U.S. Foreign Policy Obstructs Efforts to Make Abortion Safe

Taken from the September/October 2013 issue of the Women's Health Activist Newsletter.

Virginia's controversial TRAP law, which shuts down clinics in major urban hubs, finally took effect in July after a two-year back-and-forth between the state Board of Health and anti-choice Governor McDonnell, shutting down clinics in major urban hubs. As I write this in my home state of North Carolina, the State Senate is facing its second go-round on a bill that includes the most sweeping abortion regulations ever to be introduced here. If enacted, the law will shut all North Carolina abortion clinics but one, located in Asheville, in the far western part of the state.

Many people following the record number of state-level attacks on women’s reproductive rights may be unaware that U.S. foreign policy also imposes restrictions on access to safe and legal abortion care for millions of women in other countries. The Helms Amendment, named for the late Senator Jesse Helms (R-NC), states: “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”

When performed under proper medical conditions by trained personnel in a hygienic setting, abortion is extremely safe. Fewer than one percent of all U.S. abortion patients experience a major complication from the procedure; the risk of death after abortion is 10 times lower than for childbirth.1 As health advocates, we know that restrictive laws create barriers to timely and compassionate abortion care. The restrictions are intended to prevent women from having an abortion, but they just end up forcing women to seek unsafe abortions provided in unhygienic conditions and/or by untrained providers. Every year, 22 million procedures occur in unsafe conditions, and approximately 47,000 women die needlessly, almost all of them in the developing world.2

The Helms Amendment applies unfortunate and far-reaching Federal restrictions on funding for abortion care internationally. Essentially, it restricts any national government or non-governmental organization (NGO) that receives U.S. foreign aid from using those funds to provide abortion care (in most circumstances) or even information about abortion — even if abortion is legal in their country. The restriction applies regardless of whether the U.S. funds are targeted for maternal health, family planning, refugee assistance, etc.

On the surface, it is clear that the Helms Amendment holds women in other countries hostage to a U.S. domestic political debate over abortion. But, the policy also has other, less obvious, consequences that weaken our position as a global leader in health, development, and human rights.

Governments and human rights authorities have long recognized the importance of safe abortion to ensure maternal health and women’s human rights. At the U.N. 1994 International Conference on Population and Development, 179 governments (including the U.S.) affirmed that control of one’s fertility is a basic human right.3 This was reaffirmed at the 1995 Fourth World Conference on Women in Beijing. In 1999, the U.N. General Assembly agreed that: “where abortion is not against the law, health systems should…ensure that such abortion is safe and accessible.”As a result, governments around the world have liberalized access to abortion, recognizing that restrictive laws increase maternal death from unsafe abortion. By restricting foreign aid for abortion, the U.S. government is thwarting its global commitments.

The Helms Amendment denies women access to legal health services in their own country. The United States is one of the largest funders of developing world programs to support reproductive and maternal health — the front-line programs where women get basic health care, including family planning and maternal and child health care. But, because no induced abortion can be provided at any U.S.-funded facilities, community-level public health centers in developing countries have had to turn away women seeking safe, legal services.

Ipas works to provide reproductive rights and health services. In many countries, when women cannot access accurate information about abortion care, they delay care or turn to untrained, unsafe providers — increasing the likelihood for complications and injuries or death. Take, for example, Sunita, a 23-year-old with two children who lives in a remote area of a Southeast Asian country where abortion is legal. Sunita went to her local health clinic with an unwanted pregnancy. Because the facility is funded by the U.S. Agency for International Development (USAID), the Helms Amendment restricts it from providing abortion care or information. So, Sunita was referred to a hospital 60 miles away, which was too far for her to travel by foot or ox cart, her only options. Sunita tried to self-induce an abortion with sticks, and returned to the clinic two weeks later with a severe infection. Because U.S. foreign policy allows for emergency post-abortion care, Sunita was able to get treatment — but that would not have been needed in the first place if abortion care had been available to her earlier.

The Helms Amendment is fiscally irresponsible. Post-abortion care often requires surgery, involves more staff, and necessitates a longer hospital stay than early abortion services. For this reason, post-abortion care is far more expensive than a safe, early abortion, which is an outpatient procedure performed in a primary health care setting. Over the years, the U.S. has spent millions of dollars on post-abortion care over the years in the developing world to address the very injuries caused by unsafe abortions in countries where abortion is legal. The U.S. could spend a fraction of that amount and prevent injuries from unsafe abortion by ensuring that safe abortion care is available and accessible in facilities supported by U.S. funds.

Efforts to Repeal Helms

Women’s rights should not depend on geography. The Helms Amendment is the product of the U.S domestic battle over women’s reproductive health, and is completely divorced from the reality of women’s lives in the developing world. It conflicts with, and actively undermines, U.S. efforts to improve the health and lives of the most vulnerable women. Because the U.S. is strongly invested in protecting maternal health by promoting family planning and women’s rights — and we already pay for expensive post-abortion care — we should repeal Helms so we can actively minimize unwanted pregnancies, reduce the number of unsafe abortions, and prevent maternal deaths.

Perhaps there is some light at the end of the tunnel. In April, Rep. Gerry Connolly (D-VA) introduced a bill, the Global Partnerships Act of 2013 (HR 1793), which would effectively repeal the Helms Amendment. Whether or not the bill gets any traction (which, given the current political climate, is doubtful), it is encouraging that policymakers are finally recognizing the U.S.’s part in the preventable pandemic of unsafe abortion. We believe strongly that Helms will eventually be repealed. Learn more about these issues and stay connected to policy issues and actions by signing up for Ipas’ newsletters through our website at: www.ipas.org, friending Ipas on Facebook, and following us on Twitter (@IpasOrg).

Carey Pope is the Senior Associate for Advocacy Communications at Ipas, an international reproductive rights and health organization based in Chapel Hill, NC. She holds a master’s degree in public policy and women’s studies. Prior to joining Ipas, she served as Executive Director of NARAL Pro-Choice North Carolina.

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1. The Guttmacher Institute, “Are you IN THE KNOW: Safety of Abortion,” New York: Guttmacher Institute, 2011. Available online at: http://www.guttmacher.org/in-the-know/abortion-safety.html

2. The Guttmacher Institute, “Are you IN THE KNOW: Safety of Abortion,” New York: Guttmacher Institute, 2011. Available online at: http://www.guttmacher.org/in-the-know/abortion-safety.html

3.  U.N Population Information Network, Programme of Action of the International Conference on Population and Development, Cairo, Egypt (5-13 September 1994), New York: United Nations, 1994. Available online at: http://www.un.org/popin/icpd/conference/offeng/poa.html

4.  Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development, report of the Ad Hoc Committee of the Whole of the Twenty-First Special Session of the General Assembly, New York, 1 July 1999, para. 63 (iii).