Making birth safe - or preventing births?
Last Saturday an international conference concluded in London. It was called Women Deliver -- a snappy little title with more than a hint of the girls-can-do-anything approach to the world's problems. It is ambiguous, however, because the problem in this case concerns women for whom "delivering" is fraught with danger: those mothers in developing countries who lack basic care in pregnancy and childbirth.
The consequences are tragic. According to estimates produced for the conference by the Harvard Centre for Population and Development Studies, 535,900 women died in 2005 in pregnancy, labour or after giving birth. It is also scandalous, since the figure has barely declined since 1990 when it was 576,300.
Loss of the mother often means the death of her newborn child, while other children are left motherless. In addition, large numbers of women suffer from bleeding, infection, high blood pressure and other easily preventable complications. One of the saddest -- although easily repaired -- of these is obstetric fistula as a result of prolonged, obstructed labour. All of this creates a huge burden shared by the individual, the family and the nation.
'The agenda was so preoccupied with promoting the ideology and practice
of abortion the genuine health care needs of women and children were
virtually ignored in the plenary sessions and overwhelmed in the panel
No wonder that the United Nations made maternal health the fifth of its Millennium Development Goals, with the aim of reducing maternal mortality by three quarters by 2015. And, clearly, there is not a moment to lose if that goal is to be achieved. So, you might think, good on the girls who managed to bring around 1800 global leaders to London to forge a new consensus on this issue and stoke political will.
They even gave the issue a new spin to appeal to the economically-focused, penny-pinching types among the boys. The conference theme, as distinct from its focus, was "Invest in women -- it pays," the idea being that looking after women pays off for national economies. Someone estimated the current cost of maternal mortality at $15 billion in lost productivity.
With hundreds of politicians present it could have been a terrific conference, except that it wasn't. At least, not for the women who are facing death or ill health in bringing children into the world. It turned out that the answer to their urgent needs is not so much basic health care as abortion: 'You don't want to die having a baby? Well, start by having fewer.'
Yes, there were discussions about gaps in professional care, lack of vaccines, genital mutilation, fistula and many other things that make birth risky, but much, much more talk about ensuring that fewer births actually happen. Safe motherhood meant, above all, safe abortion, which in turn meant legal abortion.
The agenda was already clear in pre-conference publicity orchestrated by The Lancet, a UK medical journal that began a campaign a year ago to "re-launch the international family planning agenda" after a decade or two during which it has been stalled by the anti-abortion strictures of George Bush.
Prior to Women Deliver, The Lancet published a series of conference papers, the most prominent of which were the one calculating maternal mortality and another -- the work of the Alan Guttmacher Institute and the World Health Organisation -- calculating the incidence of "unsafe abortion". A press conference was held to ensure maximum coverage and the journal was pleased with the results.
Delegates from mother- and family-oriented NGOs were nevertheless unprepared for just how slanted the proceedings would be. At the finish a group of 14, more than half with consultative status at the UN, sent a letter to the organisers complaining that the "agenda was so preoccupied with promoting the ideology and practice of abortion that the genuine health care needs of women and children were virtually ignored in the plenary sessions and overwhelmed in the panel discussions."
The letter dismissed the statistical platform on which the whole conference rested: "Numerous UN reports, such as The World's Women 2005: Progress in Statistics, have concluded that accurate data about maternal mortality, including abortion, are not available, especially for the developing world. Therefore, the presentation of unsubstantiated and unreliable data on illegal abortion can only be seen as a deliberate attempt to mislead."
The letter also attacked the assertion that "unsafe abortions" are only those that are illegal, and revealed that the World Health Organisation does not collect information on deaths and harm from legal abortion -- conduct it called "unconscionable" if there is any true commitment to accurate data. These criticisms, and a final call to the conference partners to focus on "basic health care, skilled attendants and emergency obstetrics" seem doomed to be ignored by those to whom they were addressed.
Women Deliver was always going to be a convocation of the usual suspects on the reproductive rights scene. These have long since included, to the frustration of those committed to international co-operation for development, United Nations agencies: the Population Fund, the WHO, the World Bank and even UNICEF, the children's fund. The leading light of the conference was Jill Sheffield of Family Care International, standard-bearer of the Safe Motherhood (and safe abortion) movement. International Planned Parenthood was on the organising committee and Marie Stopes International played a key role (Marie Stopes held its own abortion conference straight after.) Both organisations have a financial stake in abortion. Frances Kissling of Catholics for a Free Choice -- a patently inauthentic organisation -- starred in a plenary session.
The pity of it is that they have garnered umpteen millions of dollars that will go, first and foremost, into promoting and supplying birth control. Women in Africa and Asia will continue to wait for basics like clean water, sanitation, vaccination against malaria, nutritional supplements, good birth attendants and hospitals, while the supply of contraceptives and abortions is fast-tracked. People like Dr Robert Walley of MaterCare International will struggle longer than is necessary to get funding for fistula treatment centres in Africa.
It is significant in retrospect that Women Deliver opened in the same week -- and the same city -- that DNA pioneer James Watson disgraced himself by revealing his pessimistic view of Africans, based on his theory that their "evolution" has brought them to a lower level of intelligence. But Watson was only saying what is implicit in the programme of the family planning fraternity: Africans (and Asians, and Latin Americans) are too dumb to know what is good for them (and us). Just look at how many children they have.
Today's reproductive rights movement is merely nineteenth century eugenics ("More from the fit, less from the unfit") in its respectable old age. And if eugenics is not dead, neither is colonialism, only today it is called globalisation. The reproductive conquest of the "dark races" is not yet complete. It is well under way, even in Africa, but there are some stubbornly fertile regions.
What the birth control brigade seems too stupid to see is that making motherhood -- not abortion -- really safe would reduce fertility anyway, at least to the level that couples in developing countries actually want. This is no doubt higher than western couples, brainwashed by decades of birth control propaganda, now aspire to -- and what really bugs Marie Stopes and Co.
But what self-respecting African woman wants to live like her English or American sister: still looking for a husband at 35; at risk of breast cancer from years on the pill; her fertility damaged by sexually transmitted disease and abortion; the prospect of having a child at all ever more remote. How unintelligent is that?
Carolyn Moynihan is Deputy Editor of MercatorNet.
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