Three years on from Savita Halappanavar’s death: My country still kills women.

Savita Halappanavar died three years ago today. She died of septicaemia. She died from a drawn-out miscarriage that went untreated too long. She died after spending a week in hospital.

A picture of a paper tealight-holder on a table with some papers. Printed on the holder is a young woman's face (Savita Halappanavar), and the words "Never Again"

Savita may have died of blood poisoning, but she was killed by the Eighth Amendment to the Irish Constitution. Two decades of Irish governments have blood on their hands. They were too cowardly to legislate to protect pregnant people’s lives.

Three years ago, I wrote that my country kills women: Continue reading “Three years on from Savita Halappanavar’s death: My country still kills women.”

Three years on from Savita Halappanavar’s death: My country still kills women.

Neural Tube Defects: Systemic Problems and Individualised Answers.

Yesterday in the Irish Times, Dr Rhona Mahony, Master of the National Maternity Hospital, had something to say about folic acid. Up till now, you see, women people planning to become pregnant have been advised to take folic acid supplements daily. Ireland has a high rate of neural tube defects– which cause everything from spina bifida to anencephaly- the majority of which can be prevented with folic acid.

As of yesterday, this advice has changed:

“Up to 50 per cent of all pregnancies are unplanned, but a baby’s crucial neural tube develops in the first few weeks of pregnancy when many women may be unaware they are pregnant,” Dr Mahony said. …“Women who are sexually active should start taking the vitamin daily even if a baby is the last thing on their mind”

Taken at face value, this seems like good advice. If you’re at risk of getting pregnant, then taking a simple step to prevent painful or fatal birth defects seems sensible. And from a purely medical standpoint, I can see her point. Unplanned pregnancies happen! If I were at risk of getting pregnant and thought there was a reasonable chance I’d keep any pregnancy that resulted, I would seriously consider adding some folic acid to my daily routine. And I’m sure that, as a medical practitioner, Dr Mahony sees more of the suffering that neural tube defects can cause than most.

However, this doesn’t mean that Dr Mahony’s perspective- while important- is complete, or that she fully understands the context in which she speaks. Because medical advice is never given in a vacuum, and in this context Dr Mahony’s well-intentioned advice is ill thought-out, ignorant of context and in certain cases may be actively harmful.

Let me explain. Let’s go to the beginning.

Sex is not PIV.

Not every sexually active woman is at risk of becoming pregnant. This may seem obvious to you and me, but it’s important. Not everyone who can get pregnant is a woman. Not every woman can get pregnant. And being sexually active does not necessarily imply engaging in acts that could lead to pregnancy.

Again, this may seem obvious. It may even seem irrelevant. But our society-wide glorification of one kind of sexual act- penis in vagina intercourse (PIV)- over others is a problem. It’s based on a heteronormative ideal that says not only that sex between cis men and women is the only “real” kind of sex, but that even between cis men and cis women, only one act ‘counts’.

When Dr Mahony says “all sexually active women”, and really means “all people with uteruses who regularly engage in PIV”, she’s not just using a neutral kind of shorthand. She’s using a shorthand that actively erases groups of people- queer women, some trans men, cis women who can’t have PIV, infertile women- who are already marginalised.

Sexually active is not a synonym for potential parent.

It’s a small point. On its own, it wouldn’t be a such a big deal. So let’s start getting towards the meat of the problem, shall we?

Some of us know what we want.

Not every person who could become pregnant would want to stay that way.

Dr Mahony correctly points out that half of all pregnancies in Ireland are unplanned. A simple sentence, yes, but one which leaves out what is possibly the most important factor in all of this: unplanned is not the same as unwanted.

Let me say that again. Unplanned is not the same as unwanted.

Sometimes people aren’t planning on getting pregnant but if it happens, would be happy to consider continuing the pregnancy. Sometimes people would love to be pregnant and have a kid, are working to prevent it because they’ve other plans right now, but know that if it happened, they’d change those plans and work something out.

And sometimes people know full well that they don’t want to give birth. Maybe they are certain that they don’t want to be parents. Maybe they’d love to be parents but they have overwhelming reasons why now isn’t the time. Maybe there are medical reasons why they should definitely not carry a pregnancy. Or maybe, for reasons which are entirely their own and none of our business, they are either certain or fairly sure that a pregnancy that happened isn’t one they would continue with.

Unplanned isn’t the same as unwanted. Unplanned isn’t the same as unfeasible. And yet Dr Mahony conflates the two.

In a vacuum, this mightn’t be a problem. Again, we don’t live in a vacuum. We live in a society where the assumption that women don’t know what we want- and that the default state of having a uterus is womanhood, and the default state of womanhood is (desired) motherhood- is ubiquitous. And this idea- that you Just Don’t Know What You Would Do If You Got Pregnant- infantilises women, assuming that we don’t know our own minds and are incapable of making decisions about our future. Many of us know perfectly well what choice we would make if we got pregnant, thank you very much.

For those of us who know that we would carry to term, or for those of us who aren’t sure? Folic acid could be a great idea.

But some of us know that we don’t want to be parents. Or we know that we don’t want to, or cannot, carry a pregnancy to term.

Unplanned is not a synonym for dangerous. Or for impossible. Or even for unwanted.

We Do Not Have A Choice

Until now, what we’ve been talking about are mainly annoyances. It’s annoying when ‘sexually active’ is equated with ‘fertile person having PIV’. It’s irritating when people assume that women all secretly want to be mothers.

If this were only about irritations and assumptions, we could deal. But this advice comes in a context where pregnant people legally do not have the choice over whether to remain pregnant or not. According to Irish law, if I become pregnant and don’t want to be, I can be sent to prison for fourteen years for “intentionally destroying unborn human life”. And so can anyone who helped me to terminate. (Side note: this includes letting you know how you can safely access abortion pills online).

I said above that an unplanned pregnancy is not the same as an unwanted one. In Ireland, they are the same, because you have no right to terminate an unwanted pregnancy. In Ireland, consent to PIV sex is, legally speaking, equivalent to consent to parenthood. There is no distinction. This means that EVERY sexually active person with a uterus is nothing more than a potential vessel.

In this context, the reason why every sexually active woman should take folic acid is this: If you’re having sex, you have no choice in becoming a parent.

In this context, telling all sexually active women to take folic acid daily (every single day, for decades of their lives!) just in case that get pregnant even though they’re trying their damnedest not to? Can only be described as sinister: Do not forget for a second that your body belongs to us.

Of course, it gets worse.

Sometimes, we really do not have a choice.

Let’s imagine for a second a fertile uterus-bearer whose sex life features what, if you know them, will be an entirely unsurprising absence of chances to get pregnant (hello there!).

That doesn’t mean they won’t get pregnant. When at least 1/5 of us have been sexually assaulted (without even taking into account coercion), our risk of pregnancy is often not something that we can decide for ourselves. And remember again that in Ireland, having been raped is not considered legitimate grounds for terminating a pregnancy.

Does this mean that every fertile uterus-bearer, regardless of whether they’re having consensual PIV sex or not, should take folic acid daily? After all, the life of the unborn in Ireland is already prioritised over the health, well-being and choices of a pregnant person.

Individualised Answers Don’t Solve Social Problems.

Okay, you could say. Those points make sense. But queers, childfree women, and people who get pregnant following assault don’t constitute the majority of unplanned pregnancies. We’re outliers, and isn’t it important to get information and advice to people who need it? After all, neural tube defects have risen by a massive 27% in the last two years, at the same time as folic acid intake has fallen. We can sort out our hurt feelings over terminology after we prevent dozens of kids being born with serious impairments.

I couldn’t agree more. Let’s take a closer look, then, at whether there’s something that we can do to make a real difference. From the Irish Times, back in April:

Studies of women attending the Coombe women’s hospital show that as few as a quarter have taken folic acid before conception and that the numbers taking the supplement are declining

Another recently published study has revealed a decline in the number of food products fortified with folic acid. This means women are less likely to consume the vitamin passively in their diet.

…Prof Turner said austerity might be partly to blame, as people had less money for discretionary spending on higher-quality food products fortified with folic acid. The incidence of birth defects has also been found to be higher outside Dublin, as it is thought people in the capital spend more money on food.

And from the Irish Medical Times, also in April this year:

Renewed public health interventions, including mandatory folic acid food fortification, must be considered to reduce the incidence of neural tube defects (NTD), which appears to be on the rise, new Irish research has concluded.

…In Ireland, there is no mandatory folic acid food fortification, partly due to declining NTD rates in recent years.

…Regionally, the incidence of NTDs per 1,000 births was as follows: Dublin (0.76), mid-east (1.06), mid-west (1.09), southeast (1.25), southwest (0.95), border (1.34), midlands (1.46) and west (1.09). “It is possible that socio-economic differences on food expenditure in households may explain the disparity as Dublin households have up to 20 per cent more disposable income on average compared with other regions,” the authors speculated.

…They stated the findings of the study should serve as a basis on which to review the issue of folic acid fortification, which was postponed in 2008.

Tl;dr? We can take several things from this:

  • Neural tube defects have been rising in recent years, and this is likely related to reduced intake of folic acid.
  • Urban/rural and socioeconomic divides affect a person’s likelihood of having sufficient folic acid. Rural and poorer people, who have less disposable income and choices about what food they buy, are significantly less likely to get enough, and significantly more likely to have kid with NTDs.
  • Foods can be and are fortified with folic acid. Discount foods are far less likely to be fortified than their high-end counterparts.
  • Mandatory fortification was considered but the issue was postponed seven years ago and, as far as I can tell, hasn’t been looked at since.

Even that’s too much? The people who are most at risk of having babies with NTDs are the women with the least resources. They’re the same people who have the fewest options for pregnancy prevention (contraception ain’t free, and the most effective forms are often the most difficult to access).

Education Is Not The (Primary) Problem

Let’s imagine that every person in the country knew that we should be taking folic acid for NTD prevention in the weeks before and after we get pregnant.

Even if we all knew that, we would still find ourselves in a situation where the most marginalised face higher rates of NTDs than the rest of us. Education is one part of this puzzle, yes. But education doesn’t change the fact that without mandatory fortification, those of us who shop at discount stores will have lower levels of folic acid than those who can afford to go somewhere more fancy. It doesn’t change the fact that even with this information, in the real world the majority of us who aren’t intending on having kids are highly unlikely to remember to prioritise our non-existent potential offspring over our day-to-day concerns.

I mean, let’s get real here: one of the reasons that many of us are already on long-term hormonal birth control (and why typical use of birth control pills leads to much high failure rates than perfect use)  is because remembering to take a pill every day is a giant pain in the ass. It’s a pain in the ass when you have an immediate reason to do it. It’s a pain in the ass when you live with a chronic medical condition that requires it. When you’re asked to do it for the health of a potential baby who you don’t want to have and mightn’t keep anyway? Sure, some people will do it. But there is no way that everyone will.

And because of that, we will continue to have a situation where the most marginalised people suffer higher rates of NTDs than their more privileged counterparts. That will continue. But there’ll be one essential difference: we’ll be able to tell them that it’s their fault.

We’ll be able to tell them that it’s their fault because we told them that this would happen. Because, yes, in every individual case a person could have made the decision, although they didn’t plan on getting pregnant, to take folic acid. On an individual level, it’s easy to assign blame and to force people to live with that guilt.

But on a systemic level? Individual decisions might be the responsibility of individuals. But the fact that we know that marginalised groups are more likely to suffer because of those decisions is not.

The fact that socioeconomic factors are at play here matters. It matters that the most affected here would be poorer women who can’t afford to travel for abortions, who might not have access to healthier food, who might not be able to afford the (negligible to many of us but not all) cost of supplements- or who might want to spend that money on something else instead, because when you’re broke or poor, your decisions have to be immediate. It matters that we are having this conversation in a context where pregnancy and womanhood and fertility are not neutral topics but ones where women have increasing restrictions placed upon them and are publicly shamed if they don’t live up to those. It matters that we’re in a context where the types of foods that used to be fortified with folic acid aren’t anymore, so a social problem again becomes individualised.

And yes, it matters that the people who would be most likely to be negatively affected by this are precisely the people who have the least choice over whether to become or remain pregnant.

Systemic problems require systemic solutions. Not passing the buck.

This advice comes in a context where mothers and pregnant people, specifically, face incredible restrictions, shaming and stigma surrounding dozens upon dozens of their choices and are expected at all times and in all circumstances to put their children before them, regardless of how damaging this is to them.

I don’t think this will do one jot to improve people’s quality of life.  In a context where we often don’t have the choice to not become pregnant in the first place, and where as long as we remain here we never have the choice of whether to remain pregnant or not.

And this advice comes in a context where we know that higher rates of fortification of foods with folic acid makes a difference. Where we know that women with less access to income and education also have less access to food which has been fortified. And where we know that plans to make this fortification mandatory have been ignored for the better part of a decade, while austerity left us all living with far less and rates of NTDs rose.

This advice? It’s yet another stick to beat women with- an I told you so for every unlucky person who’ll hear again that she should have kept her legs shut or at the very least treated her body as if it were in a decades-long state of pre-pregnancy. A stick wielded by people who have no excuse but to know better, when they and we know that this will continue happening as long as we take the lazy route out and pretend that we can solve systemic problems with individual advice.

Even bloggers have to pay the bills! Monthly subscriptions- no matter how small- help give me the security to devote time to this place and keep a roof over my head:

Monthly subscription
onetime donation
Why Donate?


Neural Tube Defects: Systemic Problems and Individualised Answers.

Should “potential fathers” have any say in abortion?

Of course women should have the right to choose. But.. shouldn’t the potential father have the right to be consulted, too?”

If you talk about abortion a lot, and you’re coming from the pro-choice side of the spectrum, you’ve probably heard this- or maybe even said it- a few times. The reasons people give for saying it tend to boil down to two basic ideas: that both people are parents of the potential child and so both should have a say, and that it can be incredibly hurtful to men who want to be parents, if their partners abort the pregnancy that they still want.

Both of those points refer to very real, significant things, and it’s only natural to empathise with people in that situation. However, I’m going to argue that, despite these, there should be no obligation on the part of a pregnant person to consult with, or even inform, their partner about their intent to terminate a pregnancy.

We Don’t Have The Right To Become Parents

Nobody- not you, not me, not your ma- has the right to be someone’s parent. We have the right to act, with consenting others, in ways that we hope will result in becoming parents. We can decide that we’d like to have kids, we can have oodles of unprotected PIV with people who’d like to have kids with us, we can- if we can afford it- have all kinds of fertility treatments to make pregnancy more likely, and, depending on our state’s regulations, we can seek to foster or adopt.

We have the right to seek to be parents. We do not have the inalienable right to become parents. Each of the ways in which we can become parents is subject to gatekeeping and the consent of others. If we wish to foster or adopt, we must satisfy adoption agencies that we are suitable parents (and, yes, in some countries, including my own, this depends on a shedload of factors, such as sexual orientation of parents, that are unfair, irrelevant and discriminatory). If we want to be biological parents? We need someone else’s consent for that, too, especially if we’re not equipped with a fully-functioning uterus to do the gestating in.

You could say that this isn’t fair. You would be right. It’s not fair that there are many, many people in the world who would love to have kids and who would make amazing parents who’ll never get to do that. But if something requires the consent of someone else to happen, and if for any reason, no matter how arbitrary, they do not grant or withdraw that consent? It doesn’t happen.

It’s not fair. But the alternative is far, far less fair.

Feelings vs Bodily Autonomy

Let’s go over one of the two major reasons given above for why partners of pregnant people should have a say in whether an abortion happens: that it can be incredibly hurtful to men who want to be parents, if their partners abort the pregnancy that they still want.

It can.

It’s not tough, really, to put yourself in the shoes of someone in this situation, even if it’s something you haven’t experienced. You want to be a parent- you long to be a parent. Hearing that your partner is pregnant, you’re overjoyed. All of the things you’ve dreamed of about being someone’s mum or someone’s dad suddenly seem real, because there’s a potential future person right there, growing. In your mind they’re already taking their first steps, you’re already teaching them all about dinosaurs and how to cycle their first bike and they’re already becoming a Nobel prize winning Olympic gymnast astronaut who never, ever forgets to call home. And in your mind they already have your eyes and your partner’s smile and they sit in that funny way all of your cousins do. And then? Your partner says that it’s not going to happen. And you? You’re expected to hold their goddamn hand through it all, and it hurts.

Yeah. I can imagine that hurting. I can imagine that tearing me apart. I can imagine it being genuinely, honest-to-goodness traumatic.

But a thing hurting our feelings- even in a way that tears us apart and leaves us traumatised and scarred- doesn’t mean that we have the right to infringe on someone else’s bodily autonomy.

Taking a moment to make a comparison- and understanding that all comparisons are incomplete- let’s liken this to breakups. Breakups and divorces can be amicable, they can be painful, or they can be gut-wrenchingly horrible. We all know people who’ve suffered for months or years after the particularly unpleasant ending of a relationship. It’s a horrible thing, it really is, and my heart goes out to people enduring it.

And yet, even with that, we understand that the right of a person to leave a relationship trumps the desire of another to continue it. We know that there is no obligation on the part of a dumper to let the dumpee attempt to change their mind and to take their (real, hurt) feelings into account when deciding whether or not to end a relationship. And y’know what else we know? That a lot of the time that would be a terrible idea.

We choose who to be partnered with.

Relationships aren’t even a binary proposition- there are countless shades of grey between strangers and partners. There’s no shade of grey between pregnant and not-pregnant. We each have the sovereign right to decide what we are willing to have happen inside our own bodies. We have the right to choose the people who we talk and consult with about that decision. And we have the right to make that decision on our own.

When it comes to abortion, our right to choose to carry a pregnancy to term or to terminate does not exist because of our genetic relationship to the fetus inside us- forcing a surrogate mother, say, to carry to term is abhorrent. Our right to choose exists solely because the pregnancy is in our body, is part of our body, sharing our blood, our food, water and oxygen. The right to choose is, at the end of the day, nothing to do with pregnancy. Pregnancy is simply a time when that right is contested. The right to choose is about our right to self-determination, nothing more.

Our desire for a certain outcome- and our desire to advocate for that outcome- can never trump another person’s right to self-determination.

She Has The Final Say, But..

People often counter what I’ve said earlier with what I like to call “She Has The Final Say, But..“. They acknowledge that a pregnant person has the right to make the decision over whether to terminate, but stress that she should have a moral obligation to, at the very least, talk to her partner.

She has the final say, but she should hear him out. She has the final say, but having a conversation is the only decent thing to do. She has the final say, but she should take his feelings into account. She has the final say, but..

She has the final say, but..” is nothing more than an attempt to give one person’s desires priority over another’s rights. So here’s the question I can’t but ask: why are we talking about this again? If my rights trump your desires regarding me (and vice-versa), then why are we getting sidetracked from a conversation about rights with a plea to think about what rights others would, or would not, like us to exercise?

It’s difficult to see “She has the final say, but..” as anything other than a last-ditch effort to get someone to change her mind and influence her decision. What it betrays, at heart, is where a person’s empathy lies- in this case, not with the pregnant person, but with her partner. They’re not thinking about how she would feel, or how feeling obligated to have the conversation could make a potentially difficult situation that much harder. They’re thinking solely about how her partner might feel. And also? They’re betraying a profound mistrust of women’s ability to make the decisions we need to make, in the ways that are best for us.

Either She Will, Or She Won’t.

When people plead with women to discuss our reproductive choices with the men in our lives, they do so with certain assumptions in mind. When you challenge those assumptions, the answer is that of course they weren’t talking about those situations.

When people say that women discussing our abortions with our partners is, as one person said to me last week, the “only decent thing to do”, they’re thinking of a particular kind of woman, and a particular kind of partner. They’re not thinking of women in abusive relationships, or women who aren’t in relationships at all. They’re not thinking- a surprise really, given a lot of the other rhetoric about abortion- about women who mightn’t be sure of who the father of the fetus is. They’re not thinking of relationships that, for one reason or another, might be intimate in some ways but not others. There’s no talk of, say, the person I dated who told me once that if I ever had an abortion we’d never speak again. Or of the person who longed for a child, but who also regularly spent days on end unable to leave the house. The image is always of women in loving, mutually supportive relationships who for no particular reason decide not to inform their partners that they’re pregnant and planning to terminate.

That idea? Is frankly ridiculous. If people are in a relationship where conversations on abortion would be welcome, where they feel safe and comfortable sharing intimate details with each other, and where they’ll support each other? They’ll talk about it. The pregnant person will talk about it. If, however, her partner is not someone she feels safe sharing with? Or if they’re simply not the person she thinks to go to, if there’s someone else who she is closer to?

That’s why, at the end of the day, the question of whether pregnant people “should” discuss their plans to have abortions- or not- with their partners is a meaningless one. If they have the kind of relationship where they talk about those things, then they will, and admonitions to do so are unnecessary. If they don’t? Then it’s nothing more than shaming women into doing something contrary to their best interests, in a situation which could be hurtful at best and dangerous at worst.

Which is why we say “trust women”.

Enhanced by Zemanta
Should “potential fathers” have any say in abortion?

Whose body is it anyway? Ireland and forced birth

TW for forced birth, rape.

You all know by now what the Tea Cosy stance is on abortion in Ireland– that the anti-choice lobby want nothing more than to control women’s bodies, punish us for daring to have sex (or for being raped!), force us to give birth against our will, and refuse us medical treatment even to save our lives. There is no other way to to interpret the massive pushback against the introduction of legislation to allow abortion solely to save the pregnant person’s life.

It turns out that forcing people to remain pregnant isn’t the only way that Ireland wants to take control over our lives and bodies. It’s not enough that we cannot access medical services that we need. We are now to be denied two more basic rights: to refuse medical procedures that we do not want, and to choose how (as well as if) to give birth.

From allergictopatriarchy:

How would you feel if I told you that a hospital in Ireland went to court last week, because they felt it necessary to tie a woman down, forcibly give her an anaesthetic, and slice open her abdomen, then her uterus? Horrified; disgusted; transported back to a time ofsymphysiotomies and the Magdalene Laundries? Well, they did.

Last Saturday morning, Waterford Regional Hospital made an emergency application to the High Court in an attempt to compel a pregnant woman to undergo a caesarean section. Lawyers for the hospital said that the woman was refusing to give consent for the procedure, but that a “natural” birth would pose a risk to her unborn child.


In the six news articles I’ve read on this story, there isn’t any mention of why the woman wanted to opt for a vaginal birth; the only reference is that she would have “liked” to. She may have had a perfectly valid, well thought-out reason, but the mainstream press don’t seem too concerned about the actual wishes of this person. It does say that over the weekend she began to waver between consenting to the procedure on the Sunday or Monday as she wanted her husband to be present if possible; the medical staff did not consider this a reasonable request.

Not suprising, when you consider:

Under Irish law, women are treated as incubators. The right to bodily autonomy is just one of the many rights which we no longer have while pregnant. Our right to health is automatically diminished, as we have no option to take the less-risky route of terminating the pregnancy. Rape victims have no right to choose not to go through the added trauma of invasive exams, ante- and post-natal care, and the birth process. Women with non-viable foetuses have no right not to extend this heartbreak for further months and go through the trauma of birth. We are bearers of children and little else.

Go read the rest at Allergic to Patriarchy.

But you know something? That’s not all. It’s not just that this particular woman has had her right to refuse treatment- the right to ownership of her body and to not be forcibly anaesthetised and have someone cut into her body with a scalpel when she has refused consent- revoked. You could suggest that someone could avoid this by avoiding giving birth in hospitals in the first place. If you don’t want to be operated on against your will, you can always choose a home birth, right?


Turns out that the HSE has plans to further tighten up Ireland’s already stringent rules on midwife-assisted homebirth, making it a significantly more expensive and difficult to access choice. From Eva-Louise Goussot:

The HSE is making decisions not based on the evidence but based on fears about home birth and the assumption that hospitals are safer and, crucially, that women are not equipped, or do not have the right, to decide for themselves. Time and time again, the research both in Ireland and abroad shows that midwife led care and continuity of care ensures better outcomes for low-risk mothers than obstetric-led care. Fact. And while home birth continues to be scrutinized our maternity hospitals remain in chaos, with dangerously high levels of intervention that frequently lead to negative outcomes for women with low risk pregnancies. One more fact: contrary to the frequently touted statistic , Ireland is not the safest place in the world to give birth. From this year, Ireland will now record its maternal mortality statistics in line with the UK and other countries. It is expected that overnight our “safe” rate of one death per 100,000 will increase by a factor of 10 to a less safe 10 per 100,000.

Ireland. Would you want to be pregnant here?


Whose body is it anyway? Ireland and forced birth