When I used to report on the United Nations I would saunter down to the department of public information every few days and accumulate unnecessarily thick stacks of documents — there was, in fact, already the internet. Among my reams of paper would be tucked a monthly calendar of “observances,” days the U.N. dedicates to myriad causes around the world. I was writing on global poverty and development at the time, and in uninspired moments I would try to pitch stories based on the week’s highlighted issues.
“It’s the International Day of Older Persons!” I would tell my quick-witted editor. She would pithily remind me that U.N. humanitarian declarations do not a news-event make.
So I apologize for a post centered on international observances. To make it worse, I’m late. But the days are less important than what they represent, and last week’s calendar said more than was perhaps intended about ongoing rifts in the politics of women’s bodies.
Last week was World Contraception Day. On September 26, a coalition of major international women’s health organizations reminded the world’s youth that it’s “Your Future. Your Choice. Your Contraception.”
Contraception has been getting a lot of airtime recently. The Gates Foundation, a giant in global health funding, hosted the London Family Planning Summit this summer and gathered $2.6 billion in new funding commitments. Last week German pharmaceutical company Bayer announced it would cut the cost of implant contraception for poor countries, in a deal worked out with the Clinton Health Access Initiative.
The Gates Foundation, attempting to circumvent the inherent controversy around family planning created a website assertively titled “No Controversy.” Women can write in to share their stories of how birth control changed their lives.
Melinda Gates was inspired by the stories of women she met around the world who were burdened and injured by successive pregnancy. Currently an estimated 222 million women who want it do not have access to modern contraception. If that need were met, 79,000 maternal deaths and 1.1 million infant deaths could be avoided, according the Guttmacher Insitute.
So that was the story for Wednesday.
And then last Friday, September 28, was the Global Day of Action for Safe and Legal Abortion.
Of course every cause needs its day in the sun, and illegal abortion is as worthy as World Post Day (October 9!). Unsafe abortion kills 70,000 women every year. A Lancet study found higher rates of abortion in areas with more strict abortion laws. Nearly half of the world’s abortions in 2008 were unsafe, which means women were using unregulated drugs or more gruesome self inflicted tactics.
But the 24 hour separation between World Contraception Day, and Safe Abortion Day points to the uncomfortable silence around abortion internationally, and the continuing tendency to compartmentalize women’s health.
Advocates realized they missed the boat on getting a specific commitment to reproductive health care into the Millennium Development Goals back in 2000. In 2005 world leaders amended the fifth MDG on maternal mortality, belatedly adding reproductive health care to the target. But MDG 5B hasn’t quite caught up to MDG5 (itself a straggler among the goals) and in the public discourse there is still an embarrassed glossing over the relationship between motherhood and sex.
Yet public health leaders are quick to say that comprehensive care is the only way to tackle the lingering maternal mortality crisis.
Flavia Bustreo, a long-time maternal health expert at the World Health Organization, highlighted* unsafe abortion as one of three main causes of maternal death, along with infection and excessive bleeding. She said that unsafe abortions are perpetuated by laws restricting clinical abortion in many countries. But even more so she emphasized that beneath the law is the status of women. Maternal mortality, she said, “is an expression of the position women have in society”.
Dr. Mickey Chopra, chief of health for UNICEF also highlighted that “universal health care coverage is a key intervention the U.N. is working on with countries.”
But despite broad understanding among experts that complete care–including abortion–is key to tackling maternal mortality, global campaigns, funders and advocates tiptoe around the issue.
Even the U.N. Global Strategy on Maternal and Child Health undercuts its own strong language when it comes to complete care: “partners must ensure that women and children have access to a universal package of guaranteed benefits including…safe abortion services (when abortion is not prohibited by law).”
The unspeakable nature of abortion prompted the creation of the Postabortion Care Coalition in 1993 and to this day advocates are fighting to ensure that women who induce their own abortions can at least access respectful, effective care to stop resulting hemorrhages and treat infection. So far the number of maternal deaths caused by abortion has remained static.
The gap between contraception and abortion is more than 24 hours; it’s a gulf between the spoken and the unspoken, which in health policy can be life and death.
*I met Dr. Bustreo and Dr. Chopra during the United Nations Foundation Global Issues Press Fellowship in New York