Why Is El Salvador Letting A Woman Die?

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This past month, the world has been watching a 22-year-old pregnant woman in El Salvador die, little by little. I want to say it is like watching an accident happen in slow motion, but this situation is no accident. El Salvador’s government is deliberately denying lifesaving treatment to the woman, for no reason other than that she is pregnant.

At first I couldn’t understand why.

I am not trying to be naive. I know that abortion is criminalized in all circumstances in El Salvador, and that the government therefore can hide behind the law to justify denying Beatriz (a pseudonym) medical treatment. I also know that El Salvador is a predominantly Catholic country, and that church officials are very active in the country’s political life, in particular on this issue.

But this same constellation of facts has not prevented select women in similar situations from getting access to the services they need in other countries in the region. Over the years, I have interviewed a small handful of women in Latin America who needed abortions to protect their health and lives. In most cases, after an initial negotiation with the public health ministry or prosecutor, the intervention went through on the dual condition that it got registered as “appendicitis” in the woman’s medical record, and that the women didn’t tell anyone about it. It didn’t much matter if abortion was legal or illegal in the countries where each case happened—the main motivation for allowing the intervention for the prosecutors and other public officials involved was to avoid negative publicity.

Because it doesn’t look good for El Salvador’s government officials. Sure, they are following the law. But they are also watching a woman die. And for what? The fetus Beatriz is carrying does not have a forebrain, and is likely to survive only scant hours after birth, if that. Human rights officials from the United Nations have publicly called out the situation as counter to El Salvador’s international obligations, and international media are portraying the government as “not moving a finger.”

The only reasonable explanation for the public stand-off is that Beatriz and other resource-poor women are politically expendable, and that crossing the Catholic Church is seen as worse than being hung out in the press as inhumane.

It wouldn’t be the first time poor women pay with their health and lives for politics. In Nicaragua, a mere ten days before the 2006 presidential election, the parliament voted to eliminate the possibility for legal abortion when a woman’s life is threatened by her pregnancy. Members of the Sandinista party were reportedly told to vote for the change, with the promise that it would be “fixed” after their candidate had won the election. And during the Pope’s 2007 visit to Brazil, then-President Lula publicly announced his opposition to abortion.

Let us be clear: the Catholic Church, and any other religious group or civil society organization, has the right to try and influence policies and further its agenda within the limits of the law. But governments owe everyone the same rights, regardless of faith, sex, family status, or ability to pay for votes or medical treatment. In the recent ruling, the Inter-American Court on Human Rights stated that governments cannot implement laws in a manner that reflects only one particular religion, as this would infringe on the rights of those who do not share that faith.

Nowhere is this more obvious than when it comes to the laws that criminalize abortion, even where the pregnant woman’s health or life is compromised. Not all visions of Catholicism require a woman to die for the sake of her pregnancy. And even if they did, it is Beatriz’s faith, wishes, and life the law must uphold.

I don’t understand what El Salvador’s government has to gain from watching this young woman die a preventable death. And I don’t understand how we can continue to allow this to happen.

In Europe, Same-Sex Couples Face High Barriers to Parenthood

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There was big news this week for same-sex couples who want to have kids, especially if they are trying to figure out where to have them. Europe, it seems, is not the place, despite a reputation as the world's most gay-friendly continent.

On Wednesday, the French daily Le Figaro published an article titled, “Shrinks Warn against Adoption,” referring to a legislative proposal to allow same-sex couples to adopt. Also on Wednesday, the European Court of Human Rights heard from the Austrian government that its adoption policies are based on the biological principle that a child has one father and one mother, and that this is to secure the child’s well-being.

Meanwhile, Australia granted gay parents the same rights to paid parental leave as those granted to straight parents. In contrast, same-sex adoption is legal only in part of that country.

In truth, gay parents make some people uncomfortable. This discomfort is at the root of opposition to same-sex marriage. Opponents of marriage equality often argue that reproduction is the main purpose of marriage. As many have pointed out, if the point were to reserve marriage exclusively for couples who can biologically reproduce, the institution would be off limits to the elderly and the infertile, as well as to same-sex couples.

Of course, that's not the point. The point is to prevent same-sex couples from having children through in vitro fertilization or adoption. In many countries, these options are available only to married couples. France, for example, refused to allow a lesbian to adopt her partner's biological child whom she had cared for since infancy. The couple were told earlier this year by the European Court of Human Rights that France’s refusal did not constitute discrimination. After all, the court said, straight unmarried couples would also not have been allowed to adopt each other’s children. But a straight couple could have remedied the situation by getting married, a route that is not open to same-sex couples. This was irrelevant to the court.

It is, however, relevant to same-sex couples who wish to be parents, and to the children many of them already have.

In fact, hundreds of thousands of children grow up in same-sex households or with parents who are not straight. In the United States alone, an estimated 2 million LGBTI people are interested in adoption, and one-quarter of same-sex couples are raising children. These children are adversely affected by laws and policies that exclude their de facto guardians from legal protections and privileges that straight parents enjoy. Such protections might include the right to make medical and other crucial decisions, the right to support educational decisions, and the right to bequeath property.

Most opponents of marriage equality, adoption, and parental benefits would object to any implication that their position hurts children—though that is the inevitable consequence. Many of these opponents would say that they are trying to protect children against the “dangers” of growing up with gay parents. The belief that gay parents are not as capable as heterosexual parents of raising well-balanced, healthy, and happy children is a common, and damaging, stereotype. It is constantly contradicted by studies on the well-being of children in same-sex families. Study after study shows that the welfare of children closely correlates with parental support and love, not with the parents’ sexual orientation or gender expression.

In deliberating adoption by same-sex couples, the European Court of Human Rights and the French legislature should focus on children’s rights and dignity. If they do, they will quickly conclude that children deserve parents who love and care for them. Sexual orientation has nothing to do with a parent's capacity to do just that.

The Other Side of Reproductive Justice: How Sterilization and Other Forms of Coercion Are Used Against "Unworthy" Parents

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Earlier this fall, a committee of the Parliamentary Assembly for the Council of Europe held a hearing entitled “Putting an end to coercive sterilizations and castrations.” This debate continues today, November 21, 2011. What is remarkable about this is not the outcome or the discussion, but rather that it was necessary at all. After all, most parliamentary debates about contraception and childbearing these days seem to be about how to make women have more children than they want, not less.

However, if we scratch the surface a bit, it becomes clear that two seemingly contradictory political discourses happily coexist. On the one hand, policy-makers push for limits to contraceptive access for women, generally speaking. And on the other, they enforce policies that criminalize, condemn, or render impossible the reproduction of specific subgroups of women (and men), who for various reasons are seen as undesirable parents: Roma women, lesbians and gay men, transgender people, indigenous women,injection drug users, women living with HIV—the list goes on.

In this connection, coercive sterilizations and castration are at the extreme end of a spectrum that also includes criminal sanctions for drug use during pregnancy and barring LBGT individuals from in-vitro fertilization services and adoption, as well as a host of other policies geared at making pregnancy and parenting difficult for those deemed unworthy. In fact, the more “unworthy” the individual or group is considered by the general public, the more explicitly coercive the measure to limit their possibility for parenting. So much so that by considering the lengths to which a government will go to prevent certain individuals from procreating, we can gauge the extent of the stigma they face.

For example, it would probably no longer be politically viable to implement quotas for the sterilization of indigenous women, as the Peruvian government did in the 1990s, yet Roma women and even just poor women are still routinely sterilized without their consent in several countries. Lesbian women are rarely forcefully sterilized, yet they are often excluded from becoming adoptive parents or from benefiting from in-vitro fertilization processes. Many countries require transgender individuals to be sterilized before they can legally change their names or papers to reflect their preferred gender, and intersex individuals are often assigned a sex—and in the process rendered infertile—as infants and certainly before they can give meaningful consent. The most restrictive and invasive intervention, forced castration, is reserved for convicted sex offenders who, in turn, arguably are seen as the most unworthy and reviled of all.

As a human rights issue, coerced sterilization and castration are in many ways no different from other limitations on individual reproductive choice: they violate a number of fundamental rights, including the rights to health, privacy, and physical integrity. Additionally, they make discrimination and public contempt visible and as such can help target policy interventions to alleviate abuse.

But a more interesting aspect of the practice of coerced sterilization is that it crystallizes the hypocrisy of the limitations to reproductive rights. When I did research on access to abortion in Mexico in 2005, for example, I found that rape victims routinely were denied services they, by law, were entitled to, whereas sex workers and women living with HIV who were applying to the same hospitals for the same services were offered abortions they did not need and that would technically have been illegal.

When Parliamentary Assembly for the Council of Europe continues its debate on forced sterilizations on Monday, it would do well to think through in what other ways it can support individual choices on when, if, and with whom to become a parent. Only just a year ago, the Assembly refused to recommend adequate regulation of conscientious objection in the medical profession, a move that probably already has contributed to the denial of care to many women across the continent.

These are not separate issues. The Roma woman who is forcefully sterilized suffers as much as the one who is denied an abortion or other needed care. Everyone must be allowed to make individual and responsible decisions about parenting and procreation.

UN Special Rapporteur: Abortion Restrictions Don't Work

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Restrictions on abortions just don’t work in that they don’t result in the desired outcome.  This is the predictable, yet bold, conclusion of a report to be presented at the United Nations on Monday, October 24th by Anand Grover, a UN-appointed independent expert on health.  The report, which is part of an annual report-back from various human rights experts to the United Nations’ General Assembly, consolidates years of legal analysis and empirical evidence from other experts and concludes that abortion restrictions are unworkable and damaging to women’s health. Instead, the report advocates access to full, accurate, and complete sex education and information about contraception, as well as to all forms of modern contraception, because these services and state support for women’s equality actually do work to reduce the need for abortions.

Abortion restrictions are generally justified by reference to a desire to lower the number of terminations, be it by limiting access to abortion for all women, as in Chile, El Salvador, and Nicaragua, or just for the “undeserving,” as in most of the rest of the Americas including the United States. Some explicitly prefer pregnant women to die rather than having access to a life-saving abortion, but most refer to some sort of makeshift hierarchy of morals. 

“Most people, of course, should have access free of charge,” a high school friend from Denmark told me the other day. “But women who just keep having abortions: there really should be some sort of punishment for them.”

I have heard this sentiment echoed so many times.  “Seriously, I believe in access to abortion,” a young Mexican friend told me. “But really women need to show a minimum of responsibility.” This friend had, in the course of the same conversation, told me he recently had a condom break during intercourse.  When asked if he believed the woman in that case, if she were to become pregnant, had shown the requisite minimum of responsibility he was confused and horrified.  Of course she should have access to an abortion.  At least they had tried. 

These considerations about who, if anyone, deserves access to abortion are often at the core of public debate on the issue.  All but the most radical anti-choice activists would say that pregnant rape victims should have access, as well as those whose lives or health are threatened by the pregnancy.  This distinction between the vulnerable madonnas and the physically healthy sluts is, in fact, the bright line in determining public funding for abortion services in the United States today.

The truth of the matter is that abortion restrictions in law and policy have little if anything to do with how women and girls deal with their pregnancies.  Of the hundreds of women I have spoken to about their abortions, none mentioned the law as a deciding factor in whether or not to continue an unwanted or unhealthy pregnancy. Sure, the criminalization of abortion might be an impediment to getting a safe and timely abortion, but never a real barrier to getting one at all.

In fact, the only two questions policy-makers can helpfully ask themselves about their approach to abortion are 1) is it workable; and 2) does it actually work.

Most policies that allow only partial access to abortion for the “deserving” women are not all that workable. You need a process for determining the validity of rape claims, for example, and a solid definition of just how unhealthy a pregnancy needs to be to be unhealthy enough for the woman to be entitled to care.  In Ireland, where abortion is only theoretically legal for women who will die as a result of their pregnancy, a doctor asked me in visible distress: “How terminal does she have to be?  Can I help her if she has a 51 percent chance of dying, or does it have to be more?”

The notion proposed by my Danish friend—that irresponsible women who just have one abortion after another need to be punished—is equally unworkable.  How do you determine responsibility? And how many abortions are too many?  And what would be an appropriate punishment?  Carrying the pregnancy to term?  For many, the key moral question in the abortion debate is whether women who want their pregnancies terminated actually care.  But any policy based on a value-judgement on that count raises more ethical questions than it solves.  It is not workable.

Spread the word: abortion restrictions just don’t work.

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

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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.