Access to Abortion in Ireland—A Key Human Rights Issue

(Originally published by the National Women's Council of Ireland)

Last week, Human Rights Watch launched our most recent report on women's rights -- "A State of Isolation: Access to Abortion for Women in Ireland". The report was based on interviews and research we conducted in Dublin, Cork, London, Birmingham, and Washington DC in mid 2008. And though the word "abortion" features prominently in the title, the report is about much more than abortion.

It is about the thousands of women who face crisis pregnancies every year in Ireland. And above all, it is about a government that actively sabotages their health.

Through our interviews with women who had traveled abroad for abortions, with medical practitioners, and with social workers, we documented the consistent obstacles women and girls face to independent and responsible decision-making about their pregnancies. They are not allowed to access the services they need within Ireland, they are aggressively discouraged from seeking the care they need abroad, and they cannot trust that the advice they receive is accurate or complete. Indeed, at the most basic level, the report is about information.

And to demonstrate just how important information can be, I want you to imagine a woman with a crisis pregnancy.

Perhaps she is one of the girls who got pregnant as a result of sexual abuse. Perhaps she is a married woman with 3 existing children and cannot afford to feed a fourth. Perhaps she is a student. Or a refugee going through an asylum procedure. Or perhaps she feels that something is not quite right with her pregnancy, health-wise.

Either way, she is a woman who believes she cannot and must not carry her pregnancy to term. But where can she turn?

Often, she may not know. The government has made sure that information about the termination of pregnancies remains difficult to access -- even information about how to get information about the termination of a pregnancy.

Those who provide accurate information about abortions abroad cannot advertise broadly and are prevented, by law, from supporting their patients in seeking care.

Meanwhile, those agencies who claim not to provide information about abortion remain unregulated, and therefore free to harass women and girls who are already in distress with harrowing medical claims many of which are completely inaccurate.

In many cases, the agencies that provide accurate information are indistinguishable from those that don't.

Worse still, women who depend on maternity hospitals and GPs for support also cannot be sure to get full information. Despite an exception in the law, clarified by the Supreme Court, that women have a right to an abortion within Ireland if their life is threatened by the pregnancy, there is no official protocol on when abortion might be legally performed in Ireland. Mostly doctors are reluctant to guess, and some, as a result, actively discourage pregnant women with complicated pregnancies from seeking full information about their health status: they can't do anything about it anyway.

Some might say: if the government's intention is to discourage women from having abortions, it looks as if their policy is working.

They would be wrong. Thousands of women and girls travel abroad for abortions every year. They are not prevented by the misleading or scarce information from seeking abortions. They are preventing from seeking abortions in a timely manner. This has a detrimental effect on their health, both physically and mentally.

Abortion, as a medical procedure, is safest when provided within the first 8 weeks of the pregnancy. And the longer a woman with a crisis pregnancy has to wait for the services she needs, the deeper her distress and ordeal. If the woman is suffering through a pregnancy with fatal fetal abnormalities or that has been the result of rape or incest, this is in some cases even more true. By stalling women's access to the care they need, the Irish government is complicit in their distress.

In other words: the government contributes directly to undermining women's health, dignity, and human rights. Because though decisions related to abortion are complicated and deeply personal, they are also a question of human rights. And the Irish government has an obligation to provide women with the support and information they need to navigate those decisions.

True Choices: access to safe and legal abortion is the end rather than the beginning of women's childbearing choices

(Originally published in Conscience Magazine)

FOR AN OUTSIDER, US POLITICS around choice seem oddly divorced from reality. At its most reductionist, choice in this country means merely that a pregnant woman can choose to buy herself an abortion. In a slightly more expansive line of argument, the cost and conditions related to the medical procedure are considered as limitations to choice. But rarely does the debate critically examine the other aspect of choice: whether actually having a child is viable, financially and professionally.

To me, this is the crux of the matter. I have never questioned that women are entitled to free and legal abortion as part of a continuum of necessary health care. But I believe it is tragic when women choose to terminate pregnancies they would have continued if society had provided them with the necessary support. But what would that support look like?

In Latin America there is a popular saying: "Every newborn comes to the world with a loaf of bread in their hand." Anyone who has ever looked at the cost of childrearing knows that this is not true. Apart from the basic supplies such as diapers, food and housing, children need care and education. At a minimum, women and children need access to prenatal health care, childbirth facilities with trained staff and infant health care. And there is a time issue too. Women need time off to give birth, and parents need to spend time with their children, to care for them when they are sick and to participate actively in their rearing and education generally.

The United States provides few legal protections for any of these--largely uncontested--needs. There is no law to guarantee paid sick leave or vacation, and as a result half of the US workforce must pay for their own sick days, and 20 percent for their time off for vacation.

There is no law to protect paid maternity leave, and there are no allowances for time off to breastfeed. Federal law affords 12 weeks 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. Today, some 8.7 million children in the US have no health insurance.

Childcare options are mostly private, at least until the child is four years old, and private infant-care options are limited. "The infant-care shortage in this country is amazing," says Veronica Arrealo, co-chair of the Now Mothers/Caregivers Economic Rights Committee. "As soon as that pregnancy test comes in with two lines, the first call you should be making really is to the infant-care facility, because it is generally about a nine-month wait to get a slot."

Money and time are probably two of the main concerns of those thinking of expanding their families. In most high-income countries, public policies recognize and support that. A 2008 publication from the Institute for Women's Policy Research (IWPR) in Washington, compares legislative frameworks on these issues in high-income countries to the United States, and looks briefly at their impact on key equality indicators. (Ariane Hegewisch and Janet C. Gornick, "Statutory Routes to Workplace Flexibility in Cross-National Perspective," Institute for Women's Policy Research, 2008)

The contrasts are sharp. In all countries examined--Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom and the United States--only the United States does not provide for paid parental leave. Most allow the right to a gradual return to work on a part-time basis. Many countries entitle parents to tailor the parental leave to their needs, with options such as taking the leave in one block with an allowance, or working part-time over a longer period; reducing the working day during a set time period or extending the paid leave period into unpaid leave, with job guarantees.

Not surprisingly, parents in these other high-income countries tend to spend more time with their children. Ariane Hegewisch, one of the authors of the IWPR report, notes that the proportion of married couples with children in the United States who work 80 hours a week or more is twice as high as in the next European country. "The question of choice really is a question of whether you have time to combine work with having a family," she says, "which is not really something you have in the United States."

Legislative protections for paid parental leave and part-time options, in fact, have a direct impact on women's choices because they don't force women to "choose" between being a mother and being a professional. The IWPR study shows that women with college degrees in the United States are less likely to have paid employment than women in any of the other 20 surveyed countries, implying at least in part that where more legislative protections are in place, more women get to take advantage of their education in formal employment.

What is perhaps less well-known is that many lower-income countries have much stronger legal protections for paid parental leave and options than the United States. Costa Rican and Salvadoran law, for example, provides for three months leave after an infant is born, at 80 percent and 75 percent pay respectively. Most Latin American countries require employers to allow breastfeeding mothers the time and physical space to nurse their children generally for at least a year after childbirth. And paid vacation and sick leave are protected by law almost everywhere in the region.

Having parental rights protections enshrined in law is no guarantee of time and support. For one thing, the protections are generally linked to continuous, fulltime employment, which has always been more common for men than for women. Perhaps more importantly, more and more workers--men and women alike--find themselves in more precarious situations, in part-time or temporary contracts, or are otherwise excluded from the statutory provisions that might protect their choices.

But in terms of societal understanding and support of parenting, the question is not to what extent legal protections are properly implemented, but rather if they exist at all. Few would contest that time and quality child- and health-care options are necessary for good parenting. The question is who we, as a society, believe should pay for them. It is this societal understanding of parenting responsibilities that is expressed in the law.

In the United States, the main cost of childrearing falls to the individual family or woman, because, in general, Americans think of parenting exclusively as a personal choice whereas European and Latin Americans do not. This fundamental difference in the way people think about children and families is what determines what real choice means.

Paradoxically, it may be precisely the culturally ingrained respect for seemingly free individual choices in the United States, without reference to contextual limitation such as money and time, which has led to a lack of political support for legally sanctioned parenting options. In her book, The Price of Motherhood, former New York Times writer Ann Crittenden exposes the myth of choice as one of the main reasons for the prevailing "hands-off parenting" policies in the United States: "The sidelined ambitions, the compromises mothers live with that their husbands never had to make, all justified on the grounds of women's choice ... It's their choice. No one 'made them do it,' so no one has to do anything about it."

But if you dig a bit deeper, perhaps the real opposition or political discomfort with regard to the provision of childcare and parental work flexibility options in the United States is linked to perceptions of who is seen to benefit from a stronger support network. And this, again, is closely related to how welfare policies and parenting choices are covered in the mainstream media.

Consider the case of Nadya Suleman. Ms. Suleman, already a mother of six children under the age of 7, gave birth to octuplets in January 2009 after in-vitro fertilization. Ms. Suleman's octuplets were the second full set of octuplets to be born alive in the United States and the birth was newsworthy because of that.

What is interesting is that the media coverage about the case, in particular as expressed in opinion pages and editorials, pits choice against choice. For some, Ms. Suleman is seen as epitomizing "good motherhood," making a disinterested choice to continue a multiple pregnancy that could have seriously and permanently damaged her health. For others, her choice is based on individual greed and an alleged desire to leech on society by having children she clearly can't afford to feed, clothe and house without support.

In contrast, the explicit reasoning behind European welfare policies that affect parental choice is rarely individual. Often, there is reference to a broader macroeconomic argument--that all economies need to produce the next generation of workers. At times, this argument is expressed as nationalism or poorly veiled racism: one way to reverse falling birth rates and prevent diversity in the workforce is to promote parenting through tax breaks, work-time flexibility and childcare options.

Interestingly, though, many of the basic parental support policies in Europe such as paid sick leave, paid paternity leave and caps on work hours precede the falling birthrates in the 1990s, and the corresponding concern with population composition and growth. Commentators link the motivation for these policy changes to a European notion of collective responsibility and to industry-wide union organizing that focused on establishing a social floor through permanent legislation instead of, as in the United States, through bilateral contractual obligations that can be and often are renegotiated in times of economic difficulties.

Which brings us back to the overwhelming American focus on individuality, and the resulting limited understanding of parenting as separate from a national interest in the new generation. Women's organizations in the United States have, in fact, long challenged the notion of Americans as naturally individualist. "I struggle with the word 'choice'," says Erin Mahoney, chair of the Women's Liberation Social Wage Committee. "When we emphasize the individual choice of parenting, we take away the fact that we, as women, are doing real work to rebuild society. Every child that's raised in this country is the next mailman, the next nurse. It's not the responsibility of individual women to do that work alone."

There have been times in American history where the national interest has superseded individualism, with direct consequences for the provision of childcare. In the 1930s, the federal government sponsored nursery schools under the Works Progress Administration program, which was expanded to cover daycare as a war-time necessity during World War II. Even now, women employed by the US military enjoy access to legally mandated quality childcare, a provision that, to a large extent, was motivated by a need to maintain trained personnel and prevent turnover in the military in the interest of national security.

Generally, though, in the United States children remain the exclusive concern and responsibility of their parents. And choice remains a codeword for legal but often inaccessible abortion services. Logically, one would therefore expect women in the United States to choose to have smaller families than in Europe. This is not the case. Though the birthrate has been declining in the United States, it remains higher than in most European countries. In fact, Japan and about 20 countries in Central and Eastern Europe are experiencing negative population growth (when we exclude the impact of immigration and emigration).

"The central question is why people continue to have children when it is so hard," muses Ariane Hegewisch. "And conversely, there is no evidence that everyone in Europe has 16 kids, just because they can."

One reason may be that while politics in the United States is traditionally unconcerned with women and equality, children are, at least in political rhetoric, a strong motivator for change. Just recently, the corporate bailouts and economic rescue plan, while seemingly inconsistent with American individualism, have been justified by reference to the next generation.

Perhaps the policies that protect women's choices as mothers would be more palatable to American policymakers and to the public at large if they were articulated as necessary for children. "When you deny support to mothers, you punish the children," says Hegewisch. Veronica Arreola from now agrees: "All of the things we advocate for: childcare, infant care, health care, sick leave, etc. All are things that, when it comes right down to it, are about caring for our children."

In my experience interviewing hundreds of women about their childbearing choices, access to safe and legal abortion is the end rather than the beginning of that choice. 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 childcare and about limited healthcare 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. Public policy on choice should reflect all of these essential concerns.

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.