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You Can’t Have it Both Ways: The Interpretation of Catholic Health Policy and the Consequences for Pregnant Women

12:46 pm in Uncategorized by RH Reality Check

Written by Marge Berer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Republished with permission from Reproductive Health Matters.

“There is only one way to be sure a woman’s life is at risk, that is, after she dies.” — Christian Fiala, 2012

 

A view of Galway Hospital and parking lot

Savita Halappanavar died at Galway University Hospital.

In 1987, the year the first Safe Motherhood Initiative was launched by the World Health Organization (WHO), there were more than half a million maternal deaths annually. The women who were dying were often anonymous and their deaths never recorded or studied. They were mainly from poor and often rural backgrounds in developing countries, such as India. A study in India published in 1999 comparing 100 maternal deaths in a Rajasthan hospital in 1983-85 to 100 in 1994-96 found that: “Most of the women who died in hospital in 1994-96 would have died at home in the earlier decade.”1 What had changed was that they had reached a hospital and were therefore no longer anonymous, but they were still overwhelmingly women living in poverty with little or no access to skilled pregnancy and delivery care. 

Contrast this with the death of Savita Halappanavar on 28 October 2012, a dentist from a privileged background in India, who miscarried 17 weeks into a very wanted pregnancy and died in the maternity ward of a hospital in Ireland, a country with a very low maternal death ratio.2 Savita’s death was anything but anonymous; her name and photograph circled the globe within days of her death and sparked street demonstrations and protests, not only across Ireland but also in many other parts of Europe and in India. Six weeks later, articles and blogs about her death continued to be published in many countries, demands by her husband for a maternal death audit were headline news, and the Irish government has been forced to consider the effects of her death for the law, health policy and the Constitution of Ireland. 

Savita’s death became iconic for a number of reasons. First, preventing maternal deaths has been a global priority since 1987 when the first WHO Safe Motherhood Initiative was launched. Since 2000, reducing maternal deaths by 75 percent by 2014 has been the main target of Millennium Development Goal No.5, and since 2010 it has been one of five main goals of the UN Secretary-General Ban Ki-Moon’s Global Strategy on Women’s and Children’s Health. Hence, maternal deaths have started to be a news item globally, with journals like Reproductive Health Matters carrying studies and the media in many countries where deaths remain frequent, reporting successes and failures to reduce deaths, and individual stories regularly.

Secondly, holding governments accountable for their failure to provide the required services, both antenatal and delivery care and emergency obstetric care, to prevent avoidable maternal deaths has become the subject of public protests by women’s rights advocates, of court cases, including in India, and of hearings by human rights bodies, particularly CEDAW, examining individual cases and making policy recommendations to governments.3

What was different about Savita’s death, however, was the fact that it was also about whether and when to terminate a pregnancy when it is not viable and the woman’s health and life are at risk, and how that intersected in Savita’s case with individual health professionals’ interpretation of Catholic health policy and the law on abortion in Ireland. 

As a committee of the Irish Parliament considers proposals to offer limited legal abortion in Ireland, this paper explores how these issues came together around Savita’s death, the interpretation of Catholic health policy and the consequences for pregnant women.

Preventing maternal deaths as global policy

Maternal deaths, especially in countries where they remain frequent, are getting more and more media coverage. The Millennium Development Goals have made countries with continuing high maternal mortality ratios4 conscious of their shortcomings, and civil society organizations are beginning to pursue justice and even compensation in individual cases. 

In India, for example, a petition for legal redress was filed in the Delhi High Court in the case of Shanti Devi, who died in childbirth in January 2010 after two high-risk pregnancies in which she received delayed and insufficient care. With the first of these two pregnancies, she fell down the stairs and afterwards could no longer feel the baby moving. Induction of the pregnancy was delayed until she required intensive care which, when she finally received it, was inadequate. With her health still very precarious, she became pregnant again six months later, went into labor prematurely at seven months, delivered the baby at home without a skilled birth attendant or any medical assistance, and within an hour after delivery, began hemorrhaging and died. This case ensured that the Court took into account not just the individual death but also the constitutional and human rights obligations of the central government of India.5

Some communities where women are at high risk because of the lack of routine and emergency obstetric care are also beginning to protest against maternal deaths. One such event took place in Uganda where, in May 2011, hundreds of concerned citizens and health professionals stormed the Constitutional Court in Kampala, Uganda, protesting the deaths of women in childbirth, in support of a coalition of activists who took out a landmark lawsuit against the government over two women who bled to death giving birth unattended in hospital.6

Another example from India comes from Barwani district, Madhya Pradesh, India, where there were local protests against 27 maternal deaths in the period from April to November 2010. In January 2011, an NGO fact-finding team found an absence of antenatal care despite high levels of anemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment.7

Events like these are making the governments concerned highly sensitive to criticism. As an upper middle-class woman, Savita Halappanavar would have been highly unlikely to die in India from the appalling treatment experienced by Shanti Devi or the tribal women in Barwani. Yet, ironically, the Indian government was among the first to criticism those in Ireland who failed to prevent Savita from dying. For example, India’s ambassador to Ireland said that Mrs Halappanavar may be alive if she had been treated in India.

Emergency obstetric care, termination of non-viable pregnancies and Savita’s death

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How Anti-Choice Is Paul Ryan? Check the Record

12:48 pm in Uncategorized by RH Reality Check

Written by Robin Marty for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Paul Ryan

Paul Ryan (Photo: Gage Skidmore / Flickr)

Rep. Paul Ryan is against abortion, no exceptions. Paul Ryan would allow an exception for rape. Ryan doesn’t believe in birth control. Ryan only has three children, he must believe in birth control. Ryan is pro-life “from conception to natural death.”

Ever since the moment Mitt Romney picked Wisconsin Congressman Paul Ryan as his running mate, the media has been picking intricately through votes and statements in an attempt to nail down just exactly what it is that Ryan means when he says he’s “never going to not vote pro-life.” It’s been hard to pin — for every vote restricting a woman’s right to chose, there is an explanation provided by another right-wing columnist saying that you can’t “prove” it really means he stands where it appears he stands. With so much media attention paid to his draconian budget in the last two years, few reporters spent nearly the same detail pinning down exactly what he believed when it comes to reproductive rights.

There’s a reason for that, and that is how Ryan’s couches his own language when it comes to reproductive rights — language that allows everyone to see what they want to see. By saying he would “never not vote pro-life,” he has it both ways — supporters can say that he supports forcing women to give birth regardless of the circumstances, yet when opponents say he would do that, they point to his lack of public statements to support that argument.

It’s the “hiding in plain sight” theory. There is no reference to abortion as an issue on Ryan’s campaign website, and only one news clipping even mentioning it in his media section. He speaks of “moral fabric” and a need to return God to the public square, but avoids saying outright what falls into the moral categories that need to be renewed.

For those who support abortion rights, it’s easy to look at the votes he has cast and the bills he has cosponsored and say that clearly, Ryan is an opponent of abortion in all situations. After all, he cosponsored the “forcible rape” bill, the “let her die” act and has a perfect record with National Right to Life.

Opponents disagree. If they choose, they could cast his numerous votes to ban funding and access for abortion as just a sign of his fiscal hawkishness, a vote to protect the conscience of those who are religious, or a fight to protect the fetus being carried by its mother if the mother is a victim of a crime.

So who is right, and why is it so hard to discern?

Here are the things we know for sure:

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USCCB Clarifies: Only Some Lives Worth Saving

7:55 am in Uncategorized by RH Reality Check

Written by Kathleen Reeves for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

In the wake of the "automatic excommunication” of Sister Margaret McBride, a nun who was part of a committee that granted an abortion to a woman whose pregnancy threatened her life, theologians are splitting hairs over excommunication, intention, and conscience. In order to clear things up, the U.S. Conference of Catholic Bishops has released a statement articulating the difference between “direct” and “indirect” abortion.

Direct abortion is a “procedure whose sole immediate effect is the termination of pregnancy,” including when the mother’s life is in danger.

Of course, there’s another effect, which is that the mother’s life is saved. Perhaps it’s not immediate enough?

Indirect abortion happens as follows:

"Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman” that “cannot be safely postponed until the unborn child is viable” and may “result in the death of the unborn child.”

The second is okay by the Church; the first, no.

Are you confused? If so, it’s because there is NO SUBSTANTIVE DIFFERENCE between these two scenarios. In order for a woman to live, her pregnancy must end.

The USCCB’s Committee on Doctrine provides these helpful examples:

The first involves a pregnant woman who is experiencing problems with one or more of her organs, apparently because of the added burden of pregnancy. In this case, the doctor recommends an abortion to protect the woman’s health.

In the second example, a pregnant woman develops cancer in her uterus. In this case, the doctor recommends surgery to remove the cancerous uterus as the only way to prevent the cancer from spreading. Removing the uterus also will result in the death of the unborn child.

The only difference I see in these cases is that in case two, the fetus is hidden away in the uterus, so the doctors removing it can pretend it’s not there.

And thus it is that a rich theological tradition is reduced to garbage. And unfortunately, this reasoning, reminiscent of “How many angels can dance on the head of a pin?,” is medical policy.

The USCCB has not had a good year. But, as Nicholas Kristof pointed out, at least it didn’t have to excommunicate any child molesters.