George Bush and Family Planning and Abortion in Poor Countries

The first time I got pregnant, my husband and I were teaching and living as Peace Corps Volunteers at a secondary school, a boarding school, sprawling across a rural neighborhood on a slope of Mount Masaba in Eastern Uganda.  We had decided we wanted a child, though I was skeptical that I could actually do it. So miraculous, a baby growing inside you.  My husband teased me, look around you, he said, babies everywhere, human babies, calves, chicks, baby goats, bugs, rats. In fact the rats he kept in cages in our spare room for the biology classes he taught produced a never-ending flow of what looked like little pink thumbs.

The British doctor, all those years ago, would not consider a pregnancy test until I'd missed two periods. Nature coughed out so many fertilized eggs, he said.  Why should mamas experience these events as miscarriages? 

In Uganda I was thrown off balance by the death and dying as  much as I was dazzled by the brilliant, almost garish, abundance of life. I hadn't see the death at home, though of course it was there in my hometown, New York City. Years after we left Uganda, we took our by then four year old daughter for a visit to my family.  I was so happy to be showing her Macy's and to weave with her through the carts and shouts and smells of the Garment District that I didn't realize her gaze had been caught by a drunk curled up in a doorway.  "He's dead, Mama!  Why doesn't someone help him!"  Disconcerted, I told her he was sleeping as I picked up our pace.  She said, "But he's not in a bed."

At our house at our school in Uganda, outside our kitchen door, blood spurt as our houseman decapitated chickens for our dinner.  Tiny, pale, unformed blobs and threads of blood nestled in the smooth, brown-shelled eggs the eggman brought.  At the market, the butcher swiftly sliced large chunks of muscle meat -- how much, one pound, five pounds?  from the cattle carcass hanging in his stall.  He wrapped them carefully in banana leaf packets, tied them with banana leaf fibers.  They never leaked. The local men suspected certain small animals, I don't remember what they were, of stealing chickens.  They chased them through the underbrush banging sticks and grunting in low, inhuman voices, till the terrified animals had to run into the open.  The men clubbed them to pulps near the flower beds in front of the school offices, leaving them in shreds,  hearts  pulsing through shredded muscle and membrane as they died.

More images: Brittle shells of giant insects my husband found for an entomologist friend and stored in small cardboard boxes in the pantry.  The corpse of a giant black snake slit open on our front lawn, my husband's students lifting out the soft, translucent eggs of the unborn young.  Rats, dogs,hyenas, giant birds feeding on tattered roadkill. A huge giraffe alongside the road in a game park, head intact, hyenas tearing at its belly.  Ants scouring bones until they shone. 

Wails, high pitched,  frequent.  Four men  holding high a litter, the outlines of the body clear under the cloth.  The death of babies.  So much life, but so much death, so fast in coming, the life and then the death.   And the sicknesses that sapped life: skin ulcers that wouldn't heal;  the endless cycle of malaria, its fevers sapping strength: pararasites at home in skinny kids; kwashiorkor's visible signs in babies: swollen bellies and tufts of reddish hair; elephantiasis swelling legs to painful, enormous size. People lived with these problems and persevered, often with great good humor. But the more severe, the more chronic, the more debilitating the problem became, the harder everyday life, the shorter life itself.

After several mornings of waking up sick to my stomach, I sat up in bed to see a plate of soda crackers and a glass of water next to my bed: a successful salve for morning sickness from our houseman.  I was late several times to my first period class.  One day, I walked in to find a cartoon drawing of myself, a huge pumpkin of a belly appended, on the blackboard.  The caption read, "Congratulations, Mrs. Fisher!"  The boys perched nervously on the edges of their seats.  I laughed.  They burst into applause. 

"We thought you and Mr. Fisher might perhaps be brother and sister," one of my students told me.  "You have been here so long and just now you are going to have a baby!"

Everyone in our neighborhood, not surprisingly, knew  instantly. Finally, after it was obvious to everyone, the doctor confirmed my pregnancy.

One day, I opened the door to two neighbors, women who lived a bit down the road. They were dressed formally in the long crisp cotton dresses with puffy sleeves that were the custom in the area.  We sat straight-backed, the three of us, on the edges of the chairs in my living room.  The houseman brought us tea syrupy with milk and sugar. They wanted to discuss a delicate and very private subject: birth control.  When it became known that I was not my husband's sister, but in fact his wife and capable of getting pregnant, local women immediately realized I had used birth control to avoid pregnancy.  Women where I lived were not ignorant, but they did not know specifics.  Not only that,  even if they knew the specifics, their chances of being able to use any method including or perhaps especially the rhythm method were slender indeed. Men had absolute rights over their wives.  They had the right to demand sex and they valued large numbers of children.

Each woman was in her late twenties, each had already given birth to six or seven surviving children and a couple who had died at or near birth. Though they were my contemporaries, they looked vastly older.  They told me how tired they were, how easily they got sick.   They had so much to do, so many responsibilities, and their families depended on them.  Women are responsible for the production -- the gardening and harvesting -- and preparation of their family's food, for taking care of the sick, for cleaning house and doing the laundry, without machines of course, and for getting water and fuel.  We saw them often on the roads carrying huge loads of firewood on their backs.  Even a healthy mom, if she has a lot of kids has to spread the basics of food and shelter thin.  Moms  worry about not being able to afford to send their kids to school.  In Uganda, families had to pay for all their kids' education, and schooling was increasingly seen as the only alternative to the rapidly diminishing ability to make one's living on the land.  So women have a lot of motives, not just their own health, for for trying not to have so many kids. It is not easy to see your own kids hungry.

So to safeguard the kids they have, without access to safer methods, many moms resort to what we would call back alley abortions.  And yet they can die this way, and do.  So in an effort to safeguard their kids, they leave them vulnerable.  Without mothers, children are often neglected, often join the ranks of orphans, of street kids.

The two women hoped that I might know a kind of birth control that they could keep secret from their husbands.    I thought birth control pills might work.  How silly of me.  If they had had the money, they would have had to take a taxi  the thirty miles to the nearest town with a clinic and a  pharmacy.  Of course they didn't have the money.  But if they had, they assured me, their husbands would surely find out what they'd used it for: money would be missing for one thing, or the doctor would talk, or someone in the clinic who knew them would talk, or someone would see them buying the pills and would talk. 

The only option they saw open to them was abortion, then and now the most prevalent form of birth control in rural Uganda. With an abortion they risked infection and hemorraging, infertility and death. At the least, if their husbands found out, they risked a serious beating.  But yet one more birth seemed an even worse choice.  Talk about the lesser of two evils.  Imagine, abortion as the only option.

I don't know what the statistics describing these issues were in the 1960's.Since then, Uganda as a country has been afflicted with terrible travails, from Idi Amin's murderous dictatorship in which hundreds of thousands of Ugandans were slaughtered to the AIDs epidemic to the ongoing war in the north of the country today.  In spite of this history, or maybe because of the lessons learned from it, The Uganda government has initiatives and policies strongly favoring women's right to family planning, to education, to participation in public life and to employment.  However, as with many poor countries, especially in Africa, not only the disasters mentioned above but the consequences of World Bank and International Monetary Fund policies as well as other ramifications of globalization have left the country no better off, possibly worse off economically, than it was when I was there in the 1960s.  "Modernization" has undone many wage earning, family and social structures without alternatives being developed.  There are few resources to change the status of women's health, especially in rural areas.

As I've indicated, abortion is intimately tied to reproductive practices in Uganda as, especially among the rural poor, the first line of defense against unwanted pregnancies.  Why so many unwanted pregnancies, you ask:

• Ignorance. 
• Lack of available women's health care.  In rural areas, a woman has to travel an average of twelve miles to existing services which may be inadequate.  The twelve miles (or thirty, as in the case of the two women I spoke with) is unrealistic if your only available means of transportation is walking.
• Lack of available contraceptives.
• Lack of skilled health care workers: doctors, nurses, trained aides, teachers.
• Lack of communication between men and women.
• The culture still values a large number of children in a family, though this is changing even in rural areas.
• Men often don't approve of birth control or are ignorant themselves and regard it as their right to have sex with their wives whenever they want it.  The culture condones this.  Even if women don't want more children, their position in the marital relationship denies them a say.
• Men may beat their wives if they discover them practicing birth control.
• In situations where men regard sex with their spouses as a right, "abstinence only" doesn't have a chance, not that it does in many other situations.

What makes a pregnancy unwanted in Uganda and elsewhere?

• Even in completely healthy women, pregnancy at a young age and repeated, too-close-together pregnancies, especially started under 18 and continued after thirty five, present health problems to both mother and child.
• Existing health problems increase the danger of complications in pregnancy.
• Pregnancy increases the seriousness of health problems.
• Too many kids in a family stretches available resources too thin.
• Too many kids even in extended families stretch available attention to thin.

What are some of the health issues?

• In Uganda, the risk of dying as a consequence of pregnancy is around 1 in 14, compared to the risk in North America where it is 1 in 6,366.  If there are no other health problems compounding the pregnancy or being compounded by the pregnancy, the risks are about the same as in the West: hemorrhage, sepsis, hypertensive disorders of pregnancy, obstructed labour and abortion.  About twenty percent die from a disease aggravated by pregnancy.
• According to WHO, "it is estimated that for each maternal death in a developing country, there are 124 women suffering illnesses or complications related to pregnancy and childbirth.  These conditions include anaemia, ante and postpartum hemorrhage, hypertension, infertility, prolapsed uterus, reproductive tract infections, and sepsis among others."  The report continues, "72% of women in sub-Shaharan Africa" are at risk of a pregnancy-related problem.
• The more times over five a woman delivers a child, the greater the risk for anemia, hemorrhaging, and death from hemorrhaging. 
• Risk of death is exacerbated in women with anaemia, cholera, heart diseas, hepatitis, malaria and renal disease.
• The risk of worsening of the very common infections of the genitourinary tract.
• Health consequences of high risk pregnancies can lead to social ostracism.  For instance, women who become sterile can be shunned by their husband and may end up having to support themselves as prostitutes.  WHO reports that a common complication of childbirth "among young women is obstetric fistula: awomen who suffer from the condition are often socially ostracized."

So do these women really think an unsafe abortion is a better alternative?  Apparently they do as seen by the statistics for those that didn't work out well.  For instance,

• According to WHO, "immediate complications include uterine perforation and injury to other internal organs, cervical lacerations, hemorrhage and infection.  Long term complications include increased risk of subsequent ectopic pregnancy, chronic pelvic infection, and infertility."  Safe abortions provided by people with appropriate skills and equipment under sterile conditions do not result in these complications except rarely.
• In Africa, "up to 50% of maternal deaths are due to unsafe abortion" and in Latin America, unsafe abortion may be the main cause of death in women between 15 and 39.

Remember, most of the women in Uganda who resort to unsafe abortions don't have realistic access to other methods of birth control.  The situation is complicated by the fact that safe abortions can only be provided in the case of threat to the mother's life.  Many women are afraid of getting crosswise with this law -- more afraid of this than of an unsafe abortion. 

Why should we in the US condone, or at least not condemn, legal, safe abortions in poor countries?

• Because women, especially poor women, in these countries for the reasons listed above, don't have reasonable access to contraception to prevent pregnancy.
• Many of these womens face severe consequences from unwanted pregnancies.
• Because therefore abortion is often the only line of defense against unwanted pregnancy.
• Because if legal abortions are not available, women will seek illegal, unsafe ones.  This is a universal truth.  If women are desperate to terminate a pregnancy, they will resort to an illegal abortion.
• Because if a women's health clinic provides safe abortions, the clinic will have access to that woman and her family for teaching safer, less distressing, less morally disturbing, methods of contraception.

Here's where George W. Bush's administration comes into the picture.  George and his posse have disrupted US aid to international family planning clinics in poor countries, even if they don't provide abortions, even if they themselves have nothing to do with abortion.  All these clinics have to have is the bad fortune to in some way be linked to a group that gives money to clinics that do talk about and/or provide abortions or is alleged to.  Even though these clinics save women's lives, and even though providing safe, legal abortions would also save women's lives. .

Shortly after he was elected, Bush and his posse restored what has been called "the global gag rule" of the Reagan years.  This  "rule" bans the giving of money to any group that even discusses abortion as an option with the only exceptions being threats to the life of the mother, or  pregnancy rape or incest.  The Bush Administration has withdrawn funding from the United Nations Population Fund and from The Reproductive Health for Refugees Consortium saying both of them give money to groups that support abortion in China to enforce limits to population growth.  Even their own investigator says that China is not forcing abortions. The Bush posse withdrew from a major international health conference last year because it received funds from Planned Parenthood International which does provide legal but not in any sense forced abortions as part of its efforts to improve women's health.  The Administration  tries to urge other countries notably in Latin America, sometimes with a heavy hand, to support its anti-family planning efforts including, surprise surprise, promoting abstinence over the use of condoms "particularly in developing countries ravaged by H.I.V. and AIDS." (Lizette Alvarez, NY Times, September 1, 2004)

As Timothy E. Wirth, former Senator from Colorado and current president of the United Nations Foundation and the Better World Fund said,  "On issue after issue, the current administration has placed ideology above evidence and bias above science.  Isn't it shameful that so many of the men talking about the sanctity of life are by their actions effectively condemning women to die?" (Alvarez)

I don't think there is anything we can do to convince politicians like George Bush that he is killing women.  He's not interested.   It doesn't cross his mind that he can be wrong.  It doesn't cross his mind that he can be responsible for terrible acts.  It doesn't cross his mind to put himself in someone else's shoes.  It doesn't cross his mind to care.

"Culture of life," my foot.  "Culture of death" is more like it. 

With Bush's blessing, the Right to Life movement is not only seeing to the death of women in poor countries who never had a chance, but is pushing women in this country, poor and rich, back to a similar place where there is no option available: no knowledge of birth control, no birth control, no emergency contraception, no legal abortion.

Modern family planning, including contraception (not just abstinence) and safe abortion has saved untold numbers of women's lives since they became available and with those lives, the lives and well-beings of their families..