I Know This Much Is True: Abortion Is A Medical Intervention to Which Women Need Access

@RHRealityCheck

Savita Halappanavar’s death is personal to me.

No one knows for sure yet what happened to Savita Halappanavar. We know that she wanted to be pregnant, that she miscarried, and that the care she received did not save her life. It is important to push for medical accountability in such cases, and to demand a full investigation into whether protocols existed and were followed, and if the patient was subject to discriminatory harassment and remarks, as has been alleged. It is positive that an expert has been appointed to carry out such an investigation.

But we do not have to wait for the investigation to highlight what we already know about abortion in Ireland. For me, this knowledge is weighty and painful.

In 2009, I went to Ireland with a colleague to talk with women, medical providers, and government officials about the impact of Ireland’s restrictive abortion laws on women’s health and lives. No government official agreed to receive us despite multiple requests for meetings. This refusal was the backdrop of the desperation and sadness that was palpable in the voices and testimonies of all the women, doctors, social workers, and community educators we spoke to.

And here is what I learned.

I learned that the Irish government has yet to regulate access to life-saving abortions in Ireland, despite the fact that such medical interventions have been legal in that country for two decades. I learned that the legality of abortion where the pregnant women’s life is in danger was upheld by the Irish Supreme Court in 1992 and supported by a referendum that same year. So while abortion, generally, is criminalized in Ireland, women whose lives are threatened by their pregnancy are constitutionally entitled to have an abortion in Ireland.

And in 2010, I saw that the European Court on Human Rights berated the Irish government for not regulating access to life-saving abortion clearly, creating insecurity for medical providers and patients alike. In 2011 the United Nations Human Rights Council issued various recommendations to the same effect.

My research taught me that many medical providers in Ireland want clarity on when they can intervene and when they cannot. Some asked me how the government proposes they treat a woman who may or may not die as a result of her pregnancy. Should they tell her to come back when she was sure she was going to die? How would she know? And what if it was too late? Who would be responsible for such preventable deaths? In fact, during our research in 2009, and despite the fact that abortion in life-threatening cases had been legal for almost two decades, we were not able to find one single medical provider who had ever heard of a life-saving abortion taking place in Ireland.  

But more than anything, I learned about the pain and fear pregnant women face when something is clearly wrong with their pregnancy and they know they can’t get care near home. I know this because they told me. Some told me with their heads bowed, others sitting straight up. Some told me calmly, others cried. They all spoke with quiet, sad voices about a society that does not see their suffering and a government that does not seem to care.

Savita Halappanavar’s death, however it happened and whomever (if anyone) is responsible for delivering substandard care, should serve as an opportunity for a deeper and more respectful conversation on this topic in Ireland.

Abortion is a medical intervention to which women need access, some to save their lives. This is not an opinion; it is a fact, evidenced by the thousands of women who travel from Ireland to the United Kingdom or mainland Europe to terminate pregnancies every year.

And knowing this, how can we not act?

Passing the DREAM Act Would Acknowledge the Human Rights of Migrant Children and Benefit All of Us

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November 6th was a good day for human rights, at least in Maryland. Not only did the state’s voters support same-sex marriage, they also voted in favor of expanding access to higher education for all of Maryland’s students, regardless of their immigration status.

While the Maryland ballot initiative on education is great for young migrants in that state, it highlights the fact that federal action is sorely needed to protect the human rights and dignity of migrants everywhere.

There is some good news. In June this year, President Obama signed an executive order preventing the Department of Homeland Security from deporting undocumented immigrants under 30 who came to the United States before they were 16 years old, and who fulfill a number of other criteria regarding their moral standing and education.

However, while this change rightly was hailed as a positive development for hundreds of thousands of young people, it does not overcome the need for legislative action—President Obama himself called it a “stop-gap” measure. In fact, it is now more than decade since a bipartisan initiative proposing similar benefits first was introduced in the Senate under the title “Development Relief and Education for Alien Minors (DREAM) Act.”

The idea behind the original bill—and the various versions of it introduced over the years—was to open the possibility for higher education and ultimately citizenship for noncitizen children of good moral character, regardless of their immigration status.

And the idea is solid. The individuals potentially covered by these bills are already a positive part of their communities, and many know no other home than the United States. They are, for all intents and purposes, Americans in everything but paperwork. Moreover, maintaining the documentary limbo many of them are in does nothing but make it more difficult for them to pay tax, improve their education, or otherwise contribute constructively to society. In other words: refusing to regularize the status of undocumented children risks turning them into the pariahs they never were.

However, since the first DREAM Act was introduced in 2001, and despite the passage of a version of the bill in the House of Representatives in 2010, no final legislation has been approved by both houses. Arguments that the bill would foster illegal immigration or potentially shield gang members do not bear out in reality. For starters, the bill explicitly seeks to exclude those with a criminal background and applies equally to documented and undocumented aliens. Also, from a pragmatic perspective, most people migrate because they can’t provide for their families at home, not because they think they can “pull one over” on their host country. The lack of DREAM Act-like legislation does not make foreign-born children magically disappear or "self-deport." Rather, it prevents them from fulfilling their potential as participants in society, thus becoming more of a burden than they otherwise would have been: a lose-lose situation if ever there was one.

But even more importantly, education is a human right. Numerous international human rights bodies have repeatedly clarified that states must protect the human rights of those living in their territory, regardless of their legal status. Certainly, states can and must independently determine their immigration and access policies, but they cannot decide whether any one individual has rights: we all do.

Up until this week, 11 states had already adopted their own versions of the DREAM Act, including California, Texas, and New York, all states with large and rapidly growing foreign-born populations. It is telling that states with large immigrant populations know that providing immigrant children with access to higher education only can be beneficial to everyone.

The ballot initiative approved in Maryland this week sends a powerful message to Congress that states are willing to provide, piecemeal, what the federal government should be providing, wholesale. It also underlines the uneven nature of legal protections for immigrants until federal law is passed, especially because immigration generally remains under federal purview. Hopefully, passing a federal DREAM Act is a priority item on the agenda of the new Congress.

Silence On Rape is the Biggest Obstacle to Prevention

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I recently held a seminar on rape in war with military lawyers from across the world. We talked through a number of obstacles to prevention and elimination of sexual violence, but at the end of the seminar everyone agreed that the biggest of them all is silence. “We don’t ever get to have this conversation,” the participants agreed.

Unfortunately, this is particularly true in the countries most affected by sexual violence in war: not only is rape not talked about, but many of those who try to address this terrible crime are attacked, often violently. On October 25th, unknown men carried out an assassination attempt on Dr. Denis Mukwege, and succeeded in killing his body guard, Joseph Bizimana. Dr. Mukwege is known for his tireless work in defence of women victims of sexual violence in the Congo.

Silence also reigns in Bosnia and Herzegovina. This week, Amnesty International launched a briefing paper detailing the continued silence about the rapes in Republika Srpska, almost two decades after the war in Bosnia and Herzogovina ended. To the extent there is any attention to the widespread rapes during the 1992-95 conflict, it is focused on the perpetrators—though many are still at large. Meanwhile, the women and girls who suffered systematic rape and forced pregnancies are overlooked.

It is, in fact, a widespread phenomenon that insofar as authorities and the public at large pay any attention to rape and violence against women, this attention is focused on punishing the perpetrator. And it is, of course, important to apply criminal justice where intentional harm has been done to another person, whether physically or psychologically. However, punishment is only effective as prevention when it is seen to be applied. In the case of sexual violence and rape, only a sliver of perpetrators are ever investigated, prosecuted, convicted, and serving a sentence. For more than 97 percent of those who commit rape, it is therefore of little relevance if the law metes out 10 or 20 years of jail time to a very few: most will never spend a day behind bars.

An equally important and often woefully ignored part of guaranteeing justice is to make sure rape victims have access to the justice system in the first place, and that they receive meaningful reparations for the harm they suffered as part of the sentencing.

Neither of these issues is appropriately dealt with in Republica Srpska. Many victims of widespread rape are still, after almost 20 years, unable to talk openly about their ordeals due to post-traumatic stress disorder that has not been dealt with. The authorities have not addressed the stigma attached to sexual violence in society as a whole, and has done little to overcome harmful stereotyping about gender roles, which bleed into public perceptions about rape. As a result, many women say they were mistreated, rather than raped, and the silence surrounding sexual violence continues.

More to the point, perhaps, while the silence continues, victims do not receive adequate reparations for their suffering. “Reparations” is the term for the measures states are obliged to take to help victims overcome their ordeals, and they include both what we traditionally think of as “justice” (that is, investigations and court cases) as well as guarantees of non-repetition, compensation for the abuse, and rehabilitation. Most importantly, true reparations are meant to guarantee the victim that their suffering will never re-occur.

This—guarantees of non-repetition—is where justice for individual cases meets prevention as a whole. Unfortunately, this is also where our efforts are the weakest: if part of the reason rape happens is because we allow it to, that means that to issue a guarantee that rape will stop, we have to change. And that kind of fundamental change is incredibly hard.

The good news is that it is not impossible. There are conflicts where rape is rare, and there are relationships where violence is impossible. In my recent seminar, we talked about how to change the way our most immediate family and friends think about rape. If we all make sure the 10 persons we are closest to understand that rape is wrong and never the fault of the victim, we will have changed the world.

Hopefully, change will come soon to Republika Srpska and anywhere else where silence continues to reign.

On Savile, Sandusky, and the Power of Rape

Rape is about power. The attacker seeks to control and subdue the victim's physical and psychological integrity. When we address rape, it is therefore essential to overturn this power-imbalance and restore dignity and control to the victim. Most often, we fail miserably at this.

Consider the case of recently deceased BBC television host, Jimmy Savile. BBC leadership has all but acknowledged they preferred to suspend investigations into Savile's allegedly repeated sexual assaults on hundred of children over the years, rather than risk upsetting their star. This case mirrors the decade-long collective calculated cluelessness at Penn State football coach where evidence of Jerry Sandusky's abuse of children was routinely ignored in favour of the revered coach.

It is no wonder that less than half of rape victims file a report with the police: if those around them stand with the attacker, why wouldn't the police? And, in fact, studies show that police officers believe rape victims are more likely to lie about their assault than victims of any other crime, despite evidence to the contrary. Three percent to 8 percent of rape complaints are false -- similar to the proportion of other crime complaints.

But even when sexual assault is reported, investigated, prosecuted, and a conviction has been handed down -- the probability of this happening is less than 5 percent -- power-dynamics prevail. In Ireland last week, for example, a 29-year-old man was offered the opportunity to pay his way out of jail after he was convicted of violent sexual assault of a 17-year-old girl. The sentence rightly led to protests from pundits and lay-persons alike, though it highlights a simple fact: neither rehabilitation of the attacker nor justice and support for the victim is a priority in the manner in which we deal with rape.

The priority, it seems, is power.

Over the past decades, law-makers in many countries have responded to rape and sexual assault mostly when particularly graphic violence has been detailed on the news: a child abducted and abused, a woman forced to work in a brothel. These cases are horrific, indeed, and the suffering of the victims and their families cannot be overestimated.

However, state responses to sexual assault that are born from media attention to specific cases can, and often do, have negative consequences.

First of all, narrowly targeted responses contribute to separating the "deserving" from the "undeserving" victims. Policies that focus on "forcible rape", "legitimate rape", and rape by someone who is not the victim's spouse implicitly support the notion that some people "had it coming". The list of justifications alleged perpetrators of rape have successfully used to defend their actions is truly absurd: it is not rape if the victim was my daughter, my wife, if she was drunk, or if the rape was somehow the expression of "culture."

These justifications run counter to human rights obligations on crime prevention and protection against abuse. Every individual -- adults and children alike -- has the right to live free from violence and sexual abuse. It is a core governmental obligation to promote public safety by holding offenders accountable and by putting in place effective crime prevention measures.

And narrowly targeted responses are often not effective at preventing rape. Sex offender registration laws and community notification measures in the United States, for example, have shown to be costly to society, harmful to reintegration efforts of ex-offenders, and--most notably--without any discernible effect on public safety. Indeed, the mere fact that only about 5 percent of rapists are ever convicted should say something about the effectiveness of community notification: not very high. Add to this the fact that the vast majority of sex offenders do not reoffend, and the relative uselessness of sex offender registries as instruments of public safety becomes clear.

We can restore power and dignity to rape victims by treating rape like we would treat any other crime. That means taking rape seriously and investigating it fully. It means having the necessary equipment on hand to obtain evidence in a timely and dignified way (and not, as Amnesty International found in Alaska, making women pay for flights to get to police stations that stock rape kits). It means applying the same standard of proof for all crimes and all victims, regardless of their sexual history and marital status. And it means sentences that take into account appropriate factors like the gravity of the offence, the specific circumstances of the crime, and the age and maturity of the offender.

Rape and sexual assault are expressions of power imbalances. For prevention to work, policy makers must look at the motivation behind them -- much like they should look at the motivation for other crimes. We should examine the social forces that allow some offenders to walk away with impunity and others to be punished disproportionately.

Our approach to rape should break the power dynamic, not reinforce it.

It's Official: The HPV Vaccine Will Not Turn Girls Into "Sluts"

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On October 15, the New York Times reported that adolescents who are vaccinated against human papillomavirus (HPV) aren’t more promiscuous than those who don’t get vaccinated. HPV is a sexually transmitted disease that raises the risk of some cancers. It’s not surprising that a vaccine has no effect on adolescent sexual behavior. What is surprising is that fear of “sluttiness” is the number-one reason parents decide not to vaccinate their kids against HPV.

Put another way: A large proportion of parents in the United States are more afraid of their kids having sex than they are of their kids getting cancer.

In fact, “slut-shaming” and negative messaging about female and non-straight sexuality could themselves be compared to a viral infection. A study published in November 2011 found that nearly half of students in grades seven through 12 experienced sexual harassment, and that most of the harassment is directed at girls for being either “slutty” or “prudes” or against kids who are suspected of being gay.

Seeking to shame someone because of her or his real or perceived sexual activity and desire is prevalent among teens and constitutes a type of bullying that is extremely damaging. The 2011 study noted that students reported being particularly negatively affected by slut shaming. Research consistently shows that LGBTI youth have a much higher rate of suicide or suicide attempts than the general population, with a strong correlation between depression or self-harm and gay bashing.

But teenagers are not solely responsible: Slut shaming and gay bashing originate with adults. I don’t mean just adults who tell children that all sex outside marriage is bad or consign LGBTI kids to celibacy, or banish them to hell. I mean adults who refuse to have a real conversation with teenagers about sex and all that comes with it—good or bad. The sex-negative culture we have created by not having real conversations about sex and relationships affects everyone.

Here’s how:

When we tell adolescents that sex is not something they should desire or like, we are telling them to set aside their own experiences in favor of a lie. Spoiler alert! A study looking at trends in premarital sex from the 1950s until now shows that the majority of Americans have sex before marriage. One of two things happens next, and sometimes both simultaneously:

On one hand, adolescents stop listening to the adults who tell them scare stories, because they see for themselves that the adults are wrong. Not everyone who has sex before marriage gets pregnant, contracts AIDS, or dies. And sex can feel amazing. When the adolescent-adult relationship is breached, children can lose their lifelines to trusted adults, who could have guided them through the mess that is puberty.

And some kids start doubting their own instincts. When we tell them that something that feels good to them is “bad,” they start thinking they, themselves, are bad. In this sense, slut shaming creates a culture of self-hatred in which girls in particular are only too willing to see themselves as deserving abuse.

It‘s crucially important that we teach children to trust their own feelings about sex and relationships. Instead of telling teenagers not to have sex at all—a completely outlandish notion in a post-post-Madonna world—we need to acknowledge that sexual desire exists, and that consent, not shame, is key. Only a teenager who is taught to respect and acknowledge his or her own feelings will know when touching feels wrong, and therefore when they need to say no. This is one of the few things my parents got right. My mother told me more than once that the only rule about sex in our house was that I should never have sex I didn’t want to have.

Slut shaming and gay bashing come from the same place: adult discomfort with sex. This can translate into adolescent date rape, teenage pregnancies, and sexually-transmitted-infection rates that are through the roof for those under the age of 24. Shaming someone for having sex that he or she wants to have constitutes bullying and teaches teenagers to ignore their own feelings about sex, potentially pushing them to unprotected and unhappy encounters.

In short: The sex-negative culture that has parents denying their children access to cancer prevention is the same culture that may expose these children to a sexually- transmitted, cancer-inducing virus. It’s time to get real about sex.