America revisits the abortion debate

Knapps

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01, Feb 2017

Much has been said about the crowd size at the March for Life and not so much about the race and class diversity. In his extended Global Gag Rule, US President Donald Trump has formally forced global aid groups that receive US funding with two choices – stop even mentioning abortion as part of family planning measures or no funding from the US. The repercussions may be drastic.

What does the current government say about abortion?

They claim to be what they call “pro-life”.

  • On the Monday following his inauguration, President Donald Trump signed an executive order to cut off funds to global aid groups that advocate or provide abortions as a method of family planning. The repeal and reinstatement of this Mexico City Policy or the Global Gag Rule by Democratic and Republican Presidents has led to a continuous tug-of-war scenario.

The Global Gag rule requires all NGOs operating outside of US to stop advocating or performing abortions as a method of family planning if they want to receive funds from US.

  • Trump however went one step ahead of his predecessors who implemented the rule – they had targeted only family planning organizations worldwide which received US funds but he extended the scope to all global health organizations which were recipients of US aid.
  • The next day the House passed a bill that permanently bans the use of taxpayer funds for abortion with the exceptions of rape, incest or harm to mother’s life.
  • Last Friday, the 44th annual March for Life celebrated the swing of the new rule in favor of their anti-abortion stand. Vice President Mike Pence who has a long record of doing his best to implement punitive restrictions on abortion hailed the day as the best he had ever witnessed for the March of Life due to "the election of pro-life majorities in the Congress of the United States of America," and The Global Gag rule. He promised Trump would ensure an anti-abortion Supreme Court Justice would take the place of Antonin Scalia.
  • Trump has switched sides on the issue of abortion – he was pro-choice in 1999 and now says he is against abortion except in case of exceptions like rape or incest.

Why can the repercussions be vast?

  • NGOs that may have to close down because of severe fund shortage – especially ones that work in environments where abortion – safe or unsafe – is the only accessible option of contraception – will leave women cut off from their sole source of reproductive health care. The impact could extend to family members who rely on the NGO for cervical screening, HIV prevention, testing and counselling, STI prevention and treatment, pre and post-natal care and even newborn health care and other such primary health care services.
  • Services at risk due to the policy also train health professionals such as midwives and birth attendants following traditional practices to meet the severe shortage of health professionals – statistics reveal there are 2 health professionals for 10,000 people in developing countries against 33 for the same number of people in developed countries. If these services are not able to function at their level best, the situation worsens – research also shows that countries with high number of unattended births also have much higher rates of maternal and newborn deaths.
  • Research based on past experience shows significant increase in abortions under the rule. Also, fund cuts to family planning and reproductive health prevent couples from receiving family planning services. The result is unplanned pregnancies and increase in abortions, most of which would be unsafe – research showed a $607.5 million cut would lead to six million more unplanned pregnancies and 2.3 million more abortions, two million of which will be unsafe. For developing countries where 99 percent of global maternal deaths occur, the effect will be most detrimental.
  • One of the least successful Millennium Development Goals has been ensuring access to reproductive health services and reducing maternal mortality by 2015. The US was one of the 189 countries that committed in 2000 to achieve this. The rule will make the failure even more glaring.
  • Health and economic benefits of child spacing have been witnessed and include reduced pregnancy-related deaths and improved child survival. Reduction in HIV/AIDS and STDs, woman empowerment, better education and reduction in teen pregnancy. These have been linked to family planning and will culminate in greater advantages such as drop in population growth rate, improved conservation of natural resources, climate change mitigation and economic growth.The rule attacks family planning and consequently hits all the advantages linked with it.

Academic Patricia Schwerdtle points out that the regions estimated to have the greatest increase in population rate are the poorest regions. By forcing women in such regions to have more babies, the vicious cycle of poverty only becomes reinforced. Economic development and poverty eradication will happen only with demographic transition which begins with smaller family sizes.

She concludes, “So let’s get it right: this is not a high-income country, religiously charged pro-life debate. The global gag rule actually increases abortion demand and has consequences for a range of other health issues such as HIV/AIDS, cervical cancer and child health and well-being. This misinformed short-sighted policy is as far removed from scientific evidence as denying climate change. As a global community, we have a duty to expand access to family planning for people worldwide, particularly to the most vulnerable.”

When have Courts issued landmark rulings on legalizing abortion?

Roe v. Wade, 1973

  • The Supreme Court rejected Texas’s interpretation of the abortion law – abortion was illegal in all cases except when the mother’s life was at risk – and made abortion legal in the United States. It held that a woman’s right to terminate her pregnancy fell within the purview of fundamental privacy and liberty interests contained in the Constitution.
  • But the Court also observed that the state has an “important and legitimate” interest in safeguarding the mother’s health and also that of the “potentiality of human life” inside her.

The Court therefore varied the degree of restrictions on abortion depending on the trimester.

  • For the first trimester, the Court observed that the risks associated with abortion are in even lower than the risks of childbirth. The mother was given full freedom to abort the fetus in this period and the function of the State was only to impose mandatory health safeguards – such as making it compulsory that the person performing the abortion should be a qualified professional. The State could in no way restrict access to abortion.
  • For the second trimester or till the point of fetal viability – when the fetus is capable of prolonged survival outside the mother’s womb – the Court ruled that the State could regulate abortion only in the interest of the mother’s health and not for the sake of the fetus’s well-being. The state laws should cater to this requirement.
  • Beyond the point of fetal viability or in the third trimester, the State could intervene and even forbid abortion if it has been allowed in situations in which the mother’s health or life is at risk.

In a simultaneous companion case – Doe v. Bolton – the Court largely restated the ruling it had issued in Roe v. Wade.

  • While the Roe v. Wade ruling was a landmark judgment, successive rulings by the Supreme Court gave impetus to more States to step up restrictions on a pregnant woman’s right to abort her fetus.
  • In the 1992 Planned Parenthood v. Casey case, U.S. Supreme Court reversed part of its Roe v. Wade ruling – it allowed the State to intervene in the first trimester by enacting laws that mandate pre-abortion counseling and a 24-hour waiting period for a woman who seeks to abort her fetus. It also mandated parental acceptance of the decision to abort if the decision was taken by a pregnant non-adult.

Ruling on partial-birth abortion

  • On June 28, 2000, the Supreme Court overturned a Nebraska ban on partial-birth abortion (a political term) – which the medical community refer to as “dilation and extraction” (D&X) and is usually performed late in the second semester by dilating a pregnant woman’s cervix and extracting the fetus through the birth canal. The ruling made more than 30 other states revoke their bans on D&X.
  • But it did another roundabout when it upheld the Partial Birth Abortion Act in 2007 which prohibited partial birth abortion.

Where lies the way forward?

  • The Dutch Government has come forward and says it aims to establish an international abortion fund to reach out to families hit by the Global Gag Rule. Six Opposition Labour party MPs have written to Priti Patel, Secretary of State for International Development requesting her to take action as Netherlands has said and counter the destructive impact of Trump’s Global Gag rule.
  • Congresswoman Nita M. Lowey introduced the Global Health, Empowerment, and Rights (HER) Act in the House of Representatives and Senator Jeanne Shaheen was set to do so in the Senate. The Act will permanently repeal the Global Gag rule and allow providers to use non-US funds to educate women on abortion, and offer counseling services for women in need. Americans in and outside US can contact their Senator to voice their support.
  • Remove the stigma associated with abortion. Some reproductive rights advocates have realized that anti-abortion laws are finding increased acceptance due to a complacent and fundamental ignorance of women’s lives and the widely varying circumstances across the planet. They seek to strengthen their social message through sharing personal experiences and various creative forms such as plays to connect with a wider audience.
  • Realize that abortion is not just a women’s issue. In facilitating a woman to make and control her reproductive choices, we pave the way for a better world on all fronts.
  • While learning about the issue, people need to analyze news and information critically, not merely fall in line with Internet media’s tendency to show each individual what he or she likes.
  • Americans cannot afford to think the impact of the rule will be far-flung. Overturning Roe v. Wade (or at least making utmost efforts to make its scope negligible) will severely impact poor and young women but also every woman’s right to choose. There are already efforts to penalize families and small businesses for including abortion coverage in their plans. Financial help and social activism are the need of the moment.

India

Alaka M. Basu, professor of Development Sociology and Senior Fellow, UN Foundation has analyzed a few possible consequences of the rule in India.

  • For temporary methods of birth control excluding female sterilization – which itself accounts for 67 percent of contraceptive use – the NGO sector handles more than 50 percent of the contraceptive use. The implications for this sector remain unknown so far.
  • In India, US aid flows in through public-private/NGO partnerships to address specific issues at hand – urban health, school cleanliness drives, or rural child mortality. The Indian Government’s suppression of NGOs may strengthen following the rule.
  • Several issues related to sex and reproduction is left to the NGO sector in India. If the rule stifles sex educators from speaking about abortion while explaining birth control, there arises cause for concern.
  • Also India has witnessed recurrent incidents of forced abortions and involuntary sterilizations. Whether the rule could enforce a reduction of these incidents is yet to be soon.
  • A stronger NGO-government relationship would definitely help the progressive social work tide over barriers.
  • Caveats NGOs need to be aware of include scope of the rule – it only applies to abortion in relation to family planning not abortion after sexual attack or abortion to save a pregnant woman’s life. Additionally the rule does not restrict post-abortion care for women with complications, irrespective of how they underwent the abortion. The fear is that NGOs will not examine these intricacies and instead choose to wash their hands off any issue concerning abortion completely.

Who have reacted in what way to the extended global gag rule?

Family planning groups and Democrats have strongly denounced the move while Republicans and self-claimed pro-life groups hailed it.

Reactions of Democrats

  • It’s a new year, new Congress, new Administration, but R’s are taking us back to a dangerous past. We won't go back to coat hanger medicine”, said Florida Rep. Lois Frankel in a tweet.
  • House Minority leader Nancy Pelosi said the order Trump signed “returns us to disgraceful era that dishonored the American values of free speech and inflicted untold suffering on millions of women around the world.

Reactions of a few March for Life participants

  • Father Don Bedore, a Catholic priest from Kansas said he hoped Trump would not have another opinion-change on abortion rights.
  • Sue Thayer, a voter for who her candidate’s anti-abortion stance alone was sufficient to earn a vote saw Trump’s presidency as the best chance to overturn Roe v. Wade.

Some reactions from dissenting NGOs

  • As a rights-based health organization that seeks to protect and enhance the lives of women, men and young people throughout the Americas and Caribbean, IPPF/WHR will not sign a policy that denies human rights and puts the lives of women at risk”, confirmed the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR).
  • Marie Stopes International which receives USAID funding said it would withdraw from the partnership with USAID – Although we use USAID funding exclusively for voluntary contraception services, agreeing to the conditions of the Mexico City Policy would restrict us from providing abortion services using other funding, in countries where they are permitted. It would even restrict us from talking to women about abortion. This goes against our core principles as an organization, and therefore we will not agree to the conditions of the Mexico City Policy.

The group estimated that the consequence of implementing the Global Gag rule and unavailability of alternative funds could lead to 6.5 million unintended pregnancies, 2.2 million abortions, 2.1 million unsafe abortions, 21,700 maternal deaths and $400 million in direct healthcare costs up to 2020.

  • Debra Hauser, President of Advocates for Youth said, “It is beyond comprehension that after women marched in the streets in more than 600 cities across the U.S. and the world this administration chose to reinstate the Global Gag Rule on one of its first days in office, forcing health care providers working in developing countries to choose between receiving U.S. global health assistance and providing comprehensive sexual and reproductive health care”
  • Kalpana Apte, secretary general of Family Planning Association of India (FPA) said, “We use different streams of funding to carry out comprehensive health programmes that include many non-abortion schemes too. All of this is going to be impacted if the US decides to pull out funding.

Mark Joseph Stern, writing in Slate, uses examples of previous Supreme Court rulings to point out why a significant part of this rule may be unconstitutional.

  • In the Rust v. Sullivan decision, the Supreme Court clarified that while the Congress had a right to control how it wanted its funds to be utilized by recipients, it could not dictate how these NGOs chose to use funds from other sources.
  • This clarification was reinforced in a 2013 landmark ruling in which the Supreme Court declared that the Congress, by mandating NGO beneficiaries of federal funds to enforce an explicit anti-prostitution policy – which would prevent NGOs from using funds even from other sources to advocate for the decriminalization of sex work – was violating the first Amendment; it was imposing curbs on the organizations’ free speech rights and forcing them to promote the Government’s view.
  • Stern points out that Trump’s global gag rule prevents a recipient organization from talking about abortion even on “its own time and dime.” By gagging an organization to prevent its fundamental right to use money independent of US funds to mention abortion, the rule’s implementation amounts to a violation of the first Amendment.

Sheryl Sandberg, COO of Facebook voiced her opinion: “The last time the global gag rule was in effect, research showed more women who lost access to contraception had unwanted pregnancies and abortion rates doubled. The best way to prevent abortion is through more family planning services, not fewer.” She also pledged her support to the HER Act.

Pope Francis seems to have chosen silence so far.

How is the polarization on abortion complicated?

  • Opinions extend over a wide spectrum between 100 percent pro-choice and 100 percent anti-choice. As of 2015, surveys show most Americans are fine with abortion in the first trimester of pregnancy but oppose it in the second and third trimesters. Most support it in case of rape or incest but are against it when a woman feels another child will bring in unmanageable financial stress.
  • There is ambiguity in people’s opinions. Karlyn Bowman, who studies public opinion at the American Enterprise Institute told NPR how opinions were deeply contradictory, depending on how the question is phrased – “When people are asked, " 'Is it murder ' people say yes," Bowman said. But if asked, “‘Should it be a personal choice between a woman and her doctor ' a large majority say yes."
  • Matthew Gentzkow of Stanford University conducted an analysis of data to infer the nature of polarization in general in the US last year. The conclusion was that while it can be said most Americans don’t take either of the extreme stands on issues like abortion, they make single-peaked choices and are less likely to prefer choices further away from their own. While this observation can be fairly generalized, a worrisome trend that has emerged is not only an obstinate insistence that one’s own choice is best but increasing intolerance to others opinions. As Gentzkow puts it, “We don’t see those on the other side as well-meaning people who happen to hold different opinions or to weight conflicting goals differently. We see them as unintelligent and selfish, with views so perverse that they can be explained only by unimaginable cluelessness, or a dark ulterior motive.

Manipulation by political parties

  • Abortion is one issue in American politics that has been made more divisive and been used as an excuse to espouse fanatical opinions over the past four decades. Francis Wilkinson wrote in Bloomberg of the splitting up of two factions – Republicans and Democrats – over abortion and the strengthening of each as activists on both sides joined the party that aligned with their choice. He quoted political scientist David Karol – “Once inside the party they reinforced its new position, producing further polarization and forestalling backsliding.” This shift had its origin in Richard Nixon’s anti-abortion stance to woo Catholics.
  • As it became increasingly apparent that a Democratic Party member would be pro-choice and a Republican member the opposite, the same extended to the public as well – voters aligned their views on abortion with that of party members.
  • Despite the fairly stable view on abortions per se, politicians are said to use abortion as one of the top issues to motivate, fundraise and organize. As Republicans realized in 2015, that by bringing in topics like taxpayer money used by Planned Parenthood, they are able to draw support for their extreme anti-abortion stance.

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Tags | abortion debate Global Gag Rule