Are U.S. Policies Killing Women?

Even as we commemorate the landmark 35th anniversary of Roe v. Wade this year, U.S. reproductive-health policies are having an inordinately negative effect outside of our borders. They're causing women to die or be maimed. Harsh words, but true.

For the past 24 years, except during the Clinton presidency, U.S. administrations have maintained a global gag rule against providing counseling or referrals for abortions at U.S.-funded clinics in developing nations. It's a rule that only thwarts safe abortions, while reducing the already limited availability of other family-planning services. The global gag rule has also led to a pullback in overseas delivery of contraceptives, according to recent testimony by Rep. Nita M. Lowey (D-N.Y.) before the House Foreign Affairs Committee: "U.S. shipments of contraceptives have ceased to 20 developing nations in Africa, Asia and the Middle East. In some areas, the largest distribution centers for contraceptives have experienced decreased access for over 50 percent of the women they serve."

Women's health and rights activists in the U.S. have spent the past two decades fighting against such actions, and advocating on behalf of global reproductive health issues. But progress has come slowly. While maternal mortality has been declining at 1 percent annually, it needs to decline by 5.5 percent a year in order to be three-quarters reduced by 2015 (one of the United Nation's Millenium Development Goals). Sounds like a lot -- but it would require just about $6.1 billion more in annual funding -- the price of three weeks of the Iraq war -- to achieve that goal. Without that commitment, more than 500,000 women will still die annually from childbirth and its complications, with an estimated 70,000 of those deaths due to unsafe abortions.

Take, for example, the situation of women in Kenya, where abortion remains illegal unless the pregnant woman's life is in danger (a loophole some compassionate doctors interpret liberally, as they know that desperate women will risk their lives to abort anyway). An estimated 250,000 to 320,000 abortions are carried out in the country each year, with unsafe procedures causing a shocking toll: Globally, 13 percent of maternal deaths result from abortion-related complications, but in Kenya it's as high as 40 percent.

In public hospitals such as Kenyatta National in Nairobi, about 20,000 Kenyan women are treated each year for abortion-related complications. Nearly two-thirds of the beds in the notorious gynecological section -- Ward 1D -- are occupied by those patients, who suffer everything from excessive bleeding to injured organs to sepsis. Those sufferers include women such as Wangui (not her real name), who drank a boiled concoction made from trees and took several doses of an anti-malaria drug in order to abort because her impoverished household couldn't support a fifth child. She ended up in Ward 1D because she required an urgent blood transfusion to save her life.

Women's-rights groups in Kenya have been pushing for a new national law on reproductive rights, as well as supporting a continental protocol on the rights of African women and a patients' bill of rights. But they're not helped in their efforts to improve reproductive health care by the global gag rule, which has forced a number of clinics to turn down U.S. funds rather than stop discussing abortion. Three clinics of the Family Planning Association of Kenya (an affiliate of the International Planned Parenthood Federation) and two clinics of Marie Stopes International (the U.K.-based reproductive-health NGO) have been closed for loss of funds, according to a 2004 report from the Center for Reproductive Health Research and Policy in San Francisco.

Maternity care in general is problematic in Kenya's public hospitals. The 2007 report "Failure to Deliver," produced by the Federation of Women Lawyers-Kenya (FIDA Kenya) and the Center for Reproductive Rights in New York, pointed out that public health facilities often suffer from lack of supplies and congestion. Claris Ogangah-Onyango, legal counsel for FIDA Kenya, points out the obvious: When the majority of beds in maternity hospitals are occupied by women with post-abortion complications, there is not enough space and care for other women.