Joyce Arthur
Maternal health without abortion: A fundamental hypocrisy

| October 4, 2013
Photo: DFATD | MAECD/flickr

Even with all of our advanced technology and scientific knowledge, humanity still struggles with widespread poverty and hunger, economic inequality, war and strife, environmental destruction, and a long list of serious human rights abuses -- including high rates of preventable maternal mortality. The latter has been one of the world's most intractable human rights problems because of the low status of women, but recent efforts have shown that it can be significantly reduced. All it takes is political will and a steadfast opposition to right-wing forces.

One major initiative that has seen some success is the eight "Millennium Development Goals" (MDGs) established by the United Nations in 2000 to improve global living conditions. All 189 UN member states have committed to help achieve the goals by the year 2015. Here are the MDGs, each of which includes specific targets.

1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria and other diseases.
7. Ensure environmental sustainability.
8. Develop a global partnership for development.

In late September, the UN General Assembly reviewed progress on the MDGs, with Member States adopting an outcome document that promised to accelerate efforts to meet the MDGs and continue unfinished work past 2015, particularly for the targets that are most off-track.

A great deal of progress has been achieved across all eight goals, but many gaps remain, particularly those relating to women and children (MDG 3, 4, 5). Unfortunately, improvements to women's equality and rights, including access to reproductive health services, generally lag behind most other targets. Since reducing child mortality depends on raising women's status and saving their lives, that goal also has fallen far short in some parts of the world. Each year, more than a million children are left motherless because of women dying during pregnancy or childbirth. These children are up to 10 times more likely to die prematurely than those living in families with a mother.

MDG 5 calls for a 75 per cent drop by 2015 from the 1990 maternal mortality rate. Two years from the deadline, the latest measurements show that maternal mortality has decreased by almost half -- 287,000 deaths in 2010 compared to 543,000 deaths in 1990. Further, all developing regions have made gains since 2000. But without a major acceleration of effort and resources, the 75 per cent reduction target will not be met. Unfortunately, the political will to save women's lives is still lacking in many developing countries, especially when it comes to the lives that could be saved through better access to contraception and safe abortion services.

Unsafe abortion causes 13 per cent of all maternal deaths in the world and ranks as the third or fourth leading cause, along with haemorrhage, infection, and high blood pressure. About 21 million women a year resort to unsafe (usually illegal) abortion, and 47,000 of them die.

The United Nations has come a long way on the abortion issue just in the last three years. In 2010, I wrote this article slamming the UN for "abandon[ing] women who need abortions by caving to pressure from right-wing forces." But the very next year, the UN's Special Rapporteur on the Right to Health, Anand Grover, issued an interim report that described laws restricting abortion as an abuse of state power. He said such restrictions "infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity." Grover even sent a message to the Abortion Rights Coalition of Canada in January, congratulating Canada for its 25 years of decriminalization.

Still, we have an awfully long ways to go, thanks to the culprits who perpetuate the suffering and death of women around the world. I'm speaking of the Vatican, conservative countries, and right-wing politicians, as well as various religious and "pro-life" organizations. But the real causes lie even deeper. Traditional views on women and motherhood relegate women's rights and equality to the bottom of the ladder, behind the rights of minorities and other vulnerable groups. Much of the world still clings to the deeply held assumption that women's dignity and humanity is tied to being a mother, even though this subordinates women to a biological function.

Since the United Nations operates by consensus, the reactionary attitudes of the Vatican and Member States that oppress women wield a disproportionate impact on progress for women. References to reproductive health continue to get watered down or deleted, and countries are allowed to maintain their criminal abortion laws in the name of sovereignty and "culture." This has led to unsafe abortion getting short shrift as a health problem, undermining global efforts to resolve the problem.

Progress has been sporadic and slow, but things finally seem to be changing for the better. Not only is the UN beginning to champion the decriminalization of abortion, politicians and doctors in developing countries are increasingly speaking out against unsafe abortion and the need to decriminalize abortion. Many developing countries have also taken huge steps to improve maternal health since 2010, which will help reduce unintended pregnancy and thereby unsafe abortion, even without direct funding for abortion.

When Canada hosted the G8/G20 summit in 2010, Prime Minister Stephen Harper put maternal and child health front and centre, with resulting pledges of $7.3 billion from participating countries and the Bill & Melinda Gates Foundation. At least $24 billion was needed, however, according to aid groups. Further, Harper had to be shamed into including funding for family planning services in Canada's contribution, and he refused outright to fund safe abortion in countries where it's legal.

Harper decided that Canada's money would be spent on three main needs in 10 countries (seven in Africa): strengthening health systems, reducing the burden of disease, and improving nutrition. So far, it appears that only a tiny portion of Canada's portion of the G8 funding ($2.85 billion) has been spent on family planning, although it's difficult to figure out exactly where all the money is going. Several Google searches produced these tidbits: $20 million for free prenatal care in Haiti, and undisclosed amounts for the UN Population Fund and a sexual and reproductive health project in Bangladesh; $6 million for the International Planned Parenthood Federation (for sex education, family planning and post-abortion counselling); $75 million for the Muskoka Initiative Partnership Program (to strengthen health systems, reduce disease, and improve nutrition); and most recently, $203 million to provide immunizations, basic health care, and community services to make childbirth and pregnancy safer.

Not only is Canada cherry-picking its aid for maternal/child health services, it attaches strings to it. Money can only be spent as per Canada's own goals and guidelines, giving little or no say to smaller groups on the ground in the target country. This makes it far less likely that the money will be used constructively, or will flow to needed reproductive health services such as post-abortion care.

Canada's refusal to address unsafe abortion in any way, shape or form continues. On Sept. 27, Foreign Affairs Minister John Baird called for an end to child marriage at a UN meeting in New York, saying that it "robs girls of their right to education and jeopardizes their health." That's a commendable stance, but the words ring a bit hollow without a strong commitment to funding contraception and safe abortion. Childbearing is especially dangerous for young girls, and can result in severe maternal disability or death. Baird also backed a British-led declaration condemning war rape, but refused to say whether that would extend to helping victims obtain abortions. We can guess the answer is no.

Ignoring the need for safe abortion in maternal health programs means disregarding the health and lives of millions of women. It also reveals a fundamental hypocrisy. Conservatives apparently believe that only women who have babies are worthy of support -- but most women having abortions are already mothers. As Rachel Atkins says: "There aren't women who have abortions and women who have babies. Those are the same women at different points in their lives." Abandoning women who need abortions therefore means abandoning mothers and children -- the very demographic Harper has promised to help.

Joyce Arthur is the founder and Executive Director of Canada's national pro-choice group, the Abortion Rights Coalition of Canada (ARCC), which protects the legal right to abortion on request and works to improve access to quality abortion services.

Photo: Foreign Affairs John Baird attends UN event on early and forced marriage. Credit: DFATD | MAECD/flickr


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