Who Pays For These Abortions?

Since last spring I’ve been talking to audiences around the United States at screenings of Not Yet Rain, a film that Ipas produced about abortion in Ethiopia. The film follows two young women who have been raped as they attempt to terminate unwanted pregnancies safely. Neither woman has received much education, neither knew they could become pregnant as a result of these encounters, and by the time they learned they qualified for abortion, they had to go to a local hospital for care.

In discussions following the film, I have come to anticipate certain questions, like whether the perpetrators of rape will be prosecuted, what we are doing to increase access to contraception, community education and so forth. But this past week I’ve been thinking particularly about this one:

“Who paid for their abortions?”

In most countries, it is inconceivable that the government health plan would not pay for a legal health-care procedure. When I explain this to audiences here in the United States, they have a hard time wrapping their head around it. Our government is the health care provider of last resort, and in fact has gone out of its way to ensure that poor women do not have access to the same health care as middle-class or wealthy women. What’s more, insurance companies regularly make decisions about what procedures or medications they’ll cover. Americans are used to arbitrary medical rules.

Ethiopia, a large, poor country in East Africa, stands in stark contrast. Ethiopia enacted a new abortion law in 2006, one of the most progressive in Africa. It allows abortion for a range of circumstances, including cases where a woman’s life or health are threatened, for minors or when a woman has been raped. The law was one of a number that the government supported to bring Ethiopia’s laws into alignment with the international agreements it had signed on women’s health and rights.

Let me repeat that: Ethiopia specifically sought to change their laws to bring them in line with women’s rights agreements, not to defy them. This included raising the legal marriage age to 18, imposing harsher penalties on people who commit sexual violence and passing a law that would reduce the excessively high rate of deaths from unsafe abortion. Since then, the government has been educating women, law enforcement agencies, community leaders and health-care providers about the new law. They knew that unless the government made sure that the services were available, the law may as well not exist.

I keep harking back to this as I listen to members of Congress and pundits justify allowing anti-choice members to hold health-care reform hostage to the beliefs of a few, at the expense of many. And I think about the women around the world who pay with much more than money to end an unwanted pregnancy; they knowingly put their lives on the line to terminate an unwanted pregnancy. Their injuries make such an impact on health care systems that in the past decade, more than a dozen have liberalized their abortion laws.

These governments know firsthand that safe abortion care is much more cost-efficient than paying to care for women suffering from the complications of unsafe abortion – just as they know that it is worth the investment to pay for contraception, for prenatal care and well-baby check-ups. They know that if they don’t pay for safe abortion care, women will pay with their lives.

So if governments that are committed to improving women’s health are willing to pay for safe abortion care, what does that say about the United States?

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  • womantrust

    Womantrust Thanks Kirsten for a very informative and timely piece- and what an eye opener and outrage! That a third world developing country is way ahead of the U.S. where we’re supposed to be leaders of the industrialized world. Has the U. S. also signed international agreements on womens health and rights? If so, that may be a way to block the stupid Stupak move. To block public funding for one of the most common legal medical procedures for women because a gang of bullying men in skirts (the RCC council of bishops), don’t like it is absurd and if made into law, certainly violates the separation of church and state- by mandating by law what is the religious belief of the minority. As to our lawmakers- how would they like it if they or a loved one had a pregnancy that jeapordized their health or was inconsistent with life and their insurance wouldn’t cover that procedure- as it does now? If this becomes law, it may in fact collide with rights protected by law in Roe- making a conflict of competing laws. If the RCC is successful in this move, we can expect to see comprehensive sex education, contraceptive care and sterilizations also outlawed. Thanks again for an excellent article that really shines the light on our fumbling, stumbling Congress and please keep writing.

  • al4gzuz2

    Kerstin, I have lived in Ethiopia for a month and have certainly experienced the extreme difference of their culture from that of the United States. I find it interesting that you would choose a nation so completely opposite our own to hold up as a standard for what "ought to be" in the US. You mention in your article that these women did not even understand that intercourse would lead to pregnancy. Conversely, in the US we have a high rate of literacy and education (approx. 35.5% in Ethiopia as compared with 99% in the US). When I was in Ethiopia, education was often spoken of as a hope and dream among the people I met and spoke with, and they held the US up as their standard. I find it somewhat of a reversal to then exhibit their povery and harsh living conditions as an exemplar situation for health care in our nation. Also, there are so many issues within Ethiopian culture that effect a scenario such as this- religious sterilization, for one, happens frequently, and this procedure has been the cause of disease and death for women. I enjoy Reality Check for its attempts at getting to the truth of a matter, but this seems silly to me. A country that is so clearly underdeveloped and (to be brutally honest) who should be using what health care resources they have for malaria treatment and not abortions, should not be the United States’ "ideal".

  • kirsten-sherk

    The point is not that Ethiopia is the gold standard for health-care,
    but that other countries craft their health care policies with a mind
    of what’s best for health outcomes, not the particular religious
    beliefs of a handful of legislators.


    I think it’s important that we not pit one health priority against
    another, but take a more holistic approach. This means not ignoring
    abortion when it is a major cause of maternal mortality, but increasing
    access to safe abortion care AND preventing unwanted or unsafe
    pregnancies. If you watch Not Yet Rain (which you can do online at
    http://www.notyetrain.org), I think you’ll see that we consider basic
    education crucial to the whole process. 


    Ethiopia is just one example of a country that understood that increasing access to safe abortion care would reduce matenral mortality. South Africa is another; it explicitly included legal abortion in its 1994 constitution, among other health and welfare priorities. In the 15 years since, abortion-related mortality has decreased 91%. 

  • progo35

    Then go live in Ethiopia.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich