Maternal health without abortion: A fundamental hypocrisy

Cross-posted from Rabble.ca

October 4, 2013

Even with all of our advanced technology and scientific knowledge, humanity still struggles with widespread poverty and hunger, economic inequality, war and strife, environmental destruction, and a long list of serious human rights abuses -- including high rates of preventable maternal mortality. The latter has been one of the world's most intractable human rights problems because of the low status of women, but recent efforts have shown that it can be significantly reduced. All it takes is political will and a steadfast opposition to right-wing forces.

One major initiative that has seen some success is the eight "Millennium Development Goals" (MDGs) established by the United Nations in 2000 to improve global living conditions. All 189 UN member states have committed to help achieve the goals by the year 2015. Here are the MDGs, each of which includes specific targets.

1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria and other diseases.
7. Ensure environmental sustainability.
8. Develop a global partnership for development.

In late September, the UN General Assembly reviewed progress on the MDGs, with Member States adopting an outcome document that promised to accelerate efforts to meet the MDGs and continue unfinished work past 2015, particularly for the targets that are most off-track.

A great deal of progress has been achieved across all eight goals, but many gaps remain, particularly those relating to women and children (MDG 3, 4, 5). Unfortunately, improvements to women's equality and rights, including access to reproductive health services, generally lag behind most other targets. Since reducing child mortality depends on raising women's status and saving their lives, that goal also has fallen far short in some parts of the world. Each year, more than a million children are left motherless because of women dying during pregnancy or childbirth. These children are up to 10 times more likely to die prematurely than those living in families with a mother.

MDG 5 calls for a 75 per cent drop by 2015 from the 1990 maternal mortality rate. Two years from the deadline, the latest measurements show that maternal mortality has decreased by almost half -- 287,000 deaths in 2010 compared to 543,000 deaths in 1990. Further, all developing regions have made gains since 2000. But without a major acceleration of effort and resources, the 75 per cent reduction target will not be met. Unfortunately, the political will to save women's lives is still lacking in many developing countries, especially when it comes to the lives that could be saved through better access to contraception and safe abortion services.

Unsafe abortion causes 13 per cent of all maternal deaths in the world and ranks as the third or fourth leading cause, along with haemorrhage, infection, and high blood pressure. About 21 million women a year resort to unsafe (usually illegal) abortion, and 47,000 of them die.

The United Nations has come a long way on the abortion issue just in the last three years. In 2010, I wrote this article slamming the UN for "abandon[ing] women who need abortions by caving to pressure from right-wing forces." But the very next year, the UN's Special Rapporteur on the Right to Health, Anand Grover, issued an interim report that described laws restricting abortion as an abuse of state power. He said such restrictions "infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity." Grover even sent a message to the Abortion Rights Coalition of Canada in January, congratulating Canada for its 25 years of decriminalization.

Still, we have an awfully long ways to go, thanks to the culprits who perpetuate the suffering and death of women around the world. I'm speaking of the Vatican, conservative countries, and right-wing politicians, as well as various religious and "pro-life" organizations. But the real causes lie even deeper. Traditional views on women and motherhood relegate women's rights and equality to the bottom of the ladder, behind the rights of minorities and other vulnerable groups. Much of the world still clings to the deeply held assumption that women's dignity and humanity is tied to being a mother, even though this subordinates women to a biological function.

Since the United Nations operates by consensus, the reactionary attitudes of the Vatican and Member States that oppress women wield a disproportionate impact on progress for women. References to reproductive health continue to get watered down or deleted, and countries are allowed to maintain their criminal abortion laws in the name of sovereignty and "culture." This has led to unsafe abortion getting short shrift as a health problem, undermining global efforts to resolve the problem.

Progress has been sporadic and slow, but things finally seem to be changing for the better. Not only is the UN beginning to champion the decriminalization of abortion, politicians and doctors in developing countries are increasingly speaking out against unsafe abortion and the need to decriminalize abortion. Many developing countries have also taken huge steps to improve maternal health since 2010, which will help reduce unintended pregnancy and thereby unsafe abortion, even without direct funding for abortion.

When Canada hosted the G8/G20 summit in 2010, Prime Minister Stephen Harper put maternal and child health front and centre, with resulting pledges of $7.3 billion from participating countries and the Bill & Melinda Gates Foundation. At least $24 billion was needed, however, according to aid groups. Further, Harper had to be shamed into including funding for family planning services in Canada's contribution, and he refused outright to fund safe abortion in countries where it's legal.

Harper decided that Canada's money would be spent on three main needs in 10 countries (seven in Africa): strengthening health systems, reducing the burden of disease, and improving nutrition. So far, it appears that only a tiny portion of Canada's portion of the G8 funding ($2.85 billion) has been spent on family planning, although it's difficult to figure out exactly where all the money is going. Several Google searches produced these tidbits: $20 million for free prenatal care in Haiti, and undisclosed amounts for the UN Population Fund and a sexual and reproductive health project in Bangladesh; $6 million for the International Planned Parenthood Federation (for sex education, family planning and post-abortion counselling); $75 million for the Muskoka Initiative Partnership Program (to strengthen health systems, reduce disease, and improve nutrition); and most recently, $203 million to provide immunizations, basic health care, and community services to make childbirth and pregnancy safer.

Not only is Canada cherry-picking its aid for maternal/child health services, it attaches strings to it. Money can only be spent as per Canada's own goals and guidelines, giving little or no say to smaller groups on the ground in the target country. This makes it far less likely that the money will be used constructively, or will flow to needed reproductive health services such as post-abortion care.

Canada's refusal to address unsafe abortion in any way, shape or form continues. On Sept. 27, Foreign Affairs Minister John Baird called for an end to child marriage at a UN meeting in New York, saying that it "robs girls of their right to education and jeopardizes their health." That's a commendable stance, but the words ring a bit hollow without a strong commitment to funding contraception and safe abortion. Childbearing is especially dangerous for young girls, and can result in severe maternal disability or death. Baird also backed a British-led declaration condemning war rape, but refused to say whether that would extend to helping victims obtain abortions. We can guess the answer is no.

Ignoring the need for safe abortion in maternal health programs means disregarding the health and lives of millions of women. It also reveals a fundamental hypocrisy. Conservatives apparently believe that only women who have babies are worthy of support -- but most women having abortions are already mothers. As Rachel Atkins says: "There aren't women who have abortions and women who have babies. Those are the same women at different points in their lives." Abandoning women who need abortions therefore means abandoning mothers and children -- the very demographic Harper has promised to help.

Anti-choice centres lose lawsuit: What does it all mean?

Cross-posted from Rabble.ca

September 6, 2013

Has Canada's anti-choice movement been gaining the upper hand over the last few years? It might seem that way sometimes, and a recent in-depth piece in Maisonneuve raises the spectre of a new "culture war" around abortion, led by energetic young "pro-lifers". But there's another way to look at it, especially taking into account some pro-choice victories.

The Christian Advocacy Society of Greater Vancouver (CAS) recently lost a defamation lawsuit they had launched against me personally last fall, for a 2009 report I wrote for the Pro-Choice Action Network with the help of volunteers (the organization is now defunct). The report is entitled Exposing Crisis Pregnancy Centres in British Columbia. The CAS operates two anti-choice "crisis pregnancy centres" (CPCs), one in Vancouver and the other in Burnaby.

After a one-day trial in April at the Supreme Court of BC, Madam Justice Russell dismissed the suit entirely on August 26, concluding that the disputed section of the report (pages 13-16) was not "of and concerning" those two CPCs. That section was a general list of tactics "common to many or most" CPCs in North America, of which there were about 4,200 (in 2009). The judge said: "It is interesting to note that the plaintiffs do not take any issue with respect to the information found in the Report specific to CPCs in British Columbia (pages 3-12). Instead, the plaintiffs take issue with the sections of the Report that discuss CPCs in North America."

The report didn't even mention either of the CPC plaintiffs by name except in a list in Appendix 3. Justice Russell concluded, after rebutting various aspects of the plaintiffs' case: "I find these factors, taken together, do not support the conclusion that an ordinary person, reading the Report as a whole, would believe the impugned statements brought discredit to the plaintiffs' reputation." Central to the case were the report's qualifying words "many or most CPCs," which the judge agreed meant that readers would understand that CPCs vary in their tactics and not all CPCs engage in each activity described.

Of course, the legal strategy that my lawyer employed -- arguing that the report did not specifically say that the two plaintiff CPCs used any of the described tactics from pages 13-16 -- does not necessarily mean they are absolved of all wrongdoing, as the CAS speciously claimed in a press release. One of the most puzzling aspects of the plaintiffs' case, in fact, was their silence regarding Appendices 1 and 2 of the report, which consist of 23 pages of detailed rebuttals of medical misinformation and "counselling abuses" that we found in a Volunteer Training Manual used by the plaintiff (at least until 2006). We had hired a doctor and a professionally trained counsellor to write those sections of the report. The doctor found errors, distortions or exaggerations, and inadequate referencing throughout the training manual, including in the descriptions of pregnancy and fetal development, abortion procedures, abortion risks, post-abortion counselling, and condom efficacy. The counsellor criticized the heavy religious bias of the training manual, which prioritized ideology over patients' needs, such as urging rape victims to carry their pregnancy to term, and advocating a strict, traditional model of sexuality.

The most plausible explanation for the plaintiffs' silence on the training manual is that the CAS chose a general section of the report that they felt would give them the best chance of success in a lawsuit. Indeed, they probably do not engage in "many or most" of the tactics listed on pages 13-16, some of which are horror stories from more extremist CPCs in the U.S. However, I have in my possession various pamphlets obtained directly from both the plaintiff CPCs, promoting such things as a link between abortion and breast cancer -- scientifically disproven since 2003 -- and "post-abortion syndrome," which is not even scientifically recognized. According to the American Psychological Association: "The best scientific evidence published indicates that among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy."

The lawsuit victory is significant. First, close to 200 CPCs operate in Canada, all of them from the premise that abortion is wrong and women should be persuaded to carry to term. That in itself is not necessarily the problem -- the problem is that many of them put up deceptive fronts as secular and professional agencies that promise unbiased help and accurate information on all pregnancy options. It is essential that the pro-choice movement continues to expose these centres. Second, when the judge dismissed the suit, the plaintiff CPCs were ordered to pay all court costs -- a financial setback for the CPCs, and a demoralizing one for the anti-choice movement as a whole.

Returning to the question I raised at the beginning of this article, other pro-choice successes in recent years include the defeat of Motion M-312 in September 2012, the deep-sixing of Bill C-484 by the Conservative government in 2008, and the non-votability coup scored against Motion M-408 this past March.
Further, opinion polls show a strong and increasing pro-choice majority in Canada, unless anti-choice groups or the right-wing polling agency Angus Reid write misleading questions for their own push polls.

One reason that anti-choicers have become more visible and energized in recent years is because Harper and the Conservative government hold the reins of power, which bolstered the movement's strength and morale at least in the early years. However, a positive attitude and an increased public presence do not by themselves translate to political success, and most anti-choicers are now quite disillusioned with Harper because of his refusal to legislate on abortion.

I would argue that another reason the anti-choice movement is more active lately is simply because the pro-choice movement has been fighting harder in recent years against anti-choice bills and other campaigns, causing our opposition to increasingly mobilize in turn. Although this has the side-effect of giving anti-choicers a bigger public platform, they are often quite adept at hanging themselves with their own rope. When they're given mainstream media space, they frequently make offensive or inflammatory remarks that would turn off most ordinary Canadians. The extremist Centre for Bio-Ethical Reform is another case in point -- despite the group's bravado, it is losing the battle of public opinion in its campaign to force 250,000 Canadian families (including children) to view graphic postcards showing aborted fetuses.

The defamation lawsuit backfired on the Christian Advocacy Society because, in my view, the anti-choice movement doesn't always have a firm grasp on reality. They tend to be quite insular, and so become convinced their position is far more reasonable and defensible than it actually is.

The anti-choice movement does a pretty good job of disseminating misinformation and promoting abortion stigma, and it's crucial we continue opposing these things, because they have serious real-world effects such as reducing access to abortion. But I also trust that most people can see that the anti-choice movement is religiously based and generally of a fundamentalist persuasion, and Canadians don't like having religion shoved down their throats. Also, most people support women's rights and understand that the fetus-focused view of the anti-choice movement is dangerous for women's health and lives. That could be why anti-choice protesters on the street or in front of abortion clinics typically have to put up with a lot of anger and abuse from passersby. Even when anti-choicers focus their supposed concern on women and the "harms" of abortion to women, much of their rhetoric comes across as patronizing and sexist, which doesn't go over too well with Canadians either.

I hope my lawsuit victory will add to the confidence of the pro-choice movement. Of course, there's no guarantee of success in the face of conservative determination to oppress people, but having truth and justice firmly on our side, as well as public opinion, gives us plenty to be confident about.

The audacity of sex workers

Cross-posted from Rabble.ca 

August 2, 2013

When a young and timid journalist attended a recent national sex workers' conference in Las Vegas, she expected to find trafficking victims and sob stories. Instead, she found an atmosphere of happiness and empowerment.

That's what I found too, but I already knew what to expect after attending the last such conference in 2010. Organized by Desiree Alliance (a coalition of sex workers, health professionals, social scientists, educators and allies), their 5th national conference took place July 14-19 around the theme "The Audacity of Health: Sex Work, Health and Politics."

The conference was a blast. Sex workers know how to have fun -- but they also know how to soak up and share knowledge, forge valuable relationships, and support and respect each other. In between the pool parties, the sunbathing, the networking and socializing, and the entertainment attractions of Las Vegas itself, the organizers managed to fit in frequent yoga and spa breaks, a screening of the moving documentary The American Courtesans, a sex worker rights march along the casino Strip, and a wild after-party that got moved to the hotel next door after the conference hotel would not allow nudity.

At least a dozen Canadians attended the conference (out of about 250 participants) and a few gave presentations, including Maggie's from Toronto, FIRST from Vancouver, and The Vivian Women's Transitional House, a home for sex workers run by Raincity Housing in Vancouver. A diverse cross-section of the sex work industry was also represented at the conference -- in part thanks to subsidies and donations -- including street workers, transsexual workers, queer and intersex workers, male workers, independent escorts, dominatrices, erotic healers, dancers, adult performers, and more. A minority of the attendees were academics, lawyers, writers, health-care workers, and activists, although many were current or former sex workers.

The differences between Canadian and American laws and politics around sex work are significant. Sex work is completely illegal in the U.S. except in some Nevada counties that allow brothels, but prostitution is illegal in Las Vegas and Reno. In Canada, sex work itself is legal, but many activities surrounding it are criminalized, including communicating publicly with clients, working indoors at one location (a "bawdy house"), and living off the avails (income) of sex workers. In both countries, sex workers are targeted, arrested, stigmatized, and subjected to high levels of harassment and violence (often by police), but these abuses are arguably less severe in Canada overall.

Many Americans I spoke to at the conference were quite envious of Canada's situation, especially in regards to our recent Supreme Court challenge, which may result in Canada's prostitution laws being struck down as unconstitutional (more on that later). Another difference is that Canada's sex worker movement enjoys the public support of social service and health agencies to a greater degree than in the U.S., in particular HIV/AIDS groups. Such alliances are critical for gaining broader public support and reducing stigma.

The sessions I attended were on topics such as "Whorephobia and Transphobia," the usefulness of Bad Date Lists as a tool to keep sex workers safe, the damage of anti-trafficking campaigns to sex workers, the relationship between legal policy and violence against sex workers, harm reduction programs in New York City, the origins of "sacred whore" mythology, and more. However, my choices may have been more boring than what sex workers might have chosen, such as how to incorporate kinky play, promotional photography for sex workers, Tantra 101, a guide to female ejaculation, how to provide amazing experiences for couples, and creating a dungeon on a budget.

I was honoured to be asked to co-panel a session chaired by Maggie's of Toronto. Activists Morgan M. Page and Chanelle Gallant described Maggie's services and history and their new resource booklet on safer sex practices, while I presented the new book Selling Sex: Experience, Advocacy, and Research on Sex Work in Canada, edited by three Maggie's members. This anthology features chapters by sex workers, academics, and advocates (including one co-authored by myself) on the common theme of sex work as work, meaning that sex workers deserve equal labour rights, dignity and respect. Happily, Maggie's sold all the books they had brought with them to Vegas.

I led a separate session on the recent court challenges to Canada's prostitution laws, and next steps for sex workers if the laws that criminalize and endanger them are struck down. It was a great opportunity to share our excitement -- tinged with trepidation -- at the prospect of imminent decriminalization in Canada, after the Supreme Court hearing on the Bedford case in Ottawa on June 13. My presentation offered numerous quotes from sex workers I had interviewed. For example, Kerry Porth is a former sex worker from Vancouver and co-founder of Triple X (a professional group for indoor workers) who travelled to Ottawa for the big day. She is cautious but optimistic about the court striking down the laws:

"I did feel that the judges asked difficult questions from the government lawyers and beat the shit out of them. The lawyer for the Catholic Civil Rights League [was making a moral argument], and one of the female judges stopped her and said 'I feel like we're in a time warp and you're talking to me from 100 years ago.' The evidence presented from the government's side and from the interveners' side wasn't appropriate evidence. They were trying to drag trafficking into the discussion, and bring in nuisance issues when we're talking about peoples' lives at stake! So the questions they got were more difficult and they were struggling to answer the questions, while the lawyers arguing for decrim were better prepared."

Lawyers for the plaintiffs (former sex workers Terri-Jean Bedford, Valerie Scott and Amy Lebovich) did a fantastic job by all accounts. Alan Young is an associate professor of law at Osgoode Hall Law School in Toronto, and Marlys Edwardh is one of Canada's most prominent civil rights lawyers. Young argued against the living off the avails and bawdy house laws, while Edwardh argued the cross-appeal for the communicating law (which the Ontario Court of Appeal had unfortunately upheld in 2012). Plaintiff Valerie Scott said:

"Having Alan and Marlys on the case is like having the best Lear jet with the finest Rolls Royce engines. We are fortunate because about a year ago, she agreed to come on our case, to work with Alan. She's considered one of Canada's top constitutional lawyers. She only does constitutional cases, difficult stuff like Maher Arar's case. She feels our case is winnable."

Several intervener groups testified in support of the plaintiffs' case, including the BC Civil Liberties Association and the Canadian HIV/AIDS Legal Network. They all did a great job, but one standout intervener was Katrina Pacey of Pivot Legal Society, legal counsel for sex worker groups SWUAV and PACE Society in Vancouver. Pacey explained the realities of street-based sex work for the judges, and how the communicating law puts them in danger because they don't have enough time to screen clients. She showed judges a Bad Date Sheet that sex workers need time to check.

Kerry Porth watched the hearing from a nearby hotel in Ottawa (seating is very limited at the court), along with a group of Aboriginal and street sex workers from Vancouver:

"It was such an amazing moment when Katrina got up to speak. We were all on the edges of our seats, starting to tear up, hanging on her every word, clapping for her. But it was really interesting to be with members of SWUAV, who also felt a palpable sense of history being made. And particularly the evidence that Katrina presented, and the reading of the bad date sheets. To get the court to understand that it's a matter of life and death for street-based sex workers, and to be there with other women from that neighbourhood, was really powerful. They're experiencing a great deal of marginalization, racism, poverty, and they really understood that this was their moment to have their voices heard at Canada's top court."

Even if the laws are struck down, decriminalization is only the beginning. The marginalization and stigmatization of sex workers will take many years if not generations to undo. A previous column of mine detailed the various measures that sex workers want and need in a post-decrim world, such as meaningful input into any new regulations, labour law protections, better access to social and health services, and an end to repressive police enforcement and social stigma. What they don't want are things like mandatory registration and health checks, confinement to red light districts, and exorbitant licensing fees for businesses that employ sex workers.

The challenges will be immense, because a strong sex worker movement exists in only a few cities in Canada, and it will be local and provincial governments that sex workers will likely need to work with the most. However, my experience at the Desiree Alliance conference deepened my respect and admiration for sex workers, which has been growing since I first began advocating for their rights six years ago in Canada. Sex workers are among the most gutsy, confident, resilient, smart, principled and well-informed people I've ever met. Oh, and did I mention they know how to have fun?