The Means of Reproduction: Sex, Power, and the Future of the World (3 page)

Many decades later U.S. neoconservatives used Islamist abuses of women—which are, of course, quite real, as were many of the atrocities documented by Mayo—to justify American aggression in the Middle East. (Few, of course, suggest punishing friendly Saudi Arabia for its system of gender apartheid.) It is not surprising, then, that there is abundant suspicion in the developing world whenever Westerners begin cataloguing the ills visited on foreign women. However, that suspicion, and the history that gives rise to it, does not change the fact that the widespread, overwhelming abuse and devaluation of women, especially in poor countries, is the biggest human rights crisis in the world today.

G
iven the range of horrors to which women are subject, perhaps it’s fair to ask why focus on reproductive rights at all. Access to contraception and abortion are obviously not all that’s needed for equality. The right to work and go to school, to own land, to inherit, to live free from violence—these are life-and-death issues for many women in developing countries. They often have far more day-to-day salience than family planning.

Yet reproductive rights are the place where many of the crucial forces shaping and changing women’s lives—religious authority, globalization, patriarchal tradition, demographics, American foreign policy, international law, environmentalism, and feminism—intersect. They are the ground on which major battles about women’s status are being fought. And a woman’s right to control her own body, to make her own decisions about childbearing, is closely bound up with other rights in myriad ways, as we’ll see throughout this book.

For one thing, reproductive rights are intimately related to women’s economic freedom. Having smaller families allows women to work. When they bring financial resources into the family, their power tends to increase and their daughters’ welfare improves. When their daughters are educated, they also choose smaller families, which can be better cared for. As a paper by the World Health Organization put it, “The reproductive revolution—the shift from six births, of whom several might die, to around two births, nearly all of whom survive—represents the most important step toward achievement of gender equality by boosting women’s opportunities for nondomestic activities.”
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That’s part of the reason that Bangladesh’s famed Nobel Peace Prize-winning Grameen Bank, which makes microloans to poor women, has borrowers pledge to “plan to keep our families small.”
¹⁷

At an even more elemental level, for far too many women pregnancy is either deadly or debilitating. Putting off childbearing until their bodies are mature enough protects mothers, as does spacing their pregnancies several years apart and having only as many children as they choose. Furthermore, it makes little sense to tackle maternal mortality and morbidity without paying attention to unsafe abortion, one of its major and most easily eradicated causes. Reproductive rights are not the whole of women’s rights, but they are a precondition of them. They help women survive and allow them to transcend mere survival.

They are also powerfully symbolic, because women’s reproductive role is often the justification for their subordination. International debates over family planning have as often as not become political battles over women’s rights more generally, and even over women’s humanity. Thus, reproductive rights, while being enormously consequential in and of themselves, also offer a lens through which to view even bigger questions of gender and power in a globalized but desperately unequal world.

From the anticommunist genesis of America’s attempts to stem population growth in poor countries to the current worldwide attack on women’s rights as a decadent Western imposition, the politics of sex and childbearing are woven into many of the great issues of our time. Underlying diverse conflicts—over demography, natural resources, human rights, and religious mores—is the question of who controls the means of reproduction. Women’s intimate lives have become inextricably tied to global forces. At the same time, the fate of the planet has become inextricably tied to women’s ability to control their own lives.

CHAPTER 1:
SANDINISTA FAMILY VALUES

E
ighteen-year-old Jazmina Bojorge, already the mother of a four-year-old boy, was five months pregnant when she arrived at Managua’s Fernando Vélez Paiz Hospital in early November 2006. She was feverish, bleeding, and in pain, and she’d started having contractions. She was miscarrying, and under the circumstances the doctors should have given her a drug to speed the process. The reason they didn’t remains unclear. Here’s what is known: Just a week earlier Nicaragua’s Asamblea Nacional voted to ban all abortions, even those meant to save a woman’s life. In Bojorge’s case, an ultrasound showed that her fetus was alive, and her doctors, ignoring medical protocols in order to try to rescue the pregnancy, gave Bojorge a drug to stop her contractions. She was kept on the medicine until tests a day later showed the fetus had died, at which point she was allowed to deliver. By then, though, her placenta had detached and her uterus had filled with blood. She went into shock and died.
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Feminists and human rights activists around the world called Jazmina Bojorge the first victim of an abortion ban that would soon claim many more, and the government promised an investigation. The director of the hospital insisted that the new law, which hadn’t even officially gone into effect when Bojorge died, had nothing to do with his doctors’ decisions. Many Managua gynecologists, though, spoke of the fear and confusion that had descended onto their practices, and said that they, too, might be forced to withhold help from pregnant women with complications like those of Bojorge. “They are between a wall and a sword,” said Carmen Solórzano, an ob-gyn at Managua’s bustling Hospital Militar, which serves around fifty thousand people in addition to soldiers and their families. Solórzano has short dark hair, high cheekbones, and a brisk, serious manner. Her office is a low-ceilinged room with peach-colored walls and a chugging air conditioner; outside in the waiting area dozens of chairs are set up like an overcrowded classroom, almost all of them taken. When I interviewed her in late November 2006, she’d seen a case just the day before not unlike that of Jazmina Bojorge and, apparently, like the doctors at Fernando Vélez Paiz, she’d felt forced to delay treatment.

A woman had arrived in the middle of a miscarriage. She was twelve weeks pregnant and bleeding, and her cervix was dilated. “When you have bleeding and you have a dilated cervix, you have to intervene,” Solórzano said. In such cases the medical manuals recommend giving the patient Oxytocin to help her expel the fetus. But this woman’s fetus was alive, and under the new law Solórzano couldn’t do anything until it died. In the meantime, she said, the woman was at high risk of infection. The patient’s mother pleaded with the doctor to end the pregnancy, saying she’d hire a lawyer if anyone decided to prosecute. But Solórzano had to make her wait. “If there is a heart beating, we can’t intervene,” she said. “We know the pro-life people are after the gynecologists.” (The patient, thankfully, survived.)

Among many doctors there were rumors of coming persecutions. Dr. Ligia Altamirano, an exuberant, round woman with a high, lilting voice, is the former president of the Nicaraguan Society of Gynecologists and Obstetricians. She worked for twenty-three years in the Ministry of Health before leaving it “like a bad husband.” “Undoubtedly women and doctors will go to jail,” she said. “Doctors in El Salvador tell us that in the hospitals there are people from Pro-Vida”—the so-called pro-life movement—“who, when a woman comes in with any type of miscarriage they call the attorney general, and there is an investigation.”

El Salvador is a frightening harbinger for Nicaragua’s feminists. Conservative forces in the Catholic Church, often working with American pro-life groups, have long sought to bring Latin America, the world’s most Catholic region, into line with Vatican teachings on abortion, and in El Salvador their triumph has been total. Since the late 1990s it’s been a country where all abortion is criminalized; where women with ectopic pregnancies must wait for their fallopian tubes to burst, and where, as a
New York Times Magazine
article put it, “forensic vagina inspectors” treat women’s bodies as potential homicide scenes.
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El Salvador is not the world’s only country where abortion is completely banned: Malta eliminated an exemption allowing for abortions to save a pregnant woman’s life in 1981, and Augusto Pinochet’s military dictatorship did the same in Chile in 1989. But El Salvador is the poorest such country, so many women there don’t have the means to seek abortions elsewhere, and its legal system has proven the most zealously prosecutorial.

An intensified version of American-style abortion politics has come to Latin America, pitting the local religious hierarchy and its supporters in the United States and the Vatican against feminists and their allies in Europe and the United Nations. Nicaragua has had massive pro-life marches, TV airings of
The Silent Scream
(the famous antiabortion film), and in 2006 the first protests outside women’s health clinics. The rhetoric of family values certainly isn’t new in Nicaragua—Violeta Chamorro’s 1990 presidential campaign, which led to her victory over the Sandinistas, was saturated with it. Nor did Nicaragua import its antiabortion ethos. Even before October 26, 2006, when the country’s legislature voted to eliminate all legal abortions, the procedure wasn’t easy to get. Only “therapeutic abortion,” done to save a woman’s life, was permitted, and the law required three medical professionals to sign off on each one. (In practice doctors would end ectopic pregnancies—in which the fertilized egg lodges in a fallopian tube, which bursts if left untreated—without first getting a committee’s permission.) In the years before the ban fewer than ten therapeutic abortions annually had been approved in Nicaragua’s public hospitals. By contrast, around twenty-two thousand underground abortions were performed in 2003 alone.
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Because legal abortion was so rare in the country, the intensity of the recent campaign against it seemed strange. The exemption for therapeutic abortions had been on the books for over one hundred years. Since it was already so narrow that the vast majority of women with unwanted pregnancies couldn’t take advantage of it, why did the government feel compelled to close it altogether, even if that meant sentencing some women to death?

Part of the answer lay in domestic politics. Desperate for restoration, Sandinista leader Daniel Ortega—a man who has rarely hesitated to betray the revolution’s feminist supporters—found Jesus and courted the church. By coming out in favor of the ban and instructing Sandinista lawmakers to vote for it, he ensured the law’s passage and garnered religious support for his presidential bid.

But the battle over abortion in Nicaragua was never merely local. Countries such as Nicaragua have become the site of proxy fights in a much larger international culture war. Even as feminists have tried to expand reproductive rights there, conservative leaders in Nicaragua railed against what they describe as a kind of libertine social imperialism, and networks of foreign nonprofits and sympathetic governments support both sides. Abortion has come to symbolize broader anxieties among parts of the public, about familial chaos, declining religious authority, and the temptations and pressures of a louche, foreign pop culture.

Therapeutic abortion is increasingly accepted as a human right in international law—a remarkable, little understood development. That puts countries such as Nicaragua on a potential collision course with the United Nations and other multinational bodies tasked with upholding global agreements on women’s rights. Thus, the same tensions highlighted by
Roe v. Wade
—between the liberties of the individual and the dominant mores of the community; between local sovereignty and central authority; between religion and science—are appearing all over the world.

In addition to Latin America, there are intense battles over abortion being played out in several countries in Africa and in Eastern Europe. Ethiopia, a country where one study showed that unsafe abortion was responsible for more than half of all maternal deaths,
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was on the cusp of decriminalization in 2005 when an American-style evangelical antiabortion movement arose and thwarted some (though not all) of the reforms. In 2004, a national uproar over abortion in Kenya led to the railroading of a prominent gynecologist on murder charges, eventually dropped.
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And the Protocol on the Rights of Women in Africa, the world’s first treaty that specifically delineates a right to therapeutic abortion, has been ratified by a growing list of African nations, with Kenya poised to join them.

The fight over abortion has been internationalized in Europe, too. Abortion in Poland, freely available during Communist rule, was radically restricted in 1993, and the Catholic Church continues to seek a total ban. In 2007, Alicja Tysiąc, a Polish woman forced to continue a pregnancy despite warnings that it would destroy her already failing eyesight, won a judgment from the European Court of Human Rights in Strasbourg that her rights had been violated. Her government was ordered to pay her twenty-five thousand euros in damages.

Latin America, though, is where international pressure for liberalization has had the most repeated collisions with right-wing religion. The region has both the world’s strictest abortion laws and the highest rate of clandestine abortion—four unsafe abortions for every ten births, according to the World Health Organization.
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It’s the site of a rearguard action by antiabortion forces: Even as reproductive rights expand throughout much of the world, they’ve contracted in several Latin American countries. (Mexico City, where abortion was decriminalized in 2007, is an important exception to the regional trend.) Several of the precedent-setting cases in international reproductive rights law come from Latin America, and by looking closely at it, we can see how individual women are affected by the all-ways tug-of-war between religious conservatives, feminist activists, international law, and nationalist politics.