Sunday, October 14, 2007

What "pro-life" looks like on the ground

This is a heartbreaking article (The Guardian) on the situation in Nicaragua, which now has a complete blanket ban on all abortions. You know, the ones without exceptions for rape, incest, health, or the mother's life. And that blather from anti-choicers about pregnancy being so "safe," and there never being a risk to women's lives? Still not true.

María de Jesús González was a practical woman. A very poor single mother, the 28-year-old's home was a shack on a mountain near the town of Ocotal in Nicaragua. She made the best of it. The shack was spotless, the children scrubbed. She earned money by washing clothes in the river and making and selling tortillas.

That nowast quite enough to feed her four young children and her elderly mother, so every few months González caught a bus to Managua, the capital, and slaved for a week washing and ironing clothes. The pay was three times better, about £2.60 a day, and by staying with two aunts she cut her costs. She would return to her hamlet with a little nest-egg in her purse. She bought herself one treat - a pair of red shoes - but she would leave them with her family in Managua, as they were no good on the mountain trails she had to go up to get home.

During a visit to Managua in February she felt unwell and visited a hospital. The news was devastating. She was pregnant - and it was ectopic, meaning the foetus was growing outside the womb and not viable. The longer González remained pregnant, the greater the risk of rupture, haemorrhaging and death.

What González did next was - when you understand what life in Nicaragua is like these days - utterly rational. She walked out of the hospital, past the obstetrics and gynaecological ward, past the clinics and pharmacies lining the avenues, packed her bag, kissed her aunts goodbye, and caught a bus back to her village. She summoned two neighbouring women - traditional healers - and requested that they terminate the pregnancy in her shack. Without anaesthetic or proper instruments it was more akin to mutilation than surgery, but González insisted. The haemhorraging was intense, and the agony can only be imagined. It was in vain. Maria died. "We heard there was a lot of blood, a lot of pain," says Esperanza Zeledon, 52, one of the Managua aunts.

González was not stupid and did not want to die. She knew her chance of surviving the butchery was small. But being a practical woman, she recognised it was her only chance, and took it. The story of why it was her only chance is an unfolding drama of religion, politics and power that has made Nicaragua a crucible in the global battle over abortion rights. This central American country has become the third country in the world, after Chile and El Salvador, to criminalise all abortions. It is a blanket ban. There are no exceptions for rape, incest, or life- or health-threatening pregnancies.

Which isn't all that far away from the bills that some fanatical right wing politicians have drafted here in the States.

González was told at the hospital that any doctor who terminated her pregnancy would face two to three years in jail and she, for consenting, would face one to two years. "Nicaraguan doctors are now afraid of going to trial or jail and losing their licence," says Leonel Arguello, president of the Nicaraguan Society of General Medicine. "Many are thinking that instead of taking the risk, it is better to let a woman die."

Better to let a woman die -- because when you're pro-life, that "pro" stops as soon as you're born.

For the Nicaraguan rich, a problematic pregnancy need not be a death sentence. You can fly to Miami or bribe a discreet private clinic in Managua. But in this wretchedly poor country most young women do not have money. Their choice is to go through with a pregnancy that may kill them, or attempt a DIY termination that may kill them.

Always good to remember -- if we go state by state with abortion laws, in the case of the Supreme Court overturning Roe v. Wade, then well-off women won't see much of a difference in their access to abortion. It will simply make it even more difficult for poor women. And if right wingers continue to attack Planned Parenthood, those poor women won't even have reliable access to affordable contraception. (By the by, how did PP get labeled as an "abortion factory" by the right? Have they seen what for-profit corporations look like? (Haliburton, Black Water?) And word to the wise: there's a helluva lot more money in carrying pregnancies to term (regular OB/GYN visits, lactation/delivery classes, delivery costs, etc.) than in terminating them.)

As a result of the blanket ban enacted last November at least 82 women have died, according to advocacy groups. "This new law intentionally denies women access to health services essential to saving their lives, and is thus inconsistent with Nicaragua's obligations under international human rights law," says Human Rights Watch.

The anti-abortion camp, in contrast, is euphoric. The new law, it says, is a beacon in the fight to protect the unborn. It is time to celebrate. "Now it is all penalised. And Catholics agree that is should be this way," says Roberto González, 50, a Franciscan priest in Managua. "The population sees the church as behind the law - behind the pressure that succeeded in getting the government to change the law."

Also good to remember: this ideology is *not* in touch with reality. Euphoric in the face of women bleeding to death, going into shock from septic pregnancies, or giving birth at 11 years old? And this is the Catholic church behind the law -- the folks that have elected Jesus as their hero. I'm sure Jesus would also be "euphoric." Or something.

Nicaragua provides no answer to the debate about when, between conception and birth, life begins. But in the case of González it is clear when it ended: at 28 years.

Women's rights organisations say their 82 documented deaths are the tip of the iceberg. The Pan-American Health Organisation estimates one woman per day suffers from an ectopic pregnancy, and that every two days a woman suffers a miscarriage from a molar pregnancy. That adds up to hundreds of obstetric emergencies per year.

Human Rights Watch, in a recent report titled Over Their Dead Bodies, cited one woman who urgently needed medical help, but was left untreated at a public hospital for two days because the foetus was still alive and so a therapeutic abortion would be illegal. Eventually she expelled the foetus on her own. "By then she was already in septic shock and died five days later," said the doctor.

Anti-choicers in the states will deny that this is the sort of result that they want to see. But this is exactly what would happen if we had laws in place that don't have health exceptions. Women will be left untreated due to technicalities, as doctors are afraid of legal charges. Doctors will refuse service to avoid walking a thin line between legality and illegality:

Doctors say they have been put in an impossible position. "We face extremely grave ethical conflicts, all because of politics," says Carla Serrato, a gynaecologist from Nicaragua's state-run Alemán Nicaragüense Hospital. Ligia Altamirano Gómez, an obstetrician, says they fear being overruled by the law. "We are pushed toward illegality."

In an attempt to clarify matters, the health ministry issued protocols last December that said doctors should respond to most obstetric emergencies, including ectopic pregnancies and post-abortion care. To terminate an ectopic pregnancy is legal, it turns out, because since the foetus is not in the womb the procedure would not be an abortion. But such is the climate of fear and confusion that the protocols are widely ignored and misunderstood. The doctors who turned González away from the hospital in Managua thought it was illegal, as did medical staff the Guardian interviewed in Ocotal, González's home town.

Those "clarifications" certainly didn't help María de Jesús González.

Ortega, who did not respond to interview requests for this article, has stayed pious in power. Last month he whipped Sandinista assembly deputies into voting with rightwing parties 66-3 to uphold the ban. Many former officials are disgusted with a leader and party they no longer recognise. "It's cynical and it's sad, especially when you consider our high rate of sexual violence and very young mothers," says Moisés Arana, a former mayor of Bluefields. "Here there is a lot of religiosity but only a little Christianity."

Christianity that also doesn't extend to children:

At the other end of the country, in Bluefields, Inspector Martylee Ingram has the same, almost apologetic tone. She is discussing the harrowing case of an 11-year-old girl, Vera, who has been raped and is now 27 weeks pregnant. Asked if Vera should have the baby, she hesitates. The law says yes and her job is to enforce the law. The inspector shakes her head. "But me, as a woman and policewoman, I'd say no. I feel like she shouldn't have it. It's a baby having a baby. She might not survive."

The world has gone *mad.*

Feministe has great commentary on the article -- as Jill notes:

Pro-lifers love cute little babies. Until they’re born.

In the meantime, they continue to oppose tried-and-true methods of decreasing the abortion rate and they promote policies that make abortion more common. They also agitate for outlawing abortion, which only makes it more dangerous — it doesn’t impact the abortion rate at all.

In the ideal “pro-life” world, laws across the globe would look exactly like Nicaragua’s, contraception would be unavailable, and sexual health education wouldn’t go beyond, “Keep your knees together til you’re married.” And there is absolutely no question that a lot of women would die.

But I suppose our lives aren’t all that important in the whole “pro-life” scheme of things. And if we’re collateral damage in the Culture Wars, well, we shouldn’t have gotten so uppity as to think we had that silly right to life in the first place.

And all this on the heels of the Guttmacher Institute's latest study, indicating that abortion rates remain the same regardless of laws. What does change, of course, is how many women die:

A comprehensive global study of abortion has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it.

Moreover, the researchers found that abortion was safe in countries where it was legal, but dangerous in countries where it was outlawed and performed clandestinely. Globally, abortion accounts for 13 percent of women’s deaths during pregnancy and childbirth, and there are 31 abortions for every 100 live births, the study said.

The results of the study, a collaboration between scientists from the World Health Organization in Geneva and the Guttmacher Institute in New York, a reproductive rights group, are being published Friday in the journal Lancet.

The only transition that actually saves lives, then, is when a country goes from anti-choice to pro-choice:

Some countries, like South Africa, have undergone substantial transitions in abortion laws in that time. The procedure was made legal in South Africa in 1996, leading to a 90 percent decrease in mortality among women who had abortions, some studies have found.

Abortion is illegal in most of Africa, though. It is the second-leading cause of death among women admitted to hospitals in Ethiopia, its Health Ministry has said. It is the cause of 13 percent of maternal deaths at hospitals in Nigeria, recent studies have found.

So can pro-choicers now have the label "pro-life"?

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