The eight UN Millennium Development Goals (MGDs) have been rightly criticised because they were too narrow, failed to address the underlying root causes of poverty and gender equality, and have not taken a holistic approach to development. They were considered targets for poor countries to achieve (with funding from wealthier nations) rather than something all nations must collaboratively work toward [1]. Yet even given these shortcomings, the fact of the matter is they have now shaped the future of ‘development’, ideologically and materially. Whatever Sustainable Development Goals (SDGs) the UN approves in September will serve as the benchmark to which member nations and their civil societies, policy makers, medical providers, funders, and others will have to aspire for the next 15 years. It matters a great deal, then, that comprehensive safe and legal abortion care does not appear as a concern anywhere in the Zero Draft of the SDGs.
The Zero Draft’s lack of focus on sexual and reproductive health and rights (SRHR) is generally problematic. Only two out of 17 SDGs (#3 and #5) relate to SRHR. Despite the document’s better overall inclusion of issues like climate change, it does not attempt to connect the dots of SRHR “in relation to transport, education or environment or all the other goals”[2]. A stronger focus on SRHR could have been an invaluable step toward an intersectional feminist approach to development that would have real impact on goals related to achieving gender equality and alleviation of poverty.
In this weak articulation of SRHR, abortion does not appear even once. One could – and some inevitably will – argue that it is implicitly included under “family planning,” but this is not sufficient. When the CEDAW Committee[3] has argued that abortion was a central part of the MGDs, under Article 12 having to do with “family planning” and “health care” broadly, they have been criticised by right-wing groups like the U.N Family Rights Caucus for unduly pressuring nations to improve access to or decriminalise/legalise abortion on the grounds that CEDAW was reading into the article things that weren’t there [4]. Moreover, “family planning” is inherently problematic, as it links contraceptive use to controlling reproduction rather than asserting it as an important, yet discrete, part of sexual health regardless of marital status. In practice, donors often do not support abortion care in family planning programs they fund, so we cannot assume it would be present in the SDGs without specific emphasis. For example, in Delhi in April, Dr. Babatunde Osotimehin, the Executive Director of one of the largest contributors to Family Planning 2020 (FP2020), the UNFPA, stated firmly in response to an audience question about plans for comprehensive abortion care that the UNFPA “has no position on abortion” [5].
Because abortion is such a deeply politicised issue, policy makers frequently refuse to acknowledge access to safe and legal abortion as the fundamental health and human right that it is. The authors of the new SDGs may have thought they were avoiding a quagmire, or being vague enough in including concepts like “family planning” that while not actually mentioning abortion this ambiguity would allow nations to still address it. But as Bishop Desmond Tutu famously said, “If you are neutral in situations of injustice, you have chosen the side of the oppressor.” In this case, their silence on the issue speaks loudly. If there is at least one place where discussion of safe abortion must not be siloed and suppressed, it is in the SDGs – or we can forget about sufficiently addressing gender equality, health, and poverty for the next decade and a half. Refusing to engage with the issue publicly allows space for anti-abortion voices to spread their message unchallenged. As we have seen in the United States during the last few years, the complacency and comparatively ineffective rhetoric of the abortion rights movement have allowed anti-choicers to have their way, manifesting in increased restrictions on abortion that severely limit access and safety for millions of American women [6].
A key difference between the MGDs and the new SDGs is that wealthier nations are supposed to be taking a more active part, including acknowledging and addressing problems within their own borders. The SDGs’ silence on abortion is thus a missed opportunity to engage in sustained critique of wealthier nations’ approaches to SRHR, specifically the United States refusal to provide federal funding for abortion care, domestically (Hyde Amendment) and abroad (Helms Amendment). Adding to the restrictions of Helms, since 1984 the Global Gag Rule prohibited any organisation taking U.S. aid from providing not just abortion services but even information, referrals, or advocating for access to safe abortion – even if these efforts are funded by sources other than the U.S.-derived aid. Despite President Obama’s repeal of the Global Gag Rule in 2009, many NGOs in India fear its reinstatement with the next administration [7]. Until there is a firm guarantee that such barriers cannot be (re)imposed, relevant stakeholders will continue to shy away from investing in safe abortion care. Inclusion of safe abortion in the SDGs would compel the United States to confront how these inadequacies are negatively impacting the health of millions of individuals domestically and abroad, who should not be at the mercy of the whims of the American political machine.
Therefore it is alarming that the complicity of the U.S. and large private donors who refuse to fund abortion-related care — like the Gates Foundation — is not addressed in the new SDGs. The influence of these entities means that they hold considerable sway in the crafting and implementation of the SDGs. It should not be the case that the only public word about abortion and development is Melinda Gates’ opinion that with proper contraception provision, abortions will no longer be necessary [8]. Abortion will always be needed even as contraception access expands – currently in India about 78% of pregnancies are unplanned and 25% of all pregnancies are unwanted[9]. Moreover, the WHO and the independent Expert Review Group (iERG) have identified safe abortion as an evidence-based strategy for reducing maternal deaths, one that will not cease to be necessary with better contraception coverage.
In India, not putting safe abortion at the forefront of reproductive health care means the high rates of maternal morbidity and mortality due to unsafe abortion procedures and/or due to women being forced to carry a pregnancy through that they cannot physically, emotionally, or financially support will persist. It means that even if the public health sector receives the reforms and additional resources it desperately needs, this area of reproductive health could continue to be seen as a low priority – the SDGs have not prioritised it, and the current Indian government with its slashed health budget for 2015-2016 doesn’t seem concerned either, though overall health system improvements including expanded safe abortion care would probably improve women’s lives more than the surface nod to gender equality coming from campaigns like #SelfieWithDaughter [10]. Social mindset shift is also crucially important, but this kind of patriarchal campaign that reiterates an image of girls as their father’s property – maybe just ‘apna dhan’ not ‘paraya dhan’ – will not accomplish the kind of change that is needed.
The Zero Draft claims that following the new SDGs will create the conditions for a healthy, prosperous, sustainable future for every person, everywhere. After the MDGs’ falling short on gender equality, the SDGs are under greater pressure to bring Goal 5 to fruition. These new goals will not help member nations attain gender equality, women’s empowerment, or universal health coverage if they exclude safe and legal abortion from the agenda. Women will only have “empowerment” that is worth a damn when they are able to achieve autonomy over their bodies – especially choosing if, when, and how many times they become mothers. Instead of calling wealthy nations to “invest in women,”[11] we must create the conditions for women themselves to become shareholders in sustainable development.
Endnotes:
1. Ford, Liz. “Sustainable Development Goals: All You Need to Know.” 19 January 2015. http://www.theguardian.com/global-development/2015/jan/19/sustainable-development-goals-united-nations
2. Stevens, Marion. “Making the Connections: The New SDGs and SRHR.” 20 July 2015. http://www.eldis.org/go/blog/posts/making-the-connections-the-new-sdgs-and-srhr?utm_content=bufferb7c7a&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer#.Vd32E1NVikq
3. Convention on the Elimination of all Forms of Discrimination Against Women
4. E.g. “Why States Should Keep Reproductive Rights Out of the SDGs: 15 Reasons to Remove ‘Reproductive Rights’ from SDG Target 5.6,” http://www.unfamilyrightscaucus.org/wp-content/uploads/2014/07/UNFRC_RR_SDGs.pdf
5. Osotimehin, Babatunde. “Dignity and Choice for Girls and Women in the Post-2015 Framework.” JRD Tata Oration (Q & A section), New Delhi: 24 April 2015. He did also note that the UNFPA maintains that in countries where abortion is legal, it must also be safe, and that post-abortion care and medical providers’ “compassion” is needed where abortion is not legal. Yet the UNFPA has no plans to advocate for expansion of safe abortion awareness and access, and Dr. Osotimehin was reluctant to comment further on the issue.
6. The Guttmacher Institute demonstrates that in the United States, more abortion restrictions were enacted during 2011-2013 than in the entire previous decade. For charts visually representing these restrictions please see: http://www.guttmacher.org/media/inthenews/2014/01/02/
7. Interviews conducted by the author; New Delhi, 2015.
8. Elliott-Buettner, Brooke. “SRHR Situation Report: Gates Foundation and Setting the Global Agenda.” 14 June 2010. http://www.genderacrossborders.com/2010/06/14/srhr-situation-report-gates-found/
9. Relwani, Nisha et al. “Emergency Contraception: Exploring the Knowledge, Attitude, and Practices of Engineering College Students in Nagpur District of Central India.” National Journal of Community Medicine. 3, no. 1 (2012): 17.
10. Bhattacharjee, Manash. “The Nation as Daddy: The Logic of the PM’s selfie-absorbed campaign is patriarchal.” 13 July 2015. http://www.outlookindia.com/article/the-nation-as-daddy/294779
11. Iversen, Katja. “Dear G7, it’s time to put girls and women at the top of your agenda.” 4 June 2015. http://www.theguardian.com/global-development/2015/jun/04/dear-g7-time-put-girls-women-health-rights-top-agenda
