It's women's lives stoopid

Many people will be whooping at delight that Melinda Gates is defying the hierarchy of the Catholic Church to promote and fund provision of contraception to women around the world. I’m whooping myself because we all know that women of all faiths and cultures want access to modern contraceptive methods and there is currently a massive global unmet need for them. It’s great that she has presented her view on this as one of social justice and interesting that she has linked this to the ethos of her convent education. We know that nuns are not always uncritical mouthpieces for the Vatican. In fact US Bishops have recently been ordered by the Vatican to whip their nuns into line for focussing on ‘radical feminist themes’. Historically, there is even evidence of nuns providing women with safe abortion. It’s a shame that Gates’ teachers never taught her this bit too.


Because the thing that is significantly missing from Gates’ pronouncements on contraception is a recognition that abortion too is a matter of women’s health and of social justice? While Gates hopes to generate $4bn to fund family planning services, no money is going to go towards provision of safe abortion or advocating for governments to reform restrictive abortion laws. For Gates, abortion is a step too far morally. Maybe she hopes that with good contraceptive coverage this problem will disappear, but we all know this is wishful thinking. Maybe she thinks that if she doesn’t mention abortion she can hold back the rage of the Catholic establishment –even win them round. Both of these are wishful thinking too. 


By ignoring abortion or presenting it as morally distinct from contraception - as she does - it reinforces a separation that serves women badly. It undermines the efforts of those who are trying to reform restrictive laws in their own countries, it marginalises those who do provide abortions, and maintains the invisibility of the ordinary women who have abortions each year (44 million in 2008).  It even risks limiting contraceptive options for women, as the anti-choice lobby draws our energy into debates about which drugs are abortifacient as opposed to contraceptive. We know that women everywhere have abortions - whether they are poor women in rural areas with no access to contraception, or middle class women in Europe whose contraception has failed. Catholic women are no more immune to the dilemma of an unintended pregnancy than any other women. Like all women when they know that they simply cannot continue a particular pregnancy, they will defy their religious leaders and the law of the land. They will risk excommunication, prison, and even their lives to get the abortion they have decided is the right thing for them. For some reason these women, their bodies and their lives are not a legitimate focus of social justice.


The same ear-covering ‘la la la la la I can’t hear you’ attitude is often on display in the maternal health field. Despite that fact that 13% of maternal deaths are due to unsafe abortion – a higher proportion in some regions – many in the maternal health field don't address this cause. Despite many of the women dying from pregnancies they would rather have ended, some funders and policy makers in maternal health field avert their eyes. Even as doctors pick up the pieces of unsafe abortions around the world and families bury their dead, abortion remains, at best, peripheral to the maternal health agenda.


It is only when we join up all the dots, that we will really start to improve and save women's lives. That means advocating for, and funding, comprehensive and accurate sexual health education for all young people; access to the full range of modern contraceptive methods and sexual health services for all; safe, legal and accessible abortion as a necessary safety net when things go wrong; and comprehensive ante-natal, maternity, emergency obstetric and post-partum care. Separating these things out or picking and choosing which to address to accommodate the personal morality or preferences of law makers and funders, or hoping that doing so will minimise the opposition will mean that women continue to die wholly preventable deaths.


So please funders, don’t leave out abortion  - it’s women’s lives stoopid.

Women don't really die of abortion any more

Around the world a variety of unsafe methods are still used to end unwanted pregnancies in countries where it is either illegal or inaccessible. The Alan Guttmacher Institute has documented the incidence of unsafe abortion worldwide and names some common methods including:

• Drinking turpentine, bleach or tea made with livestock manure

• Inserting herbal preparations into the vagina or cervix

• Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus

• Jumping from the top of stairs or a roof

All of these methods carry a high risk of poisoning the woman (ingested preparations) or perforating her uterus (surgical methods) which can lead to infection or heavy bleeding and death, or serious injury (self-inflicted violence – jumping or enduring beating).

The World Health Organisation estimates that 70,000 women a year die as a direct result of unsafe abortion, making it a significant contributory factor to maternal mortality worldwide.

It is expected that rates of injury and death from unsafe abortion will begin to decrease with the increasing availability of abortion medication Mifepristone and Misoprostol. These medicines are used in legal abortion services around the world, but are also increasingly available to women in countries where abortion is illegal via the internet or – in the case of Misoprostol – over the counter in some countries where it is sold to treat stomach ulcers, its original intended use.

However, we know that there are many unscrupulous people willing to sell fake medicines or sell them in the wrong dosage to vulnerable and desperate women. The only website known to EFC which provides medical consultation and provides safe doses of medication to women is Women on Web which will not sell medication to women in countries where it is safely and legally available.

Women in countries where abortion is not yet legal need to be aware that they may be committing a crime if they buy abortion medication. For example, customs officers in Ireland are known, regularly, to seize parcels containing abortion medication.

So, while medication exists that can be safely used by women in their own homes, legal barriers to accessing this medication – and serious consequences for those caught – remain an obstacle to safe abortion in countries with restrictive laws.

In some countries where abortion is legal, large numbers of women still undertake risky unsafe abortions because access is difficult for poorer women or those in remote rural areas. In fact a poor woman in India is much more likely to risk of dying from unsafe abortion than a rich woman in Ireland who can travel to mainland UK for a safe abortion.