It was a room filled with feminists. Or at least one could have assumed as much by the meeting’s theme of gender and international development. Panelists and presenters tackled pressing and difficult global issues that undermine women’s wellbeing: genital cutting, rape as a weapon of war, child marriage, gender-based violence, HIV, and family planning. It seemed we had all our gender and development bases covered. But as the event closed, it struck me: there had not been one mention of abortion.
Gender equality has become a major focus in international development circles, with the Obama administration responsible for a number of positive policies that mandate improved attention to the needs and rights of women and girls. These policies in turn have spawned massive investments in gender expertise within the global development set. Yet there is a peculiar, but predominantly unremarked, feature of the international development industry around gender that defies logic on its face: silence on one of the biggest threats to women’s health and human rights – unsafe abortion.
It’s not like unsafe abortion is an easily overlooked issue when you work in development. You would have to deliberately blind yourself to something that 21.6 million women experience every year, causing 13% of maternal deaths and 1.5 million years of healthy life lost to injury. Addressing the consequences of botched abortions is a major drain on developing countries’ health systems and economies. The impact of illegal abortion crosses sectors – keeping girls out of school and women away from work, or forcing girls and women to bear and support children they would have chosen not to have.
You can’t ignore it from a gender equality and human rights angle either. Many of the same countries that deny women and girls access to reliable and affordable contraception, comprehensive sex education, and communities or households safe from sexual assault also punish women if they have an abortion, denying their right to decide the number and timing of their children. Some countries, like South Africa, have liberalized their abortion laws, yet still do not provide access to what is a very safe procedure when conducted by trained professionals in sanitary conditions. As a result, even women seeking legal abortion are often forced to seek care from untrained providers.
Under normal circumstances, such a glaring and universal issue with clear roots in gender inequality and government control of women’s reproductive lives would be a priority for those concerned with gender and international development. But “normal” has been severely warped out of shape by U.S. laws and their very eager watchdogs in Congress. These laws prohibit U.S. foreign assistance funding for abortion when used “as a method of family planning” (the Helms Amendment, 1973) and for advocacy efforts around abortion rights The Siljander Amendment, 1981).
We have a pro-choice administration, but still these laws are interpreted far more stringently than their original intent. Even in cases when abortion falls well outside a family planning purpose, such as for girls and women raped in conflict zones, the U.S. offers no funding. But it is the self-censorship I find most startling, with administration officials hesitant to speak publicly about the global epidemic of unsafe abortion. Outside of organizations working on and committed to reproductive rights, there is almost complete silence among international development groups.
This is the insidious way longstanding U.S. policy works. You can sit in a room filled with people who unanimously and ardently believe that gender inequality is one of the most significant barriers to international development and never – not once – hear the word “abortion” uttered.
At a recent meeting on women and global health, I had an opportunity to raise the issue, asking the panel (who had not mentioned abortion) how we could increase access to safe abortion over the next two decades. I could have asked about any other topic – about sex workers, drug users, or genital cutting – and received a response based on human rights and the latest public health evidence. But with this question, I immediately felt as though I had thrown a grenade into the room, and the discomfort among the panelists was palpable. They apparently had no expectation that the topic would come up, and had very little interest in giving more than a cursory response. When I left the meeting, even though on an intellectual level I knew that it was a perfectly legitimate question, part of me felt like I had just committed professional suicide, or at the least a very unfortunate faux pas.
We know how to prevent women from dying or being injured by unsafe abortion. But when we stop ourselves from discussing the subject in meetings of people who care about gender, human rights, or maternal health, we have accepted failure as the default and we show no interest in seriously grappling with the status quo.
The Helms Amendment hasn’t budged for forty years. If the wall of silence around unsafe abortion is not lifted by those who care deeply about women’s empowerment and equality, we are complicit in its permanence for another forty. And when the women we work with around the world ask us why, what will we tell them?