Analysis Abortion

The Fight for Universal Access to Abortion

Jamie J. Hagen

The international human rights and global health communities gathered with policy-makers and government leaders last month in Washington D.C. to make the case for universal abortion access. This unheralded collaboration arrives on the heels of another first: a report from the UN secretary-general calling for access to safe abortion.

The international human rights and global health communities gathered with policymakers and government leaders last month in Washington D.C. to make the case for universal abortion access. The resulting outcome document, the Airlie Declaration on Safe Legal Abortion, calls on governments and policymakers to legalize abortion globally.

This unheralded collaboration arrives on the heels of another first: a report from the UN secretary-general calling for access to safe abortion. The timing for a global initiative of this nature for universal access to abortion is crucial, as a review of the UN Millennium Development Goals (MDGs) to set a post-2015 agenda as well as a 20-year review of the International Conference on Population and Development (ICPD + 20) are currently underway.

Post-2015 Agenda and Abortion Access

Two organizations at the forefront of the initiative to ensure universal access to abortion as a necessary part of a comprehensive package for sexual and reproductive health rights (SRHR) include the International Planned Parenthood Federation (IPPF) and Ipas. Both organizations signed on to the Airlie Declaration as representatives of their respective organizations.

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“Abortion is just another service, like access to contraception or comprehensive sexual education or HIV treatment,” said Cecilia Espanoza, Ipas advisor for Latin America. “The problem is that every time we talk about this full comprehensive package of services, there is always a lot of stigma around abortion. If it is not stated, it is not part of the service and the agreement.”

Carmen Barroso, regional director of International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), argues that providing legal and safe access to abortion makes economic sense for developing countries. “Sustainable development depends on strong economies and strong economies depend on SRHR [sexual and reproductive health and rights], that’s the bottom line,” she said.

With this in mind, IPPF just launched the Vision 2020 initiative to collect data about progress toward the next global development goals specific to SRHR, including access to contraception. This is no small matter, considering 222 million women worldwide are currently unable to access contraception, according to IPPF.

IPPF’s new initiative also recognizes the need to include youth in the conversation. “Youth [are] important because [they represent] a huge cohort, the largest in history,” said Barroso. “We realize now that without youth we can’t talk about universal access. The biggest obstacle to universal access is for young people, and that’s because the sexual rights of youth are contested, the reproductive rights of young people are ignored.”

Restricted Funding Continues to Limit Access

United States foreign policy is part of the problem when it comes to universal access to abortion, perhaps most notably in the form of the 1973 Helms Amendment, outlined by Kristina Kallas and Akila Radhakrishnan in a 2011 Rewire article. Restrictions from donor countries and program funders like this severely limit the work of international organizations advocating for SRHR.

Last year, the former head of the International Committee of the Red Cross’ (ICRC) legal division, Louise Doswald-Beck, penned a letter to President Obama to address this decades-old problem. In the letter, Doswald-Beck noted the glaring omission of protection of the right to abortion for women who are raped during conflict, stating flatly, “Raped women and girls in conflict zone are routinely denied the option of abortion.” She continued, “U.S. humanitarian aid policy presently bears a high degree of responsibility for this illegal, and thoroughly inhuman, situation.”

If stigma around abortion continues to restrict funding, “we are just closing our eyes to the reality,” said Ipas’ Espanoza. “It’s impossible to talk about a comprehensive sexual education without informing people about safe abortion.”

Success and Resistance in the Fight for Universal Access

The need for access to reproductive health care for those victimized by rape as a weapon of war, as addressed in Doswald-Beck’s letter, offers a new context for conversation about the need for legal and safe abortion.

Access to abortion in conflict and post-conflict countries was addressed in a resolution for the first time by the United Nations in 2013, with specific recommendations for abortion services in UN Security Council Resolution 2122. PeaceWomen, a program of the Women’s International League for Peace and Freedom (WILPF), monitors women’s rights in conflict and post-conflict and sees the inclusion of progressive language for abortion access as a direct result of the 2013 secretary-general’s report recommending that member states ensure the safe termination of pregnancies resulting from rape.

However, Abigail E. Ruane, PeaceWomen program manager, believes organization among the religious opposition has grown particularly politically savvy this year. “The Holy See is the only religious body with a voice in the consensus-based discussions at the UN, and therefore has disproportionate opportunity to influence these discussions,“ she said. The Global Justice Center (GJC) reports some countries, including Guatemala, have actively resisted UN resolutions with language supporting SRHR. “With the increasing sophistication of this group, it requires more and more work by progressive women’s rights advocates,” said Ruane.

On the other hand, countries such as Uruguay and Nepal have made great strides in universal access to abortion in recent years. These initiatives are driven by findings from evidence-based reporting of institutions, including the World Bank, that have proven unsafe abortions have a costly economic impact, beyond the human rights concerns at hand.

Pivotal Moment for Changing the Conversation

Stephanie Johanssen, advocacy and outreach associate at the Global Justice Center, believes organizations pulling together from different corners of the international advocacy arena have the power to shift the dominant narratives about abortion. “In the long run, we believe this has a positive impact on the discussion on abortion services worldwide and seeing abortion also in a different context such as a necessary life saving medical care for war rape victims,” she said.

Espanoza observes that governments now have an opportunity to listen to what human rights bodies and experts are saying about the SRHR needs for women to make progress, since prior goals were set on the international development agenda. In talking about the upcoming ICPD+20 review, she added, “It will be really hard to advocate for a full package of reproductive health services or having more services in terms of maternal mortality and morbidity if we don’t include safe and legal abortion”

In their report, The Right to an Abortion for Girls and Women Raped in Armed Conflict, the GJC offers recommendations for how to improve safe and universal access to abortion, such as make it clear in UN trainings, including of peacekeeping forces, that girls and women who are raped and impregnated must be informed of their right to an abortion, and the United States should revise USAID guidelines so restrictions are not placed on humanitarian aid.

But the real battle for universal access may not be fought at the UN. “The main obstacle is the indifference in the majority of the population,” said Barroso, who notes that the opposition, while not to be taken for granted, are a vocal minority who aren’t open to conversion and instead only need to be contained.

Instead, advocates may be well served to find ways to show the average person why SRSH is relevant to them. “I think we have to address the large majority of public and popular opinion who just don’t care,” Barroso added. “It’s not that they are opposed, it’s just that they are uninformed and it’s not a big priority for them and that’s because we’ve failed to address them and try to understand why they don’t prioritize it.”

CORRECTION: A previous version of this article incorrectly spelled the name of Ipas’ Cecilia Espanoza. In addition, a sentence on the countries that “have actively resisted UN resolutions with language supporting [sexual and reproductive health rights]” has been updated slightly for accuracy. Malta and Ireland were removed from that list. We regret these errors.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.

Commentary Human Rights

The Democratic National Convention Was a Remarkable Victory for Disabled People

s.e. smith

This year's convention included disabled people every evening, as part of a larger inclusive policy that made 2016 a banner year for disability rights activists.

Read more of our coverage of the Democratic National Convention here.

On Thursday night, Hillary Clinton formally accepted the Democratic Party’s nomination for president. Her speech included many of the elements one expects from a nominee, but there were some standout moments—like when she mentioned disability rights, which she did repeatedly.

Clinton integrated disability into her discussion of her record, talking about her work to ensure that disabled children have the right to go to school and bringing up the health-care needs of disabled youth. Her commentary reinforced the fact that she has always cared about disability issues, particularly in the context of children’s rights.

But she did more than that. She referenced shortages of mental health beds. She explicitly called out disability rights as necessary to defend. And at one point, she did not mention disability, which in itself was radical. When she outlined her plans for gun reform and clearly stated that she wanted to keep guns out of the hands of people who shouldn’t have them, she referenced people with criminal histories and terrorists, but not mentally ill people, who have been fighting a surge in stigma thanks to perennial (and wildly incorrect) assertions that mental illness causes violence. That omission was clearly deliberate, given the meticulous level of crafting that goes into writing one of the most important speeches of a presidential candidate’s career.

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The nominee’s speech would have been remarkable on its own, but what made it truly outstanding is that it was far from the first appearance of disability at this year’s Democratic National Convention (DNC). The convention included disabled people every evening as part of a larger inclusive policy that made 2016 a banner year for disability rights activists, who are used to being invisible. These kinds of appearances normalized disability, presenting it as a part of some people’s lives and a source of pride, not shame or misery.

On Monday, for example, disability rights activist Anastasia Somoza rolled out to give a sharp, compelling speech that didn’t cast disability in a tragic or exceptional light. She wasn’t the only wheelchair user to appear on the DNC stage—Paralympic athlete Mallory Weggemann led the pledge of allegiance on a different evening. Dynah Haubert, an attorney for Disability Rights Pennsylvania, took the stage on Tuesday. Nor were wheelchair users the only disabled people represented. Ryan Moore, a longtime friend of Clinton’s, spoke about health care and his experiences as a man with spondyloepiphyseal dysplasia congenital syndrome, a form of dwarfism. Connecticut Gov. Dannel Malloy talked about his learning disabilities. Musician Demi Lovato, who has bipolar disorder, took on mental health.

Former Iowa Democratic Sen. Tom Harkin, a nondisabled man who played an instrumental role in the push to pass the Americans with Disabilities Act (ADA) in 1990, taught the crowd sign language during a lively speech about the fight for disability rights on Tuesday, the 26th anniversary of the landmark legislation.

On Wednesday night, former Rep. Gabby Giffords (D-AZ) strode out onto the DNC stage in Philadelphia, smiling and waving at the crowd, to make a few short remarks. “Speaking is difficult for me,” she concluded, “but come January 2017 I want to say these two words: ‘Madam President.'” Her speech was about gun violence—a subject with which she’s intimately familiar after being shot in the head in 2011.

This level of representation is unprecedented. Some speakers, like Somoza, explicitly talked about disability rights, putting the subject in the spotlight in a way it’s never been at previous conventions. Others, like Giffords, came up on stage to talk about something else entirely—and happened to represent disability while they were at it. Similarly, Rep. Tammy Duckworth (D-IL), a decorated combat veteran and double amputee, talked about military policy.

This is a striking contrast from the treatment of disability at previous Democratic National Conventions: When disabled people have appeared, it’s often been in the form of a lackluster performance that objectifies disability, rather than celebrating it, as in 1996 when former actor Christopher Reeve framed disability as a medical tragedy.

Disability rights activists have spent decades fighting for this kind of representation. In 1992, two years after the passage of the ADA, the platform included just three mentions of disability. This year, the subject comes up in 36 instances, woven throughout the platform for an integrated approach to disability as a part of society, rather than as something that needs to be walled off into a tiny section of the platform, tokenized, and then dismissed.

In the intervening years, disabled people in the United States have fought for the enforcement of the ADA, and taken the right to independent living to court in 1999’s Olmsted v. L.C., which was namechecked in the 2000 platform and then forgotten. Disabled people advocated to have their rights in school codified with the Individuals with Disabilities Education Act (IDEA) in 2004, pushed for inclusion in 2010’s Affordable Care Act, and are fighting to pass the Community Choice Act and Disability Integration Act (DIA). Disability rights in the United States has come a long way since 1990’s infamous Capitol Crawl, in which disability rights activists dragged themselves up the steps of the U.S. Capitol, pleading with Congress to pass the ADA.

And as activists have pushed for progress in the courts and in Congress, disability rights have slowly become more prominent in the Democratic party platform. The ADA has been a consistent theme, appearing in every platform since 1992 alongside brief references to civil rights; historically, however, the focus has been on disability as a medical issue. The 1996 platform introduced Medicare, and health care in general, as issues important to the disability community, a refrain that was reiterated in years to come. In numerous years, Democrats addressed concerns about long-term care, in some cases positioning disabled people as objects of care rather than independent people. Disabled veterans have also played a recurring role in the platform’s discussion of military issues. But beyond these topics—again, often approached from a dehumanizing angle—and the occasional lip service to concerns about discrimination and equal rights, until the 2000s, education was the only really consistent disability issue.

In 2000, however, the Democrats went big, building on eight years under President Bill Clinton, and the influence of his then-first lady. For the first time, disability wasn’t simply lumped under “civil rights.” The platform explicitly called out the need for protection from disability hate crimes, but it also began to introduce the idea that there were other issues of relevance to the disability with a discussion of the digital divide and the obstacles that held disabled people back. Almost 30 years after the passage of the Rehabilitation Act of 1973, which barred disability discrimination by government agencies and contractors, the Democrats were starting to embrace issues like accessibility and independent living, which also played a prominent role in 2000.

It was a hint that the party was starting to think about disability issues in a serious way, especially when in 2008, the Democrats discussed the shameful delay on ratification of the United Nations’ Convention of the Rights of Persons with Disabilities, took on the Community Choice Act, talked about the need to enforce IDEA, and, again for the first time, explicitly addressed voting rights issues. By 2012, they were also calling out discriminatory voter ID laws and their disproportionate effect on the disabled community.

That’s tremendous, though incremental, progress.

And this week, the efforts of a generation of disability rights activists are on display everywhere in Philadelphia, where Daily News columnist Ronnie Polaneczky observed that accessibility is a top priority across the city. The DNC is providing expanded accessible seating, wheelchair charging stations, service dog relief areas, Braille materials, closed captioning, American Sign Language interpreters, medication refrigerators, and more. That’s radical inclusion at work, and the result of incredible efforts by disability rights organizers—including the 400 delegates who disclosed disabilities.

Those same organizers have been hounding the presidential candidates, holding them accountable on disability over and over again. They’ve brought up concerns about independent living, wage disparities, education, access to services, accessibility, hate crimes, reproductive rights, the “marriage penalty” and government benefits, and casual disablism in campaign rhetoric and practices. Advocates leaned on the Clinton campaign until it began captioning its content, for example. RespectAbility sent journalists out on the trail, #CriptheVote organized Twitter, and Rev Up encouraged people to register to vote and get involved. The disability community may be more explicitly politically active this year than ever before, and the DNC has been responding accordingly.

Clearly in consultation with disability rights activists, the Democrats have brought a host of new issues into this year’s platform, acknowledging that disabled people are part of U.S. society. Some of the many issues unique to this year’s platform include: abolition of the subminimum wage, concerns about economic opportunities with an explicitly intersectional discussion of the racial wealth gap, affordable housing, accessibility at the polls, the role of disability in the school-to-prison pipeline, and the need for more accurate Census data.

Notably, in a platform that has loudly called for a Hyde Amendment repeal and pushed for other abortion rights, the Democrats have also reinforced the need for access to reproductive health for disabled people, a revolutionary clause that’s gone virtually unnoticed.

This is a platform—and convention—of aggressive inclusion, and it reflects a victory for disabled people in the United States. It does still lack some components the disability community would like to see, like a shoutout to the DIA, which Clinton supports. This is, however, the start of what looks like a robust and real relationship between the Democrats and the disability rights community.