In almost the entire continent, ending a pregnancy without some extenuating circumstances is illegal. Ethiopia recently liberalized its law, but performing a routine abortion remains a criminal act, punishable by up to three years in prison. Pressure from anti-abortion activists purportedly trained in the United States blocked efforts at further liberalization.
A ban on the books is one thing. Reality is another. Women determined to end their pregnancies will find a way, sometimes with devastating consequences.
Ask Aynaleon Gashau. She’s the nurse in charge of family planning and maternal health at the government-run Debresina Health Center in northern Ethiopia. She treats the women and girls who come in bleeding, infected, sometimes with perforated uteruses. Many were rape victims, including those whose assailants were relatives. Some were unmarried and abandoned by their partners after they got pregnant.
One case especially haunts her. A badly ailing girl of nearly 18 who had been three months pregnant when she tried to abort came in last year and had to be sent to a hospital, where she died.
Keeping abortion illegal drives it underground, where practitioners can’t be regulated or prosecuted. In Ethiopia, there are so many botched abortion attempts that they have spawned a specialized line of treatment and health centers for “post-abortion care.”
In the town of Debre Berhan, about 20 to 30 women show up every month for treatment at the Marie Stopes clinic. It’s a local chapter of an international nongovernmental organization and specializes in post-abortion care.
If the woman was less than three months pregnant, manual vacuum aspirations can remove the remaining fetal tissue. Otherwise, the uterine lining is scraped through a process called curettage.
The women might have used herbs or roots supplied by traditional practitioners. They might have tried mixing high doses of the malaria-prevention drug chloroquine with a penicillin-type antibiotic and drinking it in a Coca Cola base. Or they might have gone to medical professionals not trained in proper abortion procedures, according to Abera Alemneh, clinic coordinator.
Another two or three girls or women a day come in seeking routine abortions and have to be turned away, Alemneh said.
Most of these women are coming from rural populations. They have little knowledge of birth control, and virtually no access to it. With only eight percent of Ethiopian couples using birth control, it’s no wonder that so many women are seeking to terminate unintended pregnancies; and with such “pro-life” policies in place, it’s no wonder that so many of them are dying.
Ethiopia isn’t happening in a vacuum. Crippled by poverty, women are leaving their babies in hospitals because they aren’t able to care for them. Babies and mothers are dying of malnutrition. Even wanted pregnancies can be exceptionally dangerous because of lack of healthcare. But when 30 percent of the Ethiopian women who die during pregnancy die because of illegal abortion, you know you have a problem. The Ethiopian government tried to deal with that problem by rescinding their restrictive abortion laws — but then Evangelical Christians and the United States stepped in.
But a group of Evangelical Christians known as the Christian Health Workers Association organized to oppose the new law and persuaded the patriarch of the largest church, the Orthodox Church, to back them. The government backed down, according to Saba Kidanemariam, Ethiopia director of Ipas International. The North Carolina-based organization offers abortion-related services and supports abortion rights.
Kidanemariam says the evangelicals were trained and financed in America and used U.S.-produced materials to make their case, in particular the controversial 1984 film, “The Silent Scream,” which purports to show a 12-week-old fetus feeling pain when aborted.
She insists that the movement to liberalize abortion law, in contrast, is based on the experiences and wishes of Ethiopian women.
The new law bans abortions except to protect the health and life of the mother and in cases of incest, rape and fetal abnormalities. It also makes exceptions for girls who are physically or psychologically unready to give birth and for women with physical or mental impairments.
But even that is going too far for some U.S. politicians. Kidanemariam says that after Rep. Chris Smith of New Jersey visited Ethiopia last year, he went to the Ethiopian embassy in Washington to ask why the law was liberalized.
These people are not pro-life. They’re happy to see women dead and maimed in order to forward their political goals. They’re cruel and misogynist, not life-loving.
And they’d like to see the United States look more like Ethiopia.
In the meantime, though, they’re happy to punish people abroad for having the audacity to have sex, or for lacking power in their communities. Case in point: The global gag rule, and its impact on international HIV/AIDS and family planning clinics. U.S. money hasn’t paid for abortions abroad since the 1970s. The gag rule doesn’t prevent U.S. funds from going to abortion — it prevents U.S. funds from going to any organization abroad that so much as mentions abortion as an option, petitions its own government for reproductive rights, or pays for abortions with its own non-U.S. money. It even goes so far as to limit funds to clinics that receive separate funding from abortion-rights groups.
In most countries, HIV/AIDS clinics aren’t separate from family planning clinics. In rural Ethiopia, the same clinic that offers HIV/AIDS testing and support will also offer condoms, sexual health information, contraception, etc. But these clinics are being de-funded because of American “pro-life” forces. A prime example is the clinic that Rekha Basu writes about:
The good news, if you had to find some in this, is that people are getting tested and counseled appropriately, and it’s making a dent in AIDS transmission. Ethiopia’s government, which in the past denied there was an AIDS problem, is stepping up its AIDS-fighting efforts, aimed at integrating prevention and treatment with reproductive health care so people going in for AIDS aren’t stigmatized. “We shouldn’t force people to reveal themselves,” declares Ethiopia’s health minister, Dr. Tewodros Adhanom.
“We are the source of stigma, the health system itself, in the way that we are approaching HIV,” Adhanom said. “Why do we treat them specially? They are sick, like any other sick person.”
Unfortunately, our own government will not support that approach. The U.S. Agency for International Development won’t give any AIDS money to the Dessie clinic because we require AIDS money to be spent separately from family-planning funds and because of the global gag rule. Under the gag rule, no U.S. government money can go to an organization that also gets money from a source that provides or supports abortion. Abortion is illegal in Ethiopia under most circumstances, but the Family Guidance Association is still ineligible for U.S. aid because it gets money from the International Planned Parenthood Federation, which supports abortion services.
I’m not sure how this makes sense, either to the goal of fighting AIDS or to the goal of promoting family planning. I can’t see it making sense to people like these clients.
They’re having a hard enough time making sense of a fatal diagnosis and a foiled future together.
I wish I could say that it ends there. But our “pro-life” administration doesn’t stop there: They also target sex workers, the most vulnerable women for HIV and STI transmission, and single them out as undeserving of compassion and effective care. Baku writes about one sex worker, Tigist, who was married at 10 to a man 20 years older, raped by him, beaten by her father, and eventually pushed into the sex trade in order to keep her head above water:
So she found her way, six months ago, into the world’s oldest profession, one she dislikes and disapproves of. But one night’s earnings of $7 to $11 are more than what she made in a month as a waitress.
She doesn’t complain that about half the clients are degrading and insulting and beat her, especially if they’re drunk. She insists on condom use, though it sometimes provokes violence. One customer demanded back the money he’d paid in advance, and kept her clothes, making her walk to the bar in only underpants to get it.
She’s resourceful. Once, when the treatment was intolerable, she excused herself to go to the bathroom, and then locked a client in the hotel room until a worker released him in the morning.
She’s learned about AIDS from outreach workers through the Woldia Health Center, which gets support from the U.S.-based nongovernmental organization EngenderHealth.
Ethiopia has more than 1.5 million people infected with HIV/AIDS, and nearly that many children have lost at least one parent to it.
U.S. money is coming into Ethiopia under President Bush’s Emergency Plan for AIDS Relief, a $15 billion, five-year project begun in 2003. But one of its provisions requires any organization that gets funds to take a stand against prostitution.
Critics say that can alienate sex workers, who are among the most vulnerable to HIV infection. Brazil refused $40 million in money from the program last year because of it. Officials in the U.S. Global AIDS coordinator’s office say that nothing in the law or emergency plan prohibits providing services to sex workers, and that the plan in fact works closely with the workers to provide condoms, counseling and treatment.
Sex worker outreach programs work. Shaming and “taking a stand” against prostitution isn’t particularly effective in getting sex workers to seek you out and listen to what you have to say. Kind of how illegalizing abortion won’t prevent it from happening.
This is why issues like the abortion ban in South Dakota matter. Anti-choicers act as if they have a monopoly on morality and an interest in life. They’re wrong. Their policies are the opposite of life-affirming: They’re dangerous and deadly.
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