US abortion politics; global consequences
Rosalind Joseph writes on how the U.S. Mexico City policy regarding abortion impacts on women worldwide.
Approximately one in five pregnancies worldwide ends in abortion. 65 000 to 70 000 women die as a result of unsafe abortion, accounting for 13% of maternal mortality worldwide. (1) With general elections drawing ever closer, the world’s eyes are intensely fixed on the USA. Abortion politics within the US have been widely publicised, mainly due to powerful and radical activists grabbing the media spotlight. However, US foreign policy concerning abortion is largely overlooked. Currently the US international family planning policy, the Mexico City Policy, restricts the provision of abortion abroad and supports restrictive laws concerning abortion.
Unsafe abortion is defined as a “procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both”. (2) According to some, the most important single determinant of abortion’s impact on women’s health is its legal status. (3) Anti-abortion groups claim that restrictive legislation on abortion will reduce the incidence of abortion. However, the lowest abortion rates in the world are in Europe, rates being below 10 per 1000 women, whereas in Africa, Latin America and the Caribbean, where abortion is highly restricted, the rates range from the mid-20s to as high as 39 per 1000 women. (4) In Romania, the shifting of abortion laws has shown dramatic differences in abortion-related mortality. In 1966, the newly enshrined Ceausescu regime banned abortion. In 1985, the decree was further restricted; imports of contraceptives was also banned. Abortion-related mortality soared; a rise from 80 deaths per 100000 live births in 1964, to 180 in 1988. (5) A distressing legacy has also been left; many women who could not obtain an illegal abortion service bore unwanted children. Approximately 150 000 to 200 000 unwanted children, many severely handicapped, were placed into institutional care for life. (6) The overwhelming evidence is that in illegal environments, unqualified abortionists can act with relative impunity and ignore any minimum standard of care. Despite this evidence, the USA has decided to support strict laws by its foreign policy, the Mexico City Policy.
The Mexico City Policy, also known as the Global Gag Rule, was announced by President Reagan in 1984. The Policy requires that, in exchange for US family planning assistance and funding, non-US Non-Governmental Organisations (NGOs) must certify that they will not use even their own, privately-raised funds to provide or inform women of safe abortion services or advocate a reform of restrictive abortion laws. (7) If this rule is broken, the overall amount of funding available to the reproductive health program will be reduced automatically by $12.5 million. It is worth remembering that abortion is legal in the US, and enacting a similar policy within the US would be against US Constitutional rights. The Policy was presented by the Republican Party, pressured by influential anti-abortion groups. The issue of abortion has been rooted in domestic political struggle; between anti-abortion and pro-choice divisions, between Republicans and Democrats. Since Constitutional Rights protected liberal abortion laws in the US, focus in the 1980s shifted to preventing abortions taking place abroad. Reagan responded to his powerful anti-abortion, fundamentalist Christian constituency by enacting the aforementioned policy. It is interesting to note that the US is the only country to create such a policy, based on morality, although other strongly Christian countries exist. Perhaps the US wanted to mark its superiority; using conditions to achieve its own political ends and recognising the vast impact it could make due to its huge funding allowance and political power. (8)
The primary aim of the Mexico City Policy is to decrease the incidence of abortion. Globally, there has been a moderate decline in the number of abortions, from 45.6 million in 1995 to 41.6 million in 2003; a 9% decline. (9) Although abortion-related maternal mortality has also decreased, the proportion of unsafe abortion has increased from 44% to 48% between 1995 and 2003. (10) Furthermore, the difficulty in data-gathering due to religious and cultural issues means that these figures are likely to be underestimated. From the data, there seems to be no conclusive evidence that the Mexico City Policy has been successful in reducing abortion. This is apparent when we acknowledge that the most dramatic decline in abortion (42% decline) occurred in Europe, where legal and safe abortion services are readily accessible. Many NGOs agree that the other following effects are better indicators of the Policy’s failure.
By opposing liberalisation of strict abortion laws, the Policy encourages societies to stigmatise women who seek abortions, driving abortion underground. The Policy has also effectively blackmailed NGOs; either they continue to receive funding or sacrifice their autonomy. If they do not comply with US restrictions, NGOs face difficulties of staying afloat and health clinics are forced to close down. NGOs, representatives of the people, have in effect been stripped of their authority, leading to resentment and a loss of US credibility in the reproductive health development arena. Furthermore, many have questioned US sincerity in promoting democracy and women’s rights abroad. Opponents of the Policy argue that it is hypocritical to advocate democracy and aggressively stifle public discourse on safe abortion.
As George Bush’s term draws to a close, the controversial issue of abortion has divided US citizens. Abortion policies have become so important that they can potentially make or break a Presidential campaign. Women’s rights activists hope that, as the Democratic leader, Barack Obama will follow in Clinton’s footsteps; Clinton having revoked the Mexico City Policy in 1993, emphasising his strong philosophical commitment to reproductive health. Currently, the Mexico City Policy is still in place, after President Bush immediately reinstated the Policy on his first day of Office in January 2001. Republicans and Pro-Life campaigners trust that Republican leader, John McCain, will form abortion policies that agree with their traditional values of morality and respect for human life. Whatever the outcome of the Presidential campaign, it is apparent that the power struggles between rival Pro-Life and Pro-Choice movements in the US has worldwide consequences and can have a substantial effect on a woman’s very personal decision to terminate a pregnancy.
Rosalind Joseph, 3rd Year medical student at University College London, UK.
References
(1) Singh K, Ratnam S. The influence of abortion legislation on maternal mortality. Int J G&O 1998;63: S123-S129
(2) World Health Organisation. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003. Geneva: WHO, 2007
(3) Gorrette N, Nabukera S, Salihu H. The abortion paradox in Uganda: Fertility regulator or cause of maternal mortality. J O&G 2005;25;8: 776-780
(4) Cohen S. New Data on Abortion Incidence, Safety Incidence Key Aspects of Worldwide Abortion Debate. Guttmacher Policy Review 2007;10;4: 2-5
(5) World Health Organisation. Abortion and contraception in Romania: A strategic assessment of policy, programme and research issues. Geneva: WHO, 2007
(6) Stephenson P, Wagner M, Badea M, Serbanescu F. Commentary: The Public Health Consequences of Restricted Induced Abortion – Lessons from Romania. AJPH 1992;82;10: 1328-1331
(7) Cohen S. Abortion Politics and the U.S. Population Aid: Coping with a Complex New Law. Int Fam Plan Perspect 2000;26;3: 137-139
(8) Seevers R. The Politics of Gagging: The Effects of the Global Gag Rule on Democratic Participation and Political Advocacy in Peru. Brook J Int L 2006;31;3: 899-935
(9) Committee on Foreign Affairs. The Mexico City Policy/Global Gag Rule: Its impact on Family Planning and Reproductive Health. Washington D.C: Committee on Foreign Affairs; 2007
(10) Sedgh G, Henshaw S, Singh S, Ahman E, Shah I. Induced abortion: estimated rates and trends worldwide. Lancet 2007;370: 1338-1345