Article

Choice in a Global Context

As we approach this Sunday’s March for Women’s Lives, most of us will focus first and foremost on the imminent threats in the United States to a woman’s right to choose whether or not to carry a pregnancy to term. Attention will also naturally focus on that time in the United States—pre-Roe v. Wade—when the costs of clandestine, unsafe abortions could be tallied in the real loss of women’s lives.

Yet to understand the implications of current threats to sexual and reproductive health and rights, we hardly need to look back in time. The real costs of such restrictions are evident today both within and outside our own borders. Equally obvious across that same landscape is the role being played by the religious and political right in the United States in restricting access to the basic reproductive health services needed to reduce unintended pregnancies, unsafe abortions and HIV infections in virtually every corner of the globe.

Each year, conservative estimates indicate that more than 500,000 women worldwide die from complications of pregnancy and childbirth, of which 80,000 deaths are from complications of back-alley abortions. In many countries of Africa, Asia, and Latin America, complications of pregnancy and childbirth are the leading cause of death among women ages 15-35.

The rapid spread of HIV worldwide is making a bad situation far worse. Women and girls make up the majority of the 40 million people worldwide infected with HIV, and represent 60 percent of those infected in sub-Saharan Africa, the region hardest hit by the AIDS epidemic= In many countries, such as India, South Africa, and Zambia, the rate of new infections is highest among married women and adolescent girls. Data collected by the U.S. Centers for Disease Control (CDC) in South Africa, for example, reveals consistently high rates of new infections among pregnant women ages 20 to 24 and rising rates among those ages 25 to 34.

Unprotected heterosexual sex is the primary factor in the spread of HIV infections worldwide, and is, of course, the sole factor in the large number of unintended pregnancies and unsafe abortions that occur each year. But while women are disproportionately affected by unintended pregnancy and infection, they often have little control over when and with whom they have sex. In many countries, for example, child marriage remains the norm: 47 percent of adolescent women are married by age 18 in South and East Africa, 55 percent in West Africa, and 62 percent in Asia. In such settings, women are expected to be sexually available to their husbands at all times and face the threat of violence if they resist. Multi-country studies conducted by the World Health Organization indicate that between one fourth and one-third of women in developing countries have experienced sexual violence and coercion within marriage. These and other factors contribute heavily to high rates of unintended pregnancy, unsafe abortion, and HIV infection worldwide.

The majority of deaths and illnesses from complications of pregnancy and sexually transmitted diseases could be avoided through universal access to effective family planning and HIV prevention services and technologies. Today, however, more than 200 million married women worldwide remain without access to even the most basic contraceptive services. The majority of women at risk of HIV infection have little information on or access to prevention strategies and technologies, such as male and female condoms. These are global issues in the truest sense: millions of low-income women of color in the United States have far less access than wealthier women to basic reproductive health care; rates of HIV infection and unintended pregnancy among this group are similar to those in developing countries.

Despite these realities, the Bush administration and its allies in Congress have gone out of their way to undermine the basic services needed to prevent unintended pregnancy and HIV infections and reduce unsafe abortion worldwide. In July 2002, for example, President Bush rescinded $34 million appropriated by Congress for the United Nations Population Fund (UNFPA), justifying this decision by claiming that UNFPA “supports or participates in the management of a program of coercive abortion or involuntary sterilization in China.” UNFPA—the preeminent multilateral organization supporting universal reproductive health care—does not provide abortions anywhere in the world. A handpicked team sent by the White House to investigate its work determined that UNFPA is neither funding nor supporting coerced abortions in China and, more importantly, provides the only counterweight to such practices in those districts where it works. This “blue-ribbon” team recommended that the president restore funding to UNFPA immediately. Nevertheless, representatives of the religious right continue to spread misinformation about UNFPA in the media, and President Bush, seeking to mollify his base, has refused to provide funding to UNFPA.

Similar political motivations are behind the global gag rule—which prohibits U.S. funding to any organization that conducts research on, counsels, or provides information about abortion trends and services, even in countries where abortion is legal or where unsafe abortion is a leading killer of women and girls. Politics also plays the leading role in reductions in U.S. bilateral funding of family planning programs, in cuts in funding for family planning programs serving low-income women in the United States, and in the promotion of “abstinence-only-until-marriage” programs in the U.S. Five-Year Global AIDS Strategy. Indeed, these trends can be seen as part of the administration’s broader “export-import” program on sexual and reproductive health, in which “abstinence-only” programs funded at the expense of comprehensive education are being exported abroad—despite studies showing high failure rates among teens in the United States—and restrictions similar to the global gag rule are being pushed at the federal and state level in the United States. These ideologically driven agendas undercut the very programs needed to prevent HIV infection, abortion and other adverse outcomes, and therefore belie claims by the far right that the real issue is abortion. Instead, these struggles are fundamentally about whether women will retain any control over their bodies, health, and reproductive choices.

For these and other reasons, the March for Women’s Lives is literally that�?????about the lives and survival of women throughout the world today, not in some abstract historical sense, but in real time. It is about the lives and choices available to “our” daughters in every country, today and tomorrow. The first step taken by each person this Sunday will hopefully be but a starting place in a longer march toward actions to ensure that all individuals are able to make the choices needed to enjoy healthy and safe sexual and reproductive lives.

Jodi Jacobson is founder and executive director of the Center for Health and Gender Equity in Takoma Park, Md.

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