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Rapid Responses: Rapid Responses published:
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Let’s get our priorities right and not impose Western ideological agendas
- Peter J Saunders (3 October 2005)
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Meeting Millennium Development Goals 3 and 5
- David R Clegg (10 October 2005)
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Re: Let’s get our priorities right and not impose Western ideological agendas
- Turid Kongsvik (10 February 2006)
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Peter J Saunders, General Secretary Christian Medical Fellowship
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Simwaka et al are right to argue that the best ways of reducing maternal mortality are through improving the educational and economic status of women and providing better access to high quality antenatal and obstetric care [1]. However their implication that maternal health is somehow being hampered by ‘religious and conservative forces’ stopping women getting access to access to ‘the full range of sexual and reproductive health services’ is ideology-driven rather than evidence-based. ‘Prochoice’ factions at the UN have for many years been attempting to impose their own agenda of promoting abortion onto the Millennium Development Goals under the guise of ‘reproductive rights’. Though the UN has never official defined ‘reproductive health’ as including abortion, UN agencies and powerful non-government organizations interpret the term as including abortion and use it to pressure governments to change their laws. The irony is that this imposition of abortion is often pursued to the exclusion of alleviating poverty and improving antenatal and obstetric care. In an exchange this week in the US Congress, UN officials admitted that the term ‘reproductive health’ does not include abortion, at least in the context of the recently decided Millennium Summit Declaration. The exchange came during a hearing of the US House Committee on International Relations when Congressman Chris Smith questioned Mark Malloch Brown, senior adviser to UN Secretary General Kofi Annan. Smith asked Brown three times if ‘reproductive health’ included access to abortion. Brown finally admitted that it did not. In another significant development, only a few months ago, during the Commission on the Status of Women which marked the ten-year review of the original Beijing Women's Conference, the Bush Administration pushed for an amendment saying that Beijing did not create any new human rights and no right to abortion. Pandemonium ensued as powerful governments and NGOs insisted that the US amendment was not necessary and even redundant since everyone already understood that Beijing did not create a right to abortion. Though the US amendment failed at that time, it is significant that so many countries went on the record insisting that Beijing was silent on abortion. By all means lets do all we can to alleviate poverty and improve access to high quality obstetric care but let’s resist the temptation to misuse our power to impose abortion inappropriately on developing world cultures that find it abhorrent. There is a huge difference between, on the one hand, promoting family planning by improving the economic and educational status of women so that they willingly choose to limit family size through spacing pregnancies and, on the other, imposing birth control through abortion whilst failing to address ignorance, poverty and the standards of obstetric care. Let’s get our priorities right. 1. Simwaka BN et al. Meeting millennium development goals 3 and 5. BMJ 2005;331:708-709 (1 October) Competing interests: None declared |
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David R Clegg, Retired obstetrician and gynaecologist Not applicable
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Editor - High maternal morbidity and mortality rates cannot be blamed on gender inequality until the "skilled care in delivery and access to emergency obstetric care" (1) is available round the clock from experienced healthcare professionals. This includes the management of complicated labour and operative delivery including safe Caesarean section. It costs a rural family much to transport a mother in labour and her relative to hospital. The mother's need of emergency transport and hospital care is likely to be more frequent than that of her husband. If she has the opportunity to travel in advance to a mothers' waiting area with her relative she may have to leave her other children unattended at home. When she arrives at the nearest hospital she may find a young doctor without the hands on skills to care for her because the doctor has had no mentor, has been drawn into administration, and has had to attend workshops for running ante retroviral clinics for which the donors require extensive documentation. Most of those with whom the doctor trained may have left the country to work in other situations such as the UK NHS. The arrival of a male patient requiring major surgery at a hospital that has to refer him on to another hosp[ital is much less common than the arrival of a woman in complicated and often obstructed labour. Each such woman requires the finding of a vehicle, a driver, a midwife and fuel to transfer her. Yet working for over 25 years in sub Saharan Africa I have never known or heard of any reluctance to help a female patient because of her gender. The underlying causes of the high maternal morbidity and mortality are poverty and administrative problems to which thoughtless demands by wealthy countries have contributed much. For maternity services to combat gender inequality the first priority is to provide skilled care in the community backed up by adequate and accessible essential obstetric care at hospital level. 1 Simwaka BN, Theobald S, Amekudzi YP, Tolhurst R. Meeting millennium goals 3 and 5. BMJ 2005;331:708-709. Competing interests: None declared |
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Turid Kongsvik, counsellor for health Permanent Mission of Norway to the UN-organisations in Geneva
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A couple of points of clarification regarding the UN, reproductive rights and abortion. In the Programme of action adopted at the International Conference on Population and Development in Cairo 1994, United Nations Member States agreed that "in circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management or complications arising from abortion" (para.8.25). In resolution 49/128 the United Nations General Assembly requested the UN specialized agencies and all related organizations of the UN system to review and where necessary adjust their programmes and activities in line with the ICPD programme of action. In 2005 World Summit Outcome document, Member States committed themselves to achieve universal access to reproductive health by 2015 as set out at the ICPD. The definition of reproductive health in the ICPD- document includes abortion as specified in para.8.25. Competing interests: None declared |
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