The Means of Reproduction: Sex, Power, and the Future of the World (7 page)

A Catholic human rights group petitioned the government to bring charges against several women in the Red de Mujeres, including Violeta Delgado Sarmiento and Marta María Blandón, accusing them of covering up for Fletes in order to further their political cause. An official investigation was opened. “It’s the network’s responsibility,” the head of the Ministry of the Family told a Nicaraguan newspaper. “They knew what they were doing, and if they acted wrongly, there are laws to stop them from doing so.”
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Outraged, feminists in Nicaragua charged that Ortega was seeking revenge for their support of his own stepdaughter when she accused him of rape. “We accused the president of abuse and his wife Rosario Murillo of being complicit,” said one leading activist. “If anyone should be accused, it’s not the Red de Mujeres or the people fighting for women’s rights, but the president and his wife, who are sexual abusers and political abusers of the Nicaraguan people.”
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At the same time, human rights groups from around the world—especially Latin America—rallied to the women’s defense, staging a letter-writing campaign accusing the government of waging a political persecution. In response, the government seemed to back off a bit, and it soon looked as if the case against the feminists might fizzle out.

Legally, when it came to Nicaragua’s abortion ban, nothing had changed. Advocates still awaited the Supreme Court decision and discussed their next move. Taking the case to the Inter-American Commission on Human Rights was one option, said Lilian Sepulveda, the legal adviser for Latin America and the Caribbean at the Center for Reproductive Rights. Another possibility was appealing to the United Nations. But abortion controversies are always about more than the law, and the antiabortion movement momentarily appeared to have the moral high ground, at least in the public mind.

Meanwhile, in the year following the ban, government figures showed that maternal mortality in Nicaragua had doubled.
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Human Rights Watch documented case after case in which women had died after being refused treatment for pregnancy complications. In April 2007, Olga María Reyes, a married law student in her early twenties, hemorrhaged to death in a hospital in the city of León because her ectopic pregnancy wasn’t treated until hours after it ruptured her fallopian tube.
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“Women are afraid of seeking treatment,” said a UN employee in Nicaragua. “That’s the first step. . . . And doctors are afraid of providing treatment. . . . It’s the psychological factor. . . . And the combination may have caused deaths.”
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That autumn Pope Benedict XVI met with Nicaragua’s new ambassador to the Holy See at the papal summer villa in Castel Gandolfo. “The pope said he wanted to express his appreciation to Nicaragua for its position on social issues,” the
Catholic News Service
reported, “ ‘especially respect for life, in the face of considerable internal and international pressure.’ ”
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It remained to be seen which kind of international pressure would prevail.

CHAPTER 2:
THE GREAT POPULATION PANIC, OR FIGHTING COMMUNISM WITH CONTRACEPTION

I
n the 1950s, before he became notorious, Harvey Karman was a psychology student at UCLA, attending on the GI bill. Writing a paper on the emotional impact of abortion led him into the abortion underground, where he helped a number of desperate coeds find ways to terminate their pregnancies. “It seemed like every guy who got a girlfriend pregnant, everyone who had remotely heard about me, said, ‘This guy knows about abortion,’ ” he told
Ms
. magazine in 1975.
¹
Often he’d help young women make their way to Mexico to end their pregnancies. Some of them came through the procedures fine, but some came home sick or injured, and Karman would take them to the school’s medical center for treatment. Frustrated with this system, he eventually started performing abortions himself.

Much of Karman’s early history is hazy, but one horrific incident stands out. In 1955, one of the women who sought Karman’s help died of an infection, and he was charged with both murder and abortion. A court rejected his insistence that he was a mere middleman between the woman and a doctor, finding that he himself had tried to induce a miscarriage using a speculum and a nutcracker. Nevertheless, he was convicted only of the lesser charge, and after serving two years in prison, he emerged unfazed to resume the work that had become, for him, a kind of crusade.
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A man of the nascent counterculture, Karman dabbled in experimental films and worked with juvenile delinquents and at Head Start, but abortion remained his consuming passion.
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A sympathetic doctor told him that if he could induce just a small bit of bleeding in a pregnant girl, she could be admitted to the hospital and her abortion could be completed legally, a technique he adopted. In fact, all around the world, in countries where abortion is restricted, that’s often how it’s done. According to Malcolm Potts, an Oxford-educated doctor who is one of the world’s leading authorities on abortion, the “extralegal person is usually trying to produce uterine bleeding that will take the woman to the public hospital where she will be cleaned up.”

However standard, this system struck Karman as crazy, and he started trying to devise something better. Karman “was a very dexterous person,” said Potts, who later became his friend. “He used to make model airplanes when he was young. I once locked myself out of my car, and I’d never seen anybody break into a car as quickly as Harvey did. And he’s pretty good at breaking into the uterus.” As Potts recalled, Karman read the medical literature about abortion in Eastern Europe, where it had been legal since the 1950s. He wanted a method that was as painless as possible, allowing a woman to get up and walk away as soon as it was over. So he started experimenting in his kitchen. Karman cut the end off a large, plastic, handheld syringe, attached some polyethylene tubing to it, and soon came up with the prototype for the manual vacuum aspiration (MVA) syringe, a simple, hand-operated device that today is used all over the developing world. “It’s probably done many millions of abortions since then,” Potts said.
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Starting in the 1960s, Karman used his invention to perform illegal abortions out of a rented room next to a dentist’s office in Los Angeles. Charismatic and swaggering, he was remembered by some in the nascent abortion rights movement as a hero, by some as a huckster. He added a Ph.D. to his name, though his degree came from a dubious Swiss diploma mill.
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Without a doubt, there were abundant reasons to be suspicious of him, but he was no mercenary backroom butcher, and many recall him as more interested in spreading word of his discovery than in profiting from it, giving free demonstrations to interested doctors and health care workers. “I was most impressed . . . because of the safety for the women and because [the technique] made it possible to bring the price way down. And Harvey never charged a cent for his visits,” one San Diego Planned Parenthood official told
Ms
.
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In 1972, Karman enlisted Potts to cowrite an article about the MVA syringe in
The Lancet,
the prestigious British medical journal. The first medical director of International Planned Parenthood, Potts had been fighting for safe, legal abortion since 1963, when, as a young obstetrician doing his internship, he had had to deal with botched or incomplete terminations nearly every night. He was familiar with the techniques used all over the world, and Karman’s invention impressed him as a “very powerful technology.” He showed it to Reimert Ravenholt, the head of population affairs at the U.S. Agency for International Development, whom he’d met at a family planning conference in what was then East Pakistan.

Ravenholt, a roguish figure gleefully dismissive of political sensitivities, had already decided that poor countries sorely needed abortion equipment that could be run without electricity. USAID was primarily focused on spreading contraception, but government officials knew that birth control was always going to fail for a certain percentage of people, especially in places where access was sporadic and use inconsistent. As a then classified 1974 government report on overpopulation would conclude, “[I]ncreasing numbers of women in the developing world have been resorting to abortion, usually under unsafe and often illegal conditions. . . . [A]bortion, legal and illegal, now has become the most widespread fertility control method in use in the world today.”
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To Ravenholt it seemed obvious that no comprehensive American program to bring family planning to the world could ignore abortion. Besides, after
Roe v. Wade
was decided at the beginning of 1973, the issue seemed to be settled. Abortion was legal in America. Why shouldn’t American aid reflect that?

Agreeing with Potts about the potential of Karman’s innovation, Ravenholt had USAID contract with the Battelle Corporation to reengineer it for mass production. Not long after the
Roe
decision came down, Battelle, at Ravenholt’s urging, hired Karman, and soon they’d come up with a device that Ravenholt deemed “pretty ideal.” It was a modified 50 cc syringe topped with a thin plastic tube, or cannula. When the plunger was pulled, a thumb-operated valve retained the vacuum. The abortionist would insert the cannula through the cervix, then gradually release the valve to suction out the uterus. “This was a very efficient way of terminating early pregnancies,” said Ravenholt.

If there was a risk in putting an illegal abortionist to work, albeit indirectly, for the U.S. government, it seems not to have occurred to Ravenholt. “I knew what we needed, and Harvey had done something along that line, so what the hell?” he said. Through the U.S. government’s General Services Administration, he ordered a thousand “menstrual regulation kits” that included a syringe, a dozen cannula, a speculum, and a plastic basin, and he supplied them to doctors all over the world. The feedback was positive, so he ordered ten thousand more. His staffers would bring suitcases full of them when they went on trips abroad. The technology has since been introduced in over one hundred countries.
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“I have a friend—a woman obstetrician-gynecologist in Malaysia—who, using one kit, with some replacement cannulae, did sixty-eight hundred pregnancy terminations,” Ravenholt said, delighted and proud. “This was remarkably cost-effective. In fact, some women used it themselves, and nurses and midwives and others could use this with fair safety.”
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I
t’s hard to believe now, after years in which the United States has exported its antiabortion movement all over the globe, that the American government was once responsible for bringing safe abortion to great swaths of the developing world. Hard to believe, too, that support for distributing contraceptives to remote corners of the planet was once a solidly bipartisan undertaking. As George H. W. Bush wrote in 1973, “Success in the population field, under United Nations leadership, may, in turn, determine whether we can resolve successfully the other great questions of peace, prosperity, and individual rights that face the world.”
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(As a congressman, Bush earned the nickname “Rubbers” for his enthusiastic interest in family planning.)

Americans are used to thinking of birth control and abortion as thoroughly domestic issues, but reproductive politics have been global from the start. In the second decade of the twentieth century the American birth control movement created its clinic-based system on the groundbreaking model pioneered in the Netherlands, a country that remains in the vanguard of international family planning. Margaret Sanger, the glamorous dynamo who pioneered birth control access in America and around the world, was something of a hero in Japan; she was the first foreigner ever invited to address the Japanese parliament.
¹¹
Abortion methods travel from country to country; the technique most often used in the United States today was pioneered by two doctors in the former Yugoslavia, a father and son team. The former had been the gynecologist to Yugoslavia’s royal family before World War II, when illegal abortion was so common in that country it was called the white plague.
¹²

Today abortion is broadly legal in the vast majority of the developed world and in Asian countries, including China and India; more than 60 percent of people live in countries with liberal abortion laws. Another 14 percent or so live in nations like Colombia and Ghana that allow abortion under certain circumstances. But in many poor countries, including large parts of Africa and Latin America and parts of Asia and the Middle East, abortion is either banned entirely or allowed only to save a woman’s life. Twenty-six percent of the world’s women and men live under such laws, which are largely the relics of colonial constitutions promulgated by European countries that have since abandoned such restrictions for themselves.
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Given that so many abortion bans are artifacts of colonialism, it is particularly ironic when the contemporary global antiabortion movement accuses reproductive rights activists of neoimperialism. Yet it’s also true that realpolitik-driven fears of swelling third world population, more than humanitarianism, drove early efforts by the United States to bring family planning to poor countries. America’s international commitment to birth control was intended to fight communism, not to liberate women. If it did the latter, that was at best a bonus. Eventually, the national security rationale would give way to a focus on women’s rights, leaving birth control programs far more politically vulnerable to right-wing attacks, since nothing but women’s lives was at stake.