OpenForum – a blog by the Health and Human Rights community

Media coverage of Dr. George Tiller’s murder may have lessened since his fatal shooting on May 31^st, but the severe restrictions placed on women’s access to abortion services continue. A new report from the Center for Reproductive Rights describes the “unacceptable obstacles” that abortion providers face in providing reproductive rights, using testimony from both providers and women seeking abortions throughout the country. The reasons cited for limited access to abortion services include a shortage of providers due to the social and financial costs of performing abortions, intimidation and harassment of providers and women seeking abortions, and legal restrictions such as mandatory waiting periods and prohibitions on federal funds.

Constant harassment and intimidation at abortion clinics continue to limit the ability of abortion providers to do their jobs and of women to obtain abortions in a safe and respectful space. Laws such as the Freedom of Access to Clinic Entrances Act (FACE) are meant to stop the often violent harassment that anti-abortion protesters use outside of abortion clinics. However, local and federal law enforcement can be lax in investigating threats: the report notes that the police often do not understand the provisions of FACE, or are unwilling to interfere with what they perceive as “the expected cost of providing abortion.”

Increasingly, anti-abortion groups are using litigation as a strategy to further harass abortion providers and burden law enforcement and the judicial system. For example, an anti-abortion group in Allentown, Pennsylvania sued the city after their protesters were arrested for “trespass, impeding access, racist and sexual taunting, and residential picketing” outside of a women’s clinic. The city eventually settled after a lengthy case, paying $10,000 to each of the 13 protestors. Experiences such as these have made law enforcement officials reluctant to interfere with protests outside clinics for fear of the legal repercussions. In this case, the Allentown City Solicitor told the clinic director that the city could no longer respond to any complaints at the clinic “unless there is a threat to life or person,” effectively admitting to the city’s almost complete inability to enforce the law with regards to abortion protestors. Read more

The absolute abortion ban enacted in Nicaragua in 2008 is endangering the lives of women and girls in that country and marks a “grave departure” from the Nicaraguan government’s efforts in improving health and equality, according to a new report from Amnesty International. The report details the results of the ban, which it says has denied women and girls life-saving treatment and prevented health care professionals from providing necessary medicine. Of the 115 maternal deaths that occurred in Nicaragua in the past year, it has been estimated that over 10% (at least 12 deaths) could have been prevented if therapeutic abortions had been available.

The ban, included in Nicaragua’s revised Penal Code, allows no exceptions, even in the case of maternal health, incest, or rape. Previously, therapeutic abortion (performed if the life or health of the woman is at risk because of the pregnancy) was legal but highly restricted – it was only permissible if three medical practitioners deemed it necessary and a family member agreed. Now, however, medical practitioners can even be arrested for treating a pregnant woman with a condition such as HIV/AIDS or cancer, because the treatment may cause injury or death to the fetus. Health care workers can also be prosecuted if a fetus is accidentally injured or harmed during birth. The threat of these harsh legal consequences may simply keep medical professionals from seeing pregnant women at all, to avoid prosecution in the event of unintentional fetal injury or death. Even women who have miscarriages fear being arrested, as it can be nearly impossible to determine whether an abortion was spontaneous (a miscarriage) or intentional.

Women and girls who are raped or victims of incest are also included under the abortion ban. Most reported rape cases in Nicaragua involve victims under the age of 18, and 87% of rape or incest victims who get pregnant are between 10 and 14 years old. In the report, a local NGO described supporting a nine-year-old victim of incest and rape through pregnancy, because no other legal options were available. Young women and girls who have not reached physical maturity have higher rates of pregnancy complications and are particularly endangered by this abortion ban. Read more

Almost 20 years ago, Amartya Sen, in the New York Review of Books, explained how to calculate the number of “missing women” in a given country: determine the number of surplus women who should be alive in, for example, China – if China had the same ratio of men to women as do countries that provide comparable health care to both sexes. According to Sen’s math, there were more than 50 million missing women in China alone; added to the missing women in South Asia, West Asia, and North Africa, that number jumped to 100 million. “These numbers,” Sen wrote, “tell us, quietly, a terrible story of inequality and neglect leading to the excess mortality of women.” While Sen’s theory did not go unchallenged (see links at end of this post), the numbers are startling. And in 2005, the UN doubled the estimate, to 200 million. Last month the Toronto Star profiled the work of two economists who have gone a long way toward answering a simple but important question: What’s happening?

Siwan Anderson and Debraj Ray analyzed figures from the year 2000 from sub-Saharan Africa, China, and India, to better understand at what age the missing women are dying, and what they’re dying from. As they explain in their paper, Missing Women: Age and Disease, “The possibility of gender bias at birth and the mistreatment of young girls are widely regarded as key explanations. . . . While we do not dispute the existence of severe gender bias at young ages, our computations yield some striking new findings.”

Their news? Anderson and Ray found that the majority of missing women died as adults (older than 15), not from sex selection in utero or childhood gender bias, as previously thought. The authors’ suggested percentages of “excess female deaths” occurring later in life are striking: 66 percent in India, 55 percent in China, and 83 percent in sub-Saharan Africa. Read more

A new campaign in Cameroon is seeking to bring more attention to sexual violence against women by encouraging survivors of rape to talk openly about their experiences. This campaign, led by the German development group GTZ, focuses on raising awareness of rape and incest, subjects rarely discussed publicly. GTZ estimates that as many as 432,000 women and girls were raped in Cameroon in the past 20 years, one out of five by a family member. To address this widespread violence, the campaign’s opening ceremony in the capital Yaoundé featured approximately 200 rape survivors; many of these women and girls publicly shared their stories. It is hoped that more open and public discussions of the experience and consequences of rape will shift societal views that tend to trivialize sexual assault.

The African women’s organization Akina Mama wa Afrika, which means “solidarity among women” in Swahili, met recently in Kampala to discuss new efforts to prevent violence against women in conflict and post-conflict areas of Africa. This group is seeking to improve legal and judicial systems to better protect the rights of women. They believe improved documentation of women’s experiences is the first step, as there is a critical lack of statistics surrounding these crimes. “Shame constrains many women’s actions,” says Annie Chikwanha, Senior Fellow at the African Human Security Initiative Institute of Security Studies. “Most times you have to seek permission of men to access the woman’s voice. Men insist on listening to the conversation. So the women feel constrained…” Instead, Chikwanha says, “it is women who suffer these atrocities so they should talk about them instead of a third party who can distort the information…let us empower women with skills to have these experiences documented.” Read more

Signed by President Karzai in March, Afghanistan’s Shia Family Law contains provisions that legalize marital rape and child marriage, and require women to get permission from their husbands to leave the house. In light of protests in Kabul and intense international pressure, Karzai has agreed to review and amend the law, which affects the Shia Muslim minority.

After initially defending the law as being misunderstood, Karzai later explained that he was unaware of some provisions when he signed it. During a press conference in Kabul on April 27, he made assurances that the new law will be in line with human rights treaties and the Afghan Constitution, which guarantees gender equality. We have yet to see whether these amendments will actually do so. In Afghanistan, opponents of the law include women, hundreds of whom protested in Kabul and faced stoning from male counter-protesters, as well as officials and legislators who claim it represents a return to oppressive Taliban-style rule.

With a backlash against Western interference by both backers and opponents of the law in Afghanistan, it remains unclear how proponents of international women’s rights can best support Afghanis in their own fight against rights violations. Read more