By Assata Baxter
In the United States, one in three of us has had one. We don't share this. In the midst of making hard decisions, we bear the vitriolic harassment of those who have never and will never carry children, or those who chose to project the insecurities of their own decisions on others, before we can get to the door. We are blamed and shamed in clinic parking lots with pictures of 56 week old dead fetuses. We enter clinics alone without our partners' knowledge, weighted with surprises in pink lines when it's not yet our time. Or our partners hold our hands and say that whatever we choose they are beside us. Or depending where we are in a low-income country, there may be no clinics. So, we ask our friends if anyone has a doctor in the family who can write a prescription; anyone who knows someone who knows someone who works at a pharmacy. We look up which combination of pills it requires, and pray that it works. We go to sangomas in another village. We put our lives in the hands of "surgeons" and hope that we wake up with use of our reproductive organs… or that we wake up period. There are no certain answers. No "do-it-yourself" manuals. And every 8 minutes in low-income countries, one of us will die of complications arising from it.
We don't announce our decisions on Facebook, or post pictures to Instagram of the sonogram, of the fetus we have chosen not to keep. We may tell some close to us, but often we don't tell our best friends, our parents, our siblings, sometimes our partners. We are afraid their religion or recently recognized righteousness will get in the way of them hearing us…that they will guilt us into thinking otherwise, or it may change forever how they see us. We fear scarlet letter branding. We talk in hushed whispers if at all. Sometimes we find support groups. Sometimes we continue life as usual. Sometimes we are forever changed. While our experiences are different, what remains consistent is that abortion sits squarely at the juncture of ethics, religion, morals, science, gender and politics. And yet the discussion of the experience remains taboo.
I have had two abortions; one in Kenya, one in Djibouti, both "back alley" in the sense that they lacked medical supervision or prescription. I was not raped. My health was not in danger. Simply, neither the birth control, nor the morning after pill worked. I give you these moderating factors for two reasons. One, because the myth often goes that underserved populations use abortion as birth control. This was not the case. Further these very factors had both an impact on my conscience and impacted accessibility to any legal type of procedure.
My period was a week late. But, my period was always a little bit hard to calculate. It didn't cross my mind that I could be pregnant until week two. We always used protection, and our one accident, I had taken the morning after pill. I bought a take-home pregnancy test at the nearby market. I remember crouching on the floor of my apartment in south B, Nairobi watching the Test line appear. The test was supposed to take three minutes, but positives appear faster… and even the few seconds it took, seemed like a lifetime. I rocked back and forth, hugging my knees to my chest, crying… I called my boyfriend, shaking, inconsolable, tears pouring down my face. He rushed over and held me as I cried myself to sleep. I wished it happened like in the movies. The girl who finds herself pregnant always magically miscarriages. She never actually has to make a decision. She can share her story freely, with whoever chooses to listen, because miscarriages are not of our choosing. They are not our fault or our choice. They are met with sorrow or pity or empathy, because they are God's will or the will of the Universe or whomever we believe in. We hold no "fault".
But it did not happen like the movies. I bought three more pregnancy tests the next week. I convinced myself I had ovarian cysts, that I kept contaminating the urine sample, or that the pharmacy by my house was selling expired tests. By the end of the week, I started having dizzy spells. I was beginning to feel nauseous quite often, but I had three days off work before heading to rural Uganda for work, and so the race against the clock started. The next day I woke up I felt awful, and depressed. I wanted to see a doctor. That would be the only way to know for sure. We made an appointment at a nearby hospital. I explained the situation and they too thought that pregnancy was unlikely, particularly given the dates of my last period and encouraged me to do an ultrasound. I agreed. For once and for all, I would know.
My memories of the next few moments that day are very blurred. I remember hearing a heartbeat. I remember crying and heaving in some corner in the hospital. I remember I went home with a sonogram as a parting gift, that I have never brought myself to discard. But I did not want to have a baby, even after heartbeats and sonograms. I was 24, living and working in Kenya on 2000 USD a month, with an ocean separating me from my family, and financially supporting a sick mother back at home. I was six weeks pregnant, and I did not want to be a mother, then… the same way I am unsure if I want to be a mother now. I knew immediately what I wanted to do, but had no idea how to do it, and having chosen to abort, there was nothing more that I wanted than to stop being pregnant. In my mind, I kept thinking the longer I waited, the closer the fetus came to viability, or to what in my mind was personhood. However, figuring out what to do was not easy. There is no "Planned Parenthood" in Kenya. I could not make an appointment to discuss my options. Abortion is and was illegal in Kenya, and only viable to save a woman's life or preserve her physical health.
I was not willing to wait any amount of weeks to try and fly to another country and come back. I also was not willing to literally have a back alley surgical abortion. I had one or two friends I confided in, who might have known someone who had "the surgery". I was not willing to risk my future reproductive health or a return to consciousness being unsure of what had been cut, or poked or inserted inside of my body. Here there was no RU-486. We had to find a doctor who would be willing to write a prescription for the pills I would need to give myself a medical abortion. We could not get it in the pharmacy without a prescription. We found a doctor who was willing to write a prescription however the dosage was not enough. It was for only 200mcg. We made copies of the prescription. We bribed pharmacists to give us more until we had 800mcg. There were multiple websites with multiple directions. I chose one and stuck with it. I put a pill under my tongue, wrote a letter to my unborn child, and asked for her forgiveness and to come back when it was her time. I wore a pad for the rest of the night. And in the morning, it was just as if I started my period. And that was it. I no longer felt nauseous. I just had what felt like period cramps... At least I thought that was it. I headed to Uganda for work. The secret safe between my boyfriend and I.
For the next two days life, continued as somewhat normal. However the third day, I had cramps far worse than any period I had ever had. They were so painful that I had to bite on a towel to keep from screaming out, every time I used the bathroom. I struggled through my work day, taking multiple breaks per hour. I was dizzy, sweating, and nauseous. Day four, I had what I realize now was probably Class Two hemorrhaging. I woke up to blood everywhere in the sheets. I wouldn't stop bleeding. In a town in far West Uganda, coming from the bathroom, too weak to walk, I tried to crawl back to bed, but could not make it. So, I lay on the cold floor of a hotel room, entering and exiting consciousness until morning; bleeding uncontrollably, until a friend found me in the morning. I never did see a doctor, but the process of healing from both the physical and psychological wounds was a long one. The psychological wounds remained because the physical damage to my body, the anticipated lack of support, my suffering in physical and emotional pain in silence, the battle of my conscience, and the feeling of utter loneliness did not leave immediately. But I survived… which makes me a lucky one.
International Access to Abortion
Imagine that approximately 310,000 women undergo abortions in secrecy each year in Kenya alone, according to the East Africa Centre for Law and Justice[1]. 21,000 women are admitted each year as a result of complications related to unsafe abortions, which are usually undertaken in back alley clinics. 2,600 of these women eventually die. Research from the Center for Reproductive Rights has found that unsafe abortions account for 40% of the maternal mortality rate[2]. I was fortunate enough to have a supportive boyfriend, and enough financial capital to be able to afford both seeing private doctors, and paying the costs of both prescriptions and bribes. I know that is a privilege not all women have in Kenya. Due to restricted abortion legislation, even with the new constitution, women, less than having access to a medically safe procedure, do not even have access to the human contact that would provide them with the support and empathy they seek, and the tools they would need to make an informed decision.
In sub-Saharan Africa, 98% of countries allow abortions to save the mother's life, however only 33% permit abortion in cases of rape or incest and only two allow elective abortions for any reason. But, I will point fingers neither at Kenya, nor the continent of Africa. Kenya is not the only country with restrictive abortion legislation. In fact the countries with the most restrictive abortion legislation are found in Europe, Central and South America. The Holy See (Vatican City), Malta, Dominican Republic, El Salvador, Nicaragua and Chile do not allow abortion under any circumstances, even if the mother will die from complications prior to or giving birth[3].
According to Pew Research Centre, although in Europe about 73% of countries allow abortions for any reason, Ireland, Andorra (between France and Spain) and San Marino (Italy) only allow abortions in order to save the life of the mother. In Ireland, illegal abortion carries a sentence of up to 14 years in prison. And therefore, more than 5000 women each year are forced to leave the country to have abortions outside of Ireland [4]. These same studies have revealed that 26% of countries in the world only allow abortion to save a mother's life; and 42% allow abortions only when the mother's life is at risk in combination with "at least one other specific reason, such as to preserve a woman's physical or mental health, in cases of rape or incest, because of fetal impairment or for social or economic reasons" [5]. According to the World Health Organization 21.6 million women undergo unsafe abortions every year [6]. Of those, 6.9 million women were treated for complications from unsafe abortions. I form part of the 40% of women who experienced complications but never received treatment. Unsurprisingly, almost all abortion-related deaths occur in low-income countries, with the highest number occurring in Africa. The Guttmacher Institute, according to recent studies have found that 8-18% of maternal deaths worldwide are due to unsafe abortion, and the number of abortion-related deaths in 2014 ranged from 22,500 to 44,000 [7].
What these numbers and percentages mean, is that beyond any discussion about population control in low-income countries, at what specific age human life becomes viable, if abortion is morally right or wrong, the after-life consequences of our actions, is that women are literally dying trying to get abortions, often of the surgical kind.
Trump in Our Wombs
The 1973 Helms Amendment , created in the wake of the Roe v. Wade decision, prevents the use of American foreign aid for abortions. The caveat being that the money could still be used to fund family planning, or educate women about abortions, but could not be allocated to the procedure itself. On January 23 rd 2017, beneath our noses, President Trump signed an executive order which reinstated the "global gag rule". Effectively this rule bans federal funding for international non-governmental organizations that offer abortions, advocate for the right to an abortion, or even discuss abortion as an option to mothers. In the past this order known as the "Mexico-City Policy", has been instituted by Republicans and struck down by Democrats multiple times. Yet the massive degree of funding that will be affected by this gag order is absolutely unprecedented. The gag rule will apply to about $9.5 billion dollars in global health funding which will effect organizations mostly in low and middle income countries. These cuts may even effect HIV prevention and treatment, and maternal health care. Conservative estimates by the Guttmacher Institute project that the result will be 38,000 more abortions. Marie Stopes International estimates that the global gag rule will lead to an additional 2.2 million abortions worldwide, and given the restrictive abortion policies in 68% of countries, a vast majority of these will be unsafe abortions.
Basta de Rosarios en Nuestros Ovarios (No More Rosaries in Our Ovaries)
While it is impossible to project definitively, I wonder how many more women will die this way, unaccounted for, afraid, hemorrhaging to death on the floor of a hotel room, or during surgery in the room of a back office with no windows, where her body may simply be disposed of, to ensure the continued financial gain of the "clinic". This unnecessary maternal mortality is a direct byproduct of desperation in environments that stigmatize and demonize women for unintentionally becoming pregnant, for whatever reason, and then punish them by restricting access to services. On top of this, with funding basically drained to international and national NGOs who specialize in family planning, pregnancy prevention, and pre- and post-counseling, women, especially in low-income countries are left very alone. I took years to heal from my psychological wounds. I never once regretted my decision. But I almost lost my life in the process. Reproductive rights belong to those who are doing the reproducing. Trump's new policies are invading our wombs, reaching into our bodies to yank away reproductive rights with fetal heartbeat bills and global gag rules. As has happened historically, when autonomy over our own bodies is taken away, we as women find a way to take it back. Banning abortion, or cutting funding to organizations that even discuss abortion will not make abortion disappear, it will only result in the unnecessary death of tens of thousands of women a year, by knitting needle, Misoprostol and coat hangers.
Notes
[1] http://eaclj.org/about-us/7-fida-and-kclf-landscaped-comparison.html
[2] https://www.reproductiverights.org/initiatives/maternal-mortality
[3] http://www.care2.com/causes/the-5-countries-that-would-let-a-woman-die-before-getting-an-abortion.html
[4] http://www.pewresearch.org/fact-tank/2015/10/06/how-abortion-is-regulated-around-the-world/
[5] Pew Research Center http://www.pewresearch.org/interactives/global-abortion/
[6] http://www.who.int/reproductivehealth/topics/unsafe_abortion/magnitude/en/
[7] https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
