In 1986, I came to North Carolina because the state, via the University of North Carolina at Chapel Hill, thought it fit to give me a scholarship to pursue my PhD. Thanks to that funding, I was trained in public health and medical anthropology and have spent the last 20 years in the field of global health, specifically in reproductive health. Because of North Carolina's investment, I suspect that my work in the past two decades has positively affected the lives of thousands, if not millions, of women and families around the world. But over the past several months, I've watched as my adopted state's general assembly proposed policies that will negatively affect the health and lives of the women and families of North Carolina.
After all I've learned in and from North Carolina, it's hard to sit by and watch.
Taken together, the state Republican attacks on unemployment benefits, Medicaid, education, women's rights and racial justice amount to what the rest of the world considers human rights violations. They are anti-poor, anti-woman, and anti-[economic] development. In particular, the proposed restrictions on abortion care and providers are irrational and fly in the face of global medical research and evidence. I know from my work in global health that restrictive abortion laws do not have a positive impact on women's health. Indeed, it is this knowledge that has led dozens of countries around the world to remove restrictions on abortion care while only a handful, the United States among them, move in the opposite direction.
We all read the coverage of the Beatriz case in El Salvador -- when she became pregnant unexpectedly, her doctors counseled her it would put her health at risk, but because abortion is illegal there, she was denied what was essentially lifesaving treatment for weeks and weeks, despite the grave risks to her health and the fact that the fetus had developed without a brain and would not survive.
The more abortion is restricted, the more likely it is that procedures will be clandestine or unsafe. It's just that simple. In Texas, women already seek abortion medication at shops and markets on the border, not knowing if they are getting the right drug or taking the right dosage. What restrictions won't do is reduce the number or rate of abortions. And the World Health Organization agrees: abortion rates in Latin America or Africa are as high -- or even higher -- than in the United States.
The difference is that women rarely die from abortion complications here, but half the world's deaths from unsafe abortion occur in sub-Saharan Africa. We also know that when abortion is made legal and accessible, it actually saves women's lives. In 1997, partially in an effort to curb maternal mortality, South Africa made abortion legal and worked to increase women's access to providers and facilities -- dramatically different from the actions in the United States these days. The effort worked; from 1998-2001, the number of deaths from unsafe abortion dropped 91 percent.
In a 2011 study, my Ipas colleague Janie Benson and her co-authors found that legal reform, plus expanded services for abortion care and buy-in from governments, saves women's lives. In South Africa, Romania and Bangladesh this is the case. Rather than taking away women's choices and rights, these countries made a commitment to women. They did so with the knowledge that women's ability to determine their reproductive futures has tremendous benefits for families, communities, and indeed the development of nation states.
If we really want to improve women's health and reduce the abortion rate in North Carolina -- or Texas, or Ohio, or anywhere else -- we already know what works: invest in comprehensive sex education in school, ensure that women and girls have easy access to affordable birth control, expand access to health coverage for everyone, and protect access to quality abortion care.
Decades of research by Ipas and other health experts has shown that women who want or need to terminate a pregnancy will often risk their health and lives to do so. The Moral Monday protestors in our state capitol understand this and have brought hangers with them to signify what restricting abortion will mean for North Carolina women. They will be forced to turn to back-alley providers like Kermit Gosnell for a procedure that should be safe and is their right... and is often a decision made so they can raise the children they already have. Why do legislators continue to ignore these facts?
My fellow Tarheels and I must ask ourselves what sort of state we want to live in. Do we want to live in a state that respects and trusts women, that values women's contributions to the economy and society at large, a state that learns from the experiences of others and believes in progress rooted in learning and science as exemplified by its great universities? Or, do we want to be like Nicaragua, a country where abortion is banned even at the risk of a woman's life and health, ruled by an autocrat, and is the second poorest country in the hemisphere? I fear the North Carolina General Assembly is headed south.