Why I Started Talking About Abortion
Last year, I was sitting in a hotel restaurant across from my mother. While normally this mother-daughter scene would be completely ordinary, this time together was anything but that. One week prior, my father had an unexpected medical scare in Kenya, thereby compelling my mom to take a red-eye flight from California in order to meet us at a hospital in Nairobi. Although my father was discharged from the hospital earlier that day, and has since made a full recovery, emotions continued to run high. It was in this landscape that my mom and I stole some one-on-one time together to escape talks of vital signs, insurance, and medication.
As we ordered much needed dinner, I started to share about my work at Health Development Initiative (HDI), a local non-governmental organization in Rwanda. I recounted our qualitative research study where we sought to ascertain the causes, practices, and consequences of 38 women convicted and incarcerated for illegal, unsafe abortion. After I finished talking about these women’s heart-wrenching testimonies, I paused to hear my mother’s thoughts. What she said next came as a complete shock:
“I never told you this, but when I was your age, I had an abortion.”
I was stunned. My mom, who took me to get birth control and talked openly with me about sexuality, decided to keep this choice a secret from me. I wanted to know why she hadn’t told me before. In that moment, I reassured her that I would never judge her, but rather I commended her for listening to her needs and doing what was best for her at the time. Still my mom said, “I was nervous. I felt like it was going to be a disappointment to you. That I wasn’t this perfect mother.”
Here was my mom, in her sixties, disclosing her story to her daughter and still fearing the response. Here was my mom, empathizing with the 38 other women whose stories bore stigma, releasing this silent yet deafening shame.
When I tell people that I work on international sexual reproductive health and rights (SRHR) issues, the first question I am always asked is: “Can’t you do that in the U.S.?”
The irony is, many of the reproductive decisions women face are deeply personal, but affect us all on a universal level. How many other women around the world who have had abortions, or have considered having abortions, are holding onto similar shame or guilt or fear? How many women are proud of and resolute in the decision they made? I imagine that for most women, these emotions are not singular — they are consistently interwoven and in flux. And they are shared across borders and bodies.
At the same time, reproductive decisions are influenced by the communities, cultures, and political landscapes in which they are embedded. Reproductive health laws affect women differently — with women of color, women of lower socioeconomic status, and women living in rural areas facing the brunt and brutality of these laws.
So, my answer to the domestic versus international debate is layered, but they are not mutually exclusive. The work of women’s rights defenders in Argentina has affected movements in the U.S. Laws made in Tanzania, such as the Maputo Protocol (Article 14), are cited to protect Rwandan women’s healthcare. Abortion is a global issue, just as it is a political and personal one.
While in Rwanda, I learned the importance of educating myself on national laws and women’s rights. I learned how to start often stigmatized and taboo conversations. I learned to provide space for people of multiple nationalities to share their stories. And, I learned to witness the resounding effects of U.S. policies on international girls’ and women’s bodies.
Due to the Mexico City Policy, or more familiarly known as the Global Gag Rule, organizations that advocate for abortion as a method of family planning or provide direct abortion services are ineligible to receive United States Government (USG) funding. Although the ruling was first inaugurated in 1984, presidential administrations can choose whether they want to enact the policy. In January of 2017, Trump chose to re-instate the policy and expand its effects. Now, the Gag Rule prohibits organizations who do abortion work from using non-USG sources of funding to provide contraception, HIV/STI testing and counseling, gender-based violence work, and maternal and child health. I witnessed how this law directly affected HDI and our work — eliminating budding partnerships, threatening employees’ jobs, and hence limiting our potential to serve the community.
Because the U.S. government continues to penalize organizations that talk about abortion as a family planning method, HDI and others are challenging the narrative around abortion. Abortion cannot be strictly defined as a family planning issue — it is a human rights issue. This conversation requires a fundamental shift in how we treat women because it requires us to stop trying to “legitimize” or question the reasoning behind different reproductive decisions. It is not about asking “why”, rather it is about listening to “who.”
How We Mobilized
HDI heard the needs of Rwandan women and joined the conversation — both by facilitating inter-university debates and also by leading advocacy initiatives. In 2012, Rwanda’s penal code stipulated that abortion was illegal except in four cases: rape, incest, forced marriage, and maternal and “unborn babies’” endangerment. Even if a woman met one of these conditions, she would still need a court order and two doctors’ signatures, creating substantial barriers to abortion access. Due to these restrictions, only half of all abortions were provided by trained professionals. Forty percent of women required medical attention, but one-third of those women were unable to obtain care. Even with these figures, HDI wanted more recent data to drive policy and programs — and thus, we embarked on our research with incarcerated women.
Similar to that of the U.S., our findings showed how stringent laws predominantly affect women of lower socioeconomic status, low literacy, and those without access to an attorney nor knowledge of their rights more broadly. Reading incarcerated Rwandan women’s testimonies and accounts of their experiences were particularly harrowing. Most were ostracized by their partners and families after their abortions, and never knew the process for how to obtain the procedure legally. Even if they had, they would not have been able to afford it. (Sound familiar? I fear that this same fate will become increasingly more prevalent in the United States.)
In Rwanda, however, I had hope. The genesis of this report allowed our NGO to form a civil society coalition and author an evidence-informed advocacy brief that was presented to Parliamentarians and the Law Reform Commission. HDI’s engagement also resulted in the removal of the court order and the inclusion of child defilement among exemption criteria for abortion. Likewise, it eventually led to the recent pardoning of over 300 incarcerated women.
I was inspired by how our small organization actively participated in legislative processes and upcoming laws — how we trained healthcare providers on these laws, and how we engaged youth in debates on SRHR. We didn’t have a march, but we definitively had a voice.
And I am learning how to use mine. With this research, I started conversations with my family and friends about abortion. I learned that not only my mother, but two other close family members had abortions. I learned that the more I talked about similar stories, other women felt permission to confide in me because they realized they were not alone.
Lessons Learned
Throughout my time in Rwanda, I wanted to be respectful of and have humility for the national system of governance and culture. I had to consistently ask myself: how do I conduct action-oriented research and advocacy as a white Westerner? Ultimately, I learned that I needed to approach my advocacy from a place of curiosity, not judgment, and to let the personal narratives of women speak for themselves. I am striving to apply these lessons in the U.S. as well.
“I learned that I needed to approach my advocacy from a place of curiosity, not judgment, and to let the personal narratives of women speak for themselves.”
Fighting against barriers to reproductive access is not easy, and it will be a long battle. It requires a strong commitment to one’s mission, despite the budget cuts and potential social backlash. It requires a transparent acknowledgement that reproductive health laws affect women differently — as such, we need to amplify the grass-roots movements led by women of color, women of lower socioeconomic status, and women living in rural areas (shout out to the incredible work of Sister Song and Yellowhammer Fund to name a few)!
Working in Rwanda, I saw the intersectionality, complexity, and nuances of identifying as a woman; but I also saw the universal, shared resilience of having our health politicized. So, today I ask you to thank the women in your life for enduring the obstacles they have had to overcome and the courage to continually persist. We will not stop until access to dignified reproductive healthcare can be enjoyed by all.
Amy Shipow was a 2017–2018 Global Health Corps fellow in Rwanda.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
