Is abortion worldwide becoming more restrictive?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8161 (Published 4 December 2012)

by Sophie Arie, freelance journalist mail@sophiearie.com

Sophie Arie examines the differences in approach to abortion around the world

Abortion has always been a subject for passionate public debate. But recently the temperature has risen, especially in the United States and Ireland. The Republic of Ireland has seen nationwide protests over the death of Savita Halappanavar, who was refused an abortion during a long and painful miscarriage because the fetus was still alive. After the fetus was finally removed she died of septicaemia and organ failure. The debate has also been reopened in the UK, where health minister Jeremy Hunt recently declared a desire to see the limit in England, Wales, and Scotland drop from 24 weeks to 12 and the prime minister expressed an interest in a more modest reduction.

In recent decades, abortion has become legal in all but five countries if a mother’s life is threatened. There has also been a general decline in the numbers of abortions worldwide as contraception has become more widely available. But World Health Organization figures show that the decline has slowed recently. So what’s going on? Is there a general shift towards tighter restrictions? Are people being discouraged from using family planning as populations dwindle? And is that forcing more women to take clandestine routes to terminate unwanted pregnancies?

Ireland

Abortion is illegal under most circumstances in both the Republic of Ireland and Northern Ireland: it is allowed only when a mother’s life is in danger or her long term health seriously at risk. In Northern Ireland, the process for approving an abortion is very strict: two doctors must agree independently that the mother’s health is at risk and the abortion must take place within nine weeks of that decision. The NHS carries out between 30 and 50 abortions a year in Northern Ireland,1 and last year 1007 women travelled to other UK countries for abortions.2 In October, Marie Stopes opened the country’s first private abortion clinic in Belfast. The organisation says it plans to work within Northern Ireland’s legal framework, but anti-abortion groups say it aims to widen access to abortion on mental health grounds.3

In the Republic of Ireland the circumstances in which a woman’s life is deemed to be at risk are not entirely clear, and the recent case of Savita Halappanavar highlighted the fact that even when a woman’s life is threatened some doctors or institutions do not consider abortion an option. At least 4149 Irish women made the journey to the UK for abortions in 2011.2 Ireland is currently revising its guidelines on what constitutes a risk to a woman’s health after three women challenged the country’s constitution in the European Court of Human Rights.4 Anti-abortion groups argue that there are always ways to protect a woman’s health without carrying out an abortion and fear that the new regulations will be the first step towards widening access to abortion.

China

China’s single child policy means that there are an estimated 13 million abortions annually—making it the country with by far the highest number.5 The numbers are thought to have been rising since 2003, after a long period of decline, which has been attributed to increased premarital sex, disruptions in access to contraceptive services because of rapid urbanisation, and a lack of condom culture (six million abortions are in women under 25).6 However, the rapid changes in China have brought growing pressure for a change to the way the one child policy is enforced. Activists monitoring the policy say that instructions have been given to local authorities not to carry out late term forced abortions after one case involving a seven month pregnant woman caused national and international outcry this summer.7 India Abortion is legal in India to protect the mother’s health, after rape, in insane women and underaged girls, or if the fetus has serious malformations. It is not legal as a way to avoid giving birth to a girl. There are hefty fines for those offering sex tests or abortions for sex selection. But India’s 2011 census showed a growing imbalance between the numbers of girls and boys aged 0-6 years, which research suggests is due to an increase in selective abortion of female fetuses.8 The government has so far failed to change or control the culture that prizes boys over girls and contributes to India having an estimated 11 million abortions per year. India’s ministry for Women and Child development reportedly wants to introduce fines and even prison terms for entire families who force a woman to abort a female fetus. And one state, Uttar Pradesh has introduced baby hatches where people can leave their unwanted baby girls.

Russia

Russia was the first country to legalise abortion in all circumstances and has the highest rate of abortion worldwide—54/1000 women aged 15-44 (compared with 24/1000 in China). Over the decades the policy has been changed, and recently it has been restricted by the government of Dmitri Medvedev, which has close ties with the Orthodox church and is facing a low birth rate and shrinking population. In October, parliament voted to limit the period for abortion to 12 weeks of gestation and up to 22 weeks in the case of rape.9 There is no time limit if there is a risk to the mother’s life. Abortion providers are now required to spend 10% of advertising costs on warning of the possible dangers to a woman’s health, and it is illegal to describe abortion as safe. The president’s wife has taken a leading role in anti-abortion campaigns alongside leaders of the Orthodox church.

United States

Abortion has always been a subject of heated debate across the US, but in the past decade there has been a frenzied tightening of restrictions in many states that were previously moderate. Overall, according to the Guttmacher Institute, there were 92 new provisions restricting abortion in 2011, compared with 34 in 2005.10 This year there have been at least 39 new restrictions. In 2000, around a third of American women of reproductive age lived in states that were hostile to abortion rights, a third in states that were supportive, and a third in states that stood somewhere in between. By 2011, over half of American women lived in states that were hostile. States found different ways to obstruct women’s access to the procedure including insisting women must first receive counselling against it, restricting public or private insurance coverage, and making it difficult for physicians to obtain supplies of mifepristone, the FDA approved treatment for medical abortions. Seven largely rural states banned telemedicine for abortion in 2011, meaning a doctor has to be with the patient when prescribing the treatment.

In 2010, Nebraska came up with a new argument for restricting the period in which abortion is permitted. The state ruled to ban abortion after 20 weeks on the basis that the fetus can feel pain at that stage. This theory is not backed up by established science,11 but seven other states (Alabama, Idaho, Indiana, Kansas, Oklahoma, Georgia, and Louisiana) followed with similar rulings. Arizona restricted abortions beyond 18 weeks in March this year using a similar argument.

Critics argue that these laws are unconstitutional because the landmark 1973 Supreme Court ruling in the case of Roe versus Wade held that states could restrict or ban abortion only after fetal viability. It is generally agreed that a fetus could survive outside the womb from 24 weeks at the earliest. Critics also argue that if the concern is for the fetus not to experience pain it would suffice to use anaesthetics. Latin America and Africa

In most of Latin America abortion is either totally banned (Nicaragua, El Salvador) or tightly restricted. Across Africa colonial laws make it legal in only a few situations—usually if a woman’s life is in danger or in the case of fetal abnormality or rape or incest. Social and religious disapproval also contributes to large numbers of women seeking clandestine abortion, which often leads to complications and deaths. WHO estimates that 5.5 million women in Africa have abortions every year, 99% of which are unsafe, and around 36 000 women die from the procedure.12 In Ethiopia, for example, unsafe abortions are thought to account for up to half of maternal deaths. Some 95% of abortions in Latin America are also unsafe.12

In both regions, a few countries have recently decided to relax their laws and make safe abortion services accessible on the basis that criminalising it causes unnecessary deaths. In Kenya, the constitution was changed in 2010 after years of debate over the need to relax the laws and increase provision of safe abortions. Argentina legalised abortion for raped women in March this year and Uruguay legalised abortion up to 12 weeks in October and is providing government funded abortion services. And since 2009, Ethiopia has piloted an apparently successful programme in which trained health workers in one region provide safe medical abortions with misoprostol.

Arab world

Unlike most Muslim countries, Tunisia legalised abortion in the 1970s. The only conditions are that it must be carried out by a qualified practitioner within the first three months of pregnancy. The country’s leaders repressed the population in many ways before the Arab Spring of 2011 but they liberated women by encouraging all sorts of birth control in a bid to control population growth. As a result, the country has the lowest birth rate in the region—2.0 births/1000 women, according to the World Bank’s latest figures.13 It remains to be seen whether the Arab Spring will lead to a relaxing of laws across the Arab world, where abortion is generally available only if a woman’s life is in danger. Data are patchy but according to the International Planned Parenthood Federation, in the five years up to 2000, there were 15 million unwanted pregnancies across the Arab world and over seven million abortions in the same period.14 Clandestine abortions seem to be common, and it is estimated that 5% of maternal deaths are due to unsafe abortions. Because of cultural disapproval, most campaign groups are focusing on promoting better awareness and availability of contraception rather than safe abortions.

Iran

Iran has a relatively low abortion rate compared with other countries, probably because its well educated population makes better use of contraception. But the country’s leaders have begun slashing family planning services and appealing for bigger families in a bid to boost the population. It’s not yet clear how much families are heeding the call to procreate, but the changing government position is likely to produce an increase in the numbers of abortions.


Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Northern Ireland Health Ministry. Statistics on terminations of pregnancy. 
2. Department of Health. Numbers travelling to UK for abortions from the Republic of Ireland and Northern Ireland. Table 12a.  
3. Smyth L. Abortion clinic may exploit and break the law, claims opponent. Belfast Telegraph 2012 Oct 18.  
4. Houston M. Ireland looks at ways to bring its abortion law into line with European judgment. BMJ2012;345:e8165.
5. China has more than 13 million abortions a year. CNN 2009 Jul 30.
6. Guttmacher Institute. Facts on induced abortion worldwide. 
7. Chinese govt may seek end to late term forced abortions. LifeNews 2012 14 Sep.
8. Jha P, Kesler MA, Kumar R, Ram F, Ram U, Aleksandrowicz L, et al. Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011. Lancet2011;377:1921-8. 
9. Kishkovsky S. Russia enacts law opposing abortion. New York Times 2011 Jul 15.
10. Benson Gold R, Nash E. Troubling trend: more states hostile to abortion rights as middle ground shrinks.
11. Colghan A. 24-week fetuses cannot feel pain. New Scientist 2010 Jun 25.
12. WHO. Unsafe abortions. 5th ed. 2005. 
13. World Bank. Fertility rate. 
14. International Planned Parenthood Federation. Abortion.

As the rate of weekly worship declines, the rate of abortion also increases exponentially

World Congress of Families, Madrid 2012

  

Catholics for Choice Report on Day One: “You can’t put too much emphasis on it; but it’s very striking.”

25 May 2012

The core message of the 2012 World Congress of Families was revealed right at the outset of day one: the legitimacy of the opinions presented as fact at this event is drawn from both international consensus and science, so long as both comport with the presenters’ worldview.

Within 20 minutes of the conference’s opening, the talking points were clear. The first was a citation from the UN Declaration on Human Rights that “the family is the natural and fundamental group unit of society, and is entitled to protection by society and the state.” The second came when speaker Jamie Mayor Ortega from the Spanish antichoice organization HazteOir asserted that “The power of the term ‘Natural Family’ also derives from the sciences—the social sciences and the natural sciences.” 

For the remainder of the day an assembly of speakers repeated these mantras while sharing their hatred of homosexuality and a woman’s right to choice, and revealing their overarching persecution complexes. The speakers struggled to make their individual viewpoints fit under a rather rickety umbrella of disdain for categories they generally agreed were bad, disgusting and dangerous. In terms of specifics the only consensus was that no proof was to be offered, no scientific studies cited.

Though attendance was announced at 2,500, the auditorium at the Palacio de Congressos de Madrid was nowhere near capacity. Of approximately 840 ground-floor seats, at best 2/3 were filled—at worst 1/2. Aside from about a dozen audio-visual crewmembers and other individuals scattered about, the spacious balcony was virtually empty. Spread out over several floors with sparse signage and rooms hidden in corners and down corridors, there was a healthy number of lost souls wandering about, attempting to find where they were supposed to be, wished to be or were instructed to be.

During the opening plenary, Dr. Javier Escrivá Ivars, visiting professor at the Faculty of Canon Law at the University of Navarra, Spain, asserted that “Heterosexuality is the anthropological basis of matrimony and if the legal concept of matrimony is destroyed the institution will follow.” Dr. Escrivá Ivars then picked up on one of the two major themes of the day when he asserted—well outside of the demonstrable evidence of any proven science—that the family was a natural fact from the dawn of time based on marriage as a natural phenomenon and the truth upon which humanity as a species is based. To continue the theme Elder Erich W. Kopischke of the Church of Jesus Christ of Latter Day Saints went on to compare God to gravity and man and woman and any union outside of narrowly defined moral parameters as “drifting from Him.” This was followed shortly afterwards by Lola Velarde, the president of the Institute for Family Policy’s European Network, making a series of assertions concerning the threat of a dwindling world population and broken marriages as two of the worst problems in the world—both assertions being presented with no proof to back up her claims.

The subject of a dwindling world population was the focus of the next plenary, “The Demographic Winter.” The presenters were now fully stretched and warmed up to sprinting speed; the uncited statistics and unfounded assertions came thick and fast. “The average couple that worships at least once a week has at least 2.4 more children [than a non-worshipping couple]. As the rate of weekly worship declines, the rate of abortion also increases exponentially,” stated John Mueller, the Lehrman Institute Fellow in Economics at the Ethics and Public Policy Center, Washington, DC. From whence Mr. Mueller acquired this shocking (and somewhat suspect) fact, was apparently unimportant—or, at least not important enough that he felt the need to state the source aloud. Donald Feder, director of communications at the Howard Center—the main sponsor of this event, picked up the baton from Mueller, claiming that the 42 million abortions a year was more than twice the number of deaths during World War II. Notwithstanding the inappropriate nature of the comparison between women’s decisions about whether to remain pregnant and the deaths of adults and children in wartime, most reasonable assessments of the death toll in World War II put the total at over 60 million. But facts were hard to find. Not to be outdone, Douglas Sylva of theCatholic Family and Human Rights Institute (C-FAM) relied on his recollection of statistics from three small and troubled countries—Palestine, Israel and Serbia—to make his case that declining populations would eventually shift the balance of global power. Lunch was a welcome diversion.

Despite the fact that numerous speakers throughout the day cited the United Nations Declaration on Human Rights and its definition of the role of the family in society, the afternoon session “How to Fight Back against International Law,” did not take a kind view of the UN. As chairman, C-FAM’s Austin Ruse stated this session was about the imposition of law by organizations such as UNICEF, the UNDP and a host of other organizations and “how to fight back—legally or otherwise” against them. Ruse accused these organizations of perpetuating atrocities, citing the UN’s support for reproductive health programs as evidence. Piero A. Tozzi from the Alliance Defense Fund later agreed with Ruse, claiming that UNICEF “promotes abortion wherever they have an opportunity.” The remainder of the seminar involved celebrating cases, mostly in Latin America, where a woman’s right to choose was obstructed or denied altogether or same-sex marriage was prohibited. Supply lists were also drawn up for those wishing to combat these international forces. As panelist Carmen Domínguez, professor of civil law at the Pontifical Catholic University of Chile, put it, “We need more data to counter statistics and information gathered by international organizations.” She then mentioned an instance where a Chilean doctor asserted that he had disproved assertions by the United Nations and various other groups that safe and legal abortion could alleviate maternal mortality. Domínguez failed to note that the Guttmacher Institute had decisively refuted the Chilean study.

The afternoon closed with a pair of seminars that increased the speed and density of cognitive dissonance and paranoia to what could best be described as a screeching blur. Within 30 seconds of standing up to address the (fittingly) sparsely populated seminar “The Demographic Winter” (a quite necessary expansion of the previous plenary session of the same name), Steve Mosher of the Population Research Institute implied that the Club of Rome had taken part in a Masonic conspiracy to misrepresent the levels of natural resources in a book they published close to 40 years ago. There was no conspiracy, Masonic or otherwise; our ability to find and access those resources has simply improved dramatically since then.

A session just down the hall entitled “Birth Control (Contraception) vs. Natural Family Planning,” was perhaps the best attended session of the day. Attendees also heard some of the most bizarre information of the day. Discussing the alleged detrimental effects of birth control pills, Joseph Meaney of Human Life International (HLI) first dismissed the studies on the environmental effects of oral contraception as silly stories about gender changing in fish, and urged the audience to instead consider the effects of the pill upon women. Within moments, he began citing studies involving the effects of birth control on animals (per the prevailing custom of the WCF he failed to specify them in any identifiable way). Animals in Krueger National Park in South Africa behaved bizarrely after they were given birth control pills. A macaque monkey called Austin “began to rape, masturbate and act completely incoherently confused” when the females in his troop were put on the pill. Returning to his initial plea to ignore these stories, Meaney then immediately added, “These are animals studies, so, you can’t put too much emphasis on it; but it’s very striking.”

And with that statement Joseph Meaney explained the underpinning of the entire day: “You can’t put too much emphasis on it; but it’s very striking.” Indeed. 

An introductory report to the WCF is available here.

Biographies for selected speakers are available here.

World Congress of Families, Madrid 2012

An Introductory Report: Multidimensional Challenges Ahead
The Echo Chamber at the World Congress of Families

This weekend, May 25–27, the biennial World Congress of Families (WCF) international conference will be held in Madrid, Spain. Running under the banner “Marriage and the Family: The Future of Society,” this year’s conference promises to be an echo chamber for regressive social views presented by advocates from a variety of arch-conservative organizations, notably the Howard Center for Family, Religion and Society, its sponsor. Biographies for selected speakers are available here.

Catholics for Choice has reported from several previous iterations of the WCF. Our previous reports are available here. Because of the nature of these gatherings, and the fact that antichoice activists tend to hold them up as examples of a new dawn in antichoice activity, we attend and report on the events in order to provide the truth about what is happening: who is there and what they are saying. Providing accurate information about the opposition’s activities helps all of us counter their propaganda from a position of strength.

The choice of Spain as the venue also provides us an opportunity to assess what really lies behind the noises that the conservative Spanish government has made about reversing the progressive laws passed under the last administration. It is clear that the decision to host this event in Spain was at least somewhat driven by the notion that “the faithful” must drive headfirst into the heart of iniquity, slaying the dragon of modernity in order to achieve salvation, both here and in the hereafter. However, as they tilt towards these windmills on Don Quixote’s home turf, it is entirely possible that a sexually progressive and politically active opposition may show up to protest. In which case, the World Congress of Families may draw some attention—just not the sort of attention that, even if they want it, will be beneficial to their cause.

One might suppose that given the current global economic climate, a significant portion of the World Congress of Families would relate to helping families make it through the crisis. Help with real challenges like unemployment, healthcare and childcare would be welcome. With breakout sessions such as “The Homosexual Lobby,” “Effects of Social Experimentation and Same-Sex Adoption,” “Solutions to Homosexual Behavior” and “Promoting Fatherhood: the Crisis of Manhood,” however, the Congress appears far more concerned with fabricated social issues that have no substantial impact on the welfare of the family.

The WCF gives the distinct impression that it means to codify an antiquated set of social behaviors they hope will safeguard them from an “encroaching darkness,” which the majority of the world simply refers to as “change,” “the future” or even “progress.”

This viewpoint draws a special assortment of speakers at the Congress. Yet the extremist nature of previous Congresses has moved big-name speakers with sympathies to the group’s aims into last-minute cancellations—the most notable of these at the last conference being Cardinal Alfonso Trujillo and Polish President Lech Kaczynski. For this year’s conference, while there are some minor EU officials, there are no figures with any sort of instant name recognition outside of the insular community of attendees.

This is no fluke—the conference has consistently failed to meet attendance expectations. In 2007, attendees to the Warsaw event were bussed in from surrounding parishes. And at one point in 2009, the only echo to be heard was conference speaker Austin Ruse infamously tweeting “What’s going on? Where is everybody?” as he looked out on an almost-empty conference hall.

The Howard Center’s first notice on the event was titled “Multidimensional Challenges Ahead,” a background document drafted by one of the Congress speakers, Dr. Farooq Hassan. With a world of rights-empowered advocates fighting for everything the Congress is fighting against, the Madrid gathering will have its work cut out as it tries to shore up its retrograde vision of society. In the next few days, Catholics for Choice will be reporting on the World Congress of Families as it faces these many challenges with all hands on deck.

For more on Catholics for Choice’s opposition work, please read Twenty Years of Taking Down the Opposition.

No more taboos, end unsafe abortions in EU

No more taboos, end unsafe abortions in EU". The European Parliament Working Group on Reproductive Health, HIV/AIDS and Development (EPWG) discussed unsafe abortions in the EU. The head of Polish member of ASTRA Network, Federation for Women and Family Planning, talked about situation in Poland and Eastern Europe, where 13% of the abortions were unsafe in 2008. The cross-party group of Members of European Parliament wants to know how the European Commission assesses the existence of this preventable public health problem within the borders of the EU and its neighboring countries. Although the EU institutions tend to avoid the problem, the EU treaties give a clear mandate to the EU to complement and coordinate national health policies, with a view to ensuring high quality health services for all. The European Parliament has affirmed several times that sexual and reproductive health policies must be integral part of the EU public health policies.

Source: Federation for Women and Family Planning

video abortion in Ireland

ought to add: in Russia teens abortions are even less than 1/10th
Source

Top British hospital "tricked" into giving Italian woman abortion

In a troubling offshoot of medical tourism, an Italian woman flew to Britain to terminate her 28-week-old pregnancy and then flew home to Rimini in north-eastern Italy to expel the dead foetus. She wanted to do this at home for emotional reasons. The unborn child had a non-fatal brain abnormality but abortion is illegal in Italy (really???). She then claimed that she had a miscarriage at 22 weeks.

The case emerged when managers at the Italian hospital discovered that the woman's gynaecologist, Dr Vincenzo Trengia, had falsified the paperwork. Trengia was fired and was charged with breaching Italy's abortion laws. However he was cleared of wrongdoing because he had acted to help the woman.

According to leading obstetricians two-country abortions are "irresponsible" and "extraordinary". The London hospital, Kings College hospital, said in a statement:

"Where cases arise at King's in which a woman from overseas chooses to return to her own country for stage two of the termination of pregnancy, her right to choose is supported. This practice is safe and poses no risk to the woman. We take steps to ensure their care is managed when they return home. We comply at all times with the Abortion Act, as well as the guidelines for termination of pregnancy set out by the Royal College of Obstetricians and Gynaecologists. This applies to all patients, whether they are from the UK or overseas."

During the court hearing in Italy, the judge was told it was likely that Trengia had referred other women to England to bypass the abortion laws. According to the UK Department of Health there are 25 abortions a year after 24 weeks which are recorded as foeticide without surgical or medical removal of the dead foetus. It is possible that these women also returned to their home country to complete the procedure.

~ The Sunday Times, Oct 9 (looking for an adequate link)
txt arrived from a friend