Pro-Choice Press

a publication of BC's Pro-Choice Action Network

Autumn 1997 Issue

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Table of Contents

"Fetal Rights" Decision

Pregnant Women Can't Be Locked Up

On October 31st, the Supreme Court of Canada ruled in a 7-2 majority decision that courts do not have the power to force a pregnant woman to undergo treatment to prevent harm to her fetus. The ruling reaffirms a woman's right to fundamental liberties, saying in effect, that a woman has the right to control her own body at all times, including when she is pregnant.

The court overturned a Winnipeg judge's controversial ruling last year that ordered a 22-year-old pregnant aboriginal woman, known as Ms. G, into a treatment program for drug addiction. At the time of the order, Ms. G was five months pregnant and had three other children, two of whom suffered brain damage traced to her sniffing of glue and solvents. The Winnipeg Court of Appeal subsequently overturned that order. Then, the Winnipeg Child and Family Services, the organization with "custody" of Ms. G, appealed to the Supreme Court of Canada.

Jo Dufay, the Executive Director of CARAL (Canadian Abortion Rights Action League), said, "This ruling sends a clear message. Pregnant women are free to seek medical care without fear of incarceration." She noted that CARAL supports the goal of healthy, wanted babies, but that the threat of incarceration would have driven women at risk away from pre-natal care, with potentially serious consequences.

"If you care about the fetus, you must care about the woman—not punish her" said Dufay. Ms. G was turned away from treatment early in her pregnancy when she voluntarily sought help. As Madam Justice McLachlin indicated in the majority decision, this is "..the all too common story of people struggling to do their best in the face of inadequate facilities". Luckily, Ms. G did manage to kick her drug habit and gave birth in December to an apparently healthy boy.

The Supreme Court said that "....From the woman's perspective .... considering the interests of her fetus separately from her own has the potential to create adversary situations with negative consequences for her autonomy and bodily integrity, for her relationship[s] with her partner and .... her physician. Judicial intervention is bound to precipitate crisis and conflict .... It also ignores the basic components of women's fundamental human rights—the right to bodily integrity..."

The Supreme Court heard arguments from counsel for Winnipeg Child and Family Services (WCFS), Ms. G, and eleven intervening groups on both sides of the issue. WCFS argued that when a pregnant woman is using drugs that may cause harm to a fetus, it should have the right to lock her up and force medical treatment on her. Some of the intervenors in support of this position argued that the fetus is protected by Section 1 of the Canadian Charter of Rights and Freedoms, thus having a right to life, and that this right must be balanced against the woman's right not to be locked up or forced to have medical treatment. (Section 1 "guarantees the rights and freedoms set out in [the Charter] subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.") Some of the intervenors hoped to erode a woman's right to have an abortion. (Intervenors included the Attorney General of Manitoba; the Yukon Government; Alliance for Life; Catholic Group for Health, Justice and Life; Evangelical Fellowship of Canada; and the Christian Medical and Dental Society.)

Counsel for Ms. G argued that the current law does not permit a court to force medical treatment on anyone and that includes a pregnant, glue-sniffing woman. Intervenors supporting Ms. G (including CARAL, Women's Legal Education and Action Fund, the Women's Health Clinic, the Canadian Civil Liberties Association, the Native Women's Transition Centre, and others) argued that forced medical treatment and confinement of pregnant women is a violation of their constitutional rights to liberty, security of the person, and equality guaranteed under Sections 7, 15, and 28 of the Charter. They successfully argued that the violation of these rights cannot be saved under Section 1, and noted also that the right of adults to refuse medical treatment is strongly enshrined in case law.

The court said that changes to existing legal principles on the status of the unborn would be of "major impact and consequence" and that only lawmakers can initiate such changes, not the courts. Legal experts say it is up to the provinces, which have jurisdiction over health (and not the federal government, which makes criminal law) to bring in a law allowing the forced treatment of pregnant women. A spokesperson for Justice Minister Anne McLellan said her officials will discuss the issue with the provinces to determine how they will respond and whether there is any role for Ottawa.

Everyone wants healthy pregnant women and healthy babies. But any measure that would imprison women and force medical treatment on them is not the way to achieve that objective. In fact, such a measure may actually be harmful. Studies from the U.S. show that fear of incarceration keeps pregnant women who are addicts away from pre-natal care. Other medical research and statements by the Canadian Society of Obstetricians and Gynaecologists support this position.

Further, the position that a pregnant woman owes a duty of care to her fetus presupposes that the fetus is a rights-bearing entity while in utero. But a woman, her fetus, and her body are all part of one whole and cannot be considered as separate. Also, courts have consistently ruled, in both civil and criminal contexts, that there is no legal personhood until there is a completed, live birth.

This case has implications for all women. To achieve the goal of equality as guaranteed in the Charter, all women must have the freedom to make decisions about all aspects of reproduction. A policy allowing forced medical treatment on some pregnant women would be a profound violation of the dignity, autonomy, and equality rights of all women in Canada. It would in effect, create a new class of persons—pregnant women—whose rights would be more or less superseded by the rights of their fetuses. And where would we draw the line? Would pregnant women who smoke, or have a few drinks, be forcibly confined? In addition, the women who would be most affected by such a measure would be women disadvantaged by systemic racism and poverty.

What is needed, of course, is not legislation, but adequate health supports. Canada's health care system is based on caring, not policing. It makes little sense to spend money on mandatory treatment programs, which are costly and have a high failure rate, when that same money could be spent on ensuring that supportive, comprehensive, and quality pre- and post-natal care is readily available for women who need it most.

Our American sisters are not as lucky as us. In an October decision from North Carolina, a woman was sentenced to eight years in prison for child neglect after her baby was born with traces of cocaine in its system. The State Supreme Court found that a viable fetus is a "person" covered by the state's child-abuse laws. Let's ensure that such a miscarriage of justice never happens in Canada.

Thanks to CARAL for some of this information.

Maurice Lewis Dies

His Appeal Has Been Dropped

Maurice Lewis, the anti-choice protester who was arrested in September 1995 for violating the bubble zone around the Everywoman's Health Centre in Vancouver, has died.

Lewis, a 43-year old truck driver, was found dead in his parked truck in northern Ontario on Sept. 5. The cause of death is unknown, but was initially at least, attributed to natural causes. Campaign Life Coalition said, "It is significant that news of Maurice's death came only minutes after the news of the death of his greatest inspiration, Mother Teresa. Both worked relentlessly for the unborn."

Lewis had planned to appeal the September 1996 decision by Madam Justice Mary Saunders, who ruled that Lewis' freedom of speech rights, although infringed by the Act, were outweighed by a woman's right to access abortion services with privacy and dignity. The court restored the Access to Abortion Services Act, which prohibits anti-choice protesters from entering "bubble zones" around clinics and providers' offices and homes.

After Lewis' death, his lawyer Paul Formby applied for a Reference to the Crown, which means a continuance of the case, even though the appellant is deceased. The Crown has since denied that application, so the Act now remains in full force.

However, there is another protester who has gone to court for violating the Act. Jim Demers was arrested outside Everywoman's Health Centre in December, 1996, after three straight days of standing inside the bubble zone holding a huge sign that read, "Every human being has the inherent right to life." Although the police were called to the clinic every day, they declined to arrest Demers until he was seen to be violating the Act several times. (Violations of the bubble zone are common, but police have made no other arrests. For example, Everywoman's recently had their outside camera stolen, and the anti-choice took advantage of the situation, openly protesting in front of the clinic.)

After some considerable delays in the processing of Demer's case, a preliminary hearing was finally held in October, with evidence submitted by Everywoman's Health Centre. The Crown expects to make a decision about charges to be laid against Demers, if any, by mid-November. If Demers is charged, as is likely, the case will take time to go through the courts, but may eventually reach the same level as Lewis' case did. When and if that happens, the pro-choice intervenors in the Lewis case (West Coast Women's Legal Education Action Fund—LEAF, the BCCAC, and the three clinics) will once again join forces to defeat any attempt to strike down the Access to Abortion Services Act.

Again, we wish to thank all of our members and supporters who generously donated their time and money to counter Lewis' appeal. Although the money has already been spent on the now-defunct appeal, it was not money wasted—the research and preparation work done so far will carry us through the Demers case and onto the next level.

New Pregnancy Options Referral Service

BC Women's Hospital and Health Centre has allocated funding to start up a province-wide Pregnancy Options Referral Service, which will provide unbiased counselling, information, and referrals for all BC women facing an unintended or seriously abnormal pregnancy. The service, which will consist of a toll-free line, will be offered from the hospital's Comprehensive Abortion and Reproductive Education (CARE) program, and should be up and running by the spring of 1998.

The referral service is being established to address current access difficulties in BC. In 1994, the BC Task Force on Access to Contraception and Abortion Services documented the inconsistent delivery of contraception and abortion options across health regions in BC. The difficulties women face in securing information and services, especially those living in remote areas, goes against the intent of the Canada Health Act, which states that health services must be comprehensive, universal, portable, and under public administration.

To make the referral service as useful as possible to all BC women, the referral program will:

  • develop a network of participating abortion providers and counselling providers
  • ensure that all possible users have access to the service
  • develop and implement strategies for improving services in health regions that are identified as lacking services

An important goal of the referral service will be to help women find the most appropriate services, close to their homes, in a timely manner. Quality of care will improve and costs will be reduced. Also, the program will take steps to ensure that all women have access to comprehensive counselling. Women who are unaware of the possibilities for support if they decide to continue an unintended pregnancy may choose abortion unnecessarily.

Those who choose abortion should know the various forms of treatment available (i.e., medical abortion, abortion under local anaesthesia, etc.). Others who experience great emotional pain may need professional support. Family physicians and abortion providers are often not in a position to provide this type of comprehensive counselling. This program can also assist health regions that do not currently provide services to establish comprehensive abortion care for local women.

It is vital for the referral program to have input from current and new abortion providers, as well as health care workers who may refer women to this service. The support of current providers, possible users of the service, BC Women's Hospital, and the Ministry of Health will be coordinated and used as a foundation to build this comprehensive referral network of abortion and counselling providers.

The committee overseeing the implementation of the referral service includes representatives from the BCCAC and all three clinics.

Abortion Symposium at UBC

80 Medical Students Attend

An informative and inspiring medical symposium on abortion was held at UBC on October 19, to persuade UBC students to learn abortion techniques and perform abortions after they graduate. The highly successful event was attended by about 80 medical students, as well as a few abortion providers and abortion clinic staff. It took place under heavy security, and no anti-choice protesters were present.

Dr. Gary Romalis, the Vancouver doctor who was shot in his home in 1994, organized the event, which was sponsored by the UBC Dept. of Obstetrics and Gynecology. The reason for the symposium was because UBC, along with many other medical schools, does not offer abortion training as part of the regular curriculum. It is offered only as an option within the Ob/Gyn specialty. But as current abortion providers retire, it is essential that new doctors start coming into the field of abortion services to safeguard the future for women's reproductive rights and sexual health.

The keynote speaker was Dr. Philip Darney, an obstetrics and gynecology professor from the University of California, San Francisco. He brought home the strong message that liberalized abortion laws in many countries around the world have consistently resulted in dramatic improvements to women's health, and have saved countless women's lives. He noted that abortion is the most commonly-performed operation on women in the world, and that it doesn't make any sense that most medical schools do not teach the procedure for philosophical or theological reasons.

Dr. Romalis also spoke, providing a personal perspective on his many years of providing abortion services. Around 1960, he was interning at Chicago's Cook County Hospital, which had a 40-bed septic obstetrics ward, mostly for patients suffering from botched illegal abortions. He reminded the audience of the importance of keeping abortion legal and available, so that horror stories from the past would never repeat themselves.

Other speakers included:

Lynn Smith, former dean of law at UBC, who discussed the legal aspects of abortion, including various cases that have had an impact on abortion law in Canada.

Norah Hutchinson, counsellor at Elizabeth Bagshaw, who gave an enlightened talk on the diverse counselling needs of women experiencing unintended pregnancies.

Dr. Ellen Wiebe, who explained medical abortions using methotrexate, which she offers at her Vancouver practice.

Dr. Kathy Greenberg, Medical Director at C.A.R.E, who discussed the techniques used for first trimester abortions.

Dr. Jonathon Cope, UBC Professor in the Dept. of Ob/Gyn, who explained various methods used to terminate late-term pregnancies.

Carolyn Egan, of the Toronto Birth Control and V.D. Information Centre, and the Ontario Coalition for Abortion Clinics, who provided a historical and current perspective on the abortion rights movement in Canada.

During lunch, the video From Danger to Dignity was shown, documenting the history of the abortion rights movement in the United States.

Evaluations from the symposium indicated that 96% of the respondents rated the entire event from very good to excellent. The organizing committee is now working towards inclusion of abortion in medical school curricula and hopes to make the medical symposium an annual event.

Medical Students for Choice

A new Vancouver chapter of Medical Students for Choice also pitched in to organize the UBC symposium on abortion.

Medical Students for Choice is a largely American group that was started in Berkeley, California in 1993. This valuable organization lobbies for inclusion of abortion training in the regular curriculum of medical schools, and works to educate medical students about the importance of providing abortion services or referrals in their future practices.

Medical Students for Choice has many chapters all over the U.S, plus one in Ontario that began last year. The new Vancouver chapter was started this summer by a third-year UBC medical student, and already has almost 100 members. By all reports, the chapter is an unqualified success so far, and should prove to be a decisive factor in the drive to include medical training on abortion at UBC.

Keep up the great work, Medical Students for Choice, and welcome to Vancouver!

Anti-Choice Must Pay

Court Awards $20,000 Damages to Clinic

by Cheryl Davies

In an October 31, 1997 provincial court decision, Justice Harvey awarded the Elizabeth Bagshaw Women's Clinic $20,000 in compensatory damages, as a result of an attempted "Operation Rescue" by anti-choice protesters at the clinic on October 9, 1991. (Protesters included Christine Hendrix, Brian Breton, and others). The clinic plans to use the money to provide abortion services.

Justice Harvey also removed a temporary injunction that he had granted to the clinic in June, 1995. In the court's opinion, the clinic now has reasonable protection under the Access to Abortion Services Act, and no longer requires the injunction. The clinic had originally gone to court to obtain a permanent injunction against the protesters, but was granted the temporary injunction when the trial was adjourned in June, 1995.

Volunteers Needed

The BCCAC's new Provincial Outreach Committee is looking for volunteers to help out with a number of new projects, including:

  • creating information sheets and media kits
  • publishing a web page
  • implementing a speaker's program
  • postcard campaign
  • networking with other women's groups and pro-choice groups
  • working at information tables at conferences and events

If you're interested in helping out, the committee's next meeting is on November 20. To confirm the time and place, please call 736-2800. And while we're at it, we can always use volunteers to help us out with administrative tasks, including filing and other office work, newsletter mailings, fundraising, grant proposal writing, etc., etc. So please call today! We need YOU!

Late-Term Abortions

by Helen Janssens

Vancouver Sun columnist Trevor Lautens wrote an Oct. 4th column "exposing" the late-term abortion procedure called intact dilation and extraction (D&X), and popularly misnamed by the anti-choice movement as "partial-birth abortion." (See our article in the Spring 1997 issue of Pro-Choice Press).

The effect of Lautens' column was to liken the use of intact D&X to a deep, dark, shameful secret, one which all moral people would abhor and denounce if only they knew about it. Lautens described the intact D&X as a "barbaric, sickening, murderous practice that ought to be considered right up there with the pioneering innovations of Hitler's doctors."

Lautens' column was a good example of inflammatory anti-choice rhetoric, because there was, of course, no hint at all of the complex reasons why women have these abortions. The bottom line is that intact D&X's are done to protect the health and lives of women, an issue which many anti-abortionists don't seem to think worthy of concern. Such abortions are usually much safer for the woman than other late-term methods.

Lautens also seriously distorts the issue by making no mention of the critical distinction between third-trimester and second-trimester intact D&X's. By so doing, he and all other anti's leave open the false and slanderous implication that healthy women are casually aborting their healthy near-term fetuses. Nothing could be further from the truth. Third-trimester intact D&X's are done only in cases of severe fetal defects incompatible with life, or where the mother's life or health is at grave risk. Further, less than 500 third-trimester procedures are performed each year in the United States (none in Canada), and about 3000 or so second-trimester procedures, all together, a minuscule one-third of one percent of all U.S. abortions. (In Canada, second-trimester D&X's are extremely rare—perhaps one every several years, and never over 20 weeks.)

Ironically, pro-choice efforts to reduce the number of second-trimester abortions by any method are hampered by anti-choice restrictions to access, funds, and information, which cause delays for women seeking abortions. This proves that the anti-choice are exploiting the intact D&X issue as a means to an end. Their main concern is not to reduce or eliminate late-term abortions, but to ban all abortions. In other words, women's rights and women's health are completely irrelevant to them.

The current move to outlaw intact D&X abortions in the U.S. poses an unacceptable risk to women's lives and health. And the idea that politicians and lawmakers could have the power to make and enforce medical decisions that are contrary to doctors' professional judgement and patients' wishes, is a profound and dangerous interference with human rights and the integrity of the medical profession.

The Story of Jane

the Legendary Feminist Abortion Service

(by Laura Kaplan, Pantheon Books, New York)

a book review by Kathleen Broome

If for no other reason, The Story of Jane is worth reading if only to remind us of a time when, with the exception of only the very rich among us, women with unwanted pregnancies risked indignity, great peril, and frequently death in order to obtain abortions. Those of us old enough to remember the 60's and earlier shudder at our own abortion experiences or have lost friends or relatives due to the bungling of backstreet butchers. Generations coming of age after the 60's tend to be unaware of the arduous struggle women fought in the 60's and 70's for the right to safe, legal abortions—a struggle which is sadly still not over. Laura Kaplan, a former member of the underground abortion service known simply as "Jane", has written a lively book that shines a klieg light on that courageous struggle and on an issue that is all too often obscured or distorted.

This disarmingly candid book, which is complemented by a gritty atmosphere and a wry sense of humour, covers the events of the feminist struggle in the late 1960's before the decisive Roe vs. Wade ruling by the U.S. Supreme Court. At that time, abortion was, in most cases, illegal and women had to seek out help wherever they could. As Kaplan heartrendingly illustrates, most women seeking abortions were desperate enough to risk their health and their lives. The lucky ones came to "Jane", a Chicago underground abortion referral service run by a motley group of feisty volunteers.

Laura Kaplan ably renders these courageous feminists memorable and endearing. There was Lois, who joined the collective because the only choices for young black women like herself were "either to have the baby or die from an abortion". She also realized that feminist groups like Jane were imperative if women of colour were to take an equal role on the American stage. Julia, a founding member of Jane and one of the "inner core" was a homemaker and mother of four who had also been involved with civil rights and the antiwar movement. Pleasant-natured, nurturing, and calmly stalwart in her beliefs, Julia was of a type frequently found among human rights activists. Claire, whose determination to join Jane had grown directly out of the civil rights struggle, worked with the Student Nonviolent Coordinating Committee during Freedom Summer helping to register black voters in the then racially volatile climate of the American South.

One of the most fascinating characters in this book, Nick, at that time a medical student, was Jane's most dependable abortionist. Always dubious of the revolutionary path that Jane was taking, he would invariably yield to the collective, eventually even teaching some of the group members how to do abortions. Nick altruistically suggested Pap smears to test Jane's clients for cancer, realizing that most of these women could not afford to get checked for cervical cancer elsewhere. Characteristically, Jane did not charge for these Pap tests.

But Jenny's case, in particular, emphasizes the need for organizations like Jane in the first place. Laura Kaplan presents the appalling vulnerability of women like Jenny who sought abortions in those days. Jenny, who had Hodgkin's Disease, and whose life was greatly endangered by her pregnancy, was turned down by the hospital board even after her oncologist, radiologist, and gynaecologist appealed for her right to an abortion! She was finally only able to obtain a legal abortion by convincing two psychiatrists that she would commit suicide rather than continue the pregnancy. This dreadful epiphany induced Jenny to immediately become an activist for choice. She later became one of Jane's most steadfast members.

Although there were other underground abortion referral groups, Jane seems to have been unique in that the women in the service took control of both administrative and medical aspects of the organization and actively encouraged their clients to take control of their own reproductive health. Although Jane was in existence for only four years, they may have done over 11,000 abortions. (Although there were times when the Jane collective members refused to perform an abortion because it was not the woman's choice. In one case, Nan had to try to convince a girl's parents to let her think about it and decide for herself, when it was clear that the parents were the only ones who wanted the abortion.) Later, Jane members did not just refer women and counsel them before and after the abortion, but assisted the doctors and gradually learned to do safe abortions themselves. The service was an absolute necessity for poor women in the Chicago area who could not afford hospital abortions. If not the first group, Jane was certainly one of the earliest to offer wellness workshops - that is, they led many self-help groups that instructed women in gynaecology, birth control, abortion, pregnancy, and the alienating images of women's bodies in the culture.

A major factor of Jane's success was the holistic, hands-on approach that they used. Jane believed that "including the woman having the abortion in the actual process added to the political dimension of their work. Jane members would explain to each client what they were doing as it was done, Jane's motto being: We don't do this to you, but with you.

Unfortunately, many of Jane's courageous volunteers suffered burnout in the face of the incredibly exhausting physical and mental demands put upon them: for example, the constant fear of police surveillance and arrest, and the collective's inability to separate themselves from their clients' often overwhelming dilemmas. Kaplan adeptly renders the truly heroic efforts of the Jane collective in their almost impossible task. Her book makes one ponder what it must be like for clinic workers in today's world of anti-abortion violence and media indifference to the rise of right-wing fanaticism.

Kaplan's book moreover illustrates many other social issues, such as the unfortunate lack of unity between black and white women at that time in the feminist movement, and the contempt and even outright abuse many doctors displayed towards their patients (the chapter on Jordan Bennett and his Asuper coils guinea pig experiment is a real eye-opener!). The author discusses also the creation of free-standing clinics in the face of women's needs to have more control over their health care. Kaplan reports on the status of present-day American clinics, including unfortunately, the lack of concern for patients and hospital-like coldness in many of them.

Kaplan reveals some pleasant surprises. For example, many people who view Baptist ministers as bible-thumping fundamentalists will be surprised to find that, as with the anti-war and civil rights movements, the Baptist church was actively involved for abortion rights! Several Baptist ministers were uppermost in the coordination of the "underground railway" for safe abortion services, some even risking jail in order to protect the anonymity of abortion providers and clients.

Kaplan's book also defeats the popular anti-abortion myth that most women are really unsure about abortion and feel guilty after having one. Claire remembers: A...only one person who seemed unsure; Claire encouraged her to take the time she needed to decide. For the most part, the last thing these women wanted was time. When she asked if they were sure, they looked at her aghast. Sure? Why would they put themselves in a stranger's hands if they weren't? Why would they be risking their lives if they weren't desperate?

The Story of Jane provides a good backdrop to the era of the counter-culture - the heady, positive, yet paranoid days of the latter half of the 60's. It is a useful reference, not only as a history of the abortion struggle, but for anyone interested in political activism and the social justice movement in general. At one point in her book, Laura Kaplan states: Abortion has been marginalized by the silence surrounding it. We can only hope that there will be more woman-positive books and media like The Story of Jane, which honour the intrepid struggle for abortion rights and insist loudly and clearly on the need for reproductive choice.

Laura Kaplan's book will not likely be found in your local bookstore, but it should be available in the Vancouver Women's Bookstore, Spartacus, and other social justice bookstores. Some of the better mainstream bookstores may have it in their women's section.

Unsafe Abortion in the Developing World

by Charlotte E. Hord (reprinted from Update, Medical Students for Choice Newsletter, May 1997)

Induced abortion is one of the world's most common surgical procedures—an estimated 36 to 53 million abortions are performed annually. But two of every five abortions are unsafely performed—by an untrained provider or in an unclean setting—because safe services are often not affordable, accessible, or legally available. Complications from these procedures cause at least 80,000 deaths each year—a stark reminder of what can happen when access to abortion services is restricted and health providers are not trained or willing to offer this service.

Sadly, unsafe abortion is almost wholly preventable. There is very little risk involved in induced abortion when it is performed by a trained and skilled provider under sanitary conditions. The death rate for first-trimester abortion in industrialized countries is now 0.6 per 100,000 procedures, compared with 1,000 deaths per 100,000 unsafe abortion procedures in developing countries.

Morbidity is also a common consequence of unsafe abortion—up to half of all women who have an unsafe abortion will need subsequent medical attention. Common complications include hemorrhage, sepsis, abdominal infection, and genital-tract injuries. Longer-term complications include chronic pelvic inflammation with permanent or recurrent pain and/or secondary infertility.

Because many countries continue to use the outdated sharp curettage technology, or "D&C," uterine evacuation is done almost exclusively in urban hospitals with operating room facilities and under general anesthesia. As a result, rural women are forced to travel long distances in search of care. Up to 80% of gynecology admissions in many hospitals are abortion-related, overwhelming the emergency rooms with patients waiting for uterine evacuation. This is often considered a minor procedure and is last on the priority list for surgery, meaning that women sometimes wait several days before they are treated.

Avoiding another unwanted pregnancy is key to helping women break a cycle of unsafe abortion. Although family planning is always part of abortion counseling in North America, emergency areas in developing country hospitals are seldom equipped for preventive contraceptive care.

In addition, U.S. government policies regulating the use of development assistance funds to other countries have deterred many family planning providers from counseling abortion patients about contraception, even though post-abortion family planning is permitted under the regulations. Women leave the hospitals as uninformed and unprotected as they arrived.

The lesson from the developing world is clear—women will terminate unwanted pregnancies, even if safe abortion services are not available.

North American health professionals can help women avoid the dangers of unsafe abortion by working to ensure that abortions are safe and accessible to all women. This includes learning and using the safest technologies for abortion, and offering abortion services in a broader range of health facilities that meet women's needs for reproductive health care.

Health professionals can use their roles in the medical community to lobby for expanded opportunities in abortion training in teaching institutions and work to reinstate international family planning funds from the U.S., which prior to recent cuts, totaled less than 1% of the U.S. federal budget. Experts predict that these cuts will result in another 1.9 million unplanned births, and 1.6 million abortions throughout the developing world.

To keep women safe and healthy here and everywhere, we have a responsibility to learn from our colleagues in the developing world.