The Handmaid's Tale Comes to Life (and Death)

Shortly before the Senate approved its version of health care reform legislation, I quiped that I was re-reading Margaret Atwood's The Handmaid's Tale in order to get psyched for the vote. Truthfully, it was only partly said in jest.

Shortly before the Senate approved its version of health care reform legislation, I quiped that I was re-reading Margaret Atwood's The Handmaid's Tale in order to get psyched for the vote. Truthfully, it was only partly said in jest.

The hijacking of abortion rights as a bargaining chip for the
provision of health care is morally reprehensible and if it stands will
result in significant harms to women's health. As women's health advocates
are working full tilt to try to stop this from happening, there is an
uncomfortable sense of having been here before. How is it possible
that we have to fight for the right to choose to have an abortion all
over again?

Blasphemous as it might sound, I think that part of the problem is the word choice, which sounds ever so frivolous compared to the right to life.
We're not deciding which pair of shoes to buy. We are fighting for the
human right to make decisions about our own lives. Full stop. As M. Gabriela Alcalde, Director of the Kentucky Health Justice Networktold me in an e-mail correspondance,

We should stop talking about the morality of individuals
and think about the morality of not providing necessary health care to
individuals and communities. Government's job is to worry about
systems working, government's moral obligation is to assure that groups
or classes of people are not excluded from society's benefits or carry
disproportionately society's burdens. Abortion is necessary when seen
from a public health perspective. In countries where it is illegal,
maternal mortality is higher, infants are abandoned at higher rates
(look at Romania), and overall maternal and child health is compromised.

Just as critically, we need to not lose sight of the fact that
abortion is only one aspect of reproductive rights. There are many
other aspects to women's health care in addition to abortion that need
to be assured. According to Alcalde,

Abortion should not be thought of separately from
prenatal care, birthing, and other reproductive and maternal health
services and experiences. separating it from the experience of
pregnancy in general is a huge mistake.

As I've noted before, according to the National Women's Law Center,

Maternity coverage continues to be largely unavailable
in the individual health insurance market, with virtually no
improvement in access to this essential health coverage from 2008 to
2009. NWLC examined over 3,600 individual health insurance policies
offered to 30-year-old women living in capital cities across the
country for 2009, and found that only 468 of those plans-or 13%-include
any coverage for maternity care.

also notes that only the current House bill prohibits the treatment of
domestic violence as a pre-existing condition and that there are still
very significant concerns about the affordability of health care which
is more likely to impact women, who earn less than men and are less
likely to be covered through an employer.

While these are the primary issues that are on the table in regard
to the current legislation, the reality is that there are other
significant women's reproductive health issues that need to be

In, "Sowing The Seeds Of Reproductive Justice In Kentucky" (Collective Voices, Fall, 2009), Alcalde points for instance to problems faced by Latina women,

Some reproductive health challenges that Latinas face
once in the U.S. include a high uninsured rate, low prenatal care rate,
high and rising HIV/AIDS rates, high maternal mortality rate, high
cervical cancer rate, and a high unintended pregnancy rate.
Additionally, Latinas have a lower contraceptive use rate and have a
higher contraceptive failure rate than other groups of women in the

Other issues that come to mind include the high c-section rate in
the U.S., affordable contraception on campuses and access to rape
crisis and abortion services in the military, and the insistence in
many parts of the country on the use of doctors (inevitably in high
cost hospital settings) instead of midwives to deliver babies.

One of the critical mis-steps in the health care debate was the
reduction of the issue to one of insurance coverage rather than health
care provision. In regards to women's health, additional damage has
been done by allowing abortion to be addressed separate from the
overall issue of reproductive health.

In "How To Talk About Reproductive Justice" (Collective Voices, Fall, 2009), Loretta Ross
provides a useful framework for a more comprehensive solution when she
defines reproductive justice as, "the right of every human being to
have a child, not have a child, and parent a child."

We need to insist that abortion not be held hostage, nor can we
allow it to be split apart from the right to full reproductive health
rights for all women at a fair and equitable price. That abortion is
being used as a bargaining chip for these basic human rights is a bald
effort to control women's lives and is unacceptable.

To fully understand this patriarchal power play, it is useful to
look at the current health care reform debate from a global context.
These are but a few examples:

1. While the population control drumbeat gets louder as we become
more aware of the implications of climate change, it bears recognition
that we are very callously already practicing exactly that by the
denial of the relatively small amounts of money
that it would take to eradicate maternal mortality which claims the
lives of more than half a million women every year throughout the world.

"Every hour of every day in DRC, four women die from
complications of pregnancy and labour, and for every woman who dies,
between 20 and 30 have serious complications, such as obstetric
fistula, which is very common in DRC," said Richard Dackam Ngacthou,
country representative of the UN Population Fund (UNFPA). For every
100,000 live births 1,100 women die, he said.

But to meet a national target of reducing the number of women who
die in childbirth by 75 percent and to provide all Congolese with
access to contraception - in line with the UN Millennium Development
Goals - new funding targets must be achieved.

The funding gap is severe: in 2008 some US$5 million went towards
the fight against maternal mortality, whereas in 2009 less than $2
million was allocated. Congo's 2010 budgetary situation is no less
dire, with only around $6 million planned to finance the entire health
sector, where some $60 million would be warranted, according to a
member of parliament.

2. In South Korea a new policy is effectively coercing women into having children:

On Dec. 9, Sungshin Women's University in Seoul
organised an event titled, 'Happy Childbirth - Rich and Strong Future',
aimed at trying to raise awareness about the country's very low birth
rate. It sparked controversy when the organisers requested women
students in the audience to submit a sworn statement that they would
have children.

A fourth year student who prefers to remain anonymous, told IPS "the
organisers almost forced female participants to write a sworn statement
for childbirth despite many participants asserting that the low birth
issue is a social problem rather than mere individual choice."

South Korea's birth rate - 1.19 in 2008, according to the Korean
Statistical Information Service, is the lowest among OECD countries -
has been in the news recently.

In November, the government's Presidential Council for Future & Vision announced "comprehensive plans for low birth rate."

The plans include a crackdown on abortion.

3. And in countries such as China and India, there has been a systemic campaign of favoring the births of male children over females:

There are about 100 million women less on this earth
than there should be. Women who are "missing" since they are aborted,
burnt, starved and neglected to death by families who prefer sons to
daughters. This column had also identified the countries of South Asia,
East Asia, West Asia and Saharan Africa as the main regions which were
missing most of these women. The estimated number of women who are
missing are 44 million in China, 39 million in India, 6 million in
Pakistan and 3 billion in Bangladesh. This is the single largest
genocide in human history. Ever. Some researchers have coined a word
for this phenomenon: Femicide, or the killing of the human female
because she is female. (Note: see also here and here.)

Until we insist that it cannot be considered separate of the overall
issue of reproductive health, abortion rights will continue to be in
jeopardy. Health care, including full reproductive health care, is a
human right, not a commodity to be controlled or bartered away by the
governments we elect to represent us. Yet clearly that is exactly what
is happening not only here but in many parts of the world. Our current
reality is not so far from Atwood's dystopia as we might like to think.

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