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

See all our coverage of the tragic case of Savita Halappanavar here.

Ireland's abortion policies cause widespread misery.

As an organisation that hears first-hand from the women who bear the burden of Ireland’s archaic abortion laws, the tragic death of Savita Halappanavar was shocking and sickening.

And yet not as surprising as you’d think.

Given that abortion laws in Ireland are among the strictest in the world, a tragedy of this kind wasn’t so much a matter of if, but when. The circumstances in which Savita died are truly abhorrent. Admitted to hospital experiencing a miscarriage at 17 weeks, despite being told that the fetus “wasn’t viable” she was made to suffer for days, left begging for an abortion that she was refused as long as there was a foetal heart beat.

Haunted by the harrowing details of Savita’s death we’re left to wonder how many more women in Ireland may have lost their lives as a result of being denied a life-saving abortion.

If Savita’s family hadn’t bravely made the decision to go public, would her senseless death have come to light? Have the lives of more women been sacrificed because a fetus was deemed more important? Even when it was known that the fetus would not survive? When, technically in Ireland an abortion is permitted if there is a “real and substantial risk to the life of the mother?” These are questions that we cannot ignore and questions that demand answers.

Savita’s death is the worst illustration of what happens when abortion is highly restricted, and the worst way for the ‘pro-life’ lobby to be proved wrong. How often do we hear that abortion is never necessary to save the life of a woman? A protester at a vigil for Savita hit the nail on the head with a placard stating ‘Pro-Life beliefs killed Savita Halappanavar — Ireland needs abortion rights.’  So did Kartha Pollit in her compelling reflection on the case When ‘Pro-Life’ kills.

But what has been absent from the mainstream media coverage of Savita’s death has been the mass, day-in day-out misery and discrimination experienced by women as a result of the near-total ban on abortion in Ireland.

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

See all our coverage of the tragic case of Savita Halappanavar here.
For days now, I’ve been putting myself in Savita Halappanavar’s shoes.

I’m expecting. Seventeen weeks in, piercing pain sends me to the hospital. For three days, I’m miscarrying. There’s no hope for my child and my own health is fading. For three days, I’m in physical agony and doctors refuse my pleas to terminate the pregnancy to save my life. The child won’t survive, but there is a “heartbeat” and doctors fear terminating will violate my country’s laws. The unthinkable happens.

The tragedy that ended Savita’s life put a human face on the abortion issue. People are demonstrating in droves and even the Indian government is pressuring Ireland to change its laws. One demonstrator held a placard reading, “Savita had a heartbeat, too.”

For many of us, the disregard for women’s human rights in the name of religion just became personal. When I see Savita’s face, I can’t help thinking that she looks like me and, like me, was educated and could afford health care — but she still suffered this indefensible fate. Everyone knew the child could not survive, but that Savita could with proper care.

What does it say about a society when it leaves a woman to die in the name of “life?”

Where is the respect for women’s lives? This irony pervades the politics surrounding women’s health in my own country, the United States. Right-wing calls for abortion bans not only keep women from living full lives of our choosing, but often fail to include exceptions for our health or death. Most of those backing these so-called “pro-life” measures are also the ones blocking efforts to provide equal pay, health care, and safety net programs women and children rely on. It seems their concern for life ends when a baby is born.

And, if this can happen to someone like Savita, a doctor herself, what about more vulnerable women? As U.S. conservatives rush to eliminate the right to choose, it is poor women, disproportionately of color, who are seeing that right fade most quickly. It is these women who often cannot afford abortions, or do not have the time and know-how to see a provider during their first trimester. Twenty-week bans and funding cuts are not only sexist, but covertly racist and classist, too.

As I plan my own future and explore whether parenthood is right for me, I am thankful I live in a place where abortion is legal and safe, and that I can afford the right to choose. I am thankful that women have always been resilient in my country, and that we have a long history of fighting for and winning reproductive rights.

With strength and courage, women in the United States have come a long way. But our journey is not complete. Too many women are still left out and too many lawmakers threaten to send us back to a time when Savita’s story could happen here. That’s why I work to not only preserve the rights I have, but to expand them for all women — because we all have a heartbeat, too.

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Written by Patty Skuster for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.
See all our coverage of the tragic case of Savita Halappanavar here.

The news of Savita Halappanavar’s tragic death after being denied an abortion has been heard around the world by now. Protesters have gathered in her honor, vigils will continue to be held and, perhaps, the end of her life will be a wake-up call. Women’s lives matter and laws should protect them — not cost them their lives.

In Ireland, abortion is against the law in most cases. But Savita should have received a legal abortion; under the constitution abortion is allowed when a woman’s life is in imminent danger. And Savita’s husband reports that doctors told them an abortion wasn’t an option, despite her repeated requests and severely declining health, because Ireland “is a Catholic country.” What that meant for Savita was that the health-care providers at Galway University Hospital made decisions based on their values (as dictated by the Catholic Church) and disregarded the value of her life.

The lack of implementation of the abortion law in Ireland is very similar to so many countries where Ipas works. In most countries, abortion is permitted for one or more reasons. Human rights authorities — including at the United Nations and ICPD–agree that governments must take steps to make legal abortion available. In fact, in 2010, the European Court on Human Rights ruled that Ireland must implement its abortion law. But when governments don’t fulfill their obligations to protect women’s reproductive rights, women can’t access safe abortion services and die as a result. Just like Savita.

We have to hold governments accountable. Laws must be clear on abortion and guidance and training need to follow. And make no mistake, these laws and policies must include regulation of providers’ refusal of service — to ensure that a woman can receive an abortion from a willing colleague through referrals or some other mechanism. And never should a woman’s life hang in the balance because of someone else’s moral objection to abortion.

Savita isn’t alone. There are so many women whose deaths are never reported or don’t have access to hospitals and die because they can’t get safe abortion care. Why? Because the laws are not implemented, people are unwilling or untrained to provide service, and abortion stigma permeates legal systems, health systems, communities and even families. For years, Ireland has failed to enact mechanisms for legal abortion because of political and social sensitivities. Without clarity about what’s permitted and what isn’t under the law, doctors and other health-care workers tend, as they did in Savita’s case, tragically, to play it really safe — for them, that is, not for the women who are affected.

At Ipas we have worked throughout the world to help governments clarify and implement abortion laws. We partner with health-care providers, civil society organizations, and health ministries to pass guidelines that enable access to legal abortion. We support the training of health-care providers and partner with community organizations and the legal sector to promote an understanding of local abortion laws.

Let’s not forget; a woman is dead after doctors refused to terminate an already unviable — yet wanted — pregnancy for a woman in incredible pain. Her husband is left to question the decisions made by these doctors — and to grapple with her death, which could likely have been prevented.

Photo by infomatique under Creative Commons license.

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

See all our coverage of the tragic case of Savita Halappanavar here.

Much has been said about the tragic death of Savita Halappanavar in Galway, Ireland last month. Even before seeing the outcome of the official investigation we can conclude that her death was the result of a combination of factors: inhumane laws, lack of guidelines on how to apply the laws that do exist, fear of prosecution on behalf of doctors, medical incompetence, influences of the most conservative wing of the Catholic Church over hospitals, and — as pointed out recently by Jodi Jacobson — a general climate of misogyny, poisoning both the medical establishment and society at large.

Twenty years ago, the Irish Supreme Court established that abortion is legal when a pregnant woman’s life is in danger. More specifically, it ruled that termination of pregnancy is lawful “if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by a termination of the pregnancy.” Please note how restrictive these words are: “real and substantial risk” and “life, as distinct from the health.” With due respect for a court that took a courageous step forward in a country where the issue of abortion is and was taboo under any circumstance, it is remarkable how the ruling goes out of its way to make this exception to the abortion ban as narrow as possible. Anyhow, these are the parameters. It is the law of the land.

But nobody knows how this rule should be understood because there is no further guidance. No written law, no guidelines, no official interpretation. So doctors in Ireland, whether pro- or anti-choice, whether in Catholic hospitals or elsewhere, must navigate around this. It may be that in Savita Halappanavar’s case, the situation was crystal clear: her life was in danger, the situation was acute, an abortion would probably have saved her, and doctors refused her care because they favored the life of her unviable fetus over hers. It is even likely that this was the case. But in most situations, threats to the life and health of the pregnant woman cannot be so clearly distinguished. Usually, a threat to life is preceded by a threat to health. So is a doctor to wait until a critical health situation turns into a life-threatening situation? It appears that way. How does this correspond with medical ethics? It doesn’t. I do not envy ob/gyns in Ireland. I cannot imagine the agony that they, or many of them, must experience when a woman shows up with pregnancy-related complications. This is not to take away any of the responsibility from those doctors or the hospital that treated, or mistreated, Savita Halappanavar. It is only to shed light on the context in which they are operating.

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About Ten Thousand People Attended A Rally In Dublin In Memory Of Savita Halappanavar

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

See all our coverage of the tragic case of Savita Halappanavar here.

The tragic and unnecessary death of Savita Halappanavar — a 31-year old Indian woman who was denied a life-saving abortion in an Irish hospital — has sparked reactions across the globe. Thousands have marched in Dublin. Demonstrations have taken place in India and elsewhere. An international day of protest is called for November 21. Tense meetings between Indian and Irish government officials are taking place. The overriding question now is: what will be the legacy of this horrible event, beyond the unspeakable grief of Savita’s loved ones? After the demonstrations have stopped, will Irish hospitals — where abortion remains illegal but is permissible in life-threatening conditions — proceed differently in the future? Will the country finally move toward legalizing abortion?

This heartbreaking incident has led me to contemplate the long history of abortion struggles around the globe and under what circumstances, change takes place. It is not an exaggeration to say that throughout history millions of women have died and even more have been injured because of the lack of safe abortion. But only some of these tragedies capture the public’s attention and become catalysts for change.  And sometimes public attitudes are affected even when a woman’s death is not involved.

Consider the history of abortion in the United States. Two events that occurred in the 1960s were instrumental in moving much of the country toward an endorsement of legal abortion. The first, in 1962, involved Sherri Chessen Finkbine, a Phoenix woman pregnant with her fifth child, who learned that the Thalidomide pills she had been using as a sleep aid were strongly associated with severe birth defects. Her doctor was able to arrange a “therapeutic” (i.e. approved) abortion for her at a local hospital, but Finkbine, in an act of decency that would prove costly, went public with her story as she hoped to warn other women who were in her situation. Her interview with a journalist created a media sensation, and nervous hospital authorities cancelled her abortion. Ultimately Finkbine, unable to find an abortion anywhere in the United States, obtained one in Sweden, where she delivered a fetus with missing limbs. Doctors told her the fetus would have had no chance of survival. Finkbine’s story spread beyond Phoenix to become a national story, including a cover on Life magazine. This incident, particularly the unprecedented visibility of abortion on the cover of the leading news magazine of the 1960s, “had a galvanizing effect on public opinion,” in the words of the journalist Linda Greenhouse, a longtime observer of the trajectory of abortion rights in the United States.
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Written by Susan Yanow for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the tragic case of Savita Halappanavar here.

Recent press about the death of Savita Halappanavar, admitted to a hospital in Ireland with medical complications in a 17-week pregnancy, is a grim reminder about the impact of abortion restrictions on women’s lives.

In Ireland, abortion is legal only to save a woman’s life. In the last two years in the United States, nine states have passed laws banning abortion after 20 weeks (in Arizona abortion is banned after 18 weeks) except to save a woman’s life. But as the death of Ms. Halappanavar so poignantly illustrates, “risk to a woman’s life” in emergency situations is extremely difficult to assess.

Savita Halappanavar was 31 years old, and had a wanted pregnancy. She began suffering severe back pain, was admitted to the hospital and was told that she was miscarrying. As the pain increased and her health worsened, she and her husband requested that the pregnancy be terminated. Because the fetus still had a heartbeat, however, she was denied her right to a safe abortion. After three days in the hospital, Savita Halappanayar died. The doctors attending her did not determine that her life was sufficiently at risk to warrant performing an abortion.

Could this happen in the United States? In short, it certainly could. Let’s remember the 1988 case of Michelle Lee, a resident of Louisiana who had a serious heart condition and was waiting for a heart transplant. She became pregnant, and because of her medical condition could not be seen at an outpatient abortion clinic. She was sent to the only hospital in Louisiana with appropriate services, Louisiana State University. However, as reported at the time:

A committee of five LSU doctors concluded that Lee’s chance of dying was not greater than 50 percent. And under Louisiana law, a public hospital could not perform an abortion on Lee unless her life were endangered. They decided her case didn’t meet the test.*

What must the chance of dying be for a woman to “qualify” for a life-saving abortion? In Louisiana, a 50 percent chance of death was not enough. Who knows how the doctors in Ireland assessed the risk to Savita Halappanavar?

In the states that have passed limits on when an abortion can be performed, lawmakers are expecting physicians to juxtapose their assessment of medical risk to a given woman with the legal risk of prosecution if, after the fact, there are “second guesses” about whether the woman was at sufficient risk to trigger the legal exception the abortion ban.  This untenable intrusion of law makers into medicine puts physicians into an impossible situation. 

We have a sobering lesson to learn from Ireland – when doctor’s medical judgement is compromised by restrictive abortion laws, it is women’s health and women’s lives that suffer.

*Activists mobilized and raised $8,000 to help Michelle Lee get a life-saving abortion in Texas. Today, Texas is one of several states considering a ban on abortions after 20 weeks in the next legislative session.

Photo by ge’shmally under Creative Commons license.

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

Chief Justice Roberts

In their bid to undo Roe v. Wade, anti-choice activists are in a race to see which of their abortion-restrictions can find its way to the Roberts Court first.  So far two distinct avenues to get Supreme Court review have emerged, the push to recognize fertilized eggs as persons under the law, and and 20-week “fetal pain” bans. And while “personhood” initiatives are designed by their nature to challenge Roe directly, it is the fetal pain bans that are most likely to undo the decision altogether.

To understand why personhood won’t likely doom Roe but fetal pain bans will we have to look at not just the language of these two abortion restrictions, but the legal strategy afoot in their passage. Take the most recent legal battle over fertilized eggs-as-people in Oklahoma.

Last spring Personhood Oklahoma circulated a proposed ballot initiative that would have amended the state constitution to define a person as “any human being from the beginning of biological development” which as the state attorney general explained, meant fertilization. The matter was immediately challenged by the ACLU and Center for Reproductive Rights. The state Supreme Court, in a unanimous opinion, declared the initiative “void on its face” because it directly contradicted precedent from Roe, through Planned Parenthood v. Casey and beyond and was therefore, in the court’s words, “constitutionally repugnant.”

Now, while the Oklahoma personhood initiative obviously conflicts with federal law recognizing a woman’s fundamental right to privacy (which includes a right to chose abortion), neither the ballot initiative process nor the ruling from the Oklahoma Supreme Court that blocked it addressed any issues of federal law. This point was made by Ryan Kiesel of the ACLU of Oklahoma in an interview with RH Reality Check:

“This case never presented any federal issues for the U.S. Supreme Court to consider,” Kiesel said. “For the Supreme Court to have intervened it would have to hold that the Oklahoma Supreme Court’s interpretation of Roe and Casey was so flawed that they could jump in.”

Kiesel explained. “States have reserved to them right to afford their state citizens the opportunity to hold a referendum or initiative on their own, and the federal courts have said that states have lots of leeway in running that process. For example, states can limit the ballot or initiative process to measures related only to revenue and taxation. In Oklahoma we have a restriction on the initiative process that prevents it from being used as a weapon to create a test case. Which is exactly what was being done here.”

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

Dear Representative Trent Franks,

What does it mean to care for women? (Photo: See-Ming Lee / Flickr)

Today, I watched you debate during the markup for H.R. 3803, or, as you may know it, the District of Columbia Pain-Capable Unborn Child Protection Act, which would ban abortion after 20 weeks in Washington, DC. I watched you valiantly fight to save “the children” from their pain even in the case of rape or incest, or when a mother has been diagnosed with cancer and the treatment needed to save her life is incompatible with the continuation of her pregnancy. I watched you warn the rest of the judiciary committee that abortions are linked to higher rates of suicide, even though this “fact,” and the basis for the bill itself (that 20-week-old fetuses can feel pain) flies in the face of all accredited scientific evidence.

And all I could think about was September 7, 2007.

It may seem strange to you. September 7, 2007 was nearly five years ago. Why think about that now? And why such a specific date?

September 7, 2007 was the night I was raped.

September 7, 2007 was the night that my rapist’s sperm met my egg and I was impregnated with the child of my rapist.

I thought about all of this as I watched you passionately advocate on behalf of “the tiny little babies” and the only reaction I could muster was “how dare you.”

How dare you, Representative Franks. Your claim of caring about the “pain of the tiny babies” rings hollow when one remembers your support of the Ryan Budget, which would have slashed over $36 billion from food assistance programs. You called them “slush funds” and “runaway federal spending.” This from a member of the House of Representatives, who makes more in a month than I do in a year.

How dare you, Representative Franks. Your claim of caring about the “increased risk of suicide” among those who seek abortions rings hollow when, again and again, you have voted to strip people like me of health care by voting for the repeal of the Affordable Care Act and the slashing of Medicare and Medicaid. These programs that I, personally, rely on so that I can afford counseling to help me deal with the trauma of being raped.  After all, “health care” involves your mental health as well.

How dare you, Representative Franks. Your faux concern for the physical and mental well-being of parents and their children is sickening when you have over and over again proven your concern for both is nonexistent.

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Written by Robin Marty for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

The anti-abortion activists and politicians in the states have made passing 20-week abortion bans based on the idea of “fetal pain” a cause-du-jour for this year’s legislative sessions.  It’s become obvious, as Kate Sheppard reported in Mother Jones, that “fetal pain” is their number one priority this year, with four new states enacting bans and a dozen others at least proposing the legislation.

Emily Bazelon writes in the New York Times that the Center for Reproductive Rights is considering their own eventual lawsuit over the bans, which are unconstitutional due to the Roe V. Wade ruling stating that abortion cannot be banned before a fetus is viable, usually at around 23 weeks.  These state-based bans are only carving off a small section of new abortions, and as Bazelon notes these bans are in many cases “symbolic.”  Some of the states involved don’t even have providers that perform second trimester abortions, and the number of women seeking them out are only a tiny percentage of the overall number of women wanting the procedure.

It’s that statistic that is so dangerous, and why the push for legal action over the ban is exactly what anti-choice activists are both hoping for and counting on.

Just as anti-abortion activists won a victory in ending “partial-birth abortion,” a made-up term that helped change the face of abortion challenges by placing a government duty to “protect” a fetus over the needs of a mother, even though very few abortions would ever be affected by the ban, “fetal pain” bans seek to do the same: allow the Supreme Court to place a new standard for which the rights of a fetus outweigh the rights of the woman carrying it.  

… Read more

Written by Susan Yanow for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

In August I cheered the injunction against Nebraska’s so called “Women’s Health Protection Act.”  This misleadingly named law would have required physicians to present all research about possible health risks related to abortion, even if the information is outdated, false or misleading, to every woman seeking an abortion.  Stopping that law was a victory. But Nebraska is not done with its attacks on women’s rights.

On October 15, Nebraska will enact another law that will have a chilling impact on women’s abortion access.  This law will ban abortions 20 weeks after conception or later, with exceptions only in cases of medical emergency, the pregnant woman’s imminent death, or a serious risk of “substantial and irreversible physical impairment of a major bodily function.”  The bill is based on unsubstantiated and misleading “science” that claims that a fetus can feel pain at 20 weeks.  It is also the first law in the country to exclude a woman’s mental health as a reason for an abortion.  Before this law is replicated in other states, advocates have to prepare us to fight this blatant attack on our right to abortion.

As advocates, we need to be able to talk about the reliable science of fetal pain and the connection between physical and mental health. We need to educate others, and ourselves and combat the use of pseudoscience and unsubstantiated “facts” as tools in the war to limit access to abortion.

The question of whether or not a fetus feels pain during an abortion can be a troubling one to some women and clinicians. The science of what a fetus experiences is complicated – without verbal reports and direct access to the mind of a fetus, scientists can only make inferences about what fetuses are able to experience. What is known is that to experience pain, the brain and nervous system must be developed enough to both react to a noxious stimulus and to have the enough neurological development and organization to experience the stimulus as “pain.” Authorities in both the U.S and Great Britain have conducted thorough reviews of all available studies of fetal pain. Both groups of experts have found that there is no evidence that fetuses develop the neural pathways necessary to feel pain until well into the third trimester. In fact, there is increasing evidence that the fetus never experiences the state of true wakefulness that is necessary for the experience of pain.  Instead, new research shows that the fetus is kept in a continuous sleep-like unconsciousness by the presence of specific chemicals in the uterine environment.  This makes sense; if a fetus inside the uterus could experience pain in the way that a baby can outside of the uterus, the sensation of having its head squeezed through the vaginal canal during birth would be excruciating!  These facts should be very reassuring to women who seek abortions and are concerned about fetal pain.  Advocates need to use these facts to counter those who would use claims of fetal pain to limit our rights. (For more information on Fetal Pain, see this fact sheet and these articles).

While the question of fetal pain is complicated, the concept that preserving a woman’s mental and emotional health is not a “good enough” reason for an abortion is infuriating.  Mental health is as important to women’s well-being as is physical health. Our brains and bodies are connected, and this interconnectedness is well recognized in medicine and in health care legislation. Roe v. Wade recognized the threat to a woman’s mental health as a legitimate reason for ending an unwanted pregnancy.  The Nebraska ban, however, will disallow mental health as a reason for abortion after 20 weeks.  The Nebraska legislature has decided that avoiding theoretical fetal pain (based on discredited scientific theories) outweighs the emotional well-being of a pregnant woman.  Nebraska’s law limits a woman’s right to abortion through the second trimester as codified in Roe v. Wade and presents a clear challenge to Roe.  Once in place, this law will limit the practice of Dr. Leroy Carhart, who currently is the only provider in Nebraska and most surrounding states who provides abortions to 24 weeks (and later for fetal anomalies).  The Nebraska ban will mean more delays, travel, expense and barriers for women in the heartland of our country who need later abortion care.

This is yet another attempt to erode our right to abortion, law by law, week by week. What happens in Nebraska unfortunately won’t stay in Nebraska.  Get the facts and be prepared for similar controversies over fetal pain and mental health in your state.