During the last week of September, I met with colleagues in the Dominican Republic to discuss disease surveillance efforts in Latin America. You might be surprised at the limited level of investment south of the border. During that time, I had the privilege of visiting a hospital not far from the Santo Domingo where the scenes unfolding before me ran the spectrum of crowded conditions reminiscent of East Africa, to a modern-looking emergency department. Dedicated clinicians and staff were bustling everywhere trying to keep up.
While the scenes of that day would be foreign to most Americans, the most striking observation for me came during a visit to the epidemiology department. This small, one-room office has been responsible for collecting vital statistics at that facility for more than 25 years. The epidemiologist we were visiting showed us a stack of manila files, each with a title of the contents. These files contained single-page reports for individual patients that were collected in 2019. The thickest file (about 2 inches) was for suspected Dengue cases. The next largest file was about one-inch thick and it was entitled, “mortalidad infantil,” or infant mortality. The next inch-thick file was entitled, “mortalidad maternal,” or maternal mortality. No other files came close to an inch. To say the least, it was chilling to consider the grief attached to each one of those sheets of paper.
It is also chilling to consider how efforts by the Trump administration will likely increase the thickness of those files in the next few years. This begins with the re-imposition of the “Mexico City policy” by Trump (one of his first official acts). This policy, which originated under Ronald Reagan, prohibits U.S. federal funding (about $9 billion in 2019) from going to any organization that provides, discusses or otherwise advocates for access to abortion services. This policy is the ultimate example of a bungling government imposing a religious doctrine on individuals’ healthcare options at a colossal scale, and producing the opposite of the stated goal.
By this I mean that our vacillating adoption and rejection of the Mexico City policy, depending the White House occupant being either Republican or Democrat, has unwittingly provided an opportunity to quantify the impact of this policy on the incidence of abortion. A recent paper in the medical journal The Lancet analyzed data from 26 sub-Saharan countries between 1995 and 2014. They found that while the Mexico City policy has been in place, there has been a 40-percent increase abortion rates, a 14-percent decrease in use of contraception, and a 12-percent increase in pregnancies. That is, efforts to reduce access to abortion services leads to reduced access to family planning and a net increase in demand for abortions.
As we see from that anonymous pile of sheets from the hospital in the Dominican Republic, pregnancy can be a death sentence, where 92 women die for every 100,000 live births. Women in South Sudan, Chad and Sierra Leone endure mortality rates that exceed 1,000 per 100,000 live births. Policies that increase pregnancy rates, particularly in impoverished countries, kill women.
Congratulations anti-abortion foes. Rather than working on just and sane policies to reduce the demand for abortions and increase the health and welfare of women around the world, you simply make things worse and cause that much more misery in the world.
I guess it was not surprising when last month, during the latest General Assembly meeting for the U.N., U.S. Health and Human Service Secretary Alex Azar announced that the U.S. was joining 18 other countries in declaring that there is ‘no international right to an abortion.’
I looked up a variety of statistics about our new “partners” in women’s health. In general, the stats are not pretty, with maternal mortality ranging from 3 deaths (Poland) to 814 (Nigeria) per 100,000 live births in 2015. Infant mortality ranged from 3 (Belarus) to 76 (Nigeria) for every 1,000 births in 2018. The one variable that was most constant among our esteemed partners was their 2018 world democracy ranking as reported by The Economist magazine. Four countries, including the U.S., were ranked as “flawed democracies” while 10 of the 19 “partners” were ranked very clearly as authoritarian.
How poetic that the Trump/Republican misogynistic approach to women’s health is now aligned with such an auspicious group of regimes. It is past time for a regime change here in the U.S. – please vote for a better world in 2020.
Douglas Call is a microbiologist. He and his family have lived on the Palouse for more than 20 years.