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.

As seen with Dr. Tiller’s murder, which occurred while he was attending church with his family, this type of violent persecution is not restricted to the healthcare facilities where abortions are performed. Many abortion providers must take certain precautions, such as holding unlisted phone numbers, listing property in a spouse’s name, and wearing bulletproof vests while traveling to and from work. Anti-abortion protestors also use the internet to further harass both providers and women seeking abortions – a group in Texas used car registry information to send out a mass email identifying by name women who entered a Planned Parenthood clinic.

The many dangers involved in providing abortions take their toll on doctors, staff, and the women themselves. Physicians in particular are driven away from performing abortions due to the significant financial expense required to secure their clinic and workers, the social stigma they and their families face, and the risk of physical harm. The number of abortion providers is shrinking, and is likely to only get worse in the future as abortion providers age and retire — the majority of current providers are over 50 years old. Few medical students are given the opportunity to observe or learn how to provide abortions, as most doctors today never saw an abortion performed during medical school, and half of OB-GYN training programs fail to provide routine instruction in abortions. This shortage means that despite the fact that one in three American women will have an abortion in her lifetime, nearly a quarter of women seeking abortions have to travel 50 miles or more to find a clinic.

Even more disturbing, it has become close to impossible to find doctors who will perform abortions after a woman is 24 weeks into pregnancy. Following Dr. Tiller’s murder, Warren Hern is one of only a few doctors to openly acknowledge that he provides late-term abortions. In a recent article, he describes the precautions, including bulletproof glass and protection from US marshals, that he and his staff members must take to protect themselves and the women they provide abortions for. Dr. Tern describes the anti-abortion movement as “a violent terrorist movement, [with] a fascist ideology,” that publicly deplores acts of violence while continuing to push for “cold-blooded, brutal political assassination[s]” such as that of Dr. Tiller.

Despite the danger, Dr. Hern continues to provide abortions at his clinic because he sees it as the most important work he can do in medicine. However, the unrelenting harassment of anti-abortion protestors threatens the reproductive rights of women seeking abortions and the safety of medical professionals that provide them. Violations of these rights by anti-abortion groups must be taken more seriously by law enforcement and local and federal government. Otherwise, acts of violence against abortion providers such as Dr. Tiller will only continue.

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.

The ban was enacted primarily due to pressure from the Catholic Church and other Christian groups; no health or human rights-based assessment of the law’s impact was carried out prior to its passage. Numerous Nicaraguan medical groups oppose the law, including the Nicaraguan Society of General Medical Practitioners, and the ban is in violation of the Nicaraguan Obstetric Rules and Protocols created by the Ministry of Health. Despite this, the National Assembly voted to revoke therapeutic abortion in October of 2006, seemingly “with full knowledge of the severe pain and suffering that necessarily follows from the denial of essential medical services to pregnant women and girls.”

The UN Committee Against Torture, the UN Committee on Economic, Social and Cultural Rights, the UN Human Rights Committee, and the Inter-American Convention on Human Rights (which Nicaragua is a party to) have all strongly objected to Nicaragua’s abortion ban. The Nicaraguan Constitution itself states that “every person enjoys state protection and recognition of the inherent rights of the human person, the unrestricted respect, promotion and protection of human rights…” However, in enacting an absolute ban on all abortions, the Nicaraguan government has seriously harmed efforts to improve the health of women and girls in the country and failed to meet its obligations to protect the human rights of all citizens.

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.

In China and India, many of these deaths are attributed to “injuries”-a term unsettling in its vagueness. In the Star article, Anderson says that the majority of China’s 141,000 excess female deaths from “injuries” were the result of suicide, usually by ingesting crop pesticides.

“Injuries” in India accounted for the deaths of 86,000 women ages 15 to 29. Here the researchers suspect dowry-related deaths, which can include “bride burnings”- a particularly brutal form of violence in which a woman is doused with kerosene and lit on fire.

The largest number of missing women is in sub-Saharan Africa, where more than one-third died of HIV/AIDS. Other factors here may also include lack of access to care and other psychosocial factors.

Two decades ago, Sen wrote that “[i]f this situation is to be corrected by political action and public policy, the reasons why there are so many ‘missing women’ must first be understood.” Anderson and Ray’s work now brings us closer to that understanding-and makes all too clear the ultimate toll gender discrimination can take on a woman’s life.

For more reading:

Economist Emily Oster’s challenge of Sen’s theory in 2005: “Hepatitis B and the Case of the Missing Women” (arguing that biology, and not gender discrimination, skewed the ratios in Asia)

Monica Das Gupta’s response to Oster’s controversial claim: “Explaining Asia’s Missing Women: A New Look at the Data” (families whose first-born was a daughter  later had sons, suggesting measures to ensure boys)

A 2008 report that the effect of HBV on sex ratio imbalance was insignificant: “Can Hepatitis B Mothers Account for the Number of Missing Women: Evidence from Three Million Newborns in Taiwan”

Oster re-examines the data and issues a 2008 retraction: “Hepatitis B Does Not Explain Male-Biased Sex Ratios in China”

Authors suggest that legalization of abortion accounted for an increase in sex ratio at birth in the 1980s-and a decrease in excess female mortality: “More Missing Women, Fewer Girls Dying: The Impact of Abortion on Sex Ratios at Birth and Excess Female Mortality”

Paper concludes that increasing female income-and holding male income constant-increases girls’ survival rates: “Missing Women and the Price of Tea in China: The Effect of Sex-Specific Income on Sex Imbalances”

Last month, the New York Times published a piece on the surprising birth bias for boys found in some Asian American communities:  “U.S. Births Hint at Bias for Boys in Some Asians“

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.”

The recent conviction of five men in a Democratic Republic of Congo (DRC) military court for the rape and torture of civilian populations is being hailed as a step forward in preventing sexual violence. These men, who committed crimes while in a local militia group, were found guilty of assault and battery, and rape; four were sentenced to life imprisonment and one to 30 years in prison. They are also required to pay significant financial compensation to their victims. Other groups have recently held public demonstrations and protest marches, often the first of their kind, despite possible threats to the women involved. Women’s groups in Chad are also attempting to improve reporting rates, legal prosecution of perpetrators, and laws protecting women’s sexual and reproductive rights.

These efforts come amidst new reports of sharply increasing rape cases in the DRC. The eastern province South Kivu has experienced Rwandan Hutu militia assaults against civilians, which resemble past attacks in South Kivu in 1998 and 1999. The use of rape as a method of war in Africa has grown increasingly common, even in areas where conflict has officially ended.

For further reading:

South African rape survey shock

Tracking the war on women in Darfur: Boston doctors detail accounts of rape, assault

Sexual Abuse: New Study Documents Rape’s Grim Toll

UN: End Rape in War – Sexual Violence Soaring a Year After the Security Council Promised Prevention

Congo’s Bemba to stand ICC trial

Video: Rape in Congo

War Against Women: The Use of Rape as a Weapon in Congo’s Civil War

Child rape survivor saves ‘virgin myth’ victims

Intended Consequences: Rwandan Children Born of Rape (exhibition of personal accounts from female survivors of the Rwandan genocide of 1994)

Nowhere to Turn (PHR report on violence against Darfuri women)

Women for Women International (organization helping women survivors of war)

My Sister’s Keeper (women-led humanitarian action group)

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.

See also:

Video: Stones thrown at Afghan Women Protesters – YouTube

A Woman Among Warlords: Women’s Rights in the Taliban and Post-Taliban Eras – PBS, Sep 2007