The following piece was written by Aerlyn Pfeil, midwife and member of the Doctors Without Borders/Médecins Sans Frontières (MSF-USA) board of directors. This content was originally published on MSF’s Because Tomorrow Needs Her blog.
I remember coaching a young woman as she pushed her first baby out of her womb following nine months of nightmares. She had been raped and abortion was restricted in Papua New Guinea. At eight weeks of pregnancy, she had arrived at a Doctors Without Borders/Médecins Sans Frontières (MSF) clinic, shaking, fearful, and sobbing, asking if I could help.
We discussed her fears, her desires for the future, and the physical, emotional, and legal risks of terminating her pregnancy, as well as the risks of continuing it.
Ultimately it wasn’t safe for her to have an abortion. But it was extremely important for her emotional well-being and her capacity to mother her yet-to-be-born child that she receive informed, unbiased, and comprehensive care.
The Mexico City Policy, also known as the Global Gag Rule (GGR), will prevent midwives all over the world from providing these vital services.
The GGR is a United States government executive order prohibiting non-governmental organizations (NGOs) that receive U.S. government funding from providing or discussing with patients the option of safe termination of pregnancy. While the U.S. has not allowed government funding for most abortion services overseas since the 1973 Helms Amendment, this executive order further restricts women’s ability to receive complete reproductive care by withholding all funding if abortion is even mentioned during patient consultations. That means no patient counseling, no public education, and no referrals related to safe abortion services.
MSF does not receive any U.S. government funding, so we’re protected from the GGR, but we are the exception. I am fearful of the far-reaching negative impact the GGR will have on women’s health worldwide.
I’m going to be upfront: discussing abortion has never been easy for me. I’ve seen that when it comes to our moral convictions, evidence does little to sway people one way or another. But I’d like to share, anyway.
Since I started attending births in 2001, I’ve provided informed care to thousands of women, regardless of my faith or personal convictions. I have witnessed girls become mothers. I have held slippery newborns as they take their first breath, and, in some cases, their only breath.
I have witnessed time and time again the strength and suffering of women.
I’d like to believe my experience makes me actively, acutely, truly, pro-life.
I also believe women have the right to make informed decisions about their reproductive health, about their bodies and families. Being a midwife means I am with and for women and yes, sometimes that means I terminate a pregnancy.
The GGR is not saving lives; it plays politics with women’s lives.
If we are against abortion in any and all cases and believe every pregnancy should be continued, regardless of the circumstances, the GGR seems to make sense. Yet, like life, the policy isn’t black and white. The GGR will actually hurt women and their children. In short, it will force NGOs to choose.
NGOs can continue to counsel women on their safe reproductive care options and lose funding for a range of life-saving services: from safe deliveries to contraception, from treatment for malnutrition and HIV, to care for Ebola, malaria, and the Zika virus, all of which uniquely impact pregnant women. Or they can withhold vitally important health information, a clear violation of medical ethics. Either way, patients — adults and children — will pay the price.
There is abundant evidence supporting the fact that highly restrictive abortion laws do not prevent the termination of pregnancy. And there is no evidence showing the GGR has in the past, or would in the future, reduce the number of abortions. Data shows that the number of abortions actually go up when the GGR has been in place. The truth is that defunding organizations that provide safe, informed reproductive health services increases the risk of a life lost. Denying a woman access to health care puts her life and the lives of the children she feeds at risk.
Some 81 percent of unintended pregnancies worldwide are a result of unmet contraceptive needs. The GGR defunds programs that provide access to much needed contraception. We know that when women have no safe options, many of them will risk their lives to end an unwanted pregnancy. Unsafe abortion is one of the leading causes of maternal mortality, killing 68,000 women every year.
The vast majority of these deaths occurs in developing countries, where the NGOs that the GGR will further restrict are often the sole providers of health care.
Almost all these deaths are preventable.
I remember two young girls who travelled across three country borders to seek contraception in South Sudan. They walked for over a month before arriving at the MSF hospital.
I remember worrying about who and what they encountered along that journey. The girls, not more than 16, were alone and scared, without money or food.
I remember informing one of them that she was already pregnant. She slept under the hospital bed, hidden by sheets and blankets.
I remember holding the hands of these girls while they cried.
I remember sitting next to their brave, stoic bodies, their grim, unsmiling faces.
These girls needed counseling, education, the ability to make informed choices.
If we want women and girls around the world to have healthy, meaningful lives, they must be given opportunities for safe, complete, and informed reproductive health care. They must not used as political pawns.
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