Pregnancy and abortion

Ariel and I went to Slimbridge today on a whim and saw ducklings hatching!

We went into the duckling room first thing to admire the ducklings and there were two eggs in the hatchery (a little warm box where it is a little drier than the egg incubator, to help the ducklings dry out once hatched, where the eggs are moved once there are signs of life). They were apricot silver calling ducks, I think. They looked very much like the one pictured, although a bit less wet and straggly!

The two eggs were both intermittently rocking a little and one had a crack where the duckling had started chipping at the shell from the inside. Duckling Woman told us that it can take many hours, even a couple of days, for an egg to hatch and that they were in the early stages, but that if we checked back later we might see a little hole in the egg rather than just a slight crack. Apparently it takes a lot of effort to break an egg with a miniscule little “egg tooth” (not a tooth, just a sort of bump really) so they often have a few little sleeps while in the process of hatching out.

When we went back an hour or so later there was a third egg which had been brought in and it already had a hole in it! We could see movement through the hole, the little beak chipping away, and feathers, and we could even see the movement of the ducking breathing. Apparently, the little air sac inside the egg gets bigger as the duckling uses up all the nutrients in the egg. When the littl’un is ready to hatch, it starts by breaking into the air sac at which point it begins to breathe! From that moment, even before it is hatched, the duckling begins to cheep. We couldn’t hear any cheeping as the 5-day-old Laysan Teal ducklings (rarest duck on earth) on the other side of the room were very noisy. But apparently they cheep to one another as they are all hatching together and this encourages them, hearing one another, and maybe it also lets mummy duck know what is going on. Anyway, it was really cool and we watched it for a while, the two original eggs had both progressed a little – the one that previously just had a little crack, had chipped almost all the way around while the other which was just rocking before had got some cracks.

A drink and a snack in the cafe later and we decided to go back and see the ducklings on our way out. All the eggs had progressed a little bit and the “middle egg” was catching up, with a visible hole although not such a big hole as the third egg. We went over to see the ducklings and just as we were looking at them and talking to Duckling Woman, someone cried out “oh look it’s come out!” and we rushed over to see the duckling hatch. It was the middle egg which had obviously got a wiggle on and overtaken its more advanced clutch-mate. It had its head out but not its feet and we saw it wiggling around and coming out – very ungainly, but just amazing to watch.

There is a little yellow sac thing that comes with it – like a placenta?? – but otherwise the egg is empty. The duckling, once unfurled, was huge compared to the egg! We got to have a look at it later on and inside the egg you could see the blood veins which had nourished the littl’un before it hatched. Duckling Woman had told us to expect that the duckling would just collapse in a heap and snooze after the mammoth effort of hatching itself, but it seemed to have plenty of energy left – maybe because the “birth” was so unexpectedly quick and easy – and spent a while just crawling around and trying to get onto its feet, rolling its fellow-eggs around and trying to cosy up to its own broken egg (return to the womb??) It was fab!

After that Duck Man came in and had a look. The third duckling – the one everyone thought would hatch first because it was ahead of the others – by now was trying desperately to push out of the egg even though it hadn’t chipped all the way around the edge yet. It was just pushing and pushing. I think (in my anthropomorphic way) that it was annoyed at having been overtaken, and encouraged by the now much louder cheeps of its clutch-mate, and possibly annoyed at the fact that the duckling was rolling the egg around as it tried to get on its feet – no wonder it wanted to get out fast!

Anyway Duck Man came in and decided to “help” by breaking the shell open a little (impatient obstetrician! episiotomy now!) I don’t know if this is a good thing or a bad thing for the chick, and it didn’t feel right, to my wholly inexpert eyes, for him to interfere – however it had the unexpected advantage for we onlookers that we got to see the second duckling hatch as well. It came out within less than a minute of being “helped” and it too was completely amazing. It came out in one go, not head first and legs after like the first one – or legs first and head later like the cartoons…

Oh it was amazing! (Amazing!) I’ve gone on and on about this – I felt while watching it, so privileged and awed.

I kept relating it back to what I know about childbirth in terms of the length of the labour, the experience of the hatching bird / birthing child, the need for time and rest, and this probably coloured my reaction to Duck Man’s intervention. It was a thoroughly absorbing natural process and it was tainted somewhat by the intervention. But still.

What a surpisingly and wonderfully powerful experience: I was walking on air for a long time afterwards – it was a little moment of Joy.

The Guardian recently published an article, which I linked to and excerpted here, by George Monbiot claiming a clear link between sex education and contraception use (two of the things that Catholics say they hate) and a reduction in abortion rates (another thing that Catholics say they hate double extra bad), thereby arguing that the Catholic church in opposing contraception and sex education are directly contributing to increases in abortion rates.

Today, Michaela Aston (a spokesperson for Life) is given the opportunity to respond.

This is her first line of attack:

Monbiot is particularly misinformed when he quotes a study which reported that “Rising contraceptive use results in reduced abortion incidence” – over 60% of women having abortions in Britain report that they had been using contraceptives. The journal Obstetrics and Gynecology recently published a meta-analysis of 23 research articles examining the impact of increased access to emergency birth control on unwanted pregnancy and abortions, concluding: “To date, no study has shown that increased access to this method reduces unintended pregnancy or abortion rates.”

What Monbiot actually said: “But, as a study published in the journal International Family Planning Perspectives shows, once the birth rate stabilises, contraceptive use continues to increase and the abortion rate falls. In this case one trend causes the other: ‘Rising contraceptive use results in reduced abortion incidence.’ The rate of abortion falls once 80% of the population is using effective contraception.

Aston does nothing here to demonstrate that the study Monbiot cited was wrong. She does not examine or critique the study at all. She seems merely to claim that the statistics she cited contradict its conclusions. But they don’t!

First, “over 60% of women having abortions in Britain report that they had been using contraceptives” – but even taking that on trust*, it takes nothing away from the assertion made in Monbiot’s study. The fact that 60% of women who decide to terminate an unwanted pregnancy ended up pregnant because of a contraceptive failure – perhaps due to ignorant or lazy or careless (rather than “effective”) use of contraception, which is a trap many of us have fallen into – doesn’t say anything at all about the validity of Monbiot’s assertion unless you also study the rates of effective contraception use in the population generally and the overall abortion rates – the manner in which women having abortions got pregnant has little to do with it.

(* And I don’t think we should. Women seeking to persuade a doctor that they “deserve” or “need” an abortion are quite likely to say that they were using contraception and that it failed, either out of simple shame / embarrassment, or in a deliberate attempt to seem like a more suitable candidate. I know I did, even though in reality the problem was that I used contraception carelessly, not that it failed. So even if 60% of women seeking an abortion do blame contraceptive failure, a massive grain of salt is needed.)

Second, “a meta-analysis of 23 research articles examining the impact of increased access to emergency birth control on unwanted pregnancy and abortions, [concluded]: ‘To date, no study has shown that increased access to this method reduces unintended pregnancy or abortion rates.'” And your point is? For one thing, without knowing whether any study was adequately designed to demonstrate the effect of increased access to this type of contraception, the fact that no study has shown any particular effect is fairly meaningless. In any case, Monbiot’s study was not making any claims about the effect of unspecified increases in access to a particular type of contraception* on abortion rates – the claim was that abortion rates decline when 80% of the population is using contraception effectively. That is a totally different claim and the evidence cited by Aston can have no bearing upon it.

(* And after-the-event contraception is probably the worst type to select as representative of contraception generally, since “effective contraception use” ordinarily involves effective use at the time of having sex, with morning-after pills being strictly for situations where this didn’t happen or where it becomes clear that the contraception used at the time failed, e.g. burst condom.)

The next criticism is this:

Monbiot claims there is “a clear relationship between sex education and falling rates of unintended pregnancy”. There is not. Most papers (including the one in the British Medical Journal that Monbiot cites) find that sex education programmes have little or no impact on rates of teenage pregnancy or abortion. Sweden’s programmes in sex education, and promotion of contraceptives, have been an admired model – yet total abortion rates* there are now higher than ours.

(*Unfortunately Aston does not explain what she means by “total abortion rates” or where she gets her figures. More on this below.)

What Monbiot actually said: “There is also a clear relationship between sex education and falling rates of unintended pregnancy. A report by the United Nations agency Unicef notes that in the Netherlands, which has the world’s lowest abortion rate, a sharp reduction in unwanted teenage pregnancies was caused by ‘the combination of a relatively inclusive society with more open attitudes towards sex and sex education, including contraception’. By contrast, in the US and UK, which have the developed world’s highest teenage pregnancy rates, ‘contraceptive advice and services may be formally available, but in a ‘closed’ atmosphere of embarrassment and secrecy’.”

Sweden does appear to have a good programme of sex education which includes contraception. This appears to have a very beneficial effect comapred with the UK in terms of teenage pregnancies, although abortion rates are still more or less equivalent to ours. Some facts:

  • Sweden’s abortion rate for the last many years has been in the region of 30,000 to 35,000 or so in a population which has now just reached 9 million (as a total rate that is about 20-25% of total pregnancies, varying from year to year). (Source.)
  • At the same time abortions in England & Wales run at about 185,000 to 195,000 or so in a population of about 50-odd million – for 2006 that translated to 18.3 abortions per 1000 women aged 15 to 44 . (Source.)
  • According to my sums, the rate of abortion in Sweden is more or less the same as the rate in the UK. I couldn’t find any direct comparison, and Aston did not say what method of comparison she was using or provide a source. However, when calculating the crude abortion rate (abortions per capita), the results are consistently pretty similar, coming out either a little higher or a little lower depending on the approach I took.

It seems to follow from the above that, despite their better programme of sex education, the Swedish abortion rate is indeed still about the same. Why?

Well, let’s look at those teenage pregnancies that Aston chose to ignore. (Source.)

  • In the mid-1990s (and I suspect things haven’t changed significantly since then) Sweden had a teenage (aged 15 to 19) pregnancy rate of 25 per thousand leading to 17.2 abortions and 7.8 births per thousand.
  • Meanwhile, Great Britain had a teenage pregnancy rate of 46.7, leading to 18.4 abortions and 28.3 births per thousand.

Evidently, although the total number of teenage abortions in Sweden and Britain may have been similar, the total number of pregnancies and births for teenaged women was *much* higher in Britain. The programme of sex education is therefore leading to far fewer pregnancies (and therefore presumably far more effective contraceptive use) and the issue is merely that in Sweden 69% of teenage pregnancies led to abortion, while in the UK only 39% of teenage pregnancies ended in abortion.

My reading of this would therefore be not that widely available sex education makes no difference – my reading would be that widely available sex education leads to better contraceptive choices and fewer teenage pregnancies, so that even when a high proportion of teenage pregnancies end in abortion the overall rate is still comparable with other countries that have rubbish sex education. My reading of this would be that even more and even better sex education is needed to improve contraceptive practices (including abstention!) further, to reduce rates of unwanted pregnancy yet further. There is only so much higher that the proportion of unwanted pregnancies ending in abortion can climb, yet I would suggest that there is still even in Sweden plenty of scope for reduction in the number of teenaged women who become pregnant by mistake.

(In this regard, for US readers, it is worth noting that in the US only 35% of the 83.6 teenage pregnancies per thousand ended in abortion, although because of the higher rate of teenage pregnancy this still resulted in the highest overall rate of abortion at 29.2 abortions per thousand teenaged women.)

So one thing that we can conclude from this analysis is that a simple look at sex education programmes compared with abortion rates is too simple. A comparison of the UK abortion rate with the rate in Sweden – where a very secular and no-nonsense approach to abortion, allowing abortion for free on request, means that it is a more popular and less stigmatised option – is unfair and decidedly does not show that sex education has little or no impact on abortion rates. There are too many confounding factors which, when explored, seem to suggest instead that Sweden are indeed on the right track – their programme has clearly been effective in reducing teenage pregnancies, even if the incidence of abortion has yet to follow suit. The point is that their programme as a whole is also effective in making abortion easily available, with the result that when accidental pregnancy does occur it is a significantly more popular choice there than here.

In any case, Monbiot points not to Sweden as his model but to the Netherlands, where the sex education programme is also extremely comprehensive. In the Netherlands in 2002, the number of abortions per 1000 women aged 15-44 was – compared with the UK rate for 2006 of 18.3 – a mere 8.7. In the same year, the rate of abortions as a percentage of all pregnancies was – compared with 20-25% in Sweden – just 12.7%. And, apparently, these figures include abortions performed on foreign women having an abortion in the Netherlands – we can reasonably speculate that the rate for Dutch women, who have been through the Dutch sex ed programme, is likely to be even lower. (Source.)

Clearly, sex education is working in the Netherlands even if, as we have seen, the picture is more complex in Sweden. It isn’t because the Netherlands has a more restrictive approach to abortion, because they don’t. Could it be that the Netherlands has better rates because it has even better sex education and even lower rates of unwanted pregnancy than Sweden has managed to date? This article states (according to Google’s extract – I don’t have access to the full article) that unwanted pregnancies are rare, although when they do happen they are (as in Sweden) likely to end in abortion; and that the rate of teenage pregnancy in the 1990s – when Sweden and the UK had respective rates of 25 and 46.3 pregnancies per 1000 teenaged women – the rate in the Netherlands was just 9.2. Can Aston answer that? She can’t.

Next, she tries this approach:

In contrast, there is clear evidence that even modest legal restrictions can help to cut abortion rates. Some US states now require parental notification before minors can get abortions. This has led to lower underage abortion rates without necessarily increasing underage births.

Firstly, this doesn’t in fact contrast with or even follow from the previous paragraph, where we weren’t actually talking about about whether legal restrictions affect underage abortion rates. However, Monbiot does talk about this, as it happens, and says: “Chillingly, as the Lancet paper shows, there is no relationship between the legality and the incidence of abortion.”

Without more details of either piece of evidence it is difficult to comment further, but I can say a couple of things. Monbiot cites an actual academic paper showing that there is no relationship between legalisation and abortion rates. He might also have cited the WHO study referred to in this article, which reached the same conclusion. Meanwhile, Aston makes some vague claim that there is, somewhere, possibly, some evidence showing that fewer underage girls get abortions if they have to tell their parents about it, coupled with the vague assertion that this doesn’t necessarily (but, by implication, it may) result in more underage births. Again, reasoning from dubious evidence about one specific aspect of abortion to a general claim about abortion in the round. I know which I find more convincing.

What’s next?

Referring to a Lancet article, Monbiot says: “When the figures are broken down, it becomes clear that, apart from the former Soviet Union, abortion is highest in conservative and religious societies.” The big problem with Monbiot’s argument is that the abortion rates from more religious countries are generally based on conjectural estimates of illegal abortions, and there is a long history of pro-abortion groups deliberately inflating such estimates. The case of Mexico provides a good example. Monbiot cites an estimate of 25 abortions per 1,000 women for Central America. Applying this figure to Mexico suggests about three quarters of a million abortions each year. In fact we now have real data for this country – due to the legalisation of abortion in Mexico City last year – which makes it highly unlikely that there were more than 70,000 illegal abortions a year. This equates to 2.1 per 1,000 women – one tenth of that quoted by Monbiot and far less than in countries where abortion is legal.

In Ireland abortion is illegal and contraception has (at least until recently) been much harder to access than in the UK. Based on the numbers of Irish women having abortions in the UK, their abortion rate is about one third that of England, and there is no evidence of significant numbers of illegal abortions.

Aston is fair to point out that estimates of illegal abortions can only ever be estimates, and that the figures for illegal abortions are less reliable than the figures for legal abortions. It may also be fair to point out that some pro-choicers have in the past been guilty of inflating estimates to make things look worse than they are (at least, I have heard about examples of this) – just as some anti-choicers have been guilty of making unfair estimates or manipulating the available information in support of their own position. Indeed, I suspect that this is something Aston is in fact doing in this article when she discusses the cited rate of illegal abortion in Central America.

This comprehensive resource* published in International Family Planning Perspectives (link courtesy of the Guttmacher Institute) gives some statistics for Mexico, the particular country that Aston has chosen to highlight as a good example (presumably good in the sense that it best supports her own position). The figures given are total abortions of about 500,000 (tolerance 300,000 to 750,000) which works out at a rate of 25.1 abortions per 1000 women aged 15 to 44 or 17.1% of total pregnancies. This is clearly a perfectly plausible estimate – it is in very much the same ballpark as the figures for Sweden and the UK, discussed above.

(* Reliability. These figures are based on a “special study” given the acknowledged difficulties of collecting reliable data on illegal activities. Although there are copious footnotes I couldn’t be bothered to wade through them to get a specific cite for the methodology or authors of the study – and I’m actually quite happy to take the figures on trust as being from a reputable, peer-reviewed source and so likely to be at least half way reliable in the absence of any convincing evidence to the contrary.)

Aston suggests that applying the rate of 25 abortions per thousand women leads to about 750,000 abortions per year – that is the highest end of the estimates given in the resource cited above, but it is worth noting that the rate of 25.1 abortions per thousand was in fact based there on a total number closer to 500,000. So it looks like Aston has got her sums wrong on that one (let’s be charitable). In any case, mentioning a raw figure is fairly meaningless without noting the total population for the country. Mexico has a total population of over 100 million, so those figures are far from astonishing, given than Sweden has 30,000+ abortions for a population of under 10 million and we have around 200,000 abortions for a population of about 60 million.

Aston also suggests that post-legalisation figures for the rate of legal abortion in Mexico, at 70,000 rather than the “750,000” she quotes as the amount allegedly put forward by pro-choicers, show just how completely bonkers the estimates of illegal abortion really were. Firstly, of course, her inflation of the estimates of illegal abortion make the position seem more extreme than it really is. Moreover, her suggestion that 70,000 is a more realistic figure given the experience since legalisation is shockingly misleading. Abortion in Mexico has only been legal since April last year and even now it is only legal for the first three months for people who live in or can travel to Mexico City. There is no suggestion that abortion is to be subsidised by the state, so presumably it will still be out of reach for the majority of women who cannot afford to pay for an abortion. All this means that there are going to be many, many illegal abortions in Mexico even now – those who cannot afford to pay, those who cannot travel to Mexico City, and to a lesser extent those who require an abortion after the three month deadline. As such it is difficult to see how statistics on the rate of legal abortion in Mexico City in the months since legalisation could possibly give us any real indication of the total numbers of abortion throughout Mexico. If Aston’s offered estimates aren’t misleading, I don’t know what is! Monbiot’s figures are much more credible.

Finally, I just wanted to comment briefly on the comparison that Aston makes between Ireland and the UK. She guesstimates that the rate of abortion in Ireland is about a third the UK rate, based on the number of women who travel from Ireland to the UK for an abortion. I haven’t investigated that claim thoroughly, so I’m going to take her at her word (although I would like to ask her more about the rate of illegal abortions in Ireland or how many women travel to other countries for abortion).

But in any case there is one totally obvious reason why it doesn’t help her case even if her claim is more or less fair, that the rate of abortions in Ireland is actually lower. For that to be in some way relevant to the question whether legalisation affects abortion rates, she would also have to claim that “if legalisation made no difference, abortion rates would be the same in all countries irrespective of legal restrictions”. However, that is clearly not the case. Abortion rates are dependent on a huge number of variables including the rates of unwanted pregnancy, cultural attitudes to abortion and the availability of good sex education and affordable contraception. Nobody suggests that abortion rates do not vary between countries or that there is a consistent pattern whereby *all* countries were abortion is illegal have higher rates than *all* countries where abortion is legal. Indeed, Monbiot expressly points out that the UK is a blip with a much higher rate than those of its European neighbours who have legalised abortion. For these reasons, pointing out that Ireland, where abortion is illegal, may have a lower rate of abortions than the UK, where abortion is legal, is completely meaningless.

Moving on, Aston criticises Monbiot’s claim that women are “condemned to death” by the outlawing of abortion. This is where her distortion becomes actually laughable.

She says:

Monbiot claims that, with his stance against abortion, the Pope “condemns women to death”. In the same Lancet issue he referred to earlier, another article gives the latest estimates of maternal mortality rates. Ireland comes out best in the world with a rate of 1 death per 100,000, vastly superior to countries where abortion is legal such as the US (11 per 100,000) and the UK (8 per 100,000).

She suggests that because Ireland has better mortality rates for pregnant women than other developed countries, this puts the lie to Monbiot’s claim that criminalising abortion increases the use of unsafe illegal abortion and hence increases the risk of pregnant women dying, as a result of unsafe abortions. This is absurd, and here’s why.

Firstly, Monbiot specifically makes clear that the women who are “condemned to death” are not, in general, those in developed countries like Ireland. He says: “But the suffering [the Catholic] church causes in the rich nations doesn’t compare to the misery inflicted on the poor… Women with no access to contraceptives will try to terminate unwanted pregnancies. A World Health Organisation report shows that almost half the world’s abortions are unauthorised and unsafe. In East Africa and Latin America, where religious conservatives ensure that terminations remain illegal, they account for almost all abortions. Methods include drinking turpentine or bleach, shoving sticks or coathangers into the uterus, and pummelling the abdomen, which often causes the uterus to burst, killing the patient. The WHO estimates that between 65,000 and 70,000 women die as a result of illegal abortions every year, while 5 million suffer severe complications.” [My emphasis.]

Second, even if Monbiot had not said this then it should have been completely obvious to Aston that Ireland was not going to be a fair comparator. For one thing, she has already claimed that there is a relatively low rate of abortion generally among Irish women, and no evidence of significant illegal abortions in Ireland, since most women who need an abortion are able to travel to UK or elsewhere. On that basis alone it is hardly surprising if there are few or even no maternal deaths in Ireland as a result of illegal abortions. Secondly, even to the extent that there is illegal abortion in Ireland, is it really likely to involve the dangerous methods described by Monbiot? Ireland where women have access to health information, the internet, mail order abortion drugs, and quite possibly clandestine but nevertheless fairly hygienic abortion clinics is hardly the typical setting for dangerous illegal abortions, is it?

All in all, the fact that criminalisation makes no difference to maternal mortality in that particular jurisdiction (even if its small population didn’t make it a statistically less significant country in the first place) is, actually, very unsurprising. And that takes nothing away from the evidence of maternal mortality in other countries. Irish women are protected by the fact that they are part of a developed world that generally has a more liberal approach than their own country; not as Aston would like us to believe, by the very restrictions they face in their own country.

Oh, and in case you missed it the first time, I will repeat Monbiot’s cited statistics on maternal mortality: The WHO estimates that between 65,000 and 70,000 women die as a result of illegal abortions every year, while 5 million suffer severe complications. In the face of those statistics, if the only way you can persuade yourself that illegal abortion is unproblematic is to look at one small country with a developed healthcare system and access to legal abortion in a neighbouring jurisdiction then, Aston, you have a problem.

You got that right, Mr Monbiot.

[Over the last couple of weeks we have seen the moon even in bright daytime - I'm talking about noon or 1pm with the sun shining. I've never seen it in the bright day before, only at night or the edges of the day. I have Ariel and her child's eyes to thank because she is the one who told me it was there. It's nice to see the moon in the light.]

George Monbiot writes in the Guardian today, arguing that the Catholic Church (these people) spreads “misery, disease and death” – by stigmatising contraception, sex education and legal/safe abortion, the real sex-negative / woman-negative brigade are contributing around the world to high levels of unprotected sex (and therefore of unwanted pregnancies and STIs) and to the horrors of unsafe/illegal abortion.

This evidence based piece is so useful I’m going to reproduce almost all of it (sorry George).

Who carries the greatest responsibility for the deaths of unborn children in this country? I accuse the leader of the Catholic church in England and Wales, His Eminence Cardinal Cormac Murphy-O’Connor…

Murphy-O’Connor has denounced contraception and abortion many times. That’s what he is there for: the primary purpose of most religions is to control women. But while we may disagree with his position, we seldom question either its consistency or its results. It’s time we started.

The most effective means of preventing the deaths of unborn children is to promote contraception.

In the history of most countries that acquire access to modern medical technology, there is a period in which rates of contraception and abortion rise simultaneously. Christian fundamentalists suggest the trends are related, and attribute them to what the Pope calls “a secularist and relativist mentality”. In fact it’s a sign of demographic transition. As societies become more prosperous and women acquire better opportunities, they seek smaller families. In the early years of transition, contraceptives are often hard to obtain and poorly understood, so women will also use abortion to limit the number of children. But, as a study published in the journal International Family Planning Perspectives shows, once the birth rate stabilises, contraceptive use continues to increase and the abortion rate falls. In this case one trend causes the other: “Rising contraceptive use results in reduced abortion incidence.” The rate of abortion falls once 80% of the population is using effective contraception.

A study published in the Lancet shows that between 1995 and 2003, the global rate of induced abortions fell from 35 per 1,000 women each year to 29. This period coincides with the rise of the “globalised secular culture” the Pope laments. When the figures are broken down, it becomes clear that, apart from the former Soviet Union, abortion is highest in conservative and religious societies. In largely secular western Europe, the average rate is 12 abortions per 1,000 women. In the more religious southern European countries, the average rate is 18. In the US, where church attendance is still higher, there are 23 abortions for every 1,000 women, the highest level in the rich world. In central and South America, where the Catholic church holds greatest sway, the rates are 25 and 33 respectively. In the very conservative societies of east Africa, it’s 39. One abnormal outlier is the UK: our rate is six points higher than that of our western European neighbours.

I am not suggesting a sole causal relationship: the figures also reflect changing demographies. But it’s clear that religious conviction does little to reduce abortion and plenty to increase it. The highest rates of all – 44 per 1,000 – occur in the former Soviet Union: under communism, contraceptives were almost impossible to obtain. But, thanks to better access to contraception, this is also where the decline is fastest: in 1995 the rate was twice as high. There has been a small rise in abortion in western Europe, attributed by the Guttmacher Institute in the US to “immigration of people with low levels of contraceptive awareness”. The explanation, in other words, is consistent: more contraception means less abortion.

There is also a clear relationship between sex education and falling rates of unintended pregnancy. A report by the United Nations agency Unicef notes that in the Netherlands, which has the world’s lowest abortion rate, a sharp reduction in unwanted teenage pregnancies was caused by “the combination of a relatively inclusive society with more open attitudes towards sex and sex education, including contraception”. By contrast, in the US and UK, which have the developed world’s highest teenage pregnancy rates, “contraceptive advice and services may be formally available, but in a ‘closed’ atmosphere of embarrassment and secrecy”.

A paper published by the British Medical Journal assessed four programmes seeking to persuade teenagers in the UK to abstain from sex. It found that they “were associated with an increase in the number of pregnancies among partners of young male participants”. This shouldn’t be surprising. Teenagers will have sex whatever grown-ups say, and the least familiar with contraception are the most likely to become pregnant. The more effectively religious leaders and conservative papers anathemise contraception, sex education and premarital sex, the higher abortion rates will go. The cardinal helps sustain our appalling level of unwanted pregnancies.

But the suffering his church causes in the rich nations doesn’t compare to the misery inflicted on the poor. Chillingly, as the Lancet paper shows, there is no relationship between the legality and the incidence of abortion. Women with no access to contraceptives will try to terminate unwanted pregnancies. A World Health Organisation report shows that almost half the world’s abortions are unauthorised and unsafe. In East Africa and Latin America, where religious conservatives ensure that terminations remain illegal, they account for almost all abortions. Methods include drinking turpentine or bleach, shoving sticks or coathangers into the uterus, and pummelling the abdomen, which often causes the uterus to burst, killing the patient. The WHO estimates that between 65,000 and 70,000 women die as a result of illegal abortions every year, while 5 million suffer severe complications. These effects, the organisation says, “are the visible consequences of restrictive legal codes”…

[Emphasis mine]

And that’s the end of Maia Does The News :)

Before the end of last year, the UK government admitted that it was dismally failing to meet its targets for reducing teenage pregnancy. The target in 1999 was to halve the rate by 2010, yet new figures show that the rate as dropped by only about 11%, while the total number of teenage pregnancies has actually increased.

(Note – Depending on who you listen to, about a third to about half of teenage pregnancies in the UK end in abortion. Many pregnancies are carried to term simply because they are not identified or reported early enough – a problem that will only worsen if anti-choice campaigners succeed in reducing the time limit for abortions.)

The reaction has been, perhaps unsurprisingly, to point the finger at the way that young people are taught about sex in schools. However, instead of berating our schools for failing to teach young people enough about sex and protection, the line most often taken seems to be that schools are teaching children too much.

The argument is that sex education strategies, and in particular the safe sex message combined with improved access to contraception, have “backfired” by encouraging teenagers to have more sex, rather than encouraging them to have sex more safely. The safe sex message isn’t working, critics say – because when a teacher says “if you decide to have sex you should use a condom”, the pupils apparently just hear “decide to have sex” and filter out the rest. Because kids, as we know, are too hormonally charged (read, thick) to hear more than what abstinence-only advocates believe they can hear. Therefore, apparently, we should stop teaching children about safe sex.

Well, here are two interesting facts.

One is that, while lambasting the UK for having a teenage pregnancy rate six times that of the Netherlands, most of these commentators completely fail to mention that the Netherlands has achieved this by giving its students more and better education about sex and sexual life – not by lecturing them to keep their pants on.

(See here, for a rare exception – in the Telegraph, Laura Donnelly summarises the Dutch approach – “Liberal campaigners in [the UK] point to Holland’s permissive health policies, including compulsory sex education in schools from the age of five, as being key to its success… Dutch campaigners say Britain’s schools tick the box for sex education by providing biology lessons and free condoms, without arming teenage girls with the confidence to say no to unwanted advances, or to care for their sexual health.“)

The second interesting fact is that the UK’s much complained about “liberal” sex education curriculum is not actually compulsory. Parents can opt their children out. Whole schools can and do (especially in the case of faith schools, especially in the case of Catholic schools) opt out of teaching their pupils anything at all about sex beyond the mandatory biology lesson covering human reproduction. Nobody knows how many parents or schools actually do this because it is one of the few remaining areas of life where the Government does not collect and record statistics.

Polly Toynbee reports on this issue here, in the Guardian. She describes a recent survey of young people which showed that many of them get no or very little sex education at all – 40% rated the sex education they had received as “poor or very poor” and more than half had never been shown how to use a condom or told where to find their local sexual health clinic.

In conclusion, teen pregnancies are going up and it’s because we are teaching our children too much about sex. Even though in the Netherlands where teenage pregnancies are far less frequent the sex education given to children starts earlier and covers more ground. Even though about half of our young people never actually receive any real sex education at school. But lala we’re not listening because we know it’s all the fault of our freakishly liberal sex education policy. So there.

(Other sources: Press Association, Telegraph, The Sun, DoH 2007 annual report, DoH 2006 abortion statistics)

When we hear about forced abortions and sterilisations, it seems almost natural that China should spring to mind.

The notorious one-child policy in China has given us the nightmare of family planning officials dragging pregnant women off to abortion clinics, even heavily pregnant women.

The latest horror story [HT Debs] is of a woman at full term, in labour, whose waters had broken, dragged off and unlawfully forced to undergo an abortion which left her infertile, and needing hospital treatment for 44 days (which her husband had to pay for!) – the reason? She fell pregnant a few months before her marriage. It wasn’t even a second child!

The good news, such as it is, is that Jin Yani and her husband have managed to persuade the Chinese courts to hear their claim for damages. It is not victory in court, but it is a victory even to get the courts to hear their case.

China also breaks its own laws in another way. Forced abortions and sterilisations (illegal in themselves) are also imposed on women who are supposed to be exempt from the one-child laws. For example, minority populations are permitted to have more than one child, yet it is frequently reported that abortions / sterilisations are carried out routinely under co-ercion, especially in Tibet (see here, here, and here, for example). There are more horror stories than I can recount. Imagine women kept in wicker cages, transported like cattle to be processed, dirty tents, dirty vans, blood, bleeding, and waste bins, bins overflowing with dead foetuses… Just imagine.

But China is not the only place where people have been forcibly sterilised or forced to undergo abortions against their will. Forced sterilisation has the longest and most “respectable” history, and has been practised now – often legally – for at least a century, in countries all over the world. Including those that profess to respect human rights.

Here is a run-down of some times and places where forced sterilisation is known to have been used:

USA, 1907 to 1970s: Thousands of criminals, ill or disabled people and generally “defective persons” were sterilised for expressly eugenic reasons – all perfectly legal at one time or another in 33 states (see here, and here), and providing a model for…

Germany, 1933-1945: Hitler sterilised 300,000 people. Need I say more? This article is a useful summary.

Finland, 1930-1955: 1,460 people were sterilised because they were considered defective (see here and here).

Sweden, 1935-1975: Another eugenics programme, in which 60,000 women and men were subjected to state-sanctioned sterilisations because they were considered defective. See here and here.

India, 1975-1977: During the Emergency declared by Indira Gandhi her son, Sanjay, was responsible for a programme of mass sterilisations of women and men, including kidnapping people in large groups for this purpose. (See here, for example.)

Peru, 1990s: 200,000 plus women were coercively sterilised in the space of a few short years (see here) and by way of “apology” Peru has suggested banning sterilisation altogether! (See here.) Interesting, that the suggested remedy for forcing women to undergo sterilisation against their will is to prevent them from having access to sterilisation even if that it what they want.

Slovakia, right now: Romani women undergo forced sterilisations in racist hospitals. See here and here. Right here, right now – in the European Union.

Hungary, right now: Romani women suffering again. See here, here, and here. Hungary apparently continues to permit doctors to sterilise women without following standard procedures whenever “it seems appropriate”. Right here, right now – in the European Union.

I had hoped that I could put together a comprehensive list, but I can’t. The more I search, the more I find. Denmark, Canada, Norway, France. The Soviet Union. Belgium, Japan, Britain. Italy. Australia. There seems to be hardly a developed or semi-developed nation anywhere in the world where involuntary, state-sanctioned sterilisation has not taken place to some degree. It still takes place.

Even in Israel – Israel! – early leaders advocated eugenics and set up “advice stations” to encourage young couples to reproduce responsibly… This article tells us what prominent physician and head of the Kupat Holim Clalit health maintenance organization, Dr Joseph Meir, had to say to Israelis : “We have no interest in the 10th child or even in the seventh in poor families from the East … In today’s reality we should pray frequently for a second child in a family that is a part of the intelligentsia. The poor classes of the population must not be instructed to have many children, but rather restricted.” and, to doctors – “in the event that a woman comes to you who is `a risk’ for giving birth to a sick baby, it is your obligation to make certain that she has an abortion.

So let’s not just think of China. Let’s remember not just those waste bins overflowing with blood. Let’s also remember the legacy of involuntary or co-erced sterilisation right here in Europe; let’s remember the inspiration of English and American thinkers like Sir Francis Galton, Charles Davenport and Harry Laughlin, who started it all; let’s remember the countless women and men that have been mutilated for the so-called benefit of their nations – for our nations.

Our hands are not clean.

[For pro-choice month on Feminist Fire]

Many people seeking to advance the cause of the unborn use grisly pictures of aborted foetuses as a way of shocking the viewer into seeing the humanity of the child, as a way of stirring their pity. I won’t post any of these pictures on this blog, for reasons which will become clear, but you can find some easily enough if you do a Google image search on “aborted foetus” or “aborted fetus”.

People who adopt this tactic say that it is a legitimate way of calling their fellow citizens to act against abortion, to stop the killing. They say that it is as legitimate as showing images of human suffering in other contexts: prisoners in a concentration camp, starving famine victims, the dead bodies of children killed in war.

I think this is problematic, for a number of reasons.

First, I am not convinced that showing human suffering actually does have the same effect today that it might have had 20 or 50 years ago. People have seen too much violence, too much suffering, too many grisly pictures. Need proof? Just consider the fact that people with spare money in their bank account can sit tight and not reach for their credit card even when faced with an image of a child with a distended belly, too listless with hunger and disease even to flick away the flies that crawl over her eyes. Showing these pictures just doesn’t shock people any more, not enough to jolt them out of complacency and into action. It doesn’t work.

Second, I don’t think the analogy between abortion and slavery, the Holocaust, war or other large-scale death projects is a valid one. The most obvious reason is that I don’t agree that a foetus is a person, unlike the people suffering and dying in famines and genocides – a critical distinction. A fairer analogy might be with pictures of what goes on in abattoirs or animal research labs – but even then the useful images are an effort to depict and communicate suffering and not just to show a bloodied corpse where suffering is, at best, inferred.

Third, I think there is at least a question about human dignity here. If that dead foetus really is a human being, shouldn’t we respect its human right to privacy? Its right not to have images of its corpse spread over trucks and across the internet? We have codes of respect in place that prevent us from publishing images of dead people: if that foetus really is a person, shouldn’t those codes apply?

Those who support the use of aborted foetus pictures to oppose abortion might brush all those things aside (especially the middle one, because such people normally do believe as a matter of faith that the foetus is a fully realised human person and would probably find despicable any analogy with mere animal suffering). They are acting for the greater good, they say. Does it matter if the pictures only influence a few people? What does it matter if we violate a foetal right of privacy if what we are doing is calling attention to a much greater violation of the foetal right to life?

Why does it matter? What harm is in it?

As I’ve said, I don’t personally believe that a foetus is a person, which means that while I agree that it is a living thing deserving of respect and dignity I won’t be addressing any question about the violation of foetal rights that may be involved in the public display of foetal corpses*. I am thinking in this post about the harm these pictures do to the general public that have to see them.

(* Although anyone who does have a different view of foetal personhood might do well to address this before they start defending the grisly picture “argument”.)

Many people are likely to be shocked and offended by these pictures. That in itself is no reason to complain about the ethics of using them. But some people, especially women who have had or are about to have abortions, are likely to suffer something more. Imagine a woman, grieving and perhaps traumatised, unable to articulate her sense of loss, or to think clearly about what she has lost or why she feels such extreme distress. Imagine that woman faced with an image of a dead foetus – imagine her tying that image in with her grief and her sense of loss – imagine her going through a process over years of mortification, guilt, self-blame, confusion, breakdown. Thinking and imagining for years about the “person” she has killed.

I am not saying that we should refrain from arguing about whether a foetus is a person just because it might make women who have had abortions feel guilty.

What I’m saying is that as we conduct the debate we should try to be sensitive to the emotional and other harm that we might cause. We should be compassionate (even to babykillers – Jesus would have been). Furthering the case against abortion by showing emotive and grisly pictures to people who might find them triggering, to people who might be vulnerable to emotional harm from them, is just cruel.

Got to be cruel to be kind, you say? That might be a tempting refuge, if you could show that the cruelty does actually result in some greater good. Can you show that grisly pictures actually do save unborn babies? Can you show that grisly pictures actually do convert waverers to anti-abortion activism? No, I thought not.

Cruelty to vulnerable women in the unsubstantiated hope that this might eventually contribute to a chain of events which might eventually reduce some types of human suffering (but not hers), is not kindness. It just isn’t. It is cruelty.

Human embryo (6 weeks)[For pro-choice month on Feminist Fire]

Do we really grieve for a tiny embryo
that would fit easily in the palm of my hand,
perhaps just recognisably human?

Do we really grieve for an organism
with no personality?
no understanding?
no communication?

Do we really grieve for an unknown, unnamed stranger?

Are we grieving
for what might have been?
for a fantasy that has slipped through our fingers?
for a blank slate that will never be coloured in?

As you stand in the bath and watch the clots of blood run away, wondering if you will ever feel clean again – is it really someone else that you grieve for?

That hollow ache is the final understanding of what it means to be a vessel.
It is a slow realisation that your time of carefree innocence is gone.
This is the day when you first understand that life is for real,
and that you only get one ticket.

Be at peace.

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