Vagina Dentata

I haven’t blogged about abortion for, oh, 3 or 4 posts so thought I’d revisit. Prompted by a great blog about the horrendous Nadine Dorries MP on Liberal Conspiracy from the Lay Scientist.

I written quite a lot about this in the past particularly at the time of the Human Fertilisation and Embryology Bill (now Act) and the activism I was involved in then (I’ll get around to posting some of that information here at some point).

This blog is going to focus on abortion as a public health issue, but I’m also working on a post about data on abortion in the UK and the oft repeated claim that ‘there are too many abortions’ which I believe is based on flawed logic. But that post requires some graph compiling so will take me a little longer. In the meantime…

I personally do not see abortion as a moral issue but primarily as a public health issue. As a medical procedure we treat it differently to any other, such as the continuing need for two doctors’ signatures which seriously undermines the concept of women’s consent to medical procedure. No other procedure puts the authority squarely with the medical profession rather than the female patient, and this is not an authority that health professionals are comfortable with and have repeatedly called for this to be changed.

Globally approximately 67,000 women every year due to unsafe illegal abortions. The deaths of women due to unsafe abortions are counted among the staggering statistics on maternal mortality where it is believed that a woman dies every minute due to reproductive related issues. The vast majority of these deaths are preventable easily and cheaply and primarily through empowering women through access to information, education and even the most basic healthcare that their predominantly developing world country can offer (99% of maternal deaths happen in the developing world).

Plus, all of these statistics are at best an educated guess because statistics on maternal mortality are notoriously terrible. The fact is that we don’t count dead women and we particularly don’t count those who have died after a botched abortion.

The best way to prevent deaths through unsafe abortion, is unsurprisingly, to offer access to safe and legal abortion. This has had a dramatic affect on the maternal mortality and morbidity stats for Bangladesh.

Not only does a restriction on access to abortion put women seeking an abortion at risk, it also regularly creates a chilling effect that prevents doctors performing therapeutic abortions for ectopic pregnancies and even from performing routine gynaecological examinations. This is most starkly apparent in Nicaragua where the complete ban on abortion has even lead the State being taken to the UN Committee against Torture on the basis of their abortion laws amounting to torture, cruel, inhuman and degrading treatment.

The chilling effect can extent to women being criminalised when they suffer a miscarriage and are accused of abortion as has been documented in West Africa (currently unpublished).

All of these examples put the UK situation into context but we also need to be vigilant against unscientific attacks on women access to health services in the UK. The attempts to reduce time limits in this country during the passage of the Human Fertilisation and Embryology Bill were based on bad science and instigated by those morally and religiously entirely opposed to abortion.

What is worse is that it would have put particularly vulnerable women at risk of being excluded from vital health services in this country. So what was the evidence?

UK Human Fertilisation and Embryology Act 2008
Forty years on from the passing of the Abortion Act, the Westminster Science and Technology Committee examined whether advances in science require a change in the law. Many advocating reducing time limits did so on the basis of “advances in medical science”. This was not however, supported by the evidence or medical establishment. (This is where in fact the Nadine Dorries story started, see Ben Goldacre’s blog on this at the time)

The British Medical Association and the Royal College of Obstetricians and Gynaecologists, neither known for their radical feminism, both submitted evidence in support of the 24 week time limit and a liberalisation of access to abortion in the first trimester (e.g. removing need for doctors signatures among other things).

So where are the medics and scientists marching in the streets asking for the law to be changed? Well, there were submissions to the Science and Technology Committee advocating time limit restrictions from medical professionals who have not declared their religious affiliations. Luckily the press can do this for us. The majority of them are activists from the Christian Medical Fellowship, an organisation which is opposed to abortion (unlike most Christians) and had made its own submission as an organisation

The scientific case hinges on the principle of the “viability” of the foetus outside the womb. It is claimed that foetuses that have been born prematurely at 24 or 22 weeks have be kept alive by ‘science’. As stated by the BMA, it is only a fraction of births at this gestation that survive, and most of those are severely disabled. A study in the British Medical Journal reiterated the point – the latest stats indicate that survival pre-24 weeks has not improved since 1995. It is also important to draw attention to the conflation between the theoretical viability of a foetus at 22 weeks and the viability of a foetus that a woman chooses to abort at this time – these are two distinct situations.

Women get a scan at 20 weeks which can show up problems with the pregnancy. Obviously we can’t be certain, but it is very very likely that those being terminated at this late stage have serious problems. Let’s remember that 20 weeks is half way through a pregnancy, women would have a very good reason for going through what is a particularly invasive surgical procedure. Either the foetus is in fact not viable or these are particularly vulnerable women. Restricting their rights further is hardly the answer.

So if the evidence didn’t back up the claim that there had been ‘scientific and medical advancements”, why were we talking about time limits? Suspicions rise further when we start looking at how many abortions we are actually talking about – in England and Wales 1.5% of all abortions in 2008 were over 20 weeks (that percentage is even lower in Scotland and abortion is illegal in Northern Ireland). So we are talking about a fraction of the abortions that take place in the UK which became a lightening rod for the abortion debate.

Why? Because this is a tactic, part of a wider strategy to chip away at the right to abortion. Banning by increment. This isn’t my wild paranoia; this is exactly the course of action taken by the Anti-Choice movement in the USA. Lowering time limits, reducing services, enforcing health professionals read out ‘warnings’ to women before a termination, ‘cooling off’ periods, parental consent, arguing against the licensing of drugs for chemical terminations with the regulators – all of these mount until it is effectively banned in some States and restricted to 13 weeks in others.

Abortion laws in the global North affect not only women in those countries, as Bush’s global gag rule demonstrates. Not only is this about public health and women’s access to safe and legal health services, it is also fundamental to the principle of female reproductive autonomy and about women’s rights over their own physical integrity. Women and girls are brought up in a global society where their bodies are open spaces for public debate. Where individuals believe their morality justifies a violent imposition on another female human being. I do not believe that I have the right to tell a woman what to do with her body and that is why I am a pro-choice campaigner.

Do NOT share cups with pigs

OK, I can’t have a science blog without mentioning swine flu. Is there a gendered analysis? Well probably in the access to healthcare for women, particularly poor women but there’s no data at this time. Generally, women do worst in natural disasters – most shocking stat I’ve come across is that between 70%-80% of the people who died in Southeast Asia after the tsunami of 2004 were female.

But also on searching for swine flu and women, I can across this hilarious conspiracy theory from Wendy Wright of Concerned Women of America (Unconcerned Women of America never really got off the ground). The ironically named Wright opined that Obama’s declaration of a state of emergency was a ruse for appointing Kathleen Sebelius as health secretary by stealth. Will this man stop at nothing?

Of course, the interesting thing is not Wright’s lunacy but the fact that she opposes the appointment of Sebelius because she is pro-choice. Sebelius has a great record of vetoing anti-abortion legislation in Kansas where she was Governor and she has been endorsed by Planned Parenthood which has fund-raised for her. All this and she is a Catholic too! Maybe she’s a fan of Catholics for Choice.

Wendy Wright on the other hand is staunchly anti-abortion which has included challenging the Food and Drug Administration’s licensing of emergency contraception, trying to stop the appointment of anyone who has had anything to do with any organisation that has advocated for women’s access to safe abortions, and she also went to Kosovo to lobby against specific articles in the constitution of the emerging state which provided:

• the right to make decisions in relation to reproduction in accordance with the rules and procedures set forth by law.
• the right to have control over his/her body in accordance with law

Apparently these are ‘bad things’. Shockingly arrogant but at least unsuccessful.

(She’s also opposed hate crime legislation and marriage equality so obviously sidelines in homophobia)

What is most concerning for feminists and the rational, is the language Wright uses to oppose reproductive rights and other politically motivated positions on science such as all forms of human cloning; saying that this is about women’s safety and protections against exploitation and the harvesting of eggs. The Right are very adroit at using feminist language when it suits them (see arguments made for the invasion of Afghanistan), but this is particularly dangerous when sisterly language is used to undermine women’s access to safe and legal healthcare and drugs:

“When a drug is easily available, it is a public health hazard to women.”
Wendy Wright talking about FDA licensed emergency contraception

OK, so it wasn’t about swine flu. But you’ve gotta love that quote.

This may seem a bit out of date to cover the Human Fertilisation and Embryology Bill, but is it still going through Westminster and the dark forces are still trying to use it as a way of restricting women’s access to abortion.

One of the main areas of ‘debate’ is whether advances in science require a change in the abortion laws. I say ‘debate’ because there is scientific consensus on the issue and it is those with a ‘moral’ perspective who are trying to create allusion of a debate.

So is there a case? Well not according to the medical establishment. The British Medical Association and the Royal College of Obstetricians and Gynaecologists, neither known for their radical feminism, have both submitted evidence to Westminster’s Science and Technology Committee in support of the 24 week time limit and a liberalisation of access to abortion in the first trimester.

So where are the medics and scientists marching in the streets asking for the law to be changed? Well, there have been submissions to the Science and Technology Committee advocating time limit restrictions from medical professionals who have not declared their religious affiliations. Luckily the press can do this for us:
Guardian Blog

The majority of them are activists from the Christian Medical Fellowship, an organisation which is opposed to abortion (unlike most Christians) and has already made a submission.

The scientific case hinges on the principle of the “viability” of the foetus outside the womb. It is claimed that foetuses that have been born prematurely at 24 or 22 weeks have be kept alive by science. As stated by the BMA, it is only a fraction of births at this gestation that survive, and most of those are severely disabled. However, then we have a conflation between the theoretical viability of a foetus at 22 weeks and the viability of a foetus that a woman chooses to abort at this time.

Women get a scan at 20 weeks which can show up problems with the pregnancy. Obviously we can’t be certain, but it is very very likely that those being terminated at this late stage have serious problems. Lets remember that 20 weeks is half way through a pregnancy, women would have a very good reason for going through what is a particularly invasive surgical procedure. Either the foetus is in fact not viable or these are particularly vulnerable women. Restricting their rights further is hardly the answer.

Which brings us back to the question, why are we talking about time limits? Suspicions rise further when we start looking at how many abortions we are actually talking about – in Scotland out of over 13,000 abortions carried out in 2006, 62 were between 20-24 weeks. That represents 0.5% of all abortions. So why exactly are we seeking to change the law for a fraction of a percentage (or around 1% UK-wide) of all abortions?

Because this is a tactic, part of a wider strategy to chip away at the right to abortion. Banning by increment. This isn’t my wild paranoia; this is exactly the course of action taken by the Anti-Choice movement in the USA. Restrict women’s access to abortion a bit at a time until it is effectively banned in some States and restricted to 13 weeks in others.

Advances in science do not change the principle that women must have control over their own body and must never be forced to endure an unwanted pregnancy.