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 Network told 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.
NWLC 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 addressed.
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 U.S..
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.