Why the Use of Steve Jobs As An Anti-Choice Political Stunt Is Flawed

@RHRealitycheck

Steve Jobs' premature death has generated much online activity, some seeking to exploit his demise for political gain. In this category are articles suggesting that Jobs' status as an adoptee is a reason to restrict abortion access in general. The arguments put forward in this regard are flawed on two levels.

First, no individual circumstances can change the overarching reality that women and girls have abortions when they need them, regardless of the legal context. Restricting abortion access does not make the practice scarce, it merely makes it unsafe.

More than 30 percent of women in the United States will have at least one abortion before they are 45 years old, even though many live in states with few or no abortion providers. Most women who have abortions already have one child or more, and many refer to their desire to have time to parent as a key reason for needing an abortion. 

In fact, in my experience interviewing women around the world about pregnancy and child-bearing, abortion is the end rather than the beginning of their decision-making processes. Women talk to me about food for their children, time to play and concern with paying for their children's education. They talk about expensive birth control and child care and about limited health care options. They talk about how difficult it is to decide when and if to become a mother. And they talk about abortion as an option where other options have failed. 

They rarely, if ever, refer to the legality or availability of abortion services as a decision-making factor.  If a woman or girl feels she needs to terminate her pregnancy, she will find a way. I once spoke to a girl who had fired a gun into her abdomen because she felt too young to be a mother and abortion was illegal in her country.

It is also noticeable that abortion, in the United States, is more and more the recourse of women without financial resources.  In 2008, more than 40 percent of those having abortions in the United States were living under the poverty level, and this proportion is growing.  There is a reason for that: children are expensive and the United States provides few legal protections for parents. There is no federal law to protect paid parental leave or sick days, and there are no allowances for time off to breast feed. Federal law guarantees 3 months of unpaid extended sick leave to be used as parental leave, and only for those who are eligible, which excludes about 40 percent of American workers. There are no general provisions for health care--not even, in most states, for children. In 2010, almost 10 percent of all children (15 percent of children living in poverty) in the United States had no health insurance.

In short, though access to abortion services is becoming more expensive in the United States mainly because service providers are farther away, some women and girls see abortion as the only viable choice available to them.  In cases where women or girls might initially be inclined to carry a pregnancy to term and give the infant up for adoption, many would not be able to pay for prenatal care and to give birth--or even get time off for visits to the doctor and for the birth itself.  This in addition to the many very valid--and private--reasons women and girls might have to not want to carry a pregnancy to term, even if adoption were an easier and less costly option than it currently is.

Secondly, Steve Jobs' life experience doesn't work as an argument for limited abortion access, even by its own logic.

It is a fact that Steve Jobs was born before the legalization of abortion in the United States.  It has been suggested that Jobs' biological mother, faced with an unwanted pregnancy, contemplated having an abortion before she decided to carry the pregnancy to term and give the infant up for adoption. Her decision to do so was based on personal, and private, considerations.  This is as it should be.

Had Steve Jobs' biological mother decided to terminate her pregnancy in 1954 when she discovered she was expecting, she would have had to have an illegal and therefore potentially unsafe abortion.  And she might have died as a result, as more than half a million women worldwide continue to do every year because abortion access is illegal or severely restricted in their countries. Let us not wish ourselves back.

From Condoms to the Pill: Trust, Control, and Violence

@HuffingtonPost

As media reports celebrate advances toward new male contraceptive methods, the fact that women currently take the larger responsibility for birth control is held up as somewhat inevitable and sad.  In effect, contraceptive use is now so firmly established as a woman’s responsibility that data on birth control often are collected from women only.  Moreover, pundits regularly question how to get a man to wear a condom—the main existing form of male contraception, barring vasectomy—and  why men are so uninterested in something that surely pertains to them too.

Historically, however, the responsibility for birth control has fluctuated.

The use of modern contraceptive methods started at least in part as a male project.  George Bernard Shaw called rubber condoms the “greatest invention of the 19^th century,” and by the early 20^th century the US birth rate had fallen significantly, in part because of effective contraceptive use,  condoms in particular.

This male control over contraception was seen by some suffrage leaders as immoral, because it made it easier for married men to cheat on their wives.  Later feminists saw access to woman-controlled birth control as essential to advancing women as equals, in particular women from the working classes.  And in time, a woman’s right to decide, alone, about the timing and spacing of her  pregnancies has become a key tenet of the women’s rights movement, evidenced by the massive improvements in women’s status since the approval of the birth control pill over 50 years ago.

Male contraception remains very much in the mix, though, and contraception decisions still are very much a matter of trust and control.

For starters, as some of the suffragettes noted, the use of contraception allows for sexual encounters with a substantially lower risk of both pregnancy and, depending on the method, sexually transmitted infections.  

As a result, if a person wants to use contraception, that is sometimes seen as a sign of their desire to “cheat,” or even as proof that they already have. In societies where male infidelity is seen as more “normal” than female straying, this can cause problems. In 2004 I spoke with dozens of women in the Dominican Republic who had been beaten by their male partners for daring to ask them to use condoms.  Human Rights Watch research from Uganda, the Philippines, Zambia, and elsewhere confirms that expectations about female fidelity and submission is a central problem in the fight against the spread of HIV/AIDS: women can’t control their husbands’ sexual encounters, and they fear abuse if they ask their husbands to use condoms.   

Trust, control, and violence are interlinked with use of contraception in other ways too.  In a news report from 2010, 20 percent of women who sought family planning care in Northern California reported that their partner had sought to pressure them into having a child, including by sabotaging their contraceptive use.  In my own reporting from Argentina, experts told me that a significant number of abusive men deliberately sabotage their wife's or partner's access to contraceptives as part of the control and abuse. One woman I spoke with, who had had 10 pregnancies during her 14-year abusive marriage -- including two miscarriages caused by the abuse -- told me her husband said: "I am going to fill you with children so that you can't leave my side." As a result of this relatively prevalent dynamic, many women in Argentina choose invisible contraceptive methods, such as voluntary sterilization or hormonal injections.

Also for those who have not personally experienced a physically abusive relationship, trust is often central to contraceptive choice.  Even the most superficial web search reveals that many men and women are loathe to trust their partners about birth control. The truth of the matter is that unless you can see it or use it yourself, you can never be 100 percent certain that a pill has been taken or a condom is intact.

Of course, putting more contraceptive options on the table, also for men, is a social good. But as I mentally review the testimonies of the hundreds of women I have spoken to about their lack of autonomy in contraceptive use, I find women’s responsibility for, and right to, birth control neither inevitable nor sad.  Most of the women I speak to are still struggling for choice, and their lack of reproductive autonomy has only brought them grief. 

Common Sense Abortion Policy

@TheHill

Abortion should not be a hard, divisive issue – at least not politically.

This week, Gallup released its annual survey on how the US public feels about it.  For the past 10 years, the figures have hovered around the same lines, with about 50 percent saying they believe abortion is morally wrong, and around 40 percent said they believe it to be morally acceptable. Older people and Republicans score higher than others on being “pro-life” and seeing abortion as “morally wrong.”

The survey also tracks how the American public feels about abortion policy. Between 50 and 60 percent say abortion should be legal in some circumstances.  Another 20 to 30 percent believe it should always be legal, and 15 to 20 percent say it should always be banned. 

Considering that discussions about abortion during the annual budget season in Congress this year threatened to shut down the federal government, some politicians might be tempted to scrutinize the Gallup survey for hints on the most politically expedient position to take on this issue.

That would be a bad idea.

Surveys on morals generally make for poor policy-making tools, not least because they can be read selectively. One Catholic blog celebrated the fact that 72 percent of those surveyed this year want abortion illegal, at least in some circumstances.  But if you read the figures from the opposite side of the debate, they show that a higher percentage of those surveyed (77 percent) believe abortion should be legal, at least in some circumstances.  Neither reading would be particularly helpful in crafting a policy response to abortion that allows for real, informed, and healthy choices.

Instead, politicians should be looking at studies on contraception use, current abortion practices, and pregnancy.

Because, if they do that, they’ll find that 1 in 5 women in the United States feel they need to terminate a pregnancy at some point in their lives.  Study after study has shown that women and girls have abortions when they need them, regardless of the legal or political context.  Knowing this, politicians should realize that the only two things a government can affect through legislation and policies are 1) to what extent abortions are needed; and 2) to what extent abortions are safe.  That makes the job of forming abortion policy a lot easier and less divisive. Few would contend that they wouldn’t want to reduce the need for abortion. And few would want abortions to be unsafe.

Abortion is obviously scarcer in situations in which women get pregnant when they want to be, and when they are in a position to expand their families.  This requires not only access to contraception and scientifically based sex education, but also paid family leave and support for child care.

Or look at it from another perspective. In countries where abortion is illegal, it is rarely scarce.  In Argentina, where abortion is criminalized for most women, an estimated 40 percent of all pregnancies terminate in abortions.  In Peru, with a similar legal framework, that proportion is 37 percent, and in Chile, where all abortion is illegal, the proportion is 35 percent. In Mexico and the United States, where the legality and access to abortion varies widely from state to state, the proportion is 20 percent. (All percentages calculated by using public figures on abortions and annual live births.)  

So in fact, where abortion is illegal, it is equally if not more prevalent than in jurisdictions where it is legal. And where abortion is illegal, it is much more likely to be unsafe.  

So, policy-wise, abortion is easy.

Of course, this does not mean that abortion doesn’t generate strong feelings.  Most everywhere, the issues related to abortion are framed as a “battle,” either for women’s lives, rights, and health, or for the life of the unborn child.  Positions are presented and regarded as immovable and based on fundamental rights. 

And it also does not mean that terminating a pregnancy doesn’t present complex questions about the worth of human life, and about when a human being begins to exist.

And it definitely does not mean that the emotions that come with facing an unwanted or unhealthy pregnancy are uncomplicated or straightforward or always lead to the conclusion we expect.  I have spoken with ardent supporters of abortion rights who have chosen to carry unplanned pregnancies to term because they felt a child grow inside them.  And I have spoken with equally ardent supporters of abortion bans who have chosen to terminate pregnancies because they just could not face having a child.

But it does mean that surveys on morals are not useful in shaping effective policies on abortion. Instead, if policymakers want to make policy that has some impact on how frequently abortion is used, they should look to research on the social, economic, and health factors that affect a woman’s ability to plan her pregnancy in the first place.  That is what makes the difference.

Argentina's Slow Tango With Women's Lives

(Originally posted on the Huffington Post)

In five days I will be addressing Argentina's House of Representatives about abortion. The occasion is as deliberately momentous as it is intentionally inconsequential. On the one hand, this is the first time Argentina's national congress has debated the legalization of abortion, and the hearing has been advertised in the national media for weeks. At the same time, the opening of this landmark debate has been scheduled in the last hours of the last legislative session this year, on a day of the week usually reserved for internal meetings.

This "schizophrenic" attitude reflects the way Argentina's government and congress have dealt with sexual and reproductive rights for decades.

On the face of it, Argentina has an impressive array of relatively well-defined and balanced laws and policies on the topic. Comprehensive sex education is mandatory in all schools. Laws stipulate that a spectrum of modern contraceptive methods must be available free through the public health system. The law also says that older adolescents must be allowed access to the medical care they need without parental authorization. And in July, President Christina Fernández de Kirchner took on the Catholic church to make Argentina the first country in Latin America to recognize same-sex marriage. Notably, abortion has been legal for more than a century for women and girls whose lives or health is threatened by their pregnancy, or when the pregnancy is the result of rape or incest.

But the law is one thing. Real access to information, services, and rights is quite a different matter. In 2005 and 2010, Human Rights Watch analyzed women's and girls' effective enjoyment of their human rights as they relate to sex and reproduction. Our conclusions were unfavorable. We found that multiple barriers keep Argentina's women from making independent decisions about their health and lives in the area of reproduction -- lack of information, inaccurate and incomplete information, domestic and sexual violence, and economic restraints the government has not addressed adequately.

We also found that the failure to remove these barriers comes at a real cost. Even today, an estimated 40 percent of pregnancies end in abortions, most of them illegal and unsafe. This in turn contributes to entirely preventable maternal deaths. In fact, unsafe abortion has been a leading cause of maternal mortality in the country for decades. In 2008, according to Argentina's national health ministry, over 20 percent of recorded deaths due to obstetric emergencies were caused by unsafe abortions.

Part of the problem is the politicization of issues related to motherhood, population growth, and, at the most basic level, sex. Argentina was one of the last countries in the Latin America region to abandon a top-down population policy approach that subjected individual decision-making to a nationalist interest in population growth. Until 1985 the sale and use of contraception was entirely prohibited, and even medical service providers still justify actions that curtail women's human rights by referring to a century-old maxim, "to populate is to govern." As recently as 1999, the government declared an annual national "Day of the Unborn Child," which some people still celebrate.

It is also true that any law that labels abortion a crime, even if it allows for exceptions, in practice makes it complicated -- if not impossible -- to get access to life- and health-preserving abortions. This is the situation in Argentina. Often, women are unaware of the circumstances in which they could legally get an abortion. Women who do seek them may be stonewalled by complicated procedures and hostile service providers in the health and justice systems. Many women with crisis pregnancies go directly to underground service providers, though some end up in the courts arguing for their right to health care, with varying success.

Much will be at stake when Argentina's parliament starts debating the legalization of abortion: women's lives, health and rights, as well as Argentina's reputation as a modern democracy respectful of human rights. I am honored to have been invited to take part in this debate. I hope the scheduling of the hearing is an indication of a busy congress rather than a symptom of the same erratic and selectively dismissive attitude that has plagued Argentina's engagement with this topic for years.

Illusions of Care

@The F-Word

In 2004, when I first went to Argentina to research women's reproductive health rights, I didn't expect a rosy picture. Argentina only ended an all-out ban on contraceptives in 1985, and some politicians and some medical providers still talk about women as instruments for population growth rather than as autonomous decision-makers.

But even if I hadn't known all that, the health statistics released by the national health minister told a story of despair. An astounding 40% of pregnancies in the country ended in - mostly illegal and unsafe - abortions. Complications from unsafe abortion have been the leading cause of maternal mortality in Argentina for decades. As a comparison, in most other countries in the region, between 15 and 25% of pregnancies end in abortions. It was obvious that something was very wrong.

No statistics, however, could have prepared me for what I found. Women who had been denied entirely legal abortions to protect their health and who suffered severe health consequences; the women and girls who had been raped and forcefully impregnated by their partners, and still could not get the police to enforce a restraining order; the women who had suffered miscarriages and sought help from a public hospital to contain the bleeding, only to find themselves the focus of police investigations.

But for me, the systematic devaluing of women's lives and decisions was the most jarring. Those using the public health system were stripped of choices: the medical provider would in many cases decide for them what contraceptive method they would use, or even whether they were old enough, married enough, young enough, had children enough (etc) to use contraception at all.

The women I spoke with did not ask for much. Most of them lived in resource-poor communities and expected to work hard for a living. In fact, many even expected abuse. Many articulated their day-to-day choices in terms of how they could best feed their children: a package of condoms cost the same as a liter of milk - you do the maths.

I spent the next five years supporting our Argentine partners as they pushed for legal changes within Argentina, and highlighting with international funders and United Nations bodies just how far the situation on the ground was from guaranteeing a life with dignity. These advocacy efforts paid off, at least on paper: spousal and judicial consent for voluntary sterilisation was declared unnecessary, by law, and sex education was made mandatory.

This year I went back to Argentina to see how much had changed for those women and girls who depend on the public health system for reproductive health care. The answer, depressingly, is not much. Government statistics confirm this. The central question is why.

Part of the explanation is linked to the continued politicisation of issues related to motherhood, population growth, and, at the most basic level, sex. Argentina legalised same-sex marriage last month, meanwhile talking about sex is still taboo.

In July 2010, the national health ministry declared its intention to guarantee access to (already legal) abortion. It immediately backtracked after aggressive questioning in the press.

Laws and policies meant to benefit women and girls go unimplemented - such as the legal exceptions to the general criminalisation of abortion, in cases when the pregnant woman's life or health is in the danger or rape. Key statistics and information are not gathered, not processed, or not shared with existing accountability structures, and when they are not, oversight can't happen. This indicates how little the government cares that laws and promises remain unfulfilled.

The report Human Rights Watch released yesterday in Buenos Aires, Illusions of Care, focuses on this lack of accountability. Or rather, it focuses on the fact that women and girls, more than a hundred years after the Argentine congress allowed for abortion in certain circumstances, and more than a quarter of a century since contraception became legalised, still don't have the power to decide whether, with whom or how often to become mothers. I trust in the transformative power of information and the fact that none of the women and girls I spoke to this time expected to be abused. They expect, deserve, and are entitled to better.