Protest the death of Savita Halappanavar

SOLIDARITY REQUEST: Protest the death of Savita Halappanavar in Ireland PLEASE SIGN AND SEND THE E-MAIL BELOW TO THE FOLLOWING: To: Taoiseach Enda Kenny (Irish Prime Minister) cc: Tánaiste Eamon Gilmore (Irish Deputy Prime Minister and Minister of Foreign Affairs) E-mails: taoiseach@taoiseach.gov.ie enda.kenny@oireachtas.ie eamon.gilmore@oir.ie Copy also to the Irish Embassy in your country. Find contact details here     Re: Death of Savita Halappanavar in Galway Honourable Taoiseach, We are writing to you to express our concern about the recent death of Savita Halappanavar, who was repeatedly denied an abortion in Galway. This tragic case demonstrates once again that the prohibition of abortion in Ireland is not just undermining the autonomy of the women across the country, it is leading to unacceptable suffering and even death. Savita Halappanavar made repeated requests for an abortion after presenting at University Hospital Galway on 21 October while miscarrying during the 17th week of her pregnancy. Her requests were refused, and she died one week later after several days in agonising pain and distress. The situation of Savita Halappanavar provides the clearest possible evidence that laws that permit abortion only to save the life of a woman, such as the Irish law, are clinically unworkable and ethically unacceptable. There are numerous clinical situations in which a serious risk posed to a pregnant woman's health may become a risk to her life, and delaying emergency action only increases that risk. There is only one way to know if a woman's life is at risk: wait until she has died. Medical practitioners must be empowered by law to intervene on the grounds of risk to life and health, rather than wait for a situation to deteriorate. You will be aware that the European Court of Human Rights, as well as a number of United Nations human rights bodies, have called upon the Irish government to bring its abortion law in line with international human rights standards. Had these calls been heeded before now, the death of Savita Halappanavar would have been prevented. With the death of Savita Halappanavar, Ireland joins the ranks of countries worldwide where abortion is denied to women and leads to their deaths. We call on your government to take urgent and decisive steps to reform the legislation that led to the death of Savita Halappanavar. Until the Irish legal system is reformed the lives, health and autonomy of women across Ireland are in jeopardy. Yours faithfully, [SIGNATURE]

Wonder Women and Other Women

As part of the Telegraph’s new ‘Wonder Women’ collective Cathy Newman has written a piece entitled ‘How the agony of my abortion made me see both sides’. In the article Newman shares her own experience of having ended a wanted pregnancy due to a diagnosis of severe fetal abnormality. She notes that she was lucky to find out about this abnormality relatively early, at 13 weeks, as many women would be having this scan at 20 weeks. She goes on to describe the difficulty of having to wait another week to access the procedure after having had this news:

‘Most women whose babies suffer from this condition wouldn't find out until the 20 week scan, if then. I was immediately offered an abortion, but quite apart from the emotional turmoil, it was extremely difficult to arrange. I was told I'd have to wait a fortnight, but eventually managed to fix the operation in a week - a week which seemed like a year as I dealt with the trauma of what was happening to me.’

We appreciate Newman sharing her personal experience, and acknowledging that there are complex situations and real people behind later term abortion, and that unavoidable delays can affect access and emotional wellbeing. However, there are a few points in the rest of the article we’d like to have seen more clarity on, this being such an important and emotive subject.

Firstly, the conclusions reached about later abortion are not entirely accurate. Newman claims that ‘if the law changes, women in similar situations might not have the choice I did’. The article’s ‘hook’ seems to be that Maria Miller, new Minister for Women and Equalities, voted in 2008 to reduce the abortion time limit to 20 weeks. In fact, if this part of the law changed it would presumably not affect somebody in a similar situation to Newman – that is somebody who had had a diagnosis of fetal abnormality, as this is a ground under which abortion can be accessed after the 24 week limit.

The more troubling statement which has been left unexplored, with no reference to scientific evidence, is that made by Miller herself regarding her reasons for supporting a reduced time limit. She claims to be:

‘driven by that very practical impact that late term abortion has on women...What we are trying to do here is not to put obstacles in people's way but to reflect the way medical science has moved on.’

There are two issues here. What is the ‘very practical impact’ that late term abortion has on women? Has this been measured against the ‘very practical impact’ which might arise from being forced to continue an unwanted or non-viable pregnancy to term? Secondly, Miller claims to be reflecting ‘the way medical science has moved on’. When Miller was voting on the 2008 Human Fertilisation and Embryology Act she would have heard that medical and scientific consensus remained in favour of maintaining a 24 week limit due to a lack of significant changes to viability before this point:

‘Having considered the evidence set out above, we reach the conclusion, shared by the RCOG and the BMA, that while survival rates at 24 weeks and over have improved they have not done so below that gestational point. Put another way, we have seen no good evidence to suggest that foetal viability has improved significantly since the abortion time limit was last set, and seen some good evidence to suggest that it has not.’

Miller’s insistence that it is ‘common sense’ which drives her desire to change the time limit should surely be questioned and backed up by relevant evidence. Rather Newman, (ironically Channel 4’s ‘factchecker’) allows this, as well as talk of ‘trauma’ to pass by, unexamined.

We know that only a tiny minority of women are accessing abortion after 20 weeks (1.5% in 2011) and as Newman acknowledges, this may be due to fetal health or delays to access (or an array of other issues, see this report from Marie Stopes for background on the reasons some women have later abortions). However, the article seems to support Newman’s own reasons for ending a pregnancy, but is shaky on the necessity of later abortion for ‘other women’. For example, women whose local hospital may not be 'one of the world's best in the field’. The quotes from Nadine Dorries in the piece are very telling – she claims that ‘prochoicers’ who support the current time limit are ‘ignoring the number of women who are traumatised and vulnerable during the abortion process’. Clearly, there are Wonder Women who can make logical, justifiable decisions about their pregnancy and there are Other Women who are vulnerable, whose choices need to be limited and who need to be ‘protected’ by politicians like Miller and Dorries.

Sarah Catt: when we've stopped pointing the finger let's ask ourselves how much we care

Sarah Catt faces an eight year jail sentence after taking abortion medication purchased over the internet to end her pregnancy at 39 weeks. I don’t know if she had any idea that she was putting her life and her liberty at risk when she did this. There is speculation as to both her motivation and her mental state, but the only fact of the matter is that for some reason the idea of giving birth to a living baby, which she almost certainly would have done within just a couple of weeks, was intolerable to her.

Speculation about whether she is a monster or just desperately ill and unhappy will, no doubt, be rife. Arguments will rage to and fro about whether she should have received such a long sentence. Others will ask whether the current time limit for abortion is right, whether there should be time limits at all or whether our focus should be on doing everything we can to make abortion as accessible as possible, as early as possible. Some people will say that this case demonstrates an argument for taking abortion out of the sphere of criminal law altogether, others that this proves we need legal limits on abortion provision because we simply cannot trust women not to go running around choosing late term abortions.

For me this case is so unusual that I’m not sure if it can helpfully inform debates about abortion law. They say that hard cases make bad law and this is probably a case in point.

If we can draw any lessons from this it might be about the support that we can provide to those women who consistently struggle to control their fertility, to choose and use an appropriate contraceptive method, and to manage relationships. There are many reasons why women who feel negative or at least ambivalent towards pregnancy still get pregnant repeatedly including complex personal circumstances. Easy as it is to blame individual women for making bad decisions (we rarely blame their partners) we also have to ask ourselves whether sometimes repeat unintended pregnancies do highlight a shortfall in services. Did Sarah ever seek or was she ever offered any support to think about her fertility, to clarify her own feelings about pregnancy and parenthood and to make informed choices about future relationships and contraceptive use?

Did she have the emotional and practical support she needed after she placed a child for adoption? Or did that process contribute to her belief that it was better to go through the potential pain and danger of labouring alone to have a stillbirth, than to give birth safely and retain the option of placing the baby for adoption? When she was turned down for abortion after 24 weeks did anyone offer her the opportunity to think about ‘what next?’ Did anyone offer to help her talk to her husband and think through the possible consequences (good and bad) of having this conversation in terms of her safety, their relationship and the future of their family?

When a healthy woman with a healthy pregnancy seeks abortion after the legal time limit, it is likely that her circumstances and her feelings about the pregnancy are pretty desperate. For good or ill, a woman in this situation cannot have an abortion after 23 weeks and 6 days. What do we offer these women to address the circumstances they find themselves in, in which continuing the pregnancy is intolerable? Are they made aware of the dangers both medical and legal of trying to induce an abortion themselves? Is there anything we can offer to make the next 16 weeks of pregnancy tolerable, safe and manageable for them...let alone the next 20 years of parenthood?

I don’t know what kind of support is available to the handful of desperate women who are turned away from abortion because they’re just too late. Later abortion is a divisive issue, but whatever anyone feels about it, we must all feel some duty of care towards women who want one, but can’t have one.

Myth Busting Monday: ‘Where abortion is legal, all women will be able to access safe, legal abortions'

This week The Guardian has published some interesting short articles on unsafe abortion in Zambia, written by Alice Klein, a young mother who has recently had an abortion herself.

Klein writes about the places women in Zambia can access illegal abortions for varying sums of money: an unhygienic Chinese clinic, drug stores selling misoprostol illegally, and ‘witch doctors’ offering herbal ‘medications’. There are also horrifying stories of women attempting to end pregnancies themselves; ‘inserting knitting needles and turkey basters into their vaginas, [to] drinking laundry bleach and jumping off stairs on to their stomachs’.

You’d be forgiven for taking from this that abortion is outlawed in Zambia, but another article reveals that this is not the case. In fact, Zambian ‘abortion law is one of the most liberal in sub-Saharan Africa and allows the procedure if the pregnancy risks the mother's physical or mental wellbeing’. However access to legal abortion is affected by a number of barriers: ‘it requires three doctors' signatures, almost impossible in a country with one doctor per 8,333 people (compared with one doctor per 435 people in the UK)’; also, in a country with an 80% poverty rate, costs of safe, clinical procedures can be prohibitive. The article also highlights the widespread stigma and religious objection to abortion in Zambia, which again, contributes to misinformation about available services, further reducing accessibility. One ‘healer’ offering illegal, herbal abortions advises the researcher to ‘avoid hospital abortions, saying metal clamps are used to open the vagina and scratchy cotton wool used to clean the womb. She repeated common myths, such as clinical abortions leave women infertile and unclean.’

Clearly, in Zambia, although abortion is effectively legal, this doesn’t mean it is accessible to all women who want to end their pregnancies. As a result, women undergoing illegal, unsafe abortions are risking their health, and in some cases, lives.

Of course, this is one example – there are many areas of the world where, although abortion is technically legal it is difficult (and generally for poorer, or younger women, virtually impossible) to access. Abortion has been legal in the U.S since 1973 but 88% of all U.S counties have no abortion provider (this rises to 97% in rural areas).

For more information on abortion worldwide, including the gaps between legality and accessibility, visit the Guttmacher Institute website.