Posts tagged ‘abortion’

December, 2013

Reproductive Justice: Day One


This week I will blog on the topic of reproductive justice, with a particular focus on access to abortion services. Each day I will blog on a particular strategic effort to restrict access to abortion services in the United Kingdom. As part of each discussion I will highlight how recent lobbying in the UK mirrors efforts to restrict access to abortion services in the USA. Each day I will suggest possible responses to these lobbying efforts. 

The themes explored in my blog this week stem from a workshop held at the University of Birmingham in March 2013. The workshop had the title ‘Beyond the Rights and Wrongs of Abortion: Access as a Question of Reproductive Justice’ and aimed to bring together interested individuals to: think of ways that academics, practitioners and third sector organisations can respond to efforts to restrict access to abortion services in countries where the procedure is allowed. 

Reproductive justice is a term used to describe the broadening out of the discussion on ‘reproductive rights’ with its focus on choice. Cook and Dickens summarise the move from reproductive rights to reproductive justice as follows:

The major contribution of judicial decisions to protect and advance reproductive health shows the success and wider potential of advocacy that moves from a reproductive choice paradigm to an emphasis on reproductive justice. [1]    

Those in the reproductive choice movement position themselves away from the privacy/choice framework and instead advocate for women’s interests and well-being in a broader context. The reproductive just movement connects reproductive choice with broader questions of social justice. As Loretta Ross summarises: ‘Reproductive Justice is the complete physical, mental, spiritual, political, social and economic well-being of women and girls, based on the full achievement and protection of women’s health rights.’[2] 

Situating access to abortion services within this framework allows us to understand abortion services, as a constituent element of women’s reproductive health needs. After all, the ability to control the timing and spacing of reproduction is key to women’s equality and a foundational aspect of social justice. 

In the last 24 months we have seen evidence of an increase in the number of attacks on abortion provision that are not directed towards questions of whether abortion is morally right or wrong but rather aim to restrict access to abortion services. They do this by focusing on efforts to restrict or hinder the activities of abortion providers. As mentioned each day I will pick a particular strategic effort that is mirrored in USA anti-abortion strategy. It is my view that in order to fully respond to current efforts to restrict access to reproductive services it is vital that we consider the impact of an increasingly ‘American’ strategy of lobbying that has been adopted by pro-life organisations in the UK. 

The influence of American pro-life organisations on lobbying in the UK has been the subject of several recent newspaper articles. Indeed it has been suggested that some of those who have been campaigning to restrict access to services in the UK have done so in conjunction with anti-abortion lobby groups in the USA.[3] This influence has been evidenced in attempts to restrict access to abortion through regulating abortion providers (e.g. the recent ‘pre-signing’ scandal) and increasing the threshold of activities needed to ensure that the consent of the pregnant woman is real (e.g. the recent discussion of ‘independent counselling’). During the legislative passage of the Health and Social Care Bill (now the Health and Social Care Act 2012) Nadine Dorries attempted to amend the Bill to include a clause that would require independent counselling for women who wished to have an abortion. During the debates she implied that abortion providers could not be trusted to provide women with impartial advice:

BPAS and other organisations would say that they do not have to meet targets and that they have no financial concerns. However, BPAS has advertised for business development managers, whose primary function is to increase its market share—those are its own words in the advert. If an organisation advertises that it wants to increase the number of abortions, can we trust it to provide vulnerable women who walk through the door with the counselling that they need? On pensions mis-selling, this place has separated by law the people who provide and sell pensions from the people who advise on pensions.[4] 

‘Independent’ or ‘crisis’ pregnancy agencies are notorious in other jurisdictions where they have been opened by pro-life organisations in order to dissuade women from having an abortion. Subsequent to this there was a ‘sting’ investigation by The Telegraph into the provision of abortion for reasons of social sex selection. This is something that was widely condemned and presumed to be illegal (it is not!). Further stories detailed allegations that doctors were ‘pre-signing’ HSA1 forms; these are the forms where a doctor verifies that the requirements of the Abortion Act have been met and a woman is entitled to an abortion. This led to then Secretary of State for Health Andrew Lansley calling on the Care Quality Commission to carry out emergency inspections on abortion clinics across the UK. 

All of these attacks are aimed at undermining the trust that the public have in clinician ability to regulate reproductive services. Given the current framing of abortion regulation in the UK this is a strategy that could provide successful in restricting access to abortion services overall. I will pick up at this point tomorrow when I discuss so-called TRAP (Targeted Regulation of Abortion Providers) laws.

[1] Rebecca J. Cook, Bernard M. Dickens ‘From reproductive choice to reproductive justice’ (2009) 106 International Journal of Gynecology and Obstetrics 106–109

[2] Loretta Ross ‘Understanding Reproductive Justice: Transforming the Pro-Choice Movement’ (2006) 14-19

[3] Polly Curtis and Ben Quinn ‘Abortion debate: Dorries campaign urged to reveal how it is funded’ The Guardian

[4] (Hansard; 7 Sep 2011 : Column 377)

Dr Sheelagh McGuinness is a Birmingham Fellow at the Birmingham Law School, University of Birmingham.

November, 2013

When law meets reality and the price women pay for non-adherence to the legal rules – Dr Ewa Truchanowicz

One woman dead, one woman blind, one woman forced to carry to term pregnancy she did not want. A raped underage girl detained to ensure the legal cut off passes.  Not because there were no facilities to carry out the terminations, not because the law made such procedures illegal. Not in a low income country, but in the European Union. Women in Poland receive the double whammy of restricted access to sexual education and effective contraception combined with the social opprobrium with regards to pregnancy termination on any grounds, including medical or rape.

Health professionals can refuse to provide optimal medical care to their female patients citing their conscience, which allows them to watch a pregnant woman die from a treatable disease (Ulcerative Colitis). Health professionals can betray patient confidentiality on national media.  Health professionals can bring in a priest, instead of following the protocols for cases of rape. Health professionals can allow a mother of two to go blind by refusing her a legal, medically justified abortion. In Poland, a pregnant woman ceases to be a patient. The perceived welfare of the foetus takes unquestionable precedence and leads to substandard treatment for the mother. As the result sometimes both the mother and the foetus perish (as in the untreated Ulcerative Colitis case).

I have just listened to a presentation at the GLOW 2013 conference citing a father from a low income African country ‘I would rather argue with a policeman, not a doctor. Everyone is frightened of the doctors. If you say anything to them they say ‘Have you ever seen a doctor in court?’’ Sounds familiar? Poland frequently features in cases brought to the European Courts for non-enforcement of the legal framework in relation to provision of abortion, but what happens to the scores of the health professionals on the ground who fail to follow the basic tenets of their profession (e.g. working within the legal rules and protocols, maintaining patient confidentiality)?

For every publicized case of a woman denied proper standard of healthcare in 21st Century Europe, there are scores of others that do not hit the headlines and suffer the consequences of the non-provision of services they are entitled to.  The Polish girl-child is well educated and can look forward to life of civic freedoms and good opportunities, but even though clean facilities are available, the health professionals are trained, and the per capita income is good, she will not be provided with optimal medical care when the need arises. Not if she happens to be pregnant.

Further useful links:

%d bloggers like this: