Commentary Abortion

Institutionalized Stigma in Ghana

Stigma Shame and Sexuality Series

A confluence of cultural, religious and geographical factors in Ghana create a sensitive environment where issues of sexual and reproductive health, especially abortion, have remained highly taboo for decades.

This post is by Jessica Mack, and is part of Tsk Tsk: Stigma, Shame, and Sexuality, a series hosted by Gender Across Borders and cross-posted with Rewire in partnership with Ipas.

Earlier this year, 28-year old Abigail Agborku became pregnant unexpectedly. Already a struggling mother of three, she sought to terminate her pregnancy. But something went wrong. She didn’t get the right advice, didn’t have adequate access, and didn’t know where to turn. She ended up in the hands of a quack, as too many women do, and died soon after.

Abortion has been legal in Ghana under a wide range of circumstances — including to protect a woman’s mental health — since 1985, making it one of the most progressive laws in Sub-Saharan Africa. Yet unsafe abortion still contributes to nearly one-third of maternal deaths. Access is chronically denied, and knowledge of the abortion law among women and health-care providers alike is scant. In Ghana, the issue of abortion is taboo. In the silence surrounding it, misinformation and stigma thrive.

Nearly 85 percent of the country identifies as Christian, and in a recent survey, almost 90 percent of Ghanaians reported that abortion was morally wrong. Yet abortion stigma must be placed within the context of even broader taboos around sex and sexuality. “In Ghana, we are sort of in denial about contraceptives. If someone is on family planning, for instance, and you ask her, ‘are you on family planning?’ She’ll say no. When you ask her, ‘well how do you space your children?’ She’ll say, ‘It is God’s grace,'” said Rose Asante, a reproductive health worker in Accra.

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“Talking about sex or family planning, or going to get a contraceptive method, people think it means that you are promiscuous,” she continues. “Our society is not a society where you can talk about sex openly. Everybody grows up knowing this is a no-go area. And especially abortion has a lot of stigma and silence around it; nobody wants to talk about it.”

Women in Ghana who seek abortions are seen as more than just promiscuous. They are considered heartless or careless. “People think you must be a really bad woman to have an abortion,” said Richard Oye*, a reproductive health clinic manager in Ghana’s Ashanti Region. “People don’t want to have it, and people who do want to hide it. That’s why the quacks are in good business. They provide services quietly in the back streets.” Though it is impossible to know exactly what role stigma played in Abigail Agborku’s fatal decision to seek an unsafe abortion, it was almost certainly a major contributor.

Enter Helms

A confluence of cultural, religious and geographical factors in Ghana create a sensitive environment where issues of sexual and reproductive health, especially abortion, have remained highly taboo for decades. Yet in 1973, the United States Congress put in place a foreign policy that would serve only to reinforce such stigma over the next forty years.

The Helms Amendment to the Foreign Assistance Act, named for the late Senator Jesse Helms (R-NC), prohibits the use of US foreign aid for the “performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” Essentially, any developing country government or NGO in the world that receives USAID money is prohibited from using those funds to provide abortions, even if it is legal in their country.   

The Helms Amendment is an affront to reproductive freedom for several reasons, but perhaps the real peril of the policy is its vague and elusive wording. What is ‘abortion as a method of family planning’? What does it mean to ‘motivate or coerce’? The language is difficult to interpret, and therefore put into practice.

An amendment added in the 1990s was meant to clarify that information and counseling for safe abortion is indeed allowed. But according to recent Ipas research in both Ghana and Nepal, this is largely being ignored in favor of near-universal censorship. NGOs and governments receiving U.S. funding fear for their job and funding security, and as a result often won’t even talk about abortion services.

“Pervasive silence and stigma around abortion is the real damage of the Helms Amendment, not so much from the law itself but as a result of its widespread misapplication,” says Patty Skuster, Ipas senior policy advisor.

While the Helms Amendment doesn’t explicitly foster abortion stigma at the community level, the way it isolates abortion services from the continuum of reproductive health care contributes to an environment of shame. Further, the policy perpetuates an institutionalized stigma at the highest levels — among the ranks of privileged and well-resourced NGO professionals, policymakers, and providers.

“Because of this rule, I don’t dare go near any abortion clinic, because it will look like I’m involved with abortion. Even if I’m just there to talk to the client about family planning — to empower her to make a decision to prevent an unintended pregnancy — because of the rule and my ‘salary,’ I will not ever go there. I don’t want to be part of it and I don’t want to be seen as being part of it,” says one USAID-funded reproductive health professional.

There is a long legacy of institutionalized abortion stigma and censorship in U.S. foreign aid. Before its repeal in 2009, the Mexico City Policy (global gag rule), saw numerous NGOs defunded by USAID for their association with abortion services. At press time, a vote on the permanent repeal of the Mexico City Policy was pending in the U.S. House.

The implications of institutionalized stigma can be disastrous for women at the community level, and for reproductive health advocates working to improve access to safe abortion. While advocates are working at the grassroots level to expand access to safe abortion services, censorship and prejudice is being reflected back to the community from the highest institutional levels. The Helms Amendment prevents doctors who should be providing and NGOs that should be advocating from doing so, both explicitly and implicitly.

Although researchers and advocates are just coming to understand the full effects of abortion stigma in Ghana, there are signs that a sea change, however slow, is possible. Says Rose Asante: “Now it’s changing; 20 years ago it wasn’t like today.  At that time you couldn’t even mention ‘abortion,’ but now you can go in, give a talk and even tell people that if you are pregnant and you don’t want to be, don’t take any drug, don’t attempt, just come to the hospital and ask for the service and there are people that can help.”   

Abortion stigma is not insurmountable. This, perhaps, is the most empowering thing we can understand as advocates. “Abortion stigma is used to control and punish women. But it’s just a social construct. It simply doesn’t have to be the reality,” says Leila Hessini, director of community access for Ipas. “We as advocates need to reflect on our own contribution to stigma, and how we are all creating it. When we legitimize some abortions — early versus late or those that don’t need public funding versus those that do — we collectively stigmatize abortion. Let’s deconstruct what we’ve learned and create a new paradigm, where women’s rights are upheld.” This, of course, would be a world where Abigail would live happily to see her three children grow.

This post is adapted from an article appearing in the Fall 2011 issue of Because, the Ipas magazine that connects U.S. readers to women around the world, highlighting reproductive health and rights and making connections between U.S. policy and global health. For a free subscription to Becauseclick here. *All names have been changed.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Law and Policy

Three Crisis Pregnancy Centers Served for Breaking California Law

Nicole Knight Shine

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act.

The Los Angeles City Attorney is warning three area fake clinics, commonly known as crisis pregnancy centers (CPCs), that they’re breaking a new state reproductive disclosure law and could face fines of $500 if they don’t comply.

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, advocates and the state Attorney General’s office indicate.

The office of City Attorney Mike Feuer served the notices on July 15 and July 18 to two unlicensed and one licensed clinic, a representative from the office told Rewire. The Los Angeles area facilities are Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

The law requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care, and for unlicensed centers to disclose that they are not medical facilities.

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“Our investigation revealed,” one of the letters from the city attorney warns, “that your facility failed to post the required onsite notice anywhere at your facility and that your facility failed to distribute the required notice either through a printed document or digitally.”

The centers have 30 days from the date of the letter to comply or face a $500 fine for an initial offense and $1,000 for subsequent violations.

“I think this is the first instance of a city attorney or any other authority enforcing the FACT Act, and we really admire City Attorney Mike Feuer for taking the lead,” Amy Everitt, state director of NARAL Pro-Choice California, told Rewire on Wednesday.

Feuer in May unveiled a campaign to crack down on violators, announcing that his office was “not going to wait” amid reports that some jurisdictions had chosen not to enforce the law while five separate court challenges brought by multiple fake clinics are pending.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before U.S. Court of Appeals for the Ninth Circuit.

In April, Rebecca Plevin of the local NPR affiliate KPCC found that six of eight area fake clinics were defying the FACT Act.

Although firm numbers are hard to come by, around 25 fake clinics, or CPCs, operate in Los Angeles County, according to estimates from a representative of NARAL Pro-Choice California. There are upwards of 1,200 CPCs across the country, according to their own accounting.

Last week, Rewire paid visits to the three violators: Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

Christie Kwan, a nurse manager at Pregnancy Counseling Center, declined to discuss the clinic’s noncompliance, but described their opposition to the state law as a “First Amendment concern.”

All three centers referred questions to their legal counsel, Alliance Defending Freedom (ADF), an Arizona-based nonprofit and frequent defender of discriminatory “religious liberty” laws.

Matt Bowman, senior counsel with ADF, said in an email to Rewire that forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs” and threatens their free speech rights.

“The First Amendment protects all Americans, including pro-life people, from being targeted by a government conspiring with pro-abortion activists,” Bowman said.

Rewire found that some clinics are following the law. Claris Health, which was contacted as part of Feuer’s enforcement campaign in May, includes the public notice with patient intake forms, where it’s translated into more than a dozen languages, CEO Talitha Phillips said in an email to Rewire.

Open Arms Pregnancy Center in the San Fernando Valley has posted the public notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Even so, reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, a person who Googled “abortion clinic” might be directed to a fake clinic, or CPC.

Oakland last week became the second U.S. city to ban false advertising by facilities that city leaders described as “fronts for anti-abortion activists.” San Francisco passed a similar ordinance in 2011.