(c) 2013 Margaret Morganroth Gullette
The Lethal Consequences of Compulsory Pregnancy
When a new Women’s Shelter opened in Nicaragua, I got to know the abused girls, none over 15 years old, who came to live there. I have a favorite, Adelina (not her real name), a silent, skinny, shy girl who came first, when she was just thirteen. After social services arrested her alleged abusers, they sent her to us.
I met Adelina the next morning, after her night of wakeful tears. I knelt down, watching her draw, speaking to her through a finger puppet. “Me gusta tu dibujo,” the puppet said in a squeaky voice. Eventually, by saying sadly “Me gusteri'a dibujar. . . pero yo no tengo dedos,” in puppet-voice ("I would love to be able to draw. . . but I don't have fingers"), I succeeded in making her laugh. That laugh founded an affectionate relationship.
She lived in the Shelter, studied, and proudly got admitted to high school. Then she was remanded to her family but continued to come for therapy five times a week. I just earned she was made pregnant, by an older boy. He is a drunk who who has been seen passed out in public. She is 23 weeks pregnant, vomiting and miserable--although she still attends her school. I am distraught and helpless.
What can a pregnant girl of fifteen who doesn’t want a baby do, if she accidentally becomes pregnant in a country that forbids abortion? Answers: Bear it. Self-abort. Commit suicide. In Nicaragua, where all abortions have been made illegal, and doctors who do the procedure are threatened with one to three years of prison, the highest number of adolescent deaths in pregnancy comes from suicide. Rat poison, a cheap and available means, is the most frequent method.
Compulsory pregnancy is the rule in Nicaragua. It may be coming here to the United States, where many states limit access—and where 20 percent in a Gallup poll agree with Nicaragua: no exceptions for fetal anomaly, incest, rape, or risk to mother. Diminishing access in Texas has led 7 percent of women who needed abortion care therein the state to try self-abortion—even before the latest bill restricting abortion.
The data on teen suicide-by-poison is provided by the Nicaraguan Ministry of Health. The absolute number is probably higher, because doctors fear record-keeping. Suicide is everywhere terrible in family life, but in countries without abortion rights, pregnancy deaths can be public, tragic, unnecessary, and cruel. The cause is not pre-existing mental illness; the cause is desperation.
The desperation is easy to understand. At times a girl has been raped very young, perhaps by a relative. She has a horror of incest. A young girl is not ready physiologically to give birth healthily, nor is she ready psychologically to raise a baby. At times it is a woman’s male partner who doesn’t want a child: he is unemployed and drunk; he is likely to abuse her. Or a woman anxiously knows that something is going wrong with her pregnancy (but if she can’t afford prenatal care, this she does not know). Very few Nicaraguan women can afford to fly to Miami. Not even the risk of botching it, nor the certainty of mortal sin (which some believe in) prevents girls from finding suicide the least bad choice.
Even if the girl or woman arriving at a Nicaraguan hospital has a fetus that will die, or if she herself will die without help, she will be turned away. An American gynecologist I know and admire—who has spent his professional life offering women abortions along with other reproductive health services in several high-quality hospitals and has sometimes been threatened with death—rejects the excuses. “The reason they give in Nicaraguan hospitals for ejecting women whose pregnancies are in crisis is that they don’t have the necessary equipment. That’s not true. If you can treat a miscarriage safely, you can do an abortion.” Dr. Phillip Stubblefield says these doctors should resign rather than refuse. A boycott of the law—with the loss of many doctors in a country so needy of trained medical professionals—would be an ethical response at the level of the damage that the law produces.
“Plan C” is One Answer
There is in fact one possible answer: safe nonsurgical abortion, sometimes called RU486. Abortion activists call medical abortion Plan C. Plan A is contraception; Plan B is the “morning-after pill.” Plan C is two pills--mifepristone in combination with misoprosto-- that can be taken safely, according to Ipas (an international NGO with a center in Managua providing information and training), for up to twenty-three weeks of gestation. http://www.ipas.org/...
It is too late for Adelina.
By 2011, fifty nations around the world had approved medical abortions. In some few countries it is sold over the counter, but not officially. Plan C is safer than carrying a baby to term. It is certainly safer than an illegal abortion that is self-induced or given by an untrained person.
But in Nicaragua, women are unlikely to know that Plan C exists. Hospitals alone have the drugs, but only for obstetric use. One of the two pills is available for ulcers, but not for abortion. Yet, it is legal to give information about Plan C in all countries that have signed the International Declaration of Human Rights. Nicaragua has; the United States hasn’t.
In the United States, only a doctor who is registered and tracks every pill can provide it, and only when a woman takes it in front of her/him. Many women in the United States are also unlikely to know about Plan C.
So here is some information. Women on Web, an organization based in Amsterdam, answers related questions online and offers a consultation. https://www.womenonweb.org/... Another group, Women on Waves, sends the pills by mail after a pregnant woman fills out their form. https://www.womenonweb.org/... The sites can be read in Spanish as well as other languages. No woman is turned away because she can’t afford the cost.
Where an abortion ban was rescinded, as in Nepal, in one year the number of deaths of pregnant women was reduced by half. Uruguay recently legalized first trimester interventions, while Colombia, Brazil, and Argentina allow abortion in following rape and in other circumstances they consider “extenuating.” Gradually, in such countries, women seeking abortions are no longer considered “potential lawbreakers” (in a distinction madebut instead treated as “citizens with problems whom the State has a responsibility to help” (a distinction made by Iqbal H. Shah and Mary Beth Weinberger in the International Journal of Gynecology & Obstetrics http://www.ijgo.org/...(12)00298-6/fulltext ) but as “citizens with problems whom the State has a responsibility to help.”).
The Montevideo Consensus, the culminating agreement of the United Nations-sponsored first session of the Regional Conference on Population and Development in Latin America and the Caribbean, urges governments “to consider amending their laws, regulations, strategies and public policies relating to the voluntary termination of pregnancy.” Nicaragua also needs to protect girls by educating boys and girls better about sexuality and contraception and women's rights--whatever is necessary so girls do not grow up to suffer what my little Adelina is going through, and will yet endure.
When a country’s legislators and jurists listen to the needs of the most vulnerable and provide appropriate care. desperation subsides—public health improves. By such standards should we measure the ethical level of a government.
Violent misogyny ill becomes democracies—whether in it is Nicaragua or the U.S. states here turning against women. “In numerous countries where the Catholic Church is powerful and abortion is banned even to preserve the woman’s life —Nicaragua, El Salvador, Chile, the Philippines—the death penalty does not exist,” Katha Pollitt, a columnist for The Nation, observes. “A serial killer is at less risk of death from the state than a pregnant woman.”
But the public too is culpable, the public that does not feel sufficient empathy for a desperate woman—that could not explain any of the deep motives of the desire for an abortion. But now, the voices of these suicides shout their lamentable truth. These atrocious deaths must stop.
Margaret Morganroth Gullette, Ph.D., has been visiting Nicaragua since 1989 to further adult education in the region. She is the award-winning author of four books and publishes in the mainstream press internationally, including El Nuevo Diario, the Guardian, Al Jazeera, and The New York Times.
(© 2013 Margaret Morganroth Gullette)
Crosspost.
This essay is based on one that appears in Tikkun, September 27, 2013, in a slightly different form. http://www.tikkun.org/...
With thanks to editor Alana Yu Lan Price.