Last month, The International Federation of Gynecology and Obstetrics (FIGO) issued new guidelines on female contraceptive sterilization. In its thorough insistence on the rights of women to make decisions about their reproductive health, it recognizes the ways in which women (particularly those who are marginalized) have historically been made to submit to non-consensual sterilization measures. FIGOs guidelines call on healthcare providers and policymakers to practically recognize forced sterilization as a violation of human rights.
In 2009, a Namibian woman called Hilma Nendongo went to hospital to have stitches removed following the delivery of a healthy baby boy by caesarean section. This routine procedure revealed that, during the casarean, Hilma had been sterilized. The decision to do this was taken, it was explained, because Nendongo was known to be HIV positive. Many other women who carried the virus had also been sterilized by the hospital, the nurse told her.
Most people reading this will be moved by this story and will feel sympathy towards the invisible figure of Hilma: her right to reproduce was taken from her with a violence that was underhand and oppressive.
Many of such sympathizers, however, will also suggest that it is indeed irresponsible for an HIV positive woman to bear a child: her baby is likely to contract the disease too and, even if it doesn’t, its childhood will be blighted by the looming emotional and financial cost of having a mother who carries the virus. Society and the state pay a heavy price when women like Hilma reproduce and therefore their essential fertility is something of a threat.
If we believe that society has a right to decide who reproduces though, then let us first get our facts straight. If Hilma is supported by the medical authorities and receives regular access to good antiretroviral (ARV) therapy, she can live a happy, long and productive life. According to Medecins Sans Frontières, HIV-related deaths around the world dropped by 19% from 2004 to 2009 as global ART access increased.
Now let us consider how likely it is that Hilma will pass HIV to her child. Many people have very sure ideas that this type of transmission is a near-inevitability. This popular certainty about the tenacity and absoluteness of HIV is deeply linked to the instinctive physical horror and anxiety we feel about the disease for all kinds of complex historical, social and biological reasons. In reality, if the relevant preventative actions are taken to limit the likelihood of transmission, fewer than 5% of babies will contract the virus from their HIV positive mothers.
Hilma’s forced sterilisation and FIGO’s recent guidelines both underline how society and the state make aggressive and ill-informed decisions about who has the right to reproduce. Often, such judgments are based on a very subtle, instinctive disregard for certain types who, through their poverty, misfortune or ethnicity, are considered wretched.
Project Prevention is a US-based organization run by Barbara Harris that certainly does not regard vulnerable women very highly. Founded in 1997 as CRACK or Children Requiring a Caring Kommunity (well, if you want a smutty acronym to work…), it pays drug addicts $300 to be sterilized.
The initiative has, unsurprisingly, been widely criticized as a shocking case of cynical social engineering. Martin Barnes of Drugscope describes it as ‘a simplistic, moralistic and exploitative approach to addressing the difficult and complex issue of drug use and pregnancy’. Addaction, a UK-based supplier of drug treatment, describes Harris’ programme as ‘morally reprehensible and irrelevant’.
Harris says that her own experience of fostering the offspring of a drug addict, however, has shown her that women who take drugs should not be allowed to have children. ‘We don’t allow dogs to breed’, she explains, ‘We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children’. In her view, it is the state’s responsibility to ensure that these people are forbidden to procreate.
Whilst the group National Advocates for Pregnant Women (NAPW) do not deny that some of the children of addicts go on to have problems related to their parents’ drug use, they insist that many drug users go on to be excellent, compassionate mothers. ‘Barbara Harris couldn't care less about the addicts themselves’, says Wyndi Anderson of NAPW, ‘while it (Project Prevention) may be dressed up in the language of choice, for them to argue that these people come to them entirely of their own free will is totally disingenuous’.
Whilst Harris says that she is appalled by the painful withdrawals newborns undergo when they are born to drug addicts, her folksy science on prenatal cocaine exposure isn’t so hot. Scientists have agreed that reports in the 80s and 90s on the dangerous effects of crack cocaine on the foetus were vastly exaggerated and now conclude that most people who were exposed to cocaine in utero are healthy and normal. The effects of crack cocaine of the unborn child are now believed to be similar to tobacco and less damaging than alcohol.
This isn’t to say that taking illegal drugs or consuming outrageous volumes of alcohol in pregnancy is acceptable and harmless. The point here is that certain discriminatory social beliefs are fed by flawed beliefs about which substances are the most risky. In naming her organization CRACK (crack cocaine is used more by black Americans than it is by whites, who favour the powder version of the drug) and by targeting campaigns on black neighbourhoods, Harris is effectively communicating that black communities are particularly degenerate.
The organization has recently started to target vulnerable women outside the US too. In Kenya, the organization pays HIV positive women $40 to get sterilized and Harris is planning on going to Haiti later this year. Taking her campaign to this economically-deprived country is an idea that makes perfect sense, she explains. ‘We're going to offer depo [contraceptive] injections every three months to women in exchange for food cards’.
Aggressive moral crusades like Project Prevention (salacious and overtly dubious in that gung-ho, unsubtle way that so many critics of right-wing America relish) are easy to loathe and dismiss. Barbara Harris’ unusual personal project, however, has its roots in a wider sense of eugenicist disgust towards certain ‘types’ in society – black people, poor people and drug users. It also expresses something of a lingering intuitive social and political disregard for women.
In America, human rights groups have been alarmed by how pro-life prosecutors there have increasingly played with interpretations of the law to erode women’s fundamental rights to make decisions about their own reproductive health. Laws that were originally intended to protect women and their foetuses from violent partners, for instance, have increasingly been bent by pro-life prosecutors so that they now target and punish the women themselves.
One of such laws is the notoriously chaotic ‘chemical endangerment law’. The statute was initially drawn up to provide legal protection for children who were at risk of drug-inhalation because their parents were cooking methamphetamines at home.
A recent victim of this law was a Mississippi teenager, whose story hit worldwide news this year when she was charged with murder under it. The case was pounced upon by the media and human rights groups because it highlighted how militantly hostile the law in the US has become towards pregnant women.
Rennie Gibbs was 15 when she gave birth to a stillborn baby. When prosecutors found out that she was a cocaine user, she was imprisoned and charged with ‘depraved-heart murder’. Her cocaine habit, they said, had damaged the baby and therefore Gibbs had knowingly caused its death. No causal link has yet been drawn between Gibbs’ alleged cocaine use and the death of her unborn child..
Catherine Roden-Jones, who is director of the Alabama Women’s Resource Network is worried about what this development means for women with treatable abuse problems. ‘Through the misapplication of (this) law, women are being sent to prison versus receiving treatment for their substance abuse’, she says. ‘What’s happening now is women that are pregnant are being tested, and instead of being offered some type of treatment it just becomes a type of criminal case.’
Pro-life groups have become wily and sophisticated, however, and the already-vague terminology of certain laws makes them easy to manipulate. In this climate, explains Lynn Paltrow of National Advocates for Pregnant Women, all kinds of basic decisions that pregnant women take can land them in serious trouble. ‘Pregnant women who miss prenatal care appointments, don't take prenatal vitamins, or drink any amount of alcohol could be deemed abusive’.
This is what happened to Melissa Ann Rowland of Salt Lake City, Utah. She was charged with murder when she gave birth to twins, one of whom was stillborn. Prosecutors decided that the baby boy died because Rowlands did not comply with medical advice --and according to Utah’s foeticide laws, her non-compliance amounted to murder. Rowland’s crime? She had declined to have an early caesarean, which a doctor recommended.
‘I hope it's not a trend that's going to catch on’, says Robert McDuff, a human rights lawyer, talking about America’s increasingly oppressive treatment of pregnant women. ‘To charge a woman with murder because of something she did during pregnancy is really unprecedented and quite extreme’.
That a foetus should be given full state constitutional rights from the moment of fertilization is the belief of the organization Personhood USA. A Christian group, it positions itself as the cooler, younger version of the old anti-abortion movement and focuses its arguments around women’s rights rather than simply on the rights of the unborn child. In doing so, it has attempted to gain support through cloaking itself with a faux-humanitarian gloss. Its vow to ‘protect the pre-born by love and law’ has resulted in a recent spate of legislation changes in US states.
In Maryland, Angela Carder suddenly became critically ill 25 weeks into her pregnancy. Her parents, friends and doctor said that they wanted to keep her alive for as long as possible – it was a decision they believed she would want too. Against their wishes, however, the hospital that she had been sent to called an emergency hearing to determine what rights her unborn baby had. The court decided that foetal rights outweighed Angela Carder’s rights to life and ordered that a caesarean be performed, despite the fact that such an invasive procedure could be fatal. The operation was performed but neither the baby nor the mother survived.
Under Personhood laws like these, explains the prominent feminist advocate Lynn Paltrow, the slope towards total destruction of women’s reproductive and human rights becomes increasingly slippery. When prosecutions like the ones of Carder, Rowlands and Gibbs are entrenched constitutionally and become socially acceptable, a pregnant woman becomes little more than a dehumanized, criminalized vessel of reproduction.
How did our society come to feel so intensely controlling over women’s reproductive health? The Pregnant Woman is a figure of intense social construction and the public’s ideas about her have played a huge part in creating the intrusive and oppressive laws we are seeing being mobilized against her in the US. The assertions that are made in the Partial-Birth Abortion Ban Act, for instance, show that a woman’s capacity to make reasonable judgments is still in doubt.
Last month the Supreme Court voted to uphold this act, which asserts that abortion is not in the best interest of the mother because it is always a psychologically and physically damaging process. Further, it argues, when a woman opts to abort, she is not thinking properly - a woman could never freely choose to have an abortion because every woman has an innate, inseverable bond with her unborn child. ‘It is simply not in a woman’s natures to want to abort her child’ the report coos. And if she thinks it is in her nature, then she’s wrong and the authorities must take action to convince her otherwise.
The idea that pregnant women are clumsy, forgetful and stupid is a widely-believed one that is part of a more general collective amusement, contempt and ownership that society feels towards them. ‘Pregnant women lack normal short-term memory concentration, and learning ability’, explains Christie Haskell in a blog that tells women what symptoms to expect during pregnancy ‘Read those breastfeeding books and learn to install the car seat before you're too dumb to remember’
This condition, however (commonly called ‘placenta brain’), was recently declared a popular myth by researchers at the Australian National University. A study they conducted of 1,241 women during and after pregnancy found that there was no difference in their cognitive speed and memory function. Professor Christensen says that her project challenged ‘the view that mothers are anything other than the intellectual peers of their contemporaries’.
As Christensen suggests, the idea that pregnant women are not able to make ‘good’ or rational decisions has been around for a long time. It hasn’t gone away, and it is being used in law to make an argument against a woman’s capacity to control her own reproductive fate.
The way that this issue is being handled by groups like Project Prevention and Personhood USA expresses a certain unstated but nevertheless potent belief that women who are pregnant are, unfortunately, even more moronic than women who aren’t. And if they are, in addition to being pregnant, black or poor or addicted to drugs, then their wretchedness is endless and their babies are (to use a phrase coined by Barbara Harris) ‘pre-doomed’.