II. Female Reproductive Rights and Abortion
Becoming a Global Trend
III. The Combined Effects of Abortion on the
Field of Health Care
IV. Impact of Abortion on the Health Care
Profession in Belgium
V. Future Ramifications and Speculations
Female reproductive choice, or more specifically abortion, is an issue that
seems to have gained popularity around the world in the post World War II
era. Reasons that may account for this include the increase in women’s
movements for equality and desire for choice, some state’s recognition
of women as an important part of society, women’s health issues and
their effect on society, and the global problem of overpopulation. A connection
appears to exist between the reproductive choice trend and its effect on the
medical community as a whole. This relationship deals with abortion, how to
manage family planning in a population more effectively, the use and dissemination
of birth control and contraception, and the health of women when approaching
reproductive choice.
As with any large scale trend, there are certain factors involved that have
contributed to the growth and development of female reproductive choice. Lack
of sexual education, along with no availability or access to birth control
and/or contraception, leads to many unwanted pregnancies. A rise in the number
of unwanted pregnancies in turn leads to abortions, which is the heart of
the reproductive choice matter. The choice of women to limit the number of
children they have or to undergo surgical procedures not to have any at all
is also an underlying factor in this trend (National Abortion & Reproductive
Rights Action League, 2003).
The issue of women’s pro-choice has prompted governments and certain
faiths such as the Catholic Church to become involved. While the Catholic
Church is an opponent of abortion, it does support women’s rights. Many
governments have also recognized the importance of supporting family planning
to increase awareness of the dangers of abortion, methods of protection, and
legality of certain procedures. Laws in Belgium, as well as most of the European
Union for example, make abortion legal for those who simply request it (Struggle
Over European Abortion Politics, 2002).
In the health care domain, women’s reproductive choice has had a significant
impact. Where it is legal, many practitioners make abortion procedures available
in a safe clean environment. However, illegal and unsafe abortion practices
that threaten the health of those women choosing this still exist. The medical
community would like to make changes to ensure health and safety as much as
possible in keeping with the tradition of continuing health and wellbeing
of humankind (World Health Organization, 2003). Pharmaceuticals are also an
area that ties this trend to medicine. Women can now receive prescriptions
for birth control pills and special contraceptive devices as means of preventing
or controlling pregnancy, thus decreasing the need for abortion.
Belgium is a country on the cutting edge of medicine and has the human and
industrial resources necessary to deal with the impacts of a trend of such
magnitude and importance as female reproductive choice (European Medical Care,
2002). Movements exist there that have led to the legalization of abortion.
The country deals with abortion by having many specially trained medical personnel
and clinics to carry out procedures but also incorporating such state funded
organizations as Planned Parenthood as a resource for women (International
Women’s Health Coalition, 2003). The way Belgium has dealt with abortion
may not be unique compared to other developed countries, but may serve as
a model to an underdeveloped or impoverished country that needs to improve
current standards for health reasons.
The issue of female reproductive rights and abortion is one that knows no
geographic or cultural boundaries. The enormity of it is also evident by how
many people and resources are consumed by the number of abortions that occur
each day in the world. An in-depth look at this trend reveals all the forces
at work and what impact it is having at a global scale.
II. Female Reproductive Rights and Abortion Becoming a Global Trend
On January 22, 1973, the U.S. Supreme Court decision in the Roe v. Wade case
guaranteed women the right to make their own reproductive choices, including
abortion. This is now the legacy of a generation of women fighting to keep
their rights. Though decided by the U.S. Supreme Court, Roe v. Wade was the
culmination of generations of pro-choice Americans fighting for women’s
right to control their reproductive lives. They helped ensure that women,
not politicians, make intimate, private decisions about abortion (National
Abortion & Reproductive Rights Action League, 2003). This is one example
of how big and far reaching abortion has become.
The scope of this issue is not limited to the United States. Virtually every
inhabited country on earth has laws regarding abortion and there are levels
of legality when it comes to abortion and a woman’s right to choose
such an operation. (See World Abortion Law Map in Appendix). Therefore, it
is easier to imagine the amount of people involved at any one time, either
directly, as in a pregnant woman, or indirectly, as in individuals or groups
supporting or opposing the trend. For example, a hypothetical situation may
look something like this: a woman is confronted with an unplanned pregnancy
and wants to have an abortion. She lives in a country where it is illegal
and decides to bring her case to court. She hires a lawyer, gets the press
involved, and stirs up groups of both protestors and supporters. Law enforcement
is needed to control crowds and before you know it there are hundreds of people
caught up with one abortion.
A look at some demographics surrounding the issue will help to gain perspective.
Specifically speaking, there are approximately 46 million abortions per year,
which breaks down to around 126,000 per day, throughout the world. Of these,
nearly 26 million women get legal abortions either in countries where it is
legal or travel outside the illegal boundaries of their home countries. An
additional 20 million abortions occur in countries where it is restricted
or prohibited by law (Abortion Statistics, Abortion TV Website, 2002).
Geographically, the majority (78%) of abortions are obtained in developing
countries while the remaining 22% are in developed countries. More often than
not, developing countries cannot and do not provide safe clean environments
in which to perform abortions which makes them dangerous to women (Centers
for Disease Control, 2003). In Asia, abortion laws range from restrictive,
such as in Bangladesh and Myanmar, to extremely liberal, as in Vietnam. Despite
liberal abortion laws in countries such as Cambodia, Vietnam, and India, women
face great difficulties in obtaining safe, high quality abortion service;
many abortions are still performed by illegal, unqualified providers and an
estimated 38,000 women die each year from complications related to unsafe
abortion in Asia (Reproductive Rights – Asia, 2001). Along with that,
in the United States, a developed country where abortion is legal upon request,
the abortion rate doubled from 1973 with the Roe v. Wade decision, to 1980
to a reported 1,553,900 (Pregnant Pause Statistics, 2001).
Most Western countries cover abortions under state or provincial health insurance
plans. In Africa however, the majority of the population has no insurance.
An abortion procedure in the US or Canada on average costs around five hundred
dollars (The Economics of Contraception, Abortion, and Unintended Pregnancy,
2003). Using the figures from earlier, that’s a little more than $10
million for the 22% of legal abortions in developed countries each year. In
1998, Canada spent an estimated $30 million on provision of abortion services
(CARAL, 2000). Other economic indicators of this trend (for the woman, health
care facilities, and government funding agencies alike) include the costs
of contraception, which are generally not covered under health care plans,
costs of pregnancy prevention programs, and the costs of unintended pregnancies.
For economic reasons, postabortion contraception and/or counseling services
are inadequate or non-existent in most Eastern and Central European and former
Soviet Union countries (Reproductive Rights - Asia, 2003). Factoring in the
wages of the medical personnel involved, costs to keep the clinics active,
money spent (not to mention time and energy) for the legal process to get
the clinic open and offer this service, and other related financial considerations,
makes abortions a large scale issue – a global issue.
Opposition to abortion comes from many individuals as well as groups supported
and even run by those people. Extreme right forces, as in the Christian Coalition,
oppose it and “believe that the government can and should require, as
a matter of law, that a woman use the private part of her anatomy to carry
an unwanted pregnancy even if she doesn’t want to” (Women’s
Reproductive Self-Determination, 2001). Other such conservative right wing
organizations influence public policy and fund right wing think tanks and
public policy centers that can influence the decision makers. Human Life International
and Focus on the Family are two such groups. Since the 1960’s use of
media outlets to spread the conservative message has also been an effective
tactic. Pat Robertson’s Christian Broadcast Network for example, is
set up exclusively to allow this one particular faith’s viewpoint, which
includes anti-abortion propaganda, to be heard around the world. Newspapers,
books, and even apolitical groups, who claim they have no political agenda,
increased the exposure of the opposition to female reproductive rights (Feminist
Majority Foundation, 2003).
On the other side of the camp, strong supporters also exist that are just
as large and influential and use many of the same sources to voice their opinions.
One example of a group that has most recently gained international recognition
in the fight is Clinicians for Choice, formed nationally in the US in 1997.
Clinicians for Choice support greater involvement of nurse practitioners,
registered nurses, and physician assistants, in all aspects of abortion service
delivery. With a membership base of almost 2500 practitioners and over thirty
state chapters in the US, they have the human resources to support fulfillment
of their goals. Some of these include forming networks with other clinicians;
increase curricular exposure to abortion care by working with clinical education
programs; writing letters to media and contacting government representatives
about abortion and the scope of their practices; and engaging fellow colleagues
in discussions about the importance of female reproductive choice and safe
abortion practices (Clinicians for Choice, 2001).
Another interesting dynamic exists within the religious realm. There is quite
a bit of religious opposition, for instance from the Catholic Church. Interestingly
enough, there also exists the Religious Coalition for Reproductive Choice.
This is a combination of Christian, Jewish, and Unitarian denominations that
provide clergy with straight forward information about abortion and female
reproductive rights instead of just condemning it. This is a complex situation
as further analysis of the situation shows. So complex in fact, that organizations
such as the Catholic Church have both supporters and those in opposition,
often creating great disparity between groups with the same foundation such
as faith (Religious Coalition for Reproductive Choice, 2002).
This is merely a glimpse at the multitude of organizations and groups in support
of or opposition to the female reproductive rights issue. Type in any one
of a plethora of terms associated with abortion or female reproductive rights
to an Internet search engine and you will experience an astounding amount
of results from which to choose. The word ‘International’ attached
to the end of some group names shows that many of these organizations span
the globe thus expanding the reach of their messages and services. It is clear
therefore, that the impact of this trend is global in both social and economic
perspectives.
III. The Combined Effects of Abortion on the Field of Health Care
Female reproductive rights and the global abortion issue have affected the
core philosophy of health care in many ways. Health care personnel have been
trained to follow the time-honored practices that provide humankind with the
knowledge and services necessary to remain as healthy as possible. When faced
with an issue that would surely affect the health of a woman, medical professionals
had to step up to the plate and attempt to learn as much as they could to
protect these women. Protection came in the form of safer advanced procedures,
increased knowledge of female physiology and the effects of an abortion on
a woman’s body, new and improved contraception and birth control methods,
and alternatives in pharmaceuticals. These protective measures are what have
had the greatest impact on the health care profession.
The evolution of abortion procedures spans thousands of years. In the last
150 years, medical professionals have made a conscious effort to change the
way abortions were performed. Namely, to complete the procedure but also to
do it in such a way that is safe and allows for as healthy an outcome as possible
for the mother (Physicians for Reproductive Choice and Health, 2003). Research
on new procedures has made it possible to identify and develop the safest
methods for different stages of fetal development. Other medical procedures
such as X-rays and ultrasound used in conjunction have permitted health care
to advance to a level where each procedure is done in the safest way possible
for the woman (WebMD, 2002).
From some points of view the reputation of medicine has been tainted by the
female reproductive choice and abortion trend. From graphic pictures of aborted
fetuses and abortions gone wrong to extremist groups advocating the use of
force or illegal actions to stop abortions, the world has been exposed to
the ugly side of a health care issue (Dixon-Mueller, 1993: 77). This has created
the need for medical personnel dealing with abortions to conduct themselves
in a very respectful, confidential, and often secretive manner. Some clinical
practitioners have gone to extraordinary lengths to avoid publicizing the
service unnecessarily, being the object of death and bomb threats or verbal
abuse, and attempt to maintain a certain level of morale among employees.
To relate just how dangerous the abortion practice became, refer to the chart
in the appendix which surveys violent acts and protests during one decade
of legal abortion history. Also, because of the sensitivity and extensive
legal aspects of the abortion issue, clinics that desire to offer abortions
have to deal with other professional fields such as lawyers and local government
boards. In some cases though, because of a difference in beliefs of a community
that influences the governing bodies, health care has had trouble getting
past the red tape. This has occasionally put a strain on the relationships
of the entities involved (Physicians for Reproductive Choice and Health, 2003).
Having its foundation in science, the field of medicine did not only concentrate
on correcting an unwanted pregnancy but also the prevention of one. Along
with millions of dollars spent on education and add campaigns, a large portion
of government and private funding went towards pharmaceutical research. A
wide variety of contraceptive products have been developed that have proved
fairly effective: creams and lotions with spermicidal chemicals, barrier methods
such as condoms and internal uterine devices (IUDs), to the many different
oral birth control pills that are available either by prescription or over
the counter (WebMD, 2003).
The most controversial product the pharmaceutical industry has created however
has most recently been approved by the Food and Drug Administration. In September
2000, RU 486, or mifepristone, was marketed in the US as an ‘emergency’
abortion pill. The product’s development (and use) over twenty years
ago in Europe is another striking example of the impact the abortion issue
has had on medicine. Human beings now have a synthetic drug that can effectively
abort a pregnancy up to three weeks after conception (International Women’s
Health Coalition, 2003).
Abortion has also had an economic impact within health care. The amounts of
clinics that have spread in the world require specially trained practitioners
and other personnel to staff them. At the same time, with the increased demand
for contraception and birth control, the pharmaceutical industry witnessed
a surge in employment to maintain the supply (Physicians for Reproductive
Choice and Health, 2002). In contrast to the increase in workforce, the support
for clinics and hospitals has not always proved sufficient. In many cases
around the world, mainly for underdeveloped countries, lack of financial resources
has hampered the ability of care facilities to offer either timely or high
quality procedures. Developing countries have also had an even more difficult
time keeping pace with lost resources because what little resources are available
do not always go to abortion practice (World Health Organization, 2003). Lack
of resources and funding has been a major influence on health care provider’s
support for starting prevention programs. Publicly funded family planning
services are relatively inexpensive to provide, very effective in reducing
the incidence of unplanned pregnancy, and have proved their worth to communities
around the world (The Economics of Contraception, Abortion, and Unintended
Pregnancy, 2003).
IV. Impact of Abortion in Belgium on the Health Care Profession
With a population of over ten million people in an area about the size of
the state of Maryland, Belgium has remained relatively stable for the last
two decades in terms of political disputes, social conflicts, and economic
hardship (The American University, 1985: Appendix A 293). Even though the
country is divided in half geographically into the Flemish (Dutch) speaking
northern region called Flanders, and the French speaking south part of Wallonia,
the glue that holds them together, and claims 80% of the total population,
is the Catholic Church (Country Profile: Belgium, Facts on File). Its capital
Brussels is home to the United Nations (UN) and the North Atlantic Treaty
Organization (NATO) which gives its people a sense of pride for the amount
of political agendas many influential world leaders attend to (Helmreich,
1976: 406). This European country is an interesting one in economic, social,
and political aspects.
Belgian women had to wait until 1990 to obtain a legal abortion in their own
country. This law states that abortion is legal up to the third trimester
(12 weeks) of pregnancy or 14 weeks of amenorrhea if the pregnancy causes
a “state of distress or emergency” for the woman. The portion
in quotes is not defined by the law and is to be interpreted as subjective
information as to the emotional condition of the woman. Before the abortion,
the woman has to sign a written declaration confirming her decision and then
wait a mandatory period of six days during which she is given information
on alternatives to abortion and the use of contraceptives (Pyck, 2000: 1).
Belgium is one of the few countries that have made it mandatory to register
and report all abortions performed in either clinics or hospitals. From 1999
to 2001, between 10,000 and 12,000 abortions were reported each year. Taking
into account some 3,000 to 4,000 that were not reported or registered, the
figure is probably closer to 15,000. This is still a fraction of the statistics
from Belgium’s two largest neighbors France – 150,000 to 180,000
per year, and Germany – 100,000 to 130,000 per year (Abortion Statistics,
Johnston, 2002). The most striking thing to mention about these statistics
is that there have been hardly any changes since the first official data became
available for the year 1993 implying that Belgium has one of the lowest abortion
rates in the world, preceded only by the Netherlands (Centers for Disease
Control, 2003).
Since the 1990 law went into effect there has been a small but significant
change in the health care industry. Thirty-four hospitals in the country now
offer the latest in advanced abortion procedures. Another forty-five abortion
clinics have opened their doors since 1990 and account for 73% of all abortions
in Belgium (European Medical Care, 2002). Obviously along with this came an
increase in the number of training programs and professionally trained individuals
who deal with the procedures.
Politically, Belgium has practiced a policy of tolerance towards abortion.
Due to the fact that Napoleonic law was considered unrealistic and outdated,
an unwritten agreement with justice departments not to prosecute those performing
or having abortions was understood. This along with the need for abortions
in cases where the mother’s health was compromised opened the doors
to the increase in health care employees working in this area and operations
(clinics and hospitals) offering the service (Pyck, 2000: 2).
A geographic element exists that shows the influence of the Catholic Church
in Belgium. Most of the hospitals in the Flemish region are run by the Catholic
Caritas Federation. In an attempt to prevent abortion services in their clinics,
the Federation made counseling services a necessary precondition to perform
legal abortions in both clinics and hospitals. Then, at the end of 1990, women
with unwanted pregnancies were turning to non-Catholic services for help which
forced Caritas to amend its policies. Still, with no legal obligation, many
service providers don’t refer women to the clinics or hospitals (International
Humanist and Ethical Union, 2003). It still holds true however, that aside
from the Catholic Church’s views and influences that Belgium has a very
low abortion rate relative to other countries of the world.
Economic factors frequently interfere with the ability of competent medical
professionals, clinics, and hospitals to carry out the number of abortions
registered for each year. The issue of the lack of resources for the abortion
clinics was becoming a major threat to the condition of high quality abortion
services, especially in the Flemish region. The clinics did not receive any
money from the government and had to charge their clients higher prices year
after year. Women currently have to pay an average of 223 euros (about 210
US dollars) for an abortion of which less than 30% is reimbursed by the Federal
social security system. July 1999 brought a new Federal government into power
who back then proposed that beginning in 2001, abortion clinics would finally
receive funding from the government. Currently, the same government consisting
of a coalition of the liberal, socialist, and green parties is considering
offering abortion services at no cost so as to quell the financial impediment
on individuals and not endanger the abortion law itself (Pyck, 2000: 5).
The Belgian health care community has chosen to confront the abortion issue
head on. The economic, social, and political factors described earlier have
all had some impact on accomplishing quality care goals. For instance, the
issue of government support previously mentioned was dealt with not only by
needy citizens, but through persistent lobbying efforts of high level practitioners
as well (Standing Committee of European Doctors, 2003).
Belgium is also leading the world in advanced abortion procedures. In a World
Markets Research Centre study of the Health of Nations conducted in 2000,
Belgium topped the 175 country list with an impressive 98 overall points.
A few interesting comments on abortion include the fact that Belgium has the
highest number of hospitals and doctors per capita that perform abortions.
Also, the most university based programs that incorporate abortion practice
into their curriculum reside in Belgium. The high-income to small population
ratio allows for a high level of investment in both research and equipment
keeping the country extremely advanced. Although not a lot of capital is dedicated
to abortion research, this area of expertise still enjoys utilization of the
latest state of the art diagnostic tools and procedural equipment (European
Medical Care Ltd, 2003).
The scope of this trend and its impact on health care in Belgium is fairly
typical of the European Union’s liberal human rights policy. It is widely
accepted that the abortion issue was at the forefront of people’s minds
when scribing certain provisions of the Charter of Fundamental Rights of the
European Union. Practitioners therefore are free to use all the resources
available to them while not having to deal with many governmental restrictions
(Charter of Fundamental Rights of the European Union, 2003).
V. Future Ramifications and Speculations
Abortion and female reproductive rights issues now span the globe. In many
developed countries advances in technology and education, along with efforts
between governments and communities brought abortion to a point where it is
safer for the mother and regulated by law. Unfortunately this is not the case
worldwide. For developing countries, lack of access to quality health care,
including abortions, the large number of unwanted pregnancies, and funds to
provide such care are all reasons why it is such a problem. Countries such
as Belgium can serve as an example of how to approach a global issue like
abortion and manage it with the resources available.
The fact that there is a disparity in the safety, cleanliness, regulation,
and quality of procedure makes abortion a very real and relevant health care
concern. For these reasons, the medical field has attempted to facilitate
learning more about abortion not only for practitioners, but for the public
as well. From this knowledge, success could come in the form of a number of
outcomes. A decrease in the number of unwanted pregnancies would decrease
the number of abortions desired. At the same time, safer and cleaner procedures
performed by competent medical personnel would mean a greater chance of a
healthy outcome for the mother.
All aspects of this global issue will require constant research and development.
One in particular is that of managing it in countries where it is a major
problem. There will need to be efforts made by the local governments as well
as outside assistance from organizations such as The World Health Organization.
Communities within these countries will also have to do their part. If there
is not a conscious understanding of the reasons it is a problem, there will
be no motivation to change.
The global abortion trend has directed health care in many ways. The future
of the profession in this area now lies in the hands of those willing to accept
the effects and who are dedicated to humanity. There is the possibility that
emergency abortion drugs would cut the abortion rate in half. Maybe more public
awareness of the dangers of illegal abortion and increased access to assistance
would do the same. It is evident though that health care professionals around
the world need to continue making the effort to eradicate unsafe abortions
and put the message out about the options for help that are available.
Overall, the abortion issue is not one that threatens the existence of civilization.
It is however, a large enough trend that deserves attention because of the
many connections it creates to other areas of life. For some people, it may
be a quick easy fix to a problem that appears to threaten a life financially
or psychologically. For others possibly the only choice to avoid unnecessary
pain and suffering on the part of either a deformed or otherwise damaged child,
or the parents themselves. Whatever the personal views or attitudes to female
reproductive rights issues people, governments, or organizations have, the
future ramifications of it will depend on how all these entities choose to
handle it.
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