moloney

BOGOTA (TrustLaw) – When Carolina answers an evening call in the Chilean capital of Santiago, she is acutely aware that she could be giving potentially life-saving information to a woman on the other end of the line.

Carolina is one of 30 self-described “militant feminist” volunteers who run an abortion hotline in Chile, providing information to women about how they can induce an abortion using the drug misoprostol.

The World Health Organisation recommends misoprostol, both taken on its own and combined with another drug mifepristone, as a safe and effective way for women to have an abortion in the first trimester of pregnancy.

In a country where abortion is a crime under any circumstances – even in cases of rape, incest or if the life of the mother or foetus is in danger – the hotline has become a lifeline, offering women a way to sidestep Chile’s blanket ban.

“Regardless of any laws, if a woman feels she needs an abortion she will get one. We know women in Chile have abortions every day. Abortion is a reality,” said Carolina, a volunteer at Lesbians and Feminists for the Right to Information, the Chilean group that runs the hotline.

“What we aim to do is to help women avoid having unsafe and clandestine abortions. The phone line is our strategy to fight that,” Carolina told TrustLaw in a phone interview in Santiago.

Originally invented as an ulcer drug, misoprostol induces an abortion by causing contractions of the uterus and is from 75 to 90 percent effective when taken correctly, WHO says.

Neither misoprostol nor mifepristone is risk-free and incomplete abortions can happen. But doctors say inducing an abortion with oral drugs rather than a surgical operation means it is less likely for an infection or a uterus perforation to occur.

UNSAFE ABORTIONS

In much of Latin America, Asia and Africa, restrictive laws or blanket bans on abortion force millions of women with unwanted pregnancies to have illegal and often unsafe abortions every year, according to WHO.

Some 47,000 women die from botched abortions each year around the world, says WHO. In Latin America meanwhile, deaths from botched abortions, often caused by severe bleeding, infections or a combination of both, account for 17 percent of maternal deaths in the region, the United Nations agency says.

That is why volunteers like Carolina are adamant it is vital to give women the information they need to stop preventable deaths from unsafe abortions.

“All women have the right to know about how to get a safe abortion,” Caroline, 32, said.

Since the hotline started in 2009, it has received more than 12,000 calls, up to 15 a day.

Sometimes it is a single mother of three who says she cannot afford to have another child. Other times, it is a young woman who does not feel ready to be a mother.

“We receive calls from young, old, poor, rich, married, single women, those with children and those without. Abortion is something that affects all kinds of women in Chile,” said Carolina, a sociologist.

Chile, like much of Latin America, is predominantly Catholic and the Catholic Church and conservative lawmakers argue that abortion infringes on the right of an unborn child, which should be protected by law at all costs.

Abortion, therefore, is both a taboo issue in Chile and a crime that can lead to imprisonment for those who perform abortions or assist on them. Because of this, hotline volunteers prefer to keep a low profile. They wear masks when promoting the hotline at public meetings and most choose not to give their full names.

It also means volunteers like Carolina are careful to only share public information with callers over the age of 18 based on a script approved by a lawyer.

“We don’t convince women to have an abortion. All women who call have already made up their minds to have an abortion,” said Carolina.

“We just provide women with information about how to have a safe abortion using misoprostol, correctly following WHO protocols.”

BLACK MARKET PILLS

On top of the country’s absolute ban on abortion, women in Chile face the additional challenge of getting hold of misoprostol.

The drug was pulled off pharmacy shelves in Chile, where it had been available with a prescription, under Michelle Bachelet, the former first female president of Chile, who now heads the U.N. Women’s agency.

It means women have to try their luck on the black market. It costs around $250 for the 12 pills needed for an abortion.

Chile’s safe abortion hotline was the brainchild of Dutch doctor and former Greenpeace activist, Rebecca Gomperts. Through her pro-choice group, Women on Waves, Gomperts has helped launch the abortion hotline in Chile, along with hotlines in Argentina, Ecuador, Peru and Venezuela.

“Medical abortion is such a revolution. Women …  can take their health, and life, in their own hands,” Gomperts told TrustLaw in an interview last year.

“PUSH AND PULL”

In Chile, any moves to decriminalise the country’s abortion laws are still a long way off, Carolina says.

“Chile is a very, very conservative country in all senses. The opinion of the Catholic Church holds a lot of weight in Chile. Maternity is seen as something sacred,” Carolina said.

“Currently, it’s not a priority among Chilean lawmakers to change the abortion laws and push for reform. Abortion isn’t an important issue in public debate.”

While there’s little headway on reproductive rights in Chile, elsewhere in Latin America attitudes have been changing.

In Colombia, for example, an absolute ban on abortion was partially lifted in 2006. A year later, abortion was made legal in Mexico City during the first 12 weeks of pregnancy and more recently last year in Uruguay.

“There’s a push and pull going on in Latin America,” Marianne Mollmann, a senior policy advisor on sexual and reproductive rights at Amnesty International, told TrustLaw.  “The countries that are stuck are Central America and Peru.”

As for Chile, the country remains a bastion for strict anti-abortion laws that force women to rely on underground activists and their telephone hotline to get a safe abortion.

 

Taking Calls on Abortion, and Risks, in Chile  

 

By Aaron Nelsen   

Published: January 3, 2013  

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

  

Roberto Candia for The New York Times

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

 

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

 

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

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

Author image

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

 

http://www.rhrealitycheck.org/files/imagecache/Teaser-Image/teaser-images/2012-10-16-anne2.jpg

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, ArgentinaEcuadorPeru 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 WHOInternational 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.

 

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Unspoken Violence on Abortion, a Case Study of Indonesia

by Samsara YK on Friday, June 15, 2012 at 3:43am ·

By : Inna Hudaya & Zulkamal Hidaayat Zakaria

 

Introduction

Most people in Indonesia has been viewing abortion as an immoral action because it against the positive norms of society. As some countries did, Indonesia preserves cultural and religious based principles which support a banning on abortion. For sure, abortion is illegal in Indonesia. Unfortunately, the government seems unaware of the side effect of such policy and fails to communicate majority and minority interests which are involved. Majority is people who support government policy on banning abortion and minority is people who against government policy on banning abortion. In this setting, the government and society also failed to identify women as a victim of the government policy. This policy has disposed women who commit abortion as criminals. Those women have been dealing with people who can’t accept abortion although it is associated with women authority over their body and future. As a result, women are more vulnerable to violence because the policy has labeled women who commit abortion as criminal instead of victim.

 

Criminalization of Abortion

The important point in understanding abortion issue in Indonesia is to recognize that it is illegal but it can be done for some specific reasons. Abortion is illegal but it can be done if the pregnancy will jeopardize the mother or fetus and if the pregnancy is caused by rape. This abortion can be taken before the gestational age of six weeks unless to save mother’s life. Even if it is possible to have an abortion until 6 weeks of gestational age, women still do not have authority over their own decision. For instance, married woman needs consent from her husband and unmarried woman needs a parental consent. In case of rape, the parental consent needs to be given with the approval statement from psychologist or psychiatrist.

 

Based on the Health National Law No 36/2009, the penalties were 10 years imprisonment or a fine of 1 billion IDR for anyone who had induced abortion. In fact, due to the restricted access on sex education, reproductive health and health service especially contraception, women are more vulnerable to unwanted pregnancy that leads to the need of safe abortion.

 

Women who are young, unmarried, less educated, poor and living in rural area, are the most vulnerable groups and severely affected while dealing with unplanned pregnancy. At this point, unsafe abortion is the available and accessible option for them. On the other hand, the criminalization of abortion did not impact only on the number of unsafe abortion and maternal mortality but it had created many kinds of violence toward women’s rights. This policy has provided an open chance for industry of abortion to develop. Most of abortion clinics in such industry are illegal, especially in Java Island. Those clinics provide abortion services for women without the considering the rights of patients. Women were taking for granted in this situation. Moreover, many drug dealers used to cheat on women who could not report it to the police because abortion is illegal. Frankly, the circumstance has been creating many forms of violence and problem toward the issue of abortion to grow.

 

Based on the facts above, criminalization of abortion is violation against women rights instead of solution. The government policy was not only possessing women as an object of violence but it was also letting people to take advantage on the situation of women itself. It is hypocrisy of nation who they believe that abortion is sin and create other forms of sin which is violating women rights.

 

Criminalization of abortion is not a proper way to reduce the number of abortion. On the contrary, this policy made violence toward women remain unspoken. The only way to reduce the number of abortion is by giving sex education and reproductive health and an open access to health services so women will have a control over their sexual and reproductive life that will protect them from unwanted pregnancy.

 

SAMSARA Project for Change: Reclaiming Access to Safe Abortion

While the government and society failed to identify women as victim from the ongoing policy, women died and suffered from complications caused by unsafe abortion. There’s no time to wait any longer for the government to take action in saving women’s live. Saving the life of women doesn’t always mean to save women from severe complications, traumas, depressions and maternal deaths. Life also means the quality of women’s living condition which includes access to education, health, economy and bargaining position. Based on the situation in Indonesia, the most important thing is a real programs and strategies that will help women to access safe abortion services and create a supportive network in society to reduce stigma and discrimination. In the future, the social changes are expected to decriminalize abortion in Indonesia.

 

SAMSARA, an organization based in Yogyakarta has been working to promote the reproductive health, sexuality, gender, spirituality, culture and human rights on abortion issues. SAMSARA also provides access to education, information and counseling on abortion based on sexuality and reproductive health and rights. Through its work, SAMSARA has found an urgent need to inform and empower women so they have sufficient knowledge and support to choose and access a safe abortion. We believe that changes are indisputably needed, not only by supporting and empowering the women but also taking a pro active part in providing education to people; influencing social movements; expanding discourses and strengthening a supportive network.

 

Since 2008, we started a program called Safe Abortion Hotline where we assist women in making decision and finding a safe clinic for abortion. Actually, women should find the clinic of abortion by themselves. Our main job in this program is to provide advice to women to recognize a reliable abortion clinic, affordable, meets the medical standard and avoid them getting deceived by service provider. Mostly, women have to go through the process by themselves without any companion. In this situation, the hotline is available to assist women in the process.

 

 

In 2011, we integrated a Medical Abortion into the hotline program. The hotline promotes the use of Misoprostol which is one of recognized method in medical abortion as an alternative option for safe abortion until 9 weeks pregnancy. Hotline is assisting women in making decision, provide information and open access to safe abortion. In this hotline program, women need to confirm their decision before the hotline counselors refer them to service provider or assist them to have abortion at home. It is necessary to ensure that abortion is the decision of the women, not the decision of her partner or family.

 

If the women can access clinic, hotline will refer women to have surgical abortion. But most women can’t access a clinic because of the distance and price. Most women choose medical abortion. Once women get the pills, a counselor will be available by phone to assist women when women have abortion at home. Usually counselor will ask women to make notes about the process so all information will be helpful for following up the consultation process. Follow up consultation is needed to ensure that the abortion is completed. Hotline also works on the improvement of its service to help women in every step so they won’t face abortion by themselves when it is being taken.

 

Between May 2011 to May 2012 we received 1.425 calls, emails and face to face session. 71,1 % of the clients are unmarried women. SAMSARA considers Medical Abortion as an ultimate option for safe abortion in a restricted setting like Indonesia. Medical Abortion is not only cheaper, but it also protects the privacy of the women, gives full control and authority to the women and encourages women to focus and care over their body.

 

Safe Abortion Hotline is an action in reclaiming access to safe abortion. Since our government failed in respect, fulfill and protect women life, it is a time for civil society to act. The absence of real actions to change the circumstance will remain the unending violence on abortion for women. We can’t rely on government to saves women in crisis. Only by listening, supporting and working together, with or without government assistance, we can save women life. The choice is ours, whether to let the unspoken violence to continue or to change the unjust to a just world.