Abortion Laws in Transnational Perspective, edited by Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens—all celebrated scholars in sexual and reproductive health and rights law—provides a comprehensive collection of landmark jurisprudence on abortion from diverse regions across the world. It examines the events that have shaped the abortion debate and the role of different actors in these initiatives. This book is highly recommended for safe abortion advocates and readers interested in legal strategies
as a platform for framing the abortion debate.
The book traces the development of abortion laws from a time when abortion was only viewed through a criminal lens to today, when abortion is regarded as a human rights issue. Discussions from Asia, Africa, Latin America, Europe and the United States provide a unique perspective on the strategies employed by the various actors, the challenges and lessons they have learned and the new frontiers to be won, while recognizing the exceptional circumstances in each country.
Beyond the formal laws, there are the informal laws and rules that play a big part in determining whether women are able to access services or are denied. In a number of countries, such as Zimbabwe, providers do not know the law and are therefore hesitant to provide abortion services even when legally permissible. In other countries, such as Ghana, Ethiopia and Zambia, where abortion laws have been liberalized, there has been an urgent necessity to develop guidelines and protocols to guide healthcare providers in service provision as a step towards implementation of the newly formulated laws.
Notably, conservative groups have not been left behind in pushing their agenda and have used these same platforms to frustrate the efforts to implement access to safe and legal abortion services. One of their strategies has been to ensure that where the laws have been liberalized, they remain rights only on paper and are not actualized. This kind of countermobilization is a grim reminder that with every abortion victory, there will be a backlash, with the opponents of abortion regrouping and staging assaults to roll back the gains made. The battle is never really over, even in big wins such as the cases celebrated in this book.
Abortion Law in Transnational Perspective uses the examples of medical abortion and conscientious objection to give insights into some of the frameworks that have been used by both prochoice groups and conservative groups to set the abortion debates. Early medical abortion has been discussed as offering the potential for easy access to abortion that challenges the neat distinction between safe and unsafe abortion. Whereas the World Health Organization defines unsafe abortion as a procedure for terminating a pregnancy performed by persons lacking the necessary skills or in an environment not in conformity with minimal medical standards (or both), medical abortion allows for the performance of safe abortion outside a medical facility by the pregnant woman within a home setting. This gives her a greater level of control over the process by, for example, determining when to administer pain relief medication and if or when to report any side effects.
Medical abortion is showcased as a transformative technology for restrictive environments, one that is client-dependent and not provider-reliant. Medical abortion offers resource-poor countries the tools to save many women’s lives with minimal expenditure. This technology would greatly benefit the Africa region, where access to reproductive health services is very poor and where a high proportion of maternal mortality is due to unsafe abortion.
Contributor Bernard M. Dickens examines the exploitation of conscientious objection by antiabortion conservative groups to curtail abortion services—even where legally permissible—and how the prochoice discourse has so far not taken full advantage of the concept of conscience from the perspective of health providers whose conscience allows them to provide abortion services. The idea of conscientious participation could be useful for purposes of reframing the abortion debate—for example, in jurisdictions where health providers are required by law to make certain medically incorrect statements to women requesting abortions, such as warning them that abortion complications would make it impossible for the women to carry a future pregnancy to term. In such cases, the provider may invoke several grounds: that the professional conscience compels them to be truthful in dealing with patients and that the ideal of “do no harm” means they must disclose what the law requires but also inform the woman that such disclosure is scientifically suspect or false—for instance, incorrect safety information regarding first trimester procedures.
Investigating the narratives that are created by the laws, litigation and language on abortion, Lisa Kelly ponders whether the court cases that we have witnessed so far are a reinforcement of the narrative of “sexual innocence, violation and parental beneficence.” She also analyzes whether through these cases, the reproductive rights advocates have inadvertently raised the bar too high for many women seeking abortion services, reinforcing the idea that a woman must meet the same high standard set by these cases to merit legal abortion.
Poverty is another common theme clearly visible throughout the cases discussed—whether it is the case of KL v. Perú, involving a 17-year-old pregnant with an anencephalic fetus; LC v. Perú, in which a 13-year-old became pregnant after repeated sexual abuse by a 34-year-old man; LMR v. Argentina, a case in which a 19-year-old with a mental age of 10 became pregnant after suspected rape; or Lakshmi Dhikta v. Nepal, in which a poor woman living with her husband and six children in rural Nepal could not afford a termination procedure. These examples confirm that the women most harmed by lack of access to safe reproductive choices are those without financial means or social connections.
Abortion remains a highly stigmatized service even in countries where it is legally permissible. Stigma is shown to manifest through criminal abortion laws, which often characterize women seeking abortions as immoral or deviant. It is also directed at providers whose conscience compels them to provide abortion services. The discussion, however, does not delve into the question of the state’s obligation to eliminate stigma as a strategy for reducing maternal mortality and morbidity from unsafe abortion.
Both sides of the debate are included by highlighting the actions of conservative groups—mostly Catholic antiabortion groups—and analyzing how they have organized not only to oppose abortion court cases such as in Brazil, but also to influence the content and implementation of laws in countries such as the US, Poland and Ireland. The book, however, does not explore much on the conservative groups’ links to political power and funding sources and how these have acted to the advantage of these groups.
The text compares the use of litigation in different regions and clearly demonstrates that, whereas Latin America has energetically used litigation to test its laws, certain regions like Africa have yet to litigate on abortion. It is not made explicit, however, why certain contexts may be more favorable for abortion litigation, or what needs to be put in place to prepare the environment for such an undertaking. Nor is it apparent if litigation is always the best strategy for every region, or what considerations are necessary for such a determination. Also missing is the impact on the ground of these celebrated cases and the challenging task of executing the judgments once issued by courts.
Abortion Law in Transnational Perspective is, at present, the most inclusive literature on the current trends in abortion legislation. I highly recommend it for anyone interested in learning more about the abortion discourse.
Abortion Law in Transnational Perspective: Cases and Controversies
Edited by Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens
(University of Pennsylvania Press, 2014, 480 pp)