Abortion Rights: Back in the Spotlight

(Originally posted on the Huffington Post)

Throughout a long election campaign, the future of abortion rights and the right to choose has remained a silent concern for many women and men as the higher-profile issues of the economy and the wars in Iraq and Afghanistan dominated debate. But the question on Roe v. Wade put to the presidential candidates at the final debate on Wednesday moved the issue front and center once again. It is an intensely personal and relevant issue for women, and for most of us it is not an abstraction.

It became central to my life a couple of years back, when my primary physician refused my request to prescribe the morning-after-pill, citing medical reasons that made no sense to me. I was in a better position than most women in the United States. I was in a dual-income relationship and had a steady job that serendipitously afforded me all the information I needed to assess my situation.

I knew I had a number of options. I had the resources to seek out another health care provider, and I would be able to afford a safe abortion if it came to that. The only option I had ruled out was to carry a potential pregnancy to term: we simply would not be able to afford childcare and other expenses for a second child.

This, to me, is the real question of choice. As voters in California, Colorado, and South Dakota are asked to decide on proposals that would limit women's access to abortion and contraception, there is precious little public debate on whether actually having a child is necessarily a viable choice, financially and professionally.

For many, it is not. Federal law affords just 12 weeks of unpaid maternity or paternity leave, and only for those who are eligible, which excludes about 40 percent of American workers. There are no allowances for time off to breastfeed. There are few public child care options before primary school, and even private alternatives generally will not take children under 2.

Perhaps most disturbing in terms of lack of support, 8.7 million children in the United States currently have no health insurance. In the eyes of the law, it would seem, physically giving birth is the only consideration: you are afforded a short time to regain your strength after the delivery, but are otherwise on your own.

Some -- even advocates for choice -- would say that if you plan to depend on the government, you shouldn't have a child in the first place. But this argument also presumes that if there were public health care and childcare, and provisions for family support, birth rates would shoot through the roof, draining government coffers. Experience from countries with much better maternity and child protections shows otherwise. In my own country, Denmark, there are provisions that are generous by American standards - 52 weeks of paid parental leave, child care and public health care. But the birth rate also is quite low, 1.74 per woman in her lifetime, compared with 2.1 in the United States.

Support services are not the only factor in making a choice about parenthood, but clearly in the United States, from a purely economic point of view, fertility is not a matter of choice for everyone.

In the United States the lack of support for child care and parental benefits also coexists with serious legal or financial obstacles to accessing safe abortion services and even, at times, contraception. Since 1973, both state and federal legislators have limited access to legal abortion through burdensome regulation. Women with limited economic resources face additional obstacles because abortion services have been subject to a federal funding freeze since 1977 except in cases of rape, or incest or where the mother's life is in danger. Furthermore, the majority of states do not provide health care funding for abortion services that fall outside these exceptions.

In fact, fertility (and, by extension, choice) often comes down to a class issue. While the overall fertility rate has stayed the same, the number of children living in low-income families has steadily increased since 2000. The point is not that poor women shouldn't have children, but that all women should have a real choice - and that means access to information about contraception and abortion, and the support they need to raise children.

In my case, I ended up finding an alternative health care provider, who prescribed me the morning-after-pill.

For me, this is more than a personal issue. I have made a commitment to press for a real opportunity for choice for all women, including access to safe abortion services for poor, adolescent, or otherwise vulnerable women.

But choice also requires science-based sex education, contraception, maternity and paternity benefits, and access to child care and health care. The rationale behind polices such as Denmark's is that rearing a child is a service to all: reproduction, at its most basic, is the reproduction of society. Both the personal and the collective nature of that choice need to be protected by law and defended by the next president.

Access to Contraceptives Promotes Abortion?

(Originally posted on the Huffington Post)

In the last five years, I have interviewed hundreds of women in developing countries regarding their access to reproductive health care. To the best of my knowledge, President Bush has not.

I would expect to be in disagreement with his administration's often demonstrably unscientific approach to family planning. However, President Bush's claim this week that giving poor women access to contraceptives promotes abortion defies logic. In a policy statement released by the office of the president on June 19 the administration has declared the president's intent to veto a bill authorizing foreign aid for family planning programs, because, according to the statement, the bill would be contrary to the administration's Mexico City Policy (also known colloquially as the "Global Gag Rule").

The administration's analysis of this issue is not only fundamentally flawed, it is also dangerous. Here's why. The Global Gag Rule restricts U.S. foreign aid to non-U.S. based organizations that (with non-U.S. funds) provide legal voluntary abortion services or advocate for less restrictive abortion laws within their country.

The Global Gag Rule is not about whether U.S. foreign aid is used to fund legal abortion services directly -- such funding has been illegal since 1973. That is, the Global Gag Rule expressly denies funding to organizations who even with their own alternative funding refuse to be silent on the devastating consequences of the criminalization of abortion on the lives of women or who simply provide reproductive health services that are fully legal.

A brief history of the Global Gag Rule is that it was first enacted by the Reagan administration; was repealed by the Clinton administration in 1993; was reintroduced by Congress in the foreign aid appropriations act (with a waiver system) in 2000, and was fully reinstated by President Bush as one of his first acts of government in January 2001.

The local health providing organizations de-funded by the Global Gag Rule (those who refuse to be "gagged") often give services spanning the full spectrum of family planning: information on contraceptive methods, youth counseling to postpone sexual initiation and prevent adolescent pregnancies, as well as the provision of condoms, diaphragms, and hormonal contraception.

Rather than preventing abortion, the real effect of the Global Gag Rule has therefore been a drop in access to reproductive health services, information, and modern contraceptive methods. These are all services primarily to women that have been proven to bring down the number of crisis pregnancies, and therefore abortions.

In short, the Global Gag Rule is bad foreign policy and bad for women.

The foreign aid bill President Bush is now threatening to veto contains a provision stating that organizations who apply for U.S. foreign aid cannot be denied funding specifically destined for the provision of contraceptives solely on the basis of the Global Gag Rule.

With this provision, Congress seems to be saying that improving access to contraceptives might give poor women a better chance to avoid using-often unsafe-abortion as their only means of family planning.

With his promised veto, President Bush is saying the opposite: that contraceptives promote abortion.

President Bush should explain this twisted logic to the many women and adolescents who -- as a result of this administration's sustained war on family planning and scientifically based health information -- will face unsafe abortion, lasting health consequences from early pregnancies, and even possible death. President Bush would certainly benefit from contact with the millions of people his policies affect.

A Convincing Argument

(Originally posted on RH Reality Check)

I am now in Los Angeles, on the last leg of my road-trip through the United States and Canada with Verónica Cruz, founder and director of the Mexican grassroots advocacy group, Las Libres (The Free Women). Las Libres works for access to safe and legal abortion in the conservative Mexican state of Guanajuato, so it is not surprising that social change - how to create and sustain it - is high on Verónica's agenda.

What might be surprising is that her reflections are universally applicable. Also to the groups that try to generate this change.

"You can't ever afford to get complacent with your work," Verónica told me Tuesday as we left a meeting with community based women's organizations in East Los Angeles. "We must all evaluate the impact our work has on creating durable social change - that's the key factor for doing things right."

In fact, setting priorities and planning for real change has been our main conversation topic throughout the week, from the panel discussion with Verónica and Dolores Huerta (the legendary founder of United Farm Workers) at the Feminist Majority's offices, over our visit to a model Rape Crisis Center in Santa Monica, to our lunch-time strategy session with latina and chicana women in East Los Angeles.

And we have come to a few conclusions.

First, we agreed, change happens through three main vehicles: conviction, financial incentives, or political pressure.

In the case of ensuring access to safe abortion for all women, an example of each of these three arguments would be something like this:

1. Women have a right to decide over their bodies (conviction);
2. The criminalization of abortion leads to adverse health complications, in particular for poor women, and this carries financial implications for the public health system (financial incentives); and
3. Promoting access to legal abortion translates directly into votes (political pressure).

Secondly, we also had to admit, we, as a movement, often are trying too hard to convince the wrong people with the wrong arguments.

Few decision-makers agree to push for social change because we convinced them of the rightness of our cause - most respond better to financial or political pressure. But to build a durable movement, the logic is inverse: if you try to pressure or buy people to join your cause, your movement will disappear as soon as the incentives subside.

And yet so many groups we know - including political parties - do just the opposite: they use energy trying to convince decision-makers and resources trying to buy or pressure grassroots.

Third, change can be almost instantaneous if you start by really listening.

"We call it listening with all five senses," said Verónica. "That's what we try to do when we talk to women in the marginalized communities we work with. We say to them: let's see what problems you have, and what resources you have to overcome them. And that way, together, we can figure out a solution that is made possible by the women themselves."

No money, no enhanced infrastructure, not even access to any other education than just a basic understanding that women are human beings and that human being have certain inalienable rights.

Finally, durable social change can only come about through a movement.

Law and political changes are important and can create an impetus for deeper social change. But they can never be enough on their own. With regard to the issue of abortion, this - perhaps quite naïve - realization cuts both ways.

In South Dakota, for example, the movement behind the referendum to defeat the proposal to criminalize most abortions made it clear that a large group of convinced people can overcome a smaller group of decision-makers motivated by financial or political incentives. The legal change was not enough to change the mentality of the people of South Dakota, who knew that criminalizing abortion does not eliminate the need for it.

In Nicaragua, the financial and political incentives won out, at least for the moment. Despite a massive movement against the criminalization of abortion; despite countless letters and petitions to the Nicaraguan Congress; despite women already dying in hospitals because they cannot get access to a therapeutic abortion; despite all of this, Nicaraguan politicians virtually fell over each over to demonstrate that they were tougher then the next guy on sending women to prison for abortion. Why? Because in Nicaragua, it seems that it is more important to have the church and the commercial interests on your side in an election, than to do the right thing. (Money and pressure weigh out conviction).

Fortunately, this legal change will not create social change. The people of Nicaragua are likely to continue to protest the unjustness of the law. And through their mobilization and work, they will create the real, the durable, social change that women everywhere deserve.

"As long as people mobilize for social justice, there is hope. Then you know you are doing the right thing," Verónica said to this morning. Indeed.

Plus ça change

(Originally posted on RH Reality Check)

In French they have a saying: "Plus ça change, plus c'est la même chose." (It means something like: "The more things change, the more it's all the same.")

This is the feeling I have as I travel with Verónica Cruz - my Mexican colleague who helps rape victims get access to legal abortion - from New York over Washington D.C., Ottawa and Toronto to Chicago. Women everywhere - and in particular poor, uneducated, young, or non-white women - are ignored and abused. The justice and health service providers charged with helping them, instead insult and mistreat them.

In Ottawa, for example, we spoke with a researcher from Canadians for Choice. The researcher had called public hospitals all over Canada, posing as a young woman with a crisis pregnancy who was looking for information on how to get a safe abortion. In Canada, abortion is, by law, considered a medical procedure the state has to provide. Even so, some hospital receptionists treated the researcher with cruelty and disdain ("No one will want to talk with you or help you!"); others referred her to anti-choice organizations that lied to her ("Virtually all young women miscarry anyway"); and still others simply hung up.

And in Chicago, Verónica only had to present her work briefly to grassroots groups working on access to health care and justice for women, before it became clear that situations were so similar in Chicago and Guanajuato that it made sense to set up an exchange program to share ideas, strategies, and work-methods in both directions.

Everywhere, women are beaten, abused, and raped. Family members and public officials ignore them, or worse: they convince women that the women themselves are to blame for the crimes committed against them.

"Women are seen as things, not as human beings," Verónica said to a local journalist this morning. "So much so, that I don't know one single woman who has not at one point or another in her life been sexually harassed, grabbed, or fondled. This happens on the street, at her work, in her home, or at school."

Me either. Including myself.

And for me, this really is the key issue when we talk about access to abortion. It is not only about abortion per se, though it is also about that. It is about choosing who we are, as women, and deciding who and what we allow to touch our bodies. It is about controlling how we want to live our lives, and if, when, how often, and with whom we want to have children. It is about the fact that women are human beings. It is about fundamental dignity.

And perhaps this is what makes abortion such a threatening topic to so many people in Mexico, in Canada, and in the United States. Many of those who oppose equitable and legal access to abortion explicitly or implicitly argue that access to abortion on demand (and free for all) will unleash women's irresponsible nature. Some say - as if it is a bad thing - that such a policy reform might convert women into the equals of men. "It's not conscious," Verónica said to me. "And that's perhaps the worst part of it: many are inherently afraid to let women make choices over their bodies because they sense this would change power and control structures. And as a consequence it would change the world as we know it."

Indeed it would. But change is not a bad thing when what's changing is women being beaten, abused, and raped.

Plus ça change...



Justice Is Possible

(Originally posted on RH Reality Check)

It's easy to get discouraged if you support women's right to decide over their bodies and choices, what with the blanket ban on abortion in Nicaragua passed last week, the imposition of demonstrably harmful "abstinence-only" sexual education in the United States and elsewhere, and the lack of access to comprehensive reproductive and sexual health care for women generally. But this month I am getting a much-needed injection of "it's possible."

I am not talking about the U.S. elections, though some electoral campaigns have given me hope that not all politicians have sold out to focus group research.

I am talking about Verónica Cruz.

Verónica Cruz is the co-founder and leader of the organization "Las Libres" (The Free Women) in the central Mexican state of Guanajuato. She is also one of only three recipients of this year's Human Rights Watch annual award for exceptional human rights activists. Part of the prize is a three-week speaking tour of the United States and Canada, where I, as her Human Rights Watch host, get to accompany her. Our trip only started Monday, but I am already energized by her enthusiasm and inherent belief that justice is possible. Even for women. Even for poor women. Even for poor, indigenous, illiterate women.

And even though Verónica and Las Libres work in a hostile environment, their results are as up-lifting as their cause is depressing.

Las Libres is the only organization in the state of Guanajuato that provides legal aid and integral health services for victims of sexual violence. In Guanajuato, as elsewhere in Mexico, sexual violence is rampant and mostly unchecked. By the government's own conservative estimates, a woman or girl is raped every four minutes in Mexico, and more than 90 percent of rape victims don't ever report the crime committed against them to the authorities.

Many women and girls know from experience that they are likely to be aggressively questioned if they go to the police or to the public prosecutors. When I investigated this issue in Mexico last year, I found appalling cases of public officials actively mistreating or summarily dismissing rape victims, even before a claim was filed. Moreover, of the 10 percent rape cases that do get reported, few get properly investigated, and even fewer end with a conviction of the perpetrator. This impunity is a further reason for rape victims not to want to report a crime: if there is no final conviction, what is the point of exposing yourself to abusive police officers and prosecutors?

But it's even worse. Rape victims who have gotten pregnant as a result of the rape bear the brunt of the mistreatment and distrust. This is closely linked with the politically touchy issue of abortion. Abortion is generally illegal in Mexico, and some states still prosecute women for having had abortions. At the same time, all 32 state penal codes include exceptions to that general criminalization. The only exception that is valid in all of Mexico is legal abortion for rape victims. This means that rape victims in theory have a right to a safe, legal, and free abortion. However, pregnant rape victims who ask authorities for help to obtain such an abortion meet with multiple obstacles, both in the justice and health systems, ultimately impeding access.

In fact, in the state of Guanajuato, not one single rape victims has been granted access to a legal abortion by the authorities during the 30 years the penal code exception has been on the books.

Luckily, rape victims in Guanajuato now have somewhere else to go with their plight: Verónica Cruz and Las Libres. Las Libres provides the mental and physical health services the state should be providing but doesn't. Las Libres convinces women, through sustained support and consciousness-raising, that impunity is fought with the law: if rape victims agree to report the rape, Las Libres will provide them with the necessary legal aid. And if rape victims are pregnant and find they want to terminate the pregnancy, they are given the choice they are legally entitled to.

I have seen Verónica's presence in a rape victim's home change almost tangible despair to hope in a matter of minutes, just from Verónica's compassionate support and direct assistance. "Women, and in particular poor women, are used to thinking that they don't have a right to justice," Verónica told me today. "We show them it's not true. Justice is a human right. And it is possible."

Of course, victims of sexual assault still face a number of obstacles in accessing justice and health services in Guanajuato as elsewhere in Mexico. But with Verónica's and Las Libres' sustained pressure, the government can no longer ignore their obligation to improve this situation. And this is already a big step forward.