Have we really made any progress? A look at reproductive rights around the world

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As Northern Ireland delivers a landmark decision on abortion, Stylist looks at the effects of restrictive reproductive rights around the world and why every woman deserves the right to choose

Words: Zoe Beaty

How many decisions have you made about your body today? From choosing what to wear and what to eat to taking medication or even deciding to have a baby. Every day, women in the UK make hundreds of choices about their bodies ranging from the seemingly inconsequential to irreversibly life-altering.

But what if that choice was taken away – or what if it was never even there to begin with? 

Last Monday, Belfast High Court delivered a ruling which could potentially change the lives of thousands of women in Northern Ireland: a judge deemed existing abortion laws in the country to be a violation of basic human rights. It might be just an hour away – a mere 21-mile ferry crossing – from England, but the realities for pregnant women in Northern Ireland and those for women in the rest of the UK are incomparable.

Current laws in the country are some of the most restrictive in the world, only allowing for terminations if there is proof of real or serious long-term damage to the physical or mental health of the pregnant woman. ‘Proof’ that is so difficult to obtain that just 23 NHS abortions took place there in 2013-14. The law is so stringent that women whose babies are too ill to survive the pregnancy are forced to carry around the dying foetus inside them until it passes away or until full term, then they are subjected to the trauma of stillbirth.

While seen as a landmark, the ruling still means that only some women are entitled to abortion – namely those who are pregnant as a result of a sex crime or whose unborn babies are suffering fatal foetal abnormalities (none of which have been allowed under Northern Irish law until now). Unlike in Wales and Scotland, the 1967 Abortion Act, which legalised abortion in England up to 28 weeks (this was later reduced to 24 weeks in 1990), was not extended to Northern Ireland. The penalty for illegal abortion is also among the harshest criminal punishments in Europe – a woman who has an illegal abortion, and anyone who assists her, faces life imprisonment if convicted. 

Extreme measures

Mara Clarke, who runs the Abortion Support Network, has seen first-hand the trauma this creates. “One woman who came to us was pregnant as a result of rape,” she explains. “She sold her car and cut off her landline but still didn’t have enough money to pay for an abortion. In that time she went to a rape crisis centre in Northern Ireland and was told that if she had an abortion then she was a worse criminal than the man who raped her – because he was just a rapist, and she was a would-be murderer. Other women, she says, contact her because they have medical issues that pregnancy could complicate. “It won’t cause them to die, but the pregnancy or birth could have an extremely detrimental effect on their health long-term, yet these women still don’t have the right to an abortion. Regardless, it’s a woman’s right whatever the reason.”

Many are driven to desperate measures. “A mother-of-four told us she was trying to figure out a way to crash her car to cause a miscarriage, but not permanently harm herself or die,” says Clarke.

A long way to go

Alarmingly, even this small step towards reform has been months in the making. Last week’s decision was the result of a challenge to the Department for Justice brought by the Northern Ireland Human Rights Commission (NIHRC) and backed by Amnesty International, which was presented almost six months ago, in June, during a three-day hearing. 

As in many countries where abortion is illegal, the issue in Northern Ireland is shrouded in religious contention – Christian pro-life movements believe a foetus has as much right to life as the woman carrying it – and, as such, veiled by harmful stigmas. Women attending appointments for abortions regularly face pro-life protesters positioned outside clinics (the Marie Stopes clinic in Belfast is heavily targeted), subjected to online abuse and shamed into silence. Each year 5,000 women are thought to travel overseas from Northern Ireland and the Republic of Ireland, often to mainland Britain, in harrowing, often financially difficult conditions, to seek terminations. Since 1970, 60,000 women have travelled to England – the majority of them to private clinics in Liverpool or Manchester – for private abortions.

With Northern Irish women denied NHS treatment, the financial repercussions can be debilitating: costs of flights and a private clinician can soar into the thousands. Many women simply cannot afford to travel and risk their health by buying abortion pills online.

“It hits the poorest women hardest – it’s an economic issue, as well as social and religious,” explains Clarke. “Women come to us for so many reasons. They come to us because they are pregnant after being raped, or have been advised of fatal foetal abnormalities. But equally, they may just not be in a position to have a child – or another child – at this point in their lives. In the past, we’ve seen women selling their children’s Christmas presents and rationing their children’s food to save money for an abortion.”

While last week’s ruling could be the first step towards liberating women from these dangerous situations in Northern Ireland, as Stylist went to press, a judge was still deliberating whether it would be possible for the existing law to be adapted to reflect the ruling. 

But the fight is far from over: any parties opposing the case still have five weeks to appeal (and potentially overturn) the decision. And, even if the ruling is upheld, there are still many questions left to be answered on how far it will go to help women: will a woman who has been raped be believed? Will she be subjected to a court process and, if so, how long will that take? Crucially, what’s next for the thousands of women in Northern Ireland who have not been raped, and whose foetuses are healthy – but who deserve the very basic human right of having autonomy over their own bodies? As Clarke says, “If this law comes into effect, it’s only going to help a very small percentage of women who want abortions.”

Global Issue

It’s a similar tale of disempowerment for millions of women the world over. Earlier this year, Amnesty International launched a campaign to stop the Iranian government bringing in legislation to ban women from using contraception. And the Catholic Church still officially prohibits contraception – something Pope Francis highlighted during a speech in the Philippines last year (where the country’s Supreme Court had just approved a decision requiring the government to provide access to contraception for the first time).

But the issue of abortion, of which 42 million take place globally, is perhaps the most controversial. More than 40% of women around the world aged 15-44 live in a country where abortion is highly restricted, according to research by the Guttmacher Institute. And it’s closer to home than you think. In the Republic of Ireland, women face 14 years in prison if they have an abortion, unless they can prove their life is in danger. Even then, the story of Savita Halappanavar, who died of multiple organ failure after being refused an emergency termination in October 2012, shows that’s not always upheld. Despite the fact that she had begun to miscarry, doctors would not abort the foetus. It led to blood poisoning, which eventually killed her. Her death prompted national outrage and the enactment of the Protection of Life Bill 2013, which allows women to undergo abortions if their lives are at risk (including by suicide). 

In El Salvador (one of five countries in the world – including Chile, Nicaragua, Vatican City and Malta – which does not allow abortion under any circumstances), an estimated 628 women have been imprisoned since the law was implemented in 1998. Today, 19 women are currently behind bars, serving sentences of up to 60 years for “aggravated murder” after having an abortion. One 24-year-old woman was sentenced to 30 years’ imprisonment after she was taken to hospital with stabbing pains in her stomach. She suffered a miscarriage due to obstetric problems, but was accused of inducing abortion. She is still in prison today. Doctors who find evidence of abortion must report patients to the police, even if the women are in need of medical attention after desperately self-inducing a termination, which is the second highest cause of maternal death in El Salvador. Some women have been handcuffed to their beds while they are treated.

Argentina has long denied women access to contraception, leading to high rates of unwanted pregnancies being aborted, and – since abortion is only allowed in the case of pregnancy as a result of rape – many of these terminations are illegal. In Nicaragua, a ban on abortion was introduced in 2006, overruling an 130-year-old policy allowing abortions in life-threatening circumstances. 

Malta remains the only EU country to ban abortion with no provisions to save a woman’s life if pregnancy has put her in danger. In Africa, approximately 26,000 women die each year due to restrictive, unsafe abortions and in the US, from 2011-2013, 26 states passed over 111 pieces of legislation restricting abortion. 

Laws prohibiting abortion do not even succeed in lowering abortion rates – in fact, the opposite is often true. The Guttmacher Institute found that, in Africa, where abortion is largely outlawed, 29 in every 1,000 women of childbearing age had undergone abortion yet, in Western Europe where abortion is chiefly legal, it drops to 12 in every 1,000 women. 

By restricting women’s options, laws banning abortion often force them into dangerous, potentially lethal situations. Around 20 million abortions a year are performed by unskilled or untrained individuals in unhygienic or unsafe places. As a result, an estimated five million women a year are hospitalised due to abortion complications – with 68,000 deaths and millions more left with permanent health problems, according to the World Health Organisation. 

It’s a figure that, unless countries like Northern Ireland modernise their legislation, will only get worse. Restrictions on reproductive rights – from abortion laws and connotations of Early Forced Marriage (EFM), which affects 15 million girls worldwide, to the effects of Female Genital Mutilation (FGM), which 130 million women worldwide have been subjected to – disproportionately harm women. Each experience is fraught with its own complexities: emotional upheavals, sadness, regret, relief and freedom. For some it’s followed by imprisonment or threats, often illness, sometimes death. 

And even women who haven’t been directly affected by reproductive rights restrictions aren’t exempt from their repercussions. Because having choice is the most powerful thing we have – and until women are afforded the right of having autonomy over their own bodies, we can never achieve true gender equality. As Hillary Clinton said, “Human rights are women’s rights, and women’s rights are human rights.” No-one, wherever they are, should be denied theirs.

When abortion was made legal in different countries

The Soviet Union: 1921
The first country in the world to legalise abortion for reasons other than to preserve the life of the pregnant woman but the law was then repealed in 1936, when abortion once again became illegal. In 1955, the original law was reinstated.

UK (excluding Northern Ireland): 1967
There are, however, a number of conditions which are still imposed to this day: the pregnancy must be shown to cause emotional or physical damage to the woman and the termination must be signed-off by two doctors, though in practice, few doctors would deny a woman an abortion if she requested one.

USA: 1973
In a landmark case, the US Supreme Court ruled that forbidding abortion was unconstitutional. Since then, however, several states – including Kansas, Virginia and Louisiana – have introduced laws which strictly prohibit a woman’s access to abortion (for instance, in 20 states, by law, a woman’s national medical insurance is not allowed to cover the cost of a termination).

China: 1979
Terminations are offered on-demand and without the need for any third-party (doctor or state) intervention as part of the national policy regulating the number of children a woman is allowed to have.

Belgium: 1990
Before being granted a procedure a woman must adhere to a six-day waiting period and prove that she is in a “state of distress”.

Colombia: 2006
An abortion can be performed only in cases where the mother’s life or physical health is in danger, in cases of rape or incest, or in pregnancies involving fatal or life-threatening foetal abnormalities. Before 2006, all abortions were illegal.

Spain: 2010
Though abortion was legalised in 1985, it was restricted to cases of rape or physical damage to the mother or child. Since 2010, women have been allowed to request an abortion up until the 14th week of pregnancy.

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