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Killing in the Name Of

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In November of last year, Nicaragua outlawed all abortions, even those deemed medically necessary. The Nicaraguan abortion ban was celebrated in "pro-life" circles, and supported by the Catholic and Evangelical churches.

The law has also killed at least 82 women since its institution. And it is just part of an international system of "pro-life" laws that are killing and maiming women, orphaning children, and turning ordinary citizens into criminals.

María de Jesús González was a practical woman. A very poor single mother, the 28-year-old's home was a shack on a mountain near the town of Ocotal in Nicaragua. She made the best of it. The shack was spotless, the children scrubbed. She earned money by washing clothes in the river and making and selling tortillas.

That nowast quite enough to feed her four young children and her elderly mother, so every few months González caught a bus to Managua, the capital, and slaved for a week washing and ironing clothes. The pay was three times better, about £2.60 a day, and by staying with two aunts she cut her costs. She would return to her hamlet with a little nest-egg in her purse. She bought herself one treat - a pair of red shoes - but she would leave them with her family in Managua, as they were no good on the mountain trails she had to go up to get home.

During a visit to Managua in February she felt unwell and visited a hospital. The news was devastating. She was pregnant - and it was ectopic, meaning the foetus was growing outside the womb and not viable. The longer González remained pregnant, the greater the risk of rupture, haemorrhaging and death.

What González did next was - when you understand what life in Nicaragua is like these days - utterly rational. She walked out of the hospital, past the obstetrics and gynaecological ward, past the clinics and pharmacies lining the avenues, packed her bag, kissed her aunts goodbye, and caught a bus back to her village. She summoned two neighbouring women - traditional healers - and requested that they terminate the pregnancy in her shack. Without anaesthetic or proper instruments it was more akin to mutilation than surgery, but González insisted. The haemhorraging was intense, and the agony can only be imagined. It was in vain. Maria died. "We heard there was a lot of blood, a lot of pain," says Esperanza Zeledon, 52, one of the Managua aunts.

González was not stupid and did not want to die. She knew her chance of surviving the butchery was small. But being a practical woman, she recognised it was her only chance, and took it. The story of why it was her only chance is an unfolding drama of religion, politics and power that has made Nicaragua a crucible in the global battle over abortion rights. This central American country has become the third country in the world, after Chile and El Salvador, to criminalise all abortions. It is a blanket ban. There are no exceptions for rape, incest, or life- or health-threatening pregnancies.

González was told at the hospital that any doctor who terminated her pregnancy would face two to three years in jail and she, for consenting, would face one to two years. "Nicaraguan doctors are now afraid of going to trial or jail and losing their licence," says Leonel Arguello, president of the Nicaraguan Society of General Medicine. "Many are thinking that instead of taking the risk, it is better to let a woman die."

Leaders of "pro-life" organization have two responses to the epidemic of abortion-related deaths that kills some 70,000 women every year: Ignore and deny.

Abortion has long been illegal in Nicaragua but there had been exceptions for "therapeutic" reasons if three doctors agreed there was a risk to the woman's life. Those exceptions were no longer necessary, said the Nicaraguan Pro-Life Association, because medical advances obviated the need to terminate pregnancies. "The conditions that justified therapeutic abortion now have medical solutions," says a spokesman.

That must come as a surprise to the family of one Jane Doe, who was refused an abortion at Nicaragua hospital. One doctor there says:

Here [at this hospital] we have had women who have died.... For example, [name withheld] came here and had an ultrasound. It was clear that she needed a therapeutic abortion. No one wanted to carry out the abortion because the fetus was still alive. The woman was here two days without treatment until she expulsed the fetus on her own. And by then she was already in septic shock and died five days later. That was in March 2007.

A recent report by the World Health Organization proved what pro-choicers have been saying all along: That outlawing abortion doesn't end the practice, it just makes it more dangerous; that abortion is no less common in countries where it is illegal than in countries where it is allowed; and that the most effective way to lower the abortion rate is through contraception access and comprehensive sexual health education.

Thirteen percent of pregnancy and childbirth-related deaths world-wide are caused by unsafe abortion. The vast majority of these deaths occur in places where abortion is illegal. Countless women are injured and maimed during clandestine procedures. Because illegal abortion means that women who terminate pregnancies are criminals, many women are hesitant to go to the hospital after botched procedures for fear that they will be reported to the authorities. Doctors -- who often face even higher penalties for performing abortions than the women who procure them -- regularly refuse to administer any treatment that might get them mixed up in the anti-abortion crusade, even if the treatment is legally permissible. And so, as one Nicaraguan doctor told Human Rights Watch, "since the law was signed, [public hospitals] don't treat any hemorrhaging, not even post-menopausal hemorrhaging."

As a result, women are dying of treatable conditions. María de Jesús González, for example, had an ectopic pregnancy, a condition where a fertilized egg implants itself anywhere other than the uterine lining (usually in the fallopian tube). Doctors, scared of abortion-related charges, turned her away. Under Nicaraguan law, they technically could have treated her -- but even the treatment they're allowed to give may be questionable, and may be further compromised if anti-choice religious forces have their way.

According to the accepted Catholic doctrine (and adopted by other conservative religious groups), life begins at the moment of conception (when the egg is fertilized) and "direct abortion" -- ending the life of that the fertilized egg, embryo or fetus -- is impermissible. In the case of ectopic pregnancy, there is no hope for the egg to ever develop into a viable pregnancy. The easiest and often safest way to end an ectopic pregnancy is to administer methotrexate, a drug which ends the pregnancy. If that is not an option, surgeons can go into the fallopian tube and remove the pregnancy directly. But under pro-life doctrine, that egg is still a life and cannot be directly terminated. And so the acceptable alternative is to remove the woman's entire fallopian tube (or her cervix or whatever other part of her body holds the fertilized egg). That compromises her future fertility and is a much more serious surgery than the other two options, but from the "pro-life" view it's kosher because the intent wasn't to kill the egg, even though that was a known side effect and even though the egg's implantation was what threatened the woman's life. Simply removing the egg without taking out the whole fallopian tube is tantamount to abortion. And abortion, they say, is murder.

Who can blame doctors in anti-choice countries for being confused and scared?

In the meantime, countries with the most "pro-life" laws have higher abortion rates than the Western European countries with the most liberal abortion laws in the world. A large part of the difference is contraception -- Eastern Europe has seen a 50 percent decrease in its abortion rate since contraception became more widely available post-Communism. And yet contraception is something else that mainstream anti-choice groups oppose.

Yes, you read that right: Mainstream "pro-life" organizations are opposed to contraception as well as abortion. They're just keeping quiet about it because they know it's an unpopular position, and they know it outs them as hypocrites who put ideology over human life. But the fact remains that none of the well-known and influential national anti-choice groups have come out in support of contraception access. None of them promote the very thing that has been proven, time and again, to lower the abortion rate.

What do they promote? Abstinence until marriage and embracing pregnancy and childbirth. (Apparently, no married woman has ever wanted an abortion or experienced pregnancy-related complications). Other than that, anti-choice groups offer no real alternative to women who don't want to be pregnant, or women who don't have a choice to say no to sex, or women whose pregnancies threaten their life or their health. They offer no solution to the problem that kills nearly 70,000 women every year, other than "don't have sex outside of marriage; only have sex if you're willing to give birth; and abortion is wrong, don't have one."

That isn't working. It has never worked.

When you combine lack of access to reproductive health care with stringent anti-abortion laws, women die. That is an undeniable fact, and it's one that "pro-life" leaders refuse to look in the face. When South Africa legalized abortion, it saw a 90 percent decrease in its abortion-related mortality rate. By contrast, abortion remains the second leading cause of death for women admitted to Ethiopian hospitals. Uganda, a country that the religious right has advertised as an abstinence education success story, has an abortion rate twice as high as the one in the United States. In Brazil, where abortion is illegal except in very limited cases, the abortion rate is significantly higher than the rate in the U.S., and some 288,700 women were hospitalized for abortion-related causes in one year. Illegal abortion is the cause of 25% of all maternal deaths in Latin America, 12% in Asia, and 13% in sub-Saharan Africa.

Abortion is a difficult topic, and well-intentioned people fall on all sides of the debate. Most people, pro-life or pro-choice or somewhere in between, are repulsed at the idea of women dying for "pro-life" ideology. Most people understand that education and contraception are the most effective ways to prevent abortion. But self-identified pro-life people need to recognize what their leaders promote and what their movement currently stands for.

So far, "pro-life" groups have been non-responsive to the dead bodies in their wake. They are, however, mobilizing around the world to spread policies like Nicaragua's far and wide. They are actively seeking to outlaw abortion in the United States, and in the meantime trying to limit access to it. Right now they're in Aurora, Illinois, opposing Planned Parenthood. They're also the base of a Republican party that regularly launches assaults at children and families. The right-wing opposition to children's health care is just the start; 100 percent of the country's worst legislators for children are "pro-life." The global gag rule, which cuts off U.S. funding to any NGO that so much as mentions the world "abortion," ends up de-funding health clinics that provide contraception, condoms and HIV prevention. As much as anti-choice leaders claim to value life and dislike abortion, their actions don't back it up.

The message is clear: Women are just collateral damage in their ideological Culture War. Our right to life is negotiable.