What If?

Contraception Availability and Abortion Prevention

Nicholas Kristof has an important op ed column in the New York Times on the impact reducing funding for contraception aid has on the incidence of abortion. I hope everyone interested in the issue will read it.

Abortion Is An Issue Like No Other

In the United States we've just elected a new president. Some voters voted against Barak Obama solely because he did not state that he was anti-abortion. But, I did vote for him, for many reasons, including his statements that although he does not want to make abortion illegal, he does want our society to work to reduce drastically women's need for abortion. That is my position too, and I'm glad to see someone in the White House who shares my own concerns and hope for co-operation between those who oppose a woman's right to choose, and those who insist she must have that right.

I often read and hear people use analogies to attempt to prove the reasonableness of their own position on the issue of abortion. But, analogies can never be used as proof, but only to illustrate some observation, or position, because nothing is ever exactly like something else, so there are no perfect analogies. And, particularly in the case of abortion, there is nothing even close to similarity. Abortion is unique and must be observed and reasoned about on its own terms. As a unique situation/issue, it must have a unique solution.

There is no way to eliminate abortion. To think so is to be ignorant or naive. As long as women can become pregnant, there will be abortion, because, whether legal and careful, clean and safe, or illegal, dirty and dangerous, it is a fact that it will happen because it will be seen as a necessary sorrow, and it will be done.

On an email discussion list today some of the subscribers have been discussing the issue. I've been reading the messages hoping for a way to share them with a wider audience, and have invited those who have thoughtfully posted their messages on the subject to come here to my blog and post them as comments. I invite you too to add your comments below.

Better Maternity Care, Less Abortion

If you want to reduce the number of abortions there is much that you as an indivdual, and as a group can do. One of the seemingly obvious, but overlooked ways is to improve maternity care for pregnant women in your own locale, and assist others in improving it elsewhere.

Women are much less inclined to carry a pregnancy to term if they or their baby are likely to die in childbirth because of dangerous conditions where they are to give birth. Many poor women consider abortion if they cannot afford the cost of maternity care.

From Great Britain:

An independent report has highlighted a huge variation in the quality of maternity care across England.

Trusts in London came out particularly badly, something that Sam Brown experienced firsthand when she gave birth to her first child.

She had been due to go into the midwife unit at her local hospital in East London but when she went into labour, staff shortages meant she ended up on the main labour ward.

She was then left to her own devices.

Feeling the need to push, Sam sent her fiancé, Adam, to fetch a midwife.

"I will never forget this. She said: 'You're in a dream world girl, it's your first child, it's going to be hours'.

"They didn't talk to me like I was a real person, the fact I wanted help was a real inconvenience to them."

A passing cleaner had to tell her how to use the gas and air and the entire hospital was "filthy", she says.

After about 40 minutes of being left in agony and "absolutely terrified", Adam called for another midwife who had just come on shift.

It was then discovered the baby's heart rate had started to drop and the consultant was called.

He said she should have been pushing, as she had thought.

She was put on a drip to hasten labour and baby Zack was born shortly after.

"It was really frightening and I started to doubt my own body.

"It was very hard for Adam and afterwards he said he was really scared for me."

From Africa

In Chad, the likelihood of a woman dying during childbirth is one in 11, a fact recently highlighted by the Panorama programme.

Mali's minister of health, Traore Fatoumata Nafo, says that in the west only one woman in 1,800 dies in childbirth. In Africa that ratio is one in 16, by far the highest in the world.

The World Health Organisation (WHO) estimates that about 250,000 mothers die every year in Africa as a result of complications due to pregnancy and childbirth.

The lifetime risk of a woman dying in pregnancy or childbirth in West Africa is 1 in 12.

From The USA

"The United States has not reached an irreducible minimum in maternal mortality; WHO estimates demonstrate that 20 countries have reduced maternal mortality levels to below those of the United States (5). Primary prevention of maternal deaths, such as those associated with ectopic pregnancy and some cases of infection and hemorrhage, is possible. However, some complications that can occur during pregnancy cannot be prevented (e.g., pregnancy-induced hypertension, placenta previa, retained placenta, and thromboembolism). Nevertheless, more than half of all maternal deaths can be prevented through early diagnosis and appropriate medical care of pregnancy complications (6,7). Hemorrhage, pregnancy-induced hypertension, infection, and ectopic pregnancy continue to account for most (59%) maternal deaths."

"When compared with white women, black women continue to have four times the risk for dying from complications of pregnancy and childbirth (2), although the risk for developing maternal complications is less than twice that of white women (8). This suggests that access to and use of health-care services for early diagnosis and effective treatment, if complications develop, may be a factor. In 1996, if the maternal mortality ratio for black women were equal to that for white women, the national maternal mortality ratio would have declined by 32% from 7.6 to 5.1 per 100,000 live births."
-----

"In 1998, the World Health Organization designated Safe Motherhood as the focus for World Health Day (April 7), indicating the importance of this issue globally. In the United States, several measures that need to be implemented include providing all women with access to family planning services, because unintended pregnancies are associated with higher risks for both mother and infant (9). Women should know how to prevent sexually transmitted diseases (STDs), and women with STDs need effective and early treatment to prevent ectopic pregnancies. All women need access to culturally appropriate and quality prenatal, delivery, and postpartum care. The prevention of complications and the early diagnosis and effective treatment of any complication is critical. Although prenatal-care use in the United States has been increasing, in 1996, approximately 10% of all pregnant women received inadequate or no prenatal care (10)."

"In the United States, the theme for World Health Day 1998 was "Invest in the Future: Support Safe Motherhood." The proposed Healthy People 2010 goal for maternal mortality remains 3.3 maternal deaths per 100,000 live births. Unless investments are made in improving maternal health for all women, this goal will not be reached."

What You Can Do

From the online Article "Dead Mums Don't Cry," about why the TV show Panorama decided to focus on the issue of maternal mortality in Africa.

"They are about the female side of the MDGs - empowering women, primary education (more girls in school), maternal and infant mortality, and maybe too about reproductive health (to some the missing MDG). The message from Kevin Watkins - who's monitoring the MDGs for the UN's Human Development Report - is that women and children are coming last."

That's the answer, women and children need to come first, not last. Reducing the incidence of abortion by reasonable and compassionate prevention is putting women and children first. There a thousand ways to do it, and everyone on earth can take part in making the changes that will bring it about. What are you doing? What are you going to do? When?

Anecephalic And Spina Bifida Prevention: What You Can Do

What can you do to help make abortion unnecessary? A lot. In the case of abortion of anencephalic and spina bifida handicapped fetuses, prevention is the best remedy of all.  Everyone old enough to read this blog can work at prevention.

We now know that neural tube defects, which include spina bifida and anencephaly, can be prevented by making sure mothers are well supplied with the vitamin folic acid, both before and during early pregnancy. There may be other unknown factors that contribute to the incidence of those defects, but studies have shown the startling reduction in cases when mothers' diets were supplemented with folic acid.

Is it not the responsibility of every person who knows this to effectively spread the information to everyone who may become pregnant now or in the future?

Health classes in public and private schools should present this information to children when they first study food, nutrition, and reproduction. It needs to be repeated whenever the opportunity arises, in textbooks, from the teachers, from parents, scout leaders, everyone who talks about food or reproduction should be sure to talk about the importance of folic acid.

Women who are of childbearing age are always vulnerable to pregnancy. They should all be well supplied with folic acid, because if one waits until pregnancy occurs, it's too late to be optimally protected from neural tube defects. Deficiencies in early pregnancy cause the most harm.

For more information:

Folic Acid: The vitamin that helps prevent birth defects

Centers For Disease Control And Prevention: Folic Acid

How Folate Can Help Prevent Birth Defects

March Of Dimes: Folic Acid

International Birth Defects Information Systems

North Carolina Folic Acid Council

What can you do now and in the future to help prevent neural tube defect related abortions?

Anencephalic

What do you think of the following situation reported on the BBC news web site?

"A 17-year-old pregnant Irish girl is appearing in the High Court in Dublin to press for the right to travel to Britain for an abortion.

Doctors have told the girl that her four-month foetus will not live more than a few days beyond birth.

She is in the care of Ireland's health service which has issued an order stopping her from going to Britain.

But a lawyer for the girl argued that the health authority had no right to stop her travelling.

Eoghan Fitzsimons told the court that police had responded to a request by the Health Service Executive (HSE) to prevent her leaving the country, saying they could not and would not do so without a court order.

Abortion is illegal in Ireland except where the mother's life is threatened by a medical condition or suicide."

Many women in Ireland go abroad for abortions, but this teen was not even able to do that without going to court for the right to travel to England in order to terminate her four month old pregnancy. She did not want to carry to term an infant who would die during birth or soon afterward, one that was missing a large portion of its brain and skull.

Would it not be more humane to both mother and child to abort as early in the pregnancy as possible rather than force this young woman to carry to term a baby who could not possibly survive more than three days? Would it not be safer for the mother as well?

Fortunately, at least I think so, she did win her court case. But, why put her through this?

Some mothers, however, do choose to carry their anencephalic babies to full term, kmowing they will die at birth or within a few days. An information and support site for carrying an enephalic to term that has quite a bit of information is at: http://www.prenatalpartnersforlife.org/Stories/AnencephalyStoriesIndex.htm

I believe that we need to support the mother's right to choose whether to carry an anencephalic baby to term or not, providing safe and speedy access to abortion for those who choose it, and support and kindness to those who choose to carry the baby to term.

What do you think?

What can we do to make it better for both mothers? For other family members?

Abandoned Newborn Babies

The abandoning of newborns is rising in Europe. In the UK The number of cases of babies being abandoned by their mothers has tripled in the last decade. Efforts to reduce the number of newborns who die as a result of abandonment include:

In Germany, efforts to pass a law providing a sort of postal drop off box for the anonymous placement of babies. Mothers could place the baby in a warm compartment, accessible from outside a building. An alarm would sound at a hospital next door, and the baby picked up within ten minutes. Babies would be kept for several weeks, and if the mother does not come forward to retrieve her child by then, the baby would be put up for adoption.

In Italy an Italian children's charity is placing adhesive stickers on public rubbish bins encouraging women not to abandon newborn babies. Rubbish bins are the most common forms of dumping grounds, but babies have also been discovered in plastic bags, washing machines and cupboards.

As critics of these remedies point out, they do not address the causes of abandonment. Why are mothers abandoning their children in the first place? What makes them take such a wrenching and desperate step? Prevention of unwanted pregnancy, support of women during pregnancy and afterward would seem to be the real solution to the problem, one of wholesome and safe prevention.

What can you do?

What can your organization do?

What project could you launch to help prevent abandonment of babies?

Being Able To Say No

The Andrea Yates case in the news again. Her conviction is being thrown out because of an expert witness' false statements at her trial.

Whenever I read about a woman like Andrea Yates, who was convicted of drowning her five children, I always think, this isn't the real story, the real story is the story behind the story.

The real story is: How did she get to that place?

I always want to sit down with her and speak gently, learn what she's like, how she ticks, who she is, and how she came to make the choices she did. I always want to write her story.

From thinking about many cases, not so newsworthy as Andrea's perhaps, but just as tragic, and just as preventable, I've come to my own conclusions about prevention. I think the place to begin is with
the girl. Andrea did what she did, not because of Rusty, her husband, who shall always be held in revulsion by women everywhere, not because of the confrontational fool evangelist, but because she could not say no.

Years ago, when I was writing my first book, about equality for women in the church, a woman who'd heard about what I was doing came to visit me. As we sat on my front porch she told me she and her husband were planning to go as missionaries into a primitive area with little in the way of financial support. Her husband had told her they wouldn't be able to afford the expense of birth control supplies so they would just have to trust God to not give them any children.

She thought this foolhardy, but did not have the confidence of certainty since it was her husband who was so convinced of this plan, and lack of faith and doubting God's power seemed involved. I told her I'd suggest she tell her husband the faith would need to be on his part, in that he'd need to trust God to take away his desire for sex under those conditions, because there wouldn't be any. I also told her it was a foolish plan and she should have no part in it. She said she thought so, but needed someone to confirm it. She'd say no.

Andrea couldn't do that. And because she couldn't say no she was backed up into an increasingly small and dangerous corner. She was very much like a reproductive rat in a cruel scientist's lab. When she got to the end of her resources, she turned and fought the only way her tormenters allowed a trapped rat of a woman who couldn't say no to fight.

If you train a girl to not be able to say no to a husband or a male authority figure you set her up for potential tragedy. She's just waiting there on the curb of the world for a predator to drive by.

We'd all like to know how we can do something, anything, to help Andrea. We also want to find the potential Andreas and head them off at the pass.

I think we can do so something, right where we are, day by day. We can teach our girls, and all the girls we meet, to say no. We can teach them how to decide when to say no and when to say maybe and when to say yes for now, but it's open to change. We can give them practice saying no and making it stick. We can model saying no and making it stick, without remorse, without guilt. We can teach all the ways to say no graciously, and the few they'll need to say it not so graciously.

No. The gift for a life, a gift to save lives.

What or who do you need to say no to today?

Gender Selection And The Value Of Women

The traditional question, "What do women want?" has been answered. The answer is, "Try asking them." The modern feminist movement has made it easier for women to give their own personal and group answers with some hope that they will be listened to.

Now, there's a new question, I think, it's, "What are women worth? What is their value, both collectively and as individuals?"

I just read an answer, a serious one, that provides a needed shock to American feminists (and those who don't want to call themselves that, but will gladly take the benefits feminists have obtained for them) who may think that their work is done.

In India, the Art of Living Foundation spiritual head Sri Sri Ravi Shankar, in an effort to send, out a message that there can be no greater sin than killing a girl child, said:

"People are forgetting their religious values as they fail to realise that killing one girl child is equivalent to killing one million cows. We are planning a campaign in all villages across the country to spread the message."

Now, we know. Each woman is worth one million cows, at least in India. The quote comes from a news report of a meeting of religious leaders to help stem the tide of prenatal gender selection that is seriously reducing the number of females born in India.

The report ended with, "In some cases, the lack of women of marriageable age is witnessing a trend where brothers are being forced to share a wife."

The problem isn't, though, an inconvenience for brothers who have to share a wife. Prenatal gender selection is a serious social problem, and India isn't alone in it. China is having the same problem.

What happens when there aren't enough women? Traditionally women's work is done by women. Duh. And if there are only half of the women to do the work, each woman will do twice as much. Or, she will die trying. And many will, as will those who needed her to aid in their survival and well being.

The problem of missing women is even worse in Africa. Women in Africa are dying now in huge numbers, from both AIDS and the sexual brutality from war.

When the women are not there, the children are not well cared for, or not cared for at all. When the women are missing, the sick and dying are not adequately cared for, or not cared for at all. When the women are missing, there is not enough food to eat, and not enough products taken to market, not enough, not enough, not enough of so many essential goods and services.

Research shows that when the status of women goes up in a society, child mortality goes down, population growth slows, and economic prosperity rises.

The best thing any country or society can do is to raise the status of women--educate them, protect their reproductive rights, open all doors of opportunity to them, allow them a voice.

And the first, most essential step in valuing women, is letting girl babies live.

Miranda's Story 3

What can Miranda do to help her avoid needing to consider abortion in her future?

Women who have had one abortion often go on to have another, or several, thinking each time that they will never have to do it again. They are reproductively vulnerable, and may not know why, or what to do to make themselves less vulnerable. They need protection, but do not know how to provide it for themselves.

What does Miranda need that she can provide for herself, and how can she provide it?

What can you do to help future Mirandas avoid having to consider abortion?

Some possibilities:

--If you are a parent.
You can relate to all your children in ways that encourage and strengthen their sense of self respect and self protection. You can avoid having a "target" or scapegoat in your family by refusing to dump our own problems on other people. You can teach your daughters to say no to anyone whenever it's not in their own best interest to say yes or to simply aquiesce.

--If you are an educator.
You can take seriously your power to damage your students, refusing to use taunts, reverse psychology, or other esteem damaging tactics. You can provide education that informs children about reproduction and responsibility.

--If you are a minister or religious leader.
You can avoid in your teaching creating two classes of people, male and female, with different rules for each. You can teach personal responsibility for one's own behavior whether male or female. You can show value for women by not restricting or diminishing their participation or expectations in home, religious environment, or society.

--If you are a legislator.
You can support laws that provide for women and children's welfare without penalizing them either directly or indirectly.

--If you are in the medical field.
You can support respectful and open discussion of reproductive information with all people of reproductive age. You can be sensitive and kind to those in vulnerable situations.
You can provide full information about reproductive choices in an unbiased and supportive manner.

What can your organization do now to help future Mirandas?

What project, personal or organizational, can you begin now, that you can take action on today to help future Mirandas?

Please share your comments and suggestions.

Miranda's Story 2

What was present in Miranda’s life that made it possible for her to not choose abortion?

--A supportive family. Particularly a mother who was there to accompany her, to advise but not pressure her, financial security for her and her child, and the belief that she could create a family with the father of her child.

--Understanding, considerate and respectful options presented by medical professionals, without pressure to make a particular decision either for or against abortion.

What could have been present in Miranda’s life that would have prevented her from having to make a choice at all regarding abortion?

--A sense of respect for and ownership of her own body. If Miranda had thought more about Miranda and less about being acceptable to an older male she would have been more likely to avoid the vulnerable position she got into.

--A better relationship with her own father. Miranda’s father was distant from his children and largely uninvolved in their lives, focusing most of his energies and attention on his career. Additionally, he was particularly critical of Miranda, more so than with her younger siblings. She grew up feeling that there was something inadequate about her that caused her father to not love her as much as the rest of the children in the family.

A girl learns about men first and most importantly from her father. He can help her be secure about her worth, or question it. I’ve repeatedly noticed that girls who have been abandoned by their fathers, either physically or emotionally, seem to always be searching for male approval. They are sitting ducks for seductive older males who want a compliant sex partner with weak personal boundaries.

--A long view rather than a short view regarding what is valuable and important to her. Miranda was not thinking long term when she began to recklessly hang out with friends who dabbled in drugs, ditched school, and engaged in petty crime.

--Parents who were able to take necessary steps to remove Miranda from associations and activities that put her in jeopardy.

--A school that effectively eliminated older non-students from school activities and proximity to the school, one that made sure parents knew when their children were not attending. Miranda’s parents learned later that her boyfriend had repeatedly called her high school, posing as her father, to excuse her for absences, days away from school which she had spent with him.

--Teachers and staff who were supportive of female students. Several incidents in Miranda’s first year at the big impersonal high school contributed to her sense of isolation, insecurity, lack of value, and low expectations for herself. A pivotal point came shortly after she had decided to stop her truant behavior and bring her grades up. After several weeks of improvement that she was proud of, she was called into the dean’s office because she had been accused of smoking in the girls lavatory. She had actually not been the smoker, but refused to accuse a friend, there at the same time, who was the smoker.

The dean, attempting either reverse physchology, or simply being inept, told Miranda at that point that she obviously did not care about her education, and he saw little reason for her to prepare for or expect more than a menial job in her future. This disregard for her improved grades and behavior and derision toward her as a person created devastating doubts in her mind about her abilities. It matched, in her thinking, her own father’s lack of interest, and the taunts she had received from snobbish classmates about her clothing and appearance. She decided to stop trying, to just get through high school and not aim for anything significant because she was probably incapable of more.

Taken together, the negative responses Miranda received to her best efforts made her particularly vulnerable to the advances of any male who provided the approval and admiration she lacked from other important sources.