My Gender Across Borders piece on the Gates Foundation’s problematic failure to address abortion issues in their sexual and reproductive health funding strategy has been quoted in an On the Issues article by a friend and respected colleague, Marcy Bloom.   In her powerful piece, titled Health Inequality: Gates Foundation Bans Abortion, Ms. Bloom calls unsafe abortion a form of violence against women and scoffs at the idea that the Gates Foundation can remain “neutral” on the issue of abortion.  An excerpt is below, full article available here.

Bill and Melinda Gates are undoubtedly aware of these realities of women’s unequal lives. The end result of their “neutrality” is but one choice for women and girls who become pregnant. That one choice equals no choice.

Allowing the further stigmatization of abortion validates and strengthens the belligerent anti-choice movement.

But the power and influence of the foundation go further. Because of its prestige, size and assets, the foundation is central to “setting the sexual and reproductive health and rights agenda around the world,” in the words of policy researcher and writer Brook Elliott-Buettner in Gender Across Borders.

Whatever the intent, the Gates Foundation is establishing, even distorting, the direction of investments by other foundations, individuals and even governments. Although Bill and Melinda Gates have the right to spend their money as they wish, it is also true that their inordinate power in determining universal health agendas demands accountability.

The Sexual and Reproductive Health and Rights Situation Report is a monthly column I write for Gender Across Borders.

This month’s column focuses on so-called “reproductive tourism,” the growing trend of women in the U.S. finding gestational surrogates in India.  Gestational surrogacy is the practice of implanting a fertilized egg in another woman’s uterus.  Through the miracle of modern science and hassle-free air travel, western women are traveling to India, where the medical infrastructure is good and most of the doctors speak English, to find a surrogate to carry their baby.  Medical tourism has been around for a while, complete with travel agencies that set you up with the doctor and the spa/hotel where you’ll recoup after your nose job.  This new twist, however, brings up a lot of problems.

In the U.S., the surrogacy process can cost up to $100,000.  In India, it’s a steal at about $12,000.  The old familiar argument is that the women who serve as surrogates benefit from the payment they receive.  According to a Marie Claire feature story on the practice, the $5,000-$7,000 each pregnant woman is paid is equivalent to 10 years salary for rural Indians.  Women serving as surrogates quoted in the story were often using the money to improve their own children’s chances at a good life.  One woman says she now has “a chance to make good marriages for my daughters,” and another that she is working as a surrogate only to pay for the expensive medical care needed by her 8-year-old son who has a heart defect.

Human Rights Watch has a webby-nominated video on maternal death in India, and a Center for Reproductive Rights advocacy document highlights maternal mortality as a human rights and gender equity issue.  The shocking stats on maternal mortality in India, which I’ve written about before, are another powerful reminder of the context in which Indian women choose to be surrogates.  For many women without expensive medical care paid for by a rich couple, pregnancy and childbirth are a potentially life-threatening proposition.

The problem is not surrogacy itself- it’s the issue of consent and exploitation.  Poor women are being pushed by  circumstance into paid pregnancies.  In a three-part series on surrogacy for RH Reality Check, Karen Smith Rotabi writes, ”poverty is coercive and the fertility choices that are made, on both sides of the global surrogacy arrangement equation, will be determined by both economic opportunity and oppression.”  The series examines the intersection between surrogacy and trafficking.

It’s difficult and ethically wooly to pay a woman to carry your child for the same reason that it is problematic to pay for organ donation; the same reason that bioethics rules limit financial compensation for people that participate in medical research.  According to the National Institutes of Health, payment could create “undue incitement” for people to participate in research that is “against their interests,” “obscure the risks,” and would preferentially attract “poorer populations.”

A number of prospective parents have expressed that it is too difficult to find a woman willing to be a surrogate in the U.S. or the U.K.  Maybe that’s because pregnancy is hard, and you’d have to be pretty poor or desperate to go through it to make a baby for someone you’ve never even met.  The Indian women profiled in every story I read on gestational surrogacy were just that– desperate to lift themselves and their families out of extreme poverty, and concerned about the future of their own children.  And many of the women who work as surrogates have to hide what they’re doing from their families or communities because it’s frowned upon and even seen as a “peculiar form of prostitution.”

This video report from Australia gives a peek into the lives of the women working as surrogates as they wait the nine months for the babies to be born.  They’re often separated from their families so that they avoid things like second-hand smoke and sex with their husbands, and many clinics house them in dormitories or hostels.

The baby business is booming.  The number of clinics in India offering surrogacy hastripled to 350 in the last five years.  The sector is predicted to generate $2.3 billion a year by 2010.  There have been a few high-profile cases of legal problems, and the Indian government is attempting to tighten the legal framework for surrogacy.  The Assisted Reproductive Technologies (Regulation) Bill is currently in draft form and would include restrictions on selling gametes, zygotes or embryos, and would explicitly lay out the “rights and duties” of surrogates and donors as well as the rights of the child.  The problem of “commodification of female reproductive organs,” as Rafia Zakaria puts it on the Ms. Blog, remains.

I’ll close with a quote from an Indian feminist sister.  Ranjana Kumari, president of a coalition of NGOs working on women’s issues, says in the Wall Street Journal, “They are using the vulnerability of the poor.  Making (a woman) a child-producing machine is not acceptable.”

I’m very excited to see that the International Planned Parenthood Federation (IPPF) has pulled from my recent column on abortion in Kenya for a News Room article.

Here it is.

From the article:

Religious leaders campaigning against the Proposed Constitution have come under criticism from a global organization for their stand on abortion.

Ms Brook Elliott Buettner has accused the clergymen of favouring the life of the unborn child over that of the mother.

….

Buettner, a social justice worker and freelance human rights policy researcher, points out that 15,000 women die annually of pregnancy-related complications and more than a third in unsafe abortion.

“Maternal mortality rates in Kenya are among the world’s highest. Direct medical causes for maternal death include haemorrhage, infection, obstructed labour and unsafe abortion,” she cautions.

Because of it’s relative stability, Kenya is a popular travel and study abroad destination, and has loads of international players working there– including USAID.  Contraceptive prevalence in Kenya hovers around 30%, and the fertility rate is between 4 and 5 children per woman. Maternal mortality rates in Kenya are among the world’s highest; a Kenyan woman has a 1 in 39 lifetime risk of dying because of pregnancy or childbirth.  Something like 15,000 women a year die this way– more than a third from unsafe abortion. Direct medical causes for maternal death include hemorrhage, infection, obstructed labor, and unsafe abortion.  As in all poor countries with high maternal mortality rates, the severity of these problems is driven by social factors.  In Kenya, health systems are lacking and infrastructure issues make it difficult to access existing resources.  Moreover, women often lack decision-making power during the entire spectrum of their reproductive lives.  Abortion is illegal, heavily stigmatized, and responsible for the deaths of thousands of Kenyan women every year.According to the Center for Reproductive Rights‘ report, “In Harm’s Way: The Impact of Kenya’s Restrictive Abortion Law,” 2,600 women die every year in Kenya due to complications from unsafe abortions.  More than half of them never sought medical care.  The in-depth report includes powerful stories of women denied the right to choose, including 14-year-old Sarah, who lost her life due to complications from an unsafe abortion; too afraid to go to a doctor as she suffered from a raging infection ” because of the risk of arrest and the fear of community condemnation.”  Make sure you watch this compelling video on the subject from CRR.After my piece last month criticizing the Gates Foundation’s refusal to fund abortion services, it’s interesting to note that the Foundation has recently announced that it will fund (to the tune of $23M) a family planning program in Kenya run by Johns Hopkins’ Jhpiego.  Jhpiego’s expertise lies in strengthening health systems, and the Gates-funded program seeks to ”meet Millennium Development Goal 5 to reduce maternal mortality by increasing women’s access to and use of RH services…”  by shoring up public and private service delivery methods.  Jhpiego also works with USAID in Kenya on the Maternal and Child Health Project.  It’s worth noting that none of these programs specifically fund abortion services.With CRR’s report and an upcoming constitutional reform process, abortion has been brought to the forefront of the discussion on maternal mortality in Kenya.  Conservative religious leaders are campaigning for a “total rejection of the draft constitution” because it wouldn’t explicitly define life as beginning at conception.  I’m baffled again by the one-sidedness of trying to protect fetal life while turning a blind eye on the thousands of women who die seeking abortions every year.  As CRR’s report points out, making abortion illegal doesn’t make it less prevalent, just more dangerous.In Kenya we again see the imposition of draconian social ideas about women’s role and worth, institutionalized in the form of policies and systems design, causing the needless deaths of thousands of women.  This is why we are global feminists- all over the world women are so lowly-valued that we lose our lives by the millions.  It must stop.

This is a cross-posting of a monthly column I write for Gender Across Borders devoted to international policy issues and current events around these critical rights called the Sexual and Reproductive Health Situation Report.

Ban Ki-moon and Melinda Gates discuss maternal health at Women Deliver. Care of AP.

At last week’s Women Deliver conference, Melinda Gates announced that the Bill and Melinda Gates Foundation would devote $1.5 billion to maternal and child health over the next five years.  They will not, however, fund abortion services.  Gates said in her remarks that she couldn’t imagine being denied the “basic right to decide how many children to have.” she also said that the Gates Foundation would focus it’s efforts “upstream,” explaining that with proper family planning abortion will not be necessary.  I don’t even think I have to address that little doozy, but if you’re interested, Columbia’s Gender and Sexuality Law Blog does a good job of taking on the problematic nature of that reasoning.

The Women Deliver Conference is part of  a swelling tide of awareness about maternal health.  Access to safe abortion is one of Women Deliver’s “Three Core Strategies to Save Lives.”  In the broader conversation, however, there is rarely an explicit recognition of the role of unsafe abortion in maternal mortality.  Because of the politicization of a public health issue, a major factor contributing to the deaths of hundreds of thousands of women every year is swept under the rug.  As The Lancet’s editor, Dr. Richard Horton, pointed out in response to the Gates Foundation’s pledge, “unsafe abortion contributes to one in seven maternal deaths across the world.”  Sadly, international donors are being allowed to turn  their faces from the issue because it is politically difficult.

The Gates Foundation’s decision not to fund abortion services goes beyond the simple failure to address a critical component of sexual and reproductive health.  The Gates Foundation, like US AID, is powerful and big enough to influence the global agenda.  If agencies that provide abortion services cannot get funding from a major funding body like US AID, some are forced to stop providing abortions so that they won’t be forced to close their doors.  This impacts the shape of the global health infrastructure by shoring up certain areas and allowing others to fall to the wayside.

This announcement is being called a “change in direction from funding specific vaccines and the fight against particular diseases,” specifically HIV/AIDS, tuberculosis and Malaria.  Several years ago, the Gates Foundation made a strategic decision to change their focus from building human capacity in the health sector.  I was working for a Gates-funded fellowship program at the time, which brought mid-career reproductive health professionals to the University of Washington for a year of study and research.  The year I worked for the program, we were invited to the Gates Foundations offices to hear about the foundation’s new strategic direction.

They talked about focusing on technologies like vaccine delivery, especially given their roots in technology, as their value-added.  I felt sad that the fellowship would end, but only grasped over time the impact of the change in direction.  When a power-player like Gates focuses on a particular issue, the rest of the world has no choice but to get on board.  NGOs all over the globe have shifted their programmatic focus toward projects that will be funded.  And while the causality is arguable, the brain drain of health professionals continues to decimate many countries’ ability to respond to health crises like maternal death.  I have seen many organizations shift their focus to HIV/AIDS projects to the detriment of other program areas because of the tremendous quantities of money available through the Gates Foundation.  In the case of a foundation as big as Gates, there is no such thing as value-added; its game-changing.

Gates’ and others refusal to fund abortion services also serves to create a separate silo for abortion, removing it from it’s rightful spot as one part of the suite of necessary services that make up holistic sexual and reproductive health care.  By categorizing abortion as different and separate from other services like prenatal care and birth control, it’s naturally going to get cut out of strapped projects.  It’s like putting an abortion rider on your health insurance plan– it sounds OK in theory to have abortion services funded separately but in reality you end up with abortion services getting shoved off the agenda and out of the clinics, and women continuing to die from the effects unsafe abortion procedures.

These deaths are preventable (when performed properly abortion is one of the safest clinical procedures available).  These are women lost because the international community has allowed ideology to trump health.  With its size and budget, The Gates Foundation wields tremendous agenda-setting power in the realm of global health.  And by removing abortion services from its equation, it will cause a ripple effect that will create the conditions for even more wholly preventable deaths over the coming years.

This is a cross-posting from a column I write for Gender Across Borders on sexual and reproductive health and rights policies and issues worldwide.

Abortion has been illegal in the Republic of Ireland since the so-called “Offenses against the Person” Act of 1860, and legislation has become increasingly restrictive over time.  Irish women now face life in prison if they have abortions, and the fetus is protected in the Irish constitution.  

There is a provision in the law for risk to the woman’s life, or if (in an astonishingly paternalistic twist) the woman can prove she is suicidal.  Recently a 16-year-old won a Supreme Court case allowing her to travel to England to abort an anecephalic pregnancy– a disorder in which the fetus is missing part of the brain and skull and would not survive more than three days outside the womb.

While there is strong, mostly Catholic, anti-abortion sentiment in Ireland, most people there do support at least some form of legalization of abortion.  And the need is there– About 7,000 women a year travel to England, where abortion has been legal since the sixties, at personal expense.  This means that once again abortion is effectively unavailable to poor women, sometimes forcing them to risk their lives with clandestine providers.

Three women are challenging the repressive law before the European Court of Human Rights (ECHR).  With the support of the Irish Family Planning Association and the British Pregnancy Advisory Service, A, B, and C are claiming that having been forced to travel to the UK to receive abortion services “stigmatised and humiliated.”  They’re arguing that the Irish law violates their rights to privacy and family life, rights protected under the European Convention on Human Rights, specifically he Articles 2, 3, 8 and 14 of the Convention: the right to life, the prohibition on torture, the right to respect family and private life, and the prohibition against discrimination.

The women have chosen to remain anonymous, and with good reason.  Not only are they at risk of imprisonment under the law, they would also undoubtedly become the targets of other Irish citizens.  The right in Ireland has resorted to nasty “baby-killer” rhetoric, and organizations which look suspiciously like “Crisis Pregnancy Centers” invite women in only to have them hold little models of fetuses and beg them not to murder their babies.

The right wing is successfully steering the conversation, and it’s not the only responsible party.  According to Human Rights Watch, the Irish government goes beyond endangering women’s lives through a legislative restriction, and has been spreading “grossly misleading information” on the nature and consequences of abortion.  Many have accused the government of uncomfortably close ties with the Catholic church, and the church has threatened ex-communication of any Irish public figures who support abortion.

The case before the Court is extremely significant for several reasons.  First, any time abortion comes before an international legal body it re-affirms the status of abortion as a human rights issue.  Second, Ireland may indeed need to re-think abortion law, as Poland has done in the wake of an abortion case recently heard by the ECHR.  Finally, each case that comes before the ECHR strengthens the imperative for liberalizing abortion law around the world, and builds jurisprudence on women’s right to decide under international law.

Interestingly, the Irish government is focusing it’s defense of the law around two key areas: the old “morality” bugaboo, and the implications of a ECHR decision for state sovereignty.  This tack fails to address the actual merits of the case, implicitly recognizing that it is very difficult to make a cogent case against a woman’s human right to access reproductive health services, including abortion.

I am hopeful that the Court will rule in favor of A, B, and C, and for the ongoing health and autonomy of Irish women.  I am also hopeful that the Court’s decision will prompt cases from other countries with repressive abortion policies and the liberalization of abortion law all over the world.

I have been working with Fran Luck, one of the co-hosts of WBAI’s feminist program, Joy of Resistance, on news stories for several months.  Archives of the stories are available here.  The following is a suite of coverage on reproductive health setbacks- one story on Canadian foreign aid and updates from several U.S. states.  The stories ran Thursday, April 1, 2010.

This is a cross-posting of the Sexual and Reproductive Rights Situation Report, a monthly column I write for Gender Across Borders. 

Since the devastating  7.0 earthquake shook Haiti on January 12, 2010, Haitians have dealt with shortages of basic needs like water and food; flooding; and even churchy American do-gooders coming for their children.  As in any humanitarian crisis, the women of Haiti have been struck harder and in different ways than men because of existing inequality and gender disparities.   As the humanitarian community continues to formalize and learn from its major challenges, it is paying increasing attention to women’s rights and gender issues in the post-disaster setting.  I’m going to focus more specifically on women’s reproductive and sexual rights and the ways in which they are threatened in humanitarian crises.     

 The situation for reproductive health in Haiti was already dire before the earthquake.  The country had the highest maternal death rates in the region by far, with 670 of every 100,000 deliveries resulting in the death of the mother, according to the United Nations Population Fund (UNFPA).  This PBS documentary, available on Family Care International’s website, chronicles the tragedy of maternal death in Haiti, pre-quake.  The 63,000 pregnant women in Haiti when the earthquake struck are at even greater risk in the aftermath of the disaster.  According to CARE, a humanitarian relief and anti-poverty NGO active in Haiti, “breastfeeding mothers and young children are at greatest risk” after the quake.    Soon after the earthquake, Sophie Perez, CARE country director in Haiti, said:     

There are a lot of pregnant women in the streets, and mothers breastfeeding new babies.  There are also women giving birth in the street, directly in the street… the situation is very critical.

Pregnant women and other vulnerable populations may be less able to fight for scarce resources, and their unique health needs may not be met.  There are many sexual and reproductive health issues that are intensified in a humanitarian crisis.     

 Although each disaster is unique, the humanitarian community, including NGOs, government agencies and multilaterals, has begun to attempt to learn from previous disaster response efforts to improve upon outcomes.  After the earthquake in Haiti, dozens of NGOs coordinated to write a letter to Secretary of State Clinton and the head of USAID encouraging a gender perspective in the US’ relief efforts, and pointing to the lessons learned and documented in a seminal document- the Gender Handbook in Humanitarian Action.    

In the last decade, several working groups on reproductive rights in post-conflict and post-disaster settings have formed, including the Inter-agency Working Group on Reproductive Health in Crises.  One of its theoretical initiatives is something called the Minimum Initial Service Package (MISP), which sets out to prioritize interventions at the outset of a humanitarian crisis to maximize positive reproductive health outcomes.  The Inter-agency Working Group is advocating for the MISP to be “provided within the context of other critical priorities, such as water, food, cooking fuel, and shelter,” which emphasizes the basic nature and life-or-death importance of reproductive health services.   

Another such group is the Reproductive Health Response in Conflict Consortium (RHRC Consortium), made up of academia and NGOs including the Women’s Refugee Commission.   Much of the work on gender in humanitarian crises is based on work that these and other agencies did on the reproductive health issues for refugees and displaced persons; many of the issues are the same.   Here’s a video from the Women’s Refugee Commission on the reproductive health situation in Haiti since the earthquake:     

RHRC Consortium released a statement following the Haiti earthquake demanding that disaster response address the health needs of women and girls.  The statement brought up a number of sexual and reproductive health issues in the post-disaster period that I hadn’t thought of before.  In addition to the needs of pregnant women and new mothers, a holistic view of sexual and reproductive health includes access to contraceptives, responsive treatment for survivors of sexual violence including emergency contraception and post-exposure prophylaxis for HIV, and continuity in ART therapies for HIV positive individuals. UNFPA and the International Research and Training Institute for the Advancement of Women (UN-INSTRAW) point out other issues including “limitations on accessing prenatal and post-natal care… greater risk of vaginal infections, pregnancy complications including spontaneous abortion, unplanned pregnancy and post-traumatic stress.”      

INCITE! Women of Color Against Violence explains in a statement on Haiti:    

Women experience the most negative consequences of catastrophic events, particularly with regards to higher rates of injury and death, displacement, unemployment, increased incidents of HIV rates, sexual and domestic violence, increased poverty, and the disproportionate responsibility for caring for others. This is especially true for women marginalized by race, sexual orientation, gender identity, class, health, ability, age, housing, and legal status.     

All of these issues highlight how existing vulnerability is magnified and intensified during a humanitarian crisis.  Women are already in a position of vulnerability due to the “interaction of biological and social risk factors.”  The World Health Organization (WHO) identifies among these risk factors gender roles, social taboos around menstruation and appropriate behavior for women and girls, existing economic and social marginalization and vulnerability to domestic and sexual violence.      

Although women’s lives and health are often threatened in the post-disaster period, they are a tremendous resource for reconstruction.  International women’s rights NGO MADRE, along with Haitian partner Zanmi Lesante, has written on women’s expertise and the marginalization of women’s experience in reconstruction.  ”When relief is distributed by women, it has the best chance of reaching those most in need.”  It’s also more likely that real reproductive health needs will be met.      

The issue of participatory planning is front-and-center these days as NGOs plan Haiti’s future.  Oxfam has been campaigning  to push world leaders to include Haitian organizations and voices in the decision-making process during reconstruction (sign on to the campaign here).      

The Gender and Disaster Network has summed up the need for an even more nuanced view of participation that includes populations often left out of the process in their Six Principles for Engendered Relief and Reconstruction.  First, they point out, Gender analysis is “integral to plan for full and equitable recovery.”  Part of engendering reconstruction is basing program development on the true needs of women, based on gender-disaggregated data, and not on stereotypes. 

They advocate working with grassroots women’s organizations- the women who know what needs to happen to create a more just society and ensure future resilience.  GDN also points out that the act of participation, based on a human rights approach, builds conditions for empowerment and develops capacity among women. 

If disaster is not to disproportionately endanger women and girls and further entrench their social inequality and vulnerability, women’s unique needs and perspectives must be respected, accounted for and implemented in every stage of the after-disaster process of response and recovery.    

Take action: Support International Planned Parenthood Federation‘s partner in Haiti, PROFAMIL, in rebuilding and providing reproductive health services; or the Global Fund for Women‘s Crisis Fund which will support Haitian women’s organizations as they rebuild.