How Grassroot Movements in Latin America can help influence the fight for Reproductive Rights in the United States.

Grassroots movements in Latin and South America, such as The Green Wave, have generated change and progress in reproductive rights by implementing modern human rights frameworks and emphasizing that criminalizing abortions does not stop them from happening. Hopefully and eventually, these movements will be adopted in the United States to help mobilize their grassroots movements to fight for reproductive 

rights by spreading awareness of the goals and methods of these groups. The United States Supreme Court’s recent nonadherence to stare decisis in the overturning of Roe v. Wade will not only have detrimental consequences for reproductive rights in the United States, but the whole world. Roe v. Wade was a landmark decision by the Supreme Court and was considered as an advocacy model for reproductive rights in many countries. In 2020 in the United States, the abortion rate was 1 out of 5 pregnancies ended in abortion. It is estimated that 20-26 states could outlaw abortions and reduce the number of resources and rights for someone who is pregnant. These new laws can then act as trigger laws for more reproductive rights reduction in more states. 

In 1970, an anonymous woman known as Jane Roe filed a lawsuit against the district attorney in Dallas, Texas, named Henry Wade. She wanted to challenge a Texas law making abortion illegal except if necessary to save a woman's life. She alleged that

the law was unconstitutional, vague, and did not protect her right to privacy. The main question that the Supreme Court had to answer: does the US Constitution recognize a woman’s right to terminate the pregnancy by abortion? 

Ultimately, the court decided that the Texas law was unconstitutional because the 14th Amendment of the Constitution has a due process clause which protects individuals against state action called the right of privacy. They decided that a person’s right to choose to have an abortion is within the right to privacy and that any other law that would prohibit abortion violates that right. 

However, in June of 2022, Dobbs v. Jackson was decided and overturned the decision of Roe v. Wade. This is because, in 2018, Mississippi legislators passed a law called the Gestational Age Act, which prohibits abortions after 15 weeks. The only licensed abortion clinic in Mississippi called the Jackson Women’s Health Organization filed a lawsuit that went all the way up to the Supreme Court. The ultimate question that they had to answer was is the Mississippi’s law banning abortion after 15 weeks unconstitutional? In the end, they would find that there is nowhere in the Constitution that gives a person a right to an abortion. The Supreme Court has broken from stare decisis in following a precedented and influential decision from 50 years ago. In the Majority Opinion, written by Justice Samuel Alito, he discussed the right to abortion as neither deeply rooted in the nation’s history nor an essential component of “ordered liberty.” 

What exactly is the United States’ history with abortion and reproductive rights? Unsurprisingly, the history is rooted in sexism, the patriarchy, and the idea that the American woman’s duty and sole purpose was to bear children. The first time that abortion was actually criminalized was in the mid-nineteenth century. In the 1850s and 1860s, doctors helped legislators pass anti-abortion laws to make it

illegal to have an abortion and to take birth control. And yet, even though all these new laws were passed criminalizing birth control, women started to take control over their bodies, pregnancies, and abortions. During this time period, many argued that too many native-born white women were terminating their pregnancies. Many people were afraid that if white American women stopped having children, America would be overrun by foreigners. Many were against the use of contraceptives as well, likening the women who used them to prostitutes. Some leaders of the anti-abortion movement were of the view that pregnancy and having children were women’s purposes in society. One of those leaders, named Horatio Storer, wrote “what a woman is in health, in character, in her charms, alike of body, mind, and soul because of her womb alone.” The ideal, white, American family was seen as one that had lots of children to carry on the ideal American society. When women started to unsubscribe from that idea, many anti-abortionists felt it threatened their society and way of life and left them open for an ‘invasion,’ if you will, of foreigners. It has only been since the 1960s that women could even think about getting access to a birth control pill. Even today, while more accessible than 50-60 years ago, birth control is still not as widely accessible as one might think. Now with the overturning of Roe v. Wade in Dobbs v. Jackson, many women in America are worried that more policies will follow that could make their accessibility to reproductive health resources even smaller. 

What about the rest of the world? A lot of times, when the United States makes policies about issues, other countries would try to follow it or model their policies on the United States. A region of the world that is very interesting to look at as a case study is Latin and South America. As the United States’ southern neighbors, a lot of what the US does affects them. As of this moment, there are only 6 countries in Latin and South America that have a ban on abortions. They are El Salvador, Haiti,

Honduras, the Dominican Republic, Suriname, and Nicaragua. In most of the countries where abortion is legal, they usually have one of two models: 

● The Grounds Model: this model is where abortion is criminalized except in certain circumstances. These could include when a pregnancy is the product of rape or if the pregnant person’s health will be at risk if they go through with the pregnancy. 

● The Mix Model: this model is used in countries such as Argentina, Colombia, Uruguay, and Mexico. It gives access to legal abortion 

resources and there are no specific circumstances or requirements to get one. 

The Grounds Model has been the most commonly used model in the Latin and South American regions for many years. However, due to increasing feminist activism there has been a rise in social movements in Latin America that have paved the way for their countries to move towards the Mix Model instead.. 

In the 1970s, an activist group started in Argentina called Abuelas de la Plaza de Mayo, or Grandmothers of the Plaza de Mayo as a result of the human rights abuses at the time. It was founded in 1976 with the goal of finding the children and grandchildren stolen and illegally adopted during the Argentine military dictatorship that occurred from 1976-1983. These children were stolen from Los Desaparecidos, or those who disappeared because they spoke out against the regime and its leaders. It is estimated that 30,000 people disappeared during the regime and at least 500 babies were taken from their parents while in captivity and given to childless military couples. This organization has made a lot of progress; since it was started, they identified thousands of bodies and relocated many of the missing children and reconnected them with their families. During their protests, Abuelas de la Plaza de Mayo wore white headscarves

on their heads which symbolized their right to know the final fate of their children and grandchildren. 

This organization has inspired many pro-abortion activitst movements today in Latin and South America. For example, a women’s rights movement called The Green Wave wears green headscarves as a symbol of their protest and solidarity with each other. This organization started in Argentina and was directly inspired by the progress and change that Abuelas de la Plaza de Mayo has made in achieving its goals. The Green Wave has helped deliver groundbreaking change and progress in reproductive rights in Latin America. Through mass protests and keeping up the pressure on lawmakers, they have gotten the government to make major steps in decriminalizing abortion. They also have helped people break away from the stigmas of birth control and abortion and have raised general awareness around reproductive rights. Through their efforts, they have forced policymakers to make sure reproductive rights and access to resources are at the center of political debate and decisions. This grassroots movement’s influence has not only been confined to Latin America. It has spread throughout the world and people are seeing their success at making real change happen around reproductive rights. For example, in Poland, people protesting against abortion bans are using green scarves on their heads as a symbol of their right to reproductive autonomy. 

Grassroots movements such as The Green Wave are focusing their goals on trying to get policymakers to move their laws closer to compliance with international human rights obligations. The global trend recently with legislators is to try to expand access to legal abortion by including and following international human rights laws into the laws of their own countries and constitutions. A good example of this strategy is in Colombia; in February 2022, the Constitutional Court in Colombia decriminalized

abortion for up to 24 weeks of pregnancy. This is a historic step in reproductive rights and for grassroots movements. Their reasoning behind this decision came from the need to decriminalize abortion so that sexual and reproductive rights could be preserved. They noted the studies done by the Committee on Economic, Social, and Cultural Rights (ESCR Committee) where they mention the right of all to enjoy the highest standard of health. 

The ESCR Committee has General Comment No. 14 and General Comment No. 22 which also played a role in Colombia’s decriminalization of abortion. These general comments talk about the right to health, equality, and freedom of conscience. By extension, the interpretation of these international human rights laws implies that denying women access to abortion is a form of discrimination that is in contrast with basic human rights. Colombia’s new policies and laws adhering to international human rights have influenced other countries in Latin America to do the same and now abortionservices have been included in health care systems all over Latin America due to the persistence and pressure of grassroots movements to make sure reproductive rights are a present topic in policy debates. 

In addition, grassroots movements have also emphasized to lawmakers how criminalizing abortions is not going to stop them from happening. Criminalization threatens the ability of women to get access to essential reproductive health care and resources. At the same time, it also increases inequality and discrimination. If a wealthy person has the resources to get an abortion, then the chances of deadly results are slimmer. The rate of unsafe abortions is four times higher and is increasing in countries with abortion laws that are restrictive and where abortion is criminalized. According to a study done by an organization in Colombia named La Mesa por la Vida y La Salud de las Mujeres says that only 1 to 12 percent of abortions are performed legally. This

implies that most women in Latin America getting abortions are doing so in unsafe conditions where their health could be at a much greater risk. Furthermore, many of the legal abortion clinics are located in major cities, which are unaccessible to many women. Women who live in rural areas already experience greater discrimination and marginalization and are now being put in an even more vulnerable situation. This is why grassroots organizations and movements are fighting for better access to clinics, information, and resources to obtain an abortion in safe conditions. The organizations are positioning reproductive rights as a social justice issue, the absence of which is a violation of women’s rights. By putting this topic into public conservation, they are helping everyday people and lawmakers think of circumstances and conditions that have not even crossed their minds. 

The main question here is: will the policymakers in the United States try to incorporate some of these strategies that grassroots organizations are implementing to help women get more access to resources for safe abortions and take steps to decriminalize abortions and birth control fully? Well, seeing how grassroots movements such as The Green Wave have already spread all through Latin and South America and have even gone to Europe, it is conceivable that these methods could be adopted by similar protest movements in the United States. By putting pressure on lawmakers and generally informing the public about abortion access and reproductive rights, these movements can make sure that these issues are at the forefront of political conversations and debates. On paper, the United States is a secular country, with very clearly laid out foundations for a separation of church and state.The model which protects the rights of women most is the decriminalization model, where abortion is recognized as an essential health care service that no one needs to be prosecuted for or die from. It is only when personal and religious beliefs are set aside and looking

toward movements are arguments that have worked for others that the United States can finally make progress in the realm of reproductive rights. 

Birth Control: Uses, History, and Policies

Across the country and the globe, some women are fortunate enough to take personal control over their health, economic opportunities, and lives. They are granted an unprecedented freedom with the help of various contraceptive. However, it is only the fortunate that control their fate for various state and federal laws within the United States make this freedom all the more onerous to attain. To understand how we came to these restrictions it is first necessary to explore the purpose of the medicine and then the history of restrictions and allowances in the United States. Finally, alternative methods of access as seen in in certain states will illuminate potential future policy aspirations.

Uses and Affects

All women have personal reasons to take birth control, in any of the many forms available. One such reason is preventing unwanted pregnancy. Of sexually active women of a reproductive age (15-44) in the United States, roughly 70% are at risk of an unwanted pregnancy. Within this group 68% of women who use contraceptives only account for 5% of unwanted pregnancies. The combination of risk and preventability profess the incredible need for accessible birth control. Statistics show the demand; in 1960 the pill became available and within five years 6.5 million American women used it. Today,  80% of sexually experienced women have used the pill. Also, alternative methods are increasing in popularity including sterilization, hormonal methods, IUDs and male condoms.

Photo from: https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states

While many women choose to take birth control to avoid becoming pregnant, there are multiple uses for the drug. An estimated 72% of women take oral contraceptives for non-contraceptive reasons alone, or for non-contraceptive reasons in tandem with contraception reasons. The pill has the ability to reduce cramps, menstrual pain, regulation, and acne treatments. It also has farther reaching effects like controlling endometriosis and polycystic ovary syndrome. Endometriosis is a condition affecting millions of American women that causes such severe pain as to drastically affect women’s ability to go about their daily lives. Polycystic ovary syndrome, on the other hand, can increase the risk of endometrial cancer and death if not properly regulated. This condition affect one in ten women and hormonal birth control is the most common treatment. In addition to health concerns, birth control has the ability to affect many aspects of a women’s lives.

Birth control and reproductive control are essential to women’s legal and economic status. Indeed during her Senate confirmation hearing, Ruth Bader Ginsburg famously said:

“The decision whether or not to bear a child is central to a woman's life, to her well-being and dignity. It is a decision she must make for herself. When Government controls that decision for her, she is being treated as less than a fully adult human responsible for her own choices.”

Restricting women’s access to birth control methods is discrimination on the basis of sex.  Sex discrimination is treating someone unfavorably because of their sex; it is cited both in terms of sexual harassment and economic opportunities. To understand access to birth control as a discriminatory issue it is essential to recognize the legal and economic repercussions. First, in regards to legality, women are only treated as independent persons under the law when they have the freedom to choose. Restricting women from this right is paramount to treating then as a lesser person under the law, unable or unqualified to make decisions for themselves. Second, birth control access is essential for protecting women’s economic opportunities. When women are able to regulate pregnancy on their own terms, the results are swift and definite. Birth control advances women’s economic status and educational opportunities. In the job market, young women have previously been relegated to low level jobs and deprived of promotions because companies assumed that they would leave within a few years to start families. Birth control has helped cull this trend and has allowed women the freedoms to choose when and if to start families. Indeed, more women are choosing to put off having children, many in favor of their job opportunities; today, a third of wage gains to women are a result of birth control access. Additionally, women’s educational opportunities are affected. Birth control is the most influential factor in women choosing to stay in college and is a large component of many women’s choice to attend in the first place: even with a bachelor’s degree, an estimated 30% increase of women in skilled jobs (medicine, law, dentistry) can be attributed to birth control access. The effects don’t merely stop with opportunities; oral contraceptives are associated with lessened risk of ovarian and endometrial cancers. However, it is important to mention that there are potential costs to taking oral contraceptives as well; namely, the associated increased risks in cervical (5% increased risk) and breast cancer (7% increased risks). Yet, both risks decline or disappear when use of oral contraceptives end.  Considering the evident benefits both to women and the economy it is important to investigate the political history of birth control to understand today’s regulations.

History

The history of birth control is riddled with inaccuracies. Since the beginning of humankind people have avoided unwanted pregnancy. However, many historic methods were very unsafe, if effective. In more modern times researchers have focused on safe and effective methods to prevent unwanted pregnancies. In the early 19th century many methods of birth control were available and easily accessible including condoms, diaphragms and douches. However, the American Medical Association began attacking these options in the 1850s. Anthony Comstock, in particular, crusaded against contraceptives and orchestrated the 1873 ban on sending contraceptives or distributing information through the mail. It was not until the 20th century that birth control increased in popularity, largely in part to the efforts of Margaret Sanger. She is attributed with coining the term “birth control” and started the American Birth Control League, later known as Planned Parenthood Federation of America. Sanger also lobbied biologist Gregory Pincus to develop a birth control pill. Pincus partnered with physician John Rock, a catholic doctor who educated people on sex and treated and tested infertility. Rock’s research on infertility paved the way for birth control pills that were later approved by the FDA in 1957. Regardless of the serious side effects of the first available version of the pill, by 1965 6.5 million American women were taking the pill. Only five years later, President Nixon signed Title X into law providing federal funding for family planning services. Other methods of birth control began taking off following this funding, most notably the IUD.

Other notable victories for birth control include the 2000 Equal Employment Opportunity Commission (EEOC) decision on contraceptives. The EEOC ruled that employers must cover contraceptives costs if their health insurance plans also pay for a number of other products that enhance well-being.  Various legislations of this nature were already in effect in 28 states by the mid-1990s.  The right to contraceptives through health plans were solidified at a federal level in 2010 when President Obama signed the Patient Protection and Affordable Care Act (ACA). The ACA added contraceptives to the list of preventative services covered without patient co-payments. Ultimately, protections of this manner have been lessened by President Trump. Religious and moral opt-outs by companies are now affecting thousands of women’s access to birth control. The religious exemptions have a basis in Burwell v. Hobby Lobby in 2014. The case allowed Hobby Lobby to opt out of providing contraception under the Religious Freedoms Act. Justice Ginsburg wrote the dissenting opinion, stating that “the exemption sought by Hobby Lobby and Conestoga would…deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage.” A similar case has recently come under scrutiny with the nomination of Judge Brett Kavanaugh to the Supreme Court by Trump. During the senate confirmation hearing Judge Kavanaugh was asked about his decision in Priests for Life v. the U.S. Department of Human and Health Services. Judge Kavanaugh sided with the religious organization that argued against health plans covering birth control because IUDs and emergency contraception are “abortion inducing drugs.”  This term, used by Judge Kavanaugh is alarming to those who use and promote access to birth control. This turn of events and increasing restrictions for birth control are making access increasingly difficult, especially considering the price of attaining birth control.

Policies

Birth control varies in cost by type of contraceptive. The average cost of the pill is anywhere in between $0-$50 before insurance that covers birth control. To be able to get the pill, many states require a yearly doctor visit costing from $0-$350, again dependent on insurance. Many have rallied against the provision of having a doctor’s visit, especially considering that many women who take the pill have done so for years, and that women have been proven to be just as accurate at self-screening as a doctor. Additionally, there is a shortage of  OB/GYNs in the United states, making it difficult for women to get a prescription in the first place. Indeed, many parts of the world have easier access to oral contraception than America.

Photo from: http://ocsotc.org/world-map/

In response, seven states have made it possible to get the pill without a prescription. California, Oregon, Colorado, New Mexico, Hawaii, Maryland and Colorado all allow pharmacists to sell birth control over the counter. States considering legislation of this manner include Illinois, Minnesota, Missouri, and New Hampshire. The District of Columbia and Utah also recently authorized similar legislation, although they have yet to implement it. This ease of access will not only lower the cost of entry, but this free-market solution also has the potential to drive down costs.  Also, birth control via mail is more readily accessible. Companies like Nurx let women get a prescription and order birth control online. The prescription part of the service is mere health questionnaire that is later reviewed and submitted to a partner pharmacy. Nurx offers over 40 types of contraception and emergency contraception. This service is already available in 18 states and is particularly popular in “contraception deserts” where women lack access to health services. Other services offer different types of birth control and have their own methods of prescribing.

Apps are also going up in popularity. There are both apps for ordering birth control via mail or to a pharmacy, and apps that provide birth control advice. Natural Cycles is an app based on the temperature method. The temperature method is the tracking of a woman’s temperature to estimate her fertility on any given day. Natural Cycles tracks the temperature and alerts women to days when pregnancy is likely or unlikely to occur after unprotected sex. The method, if used properly, is 91% effective— the same as the pill. In August of 2018 the app was approved by the FDA.

Policy Recommendations

Birth control is a necessary medicine to the equal opportunity of women under the law and in regard to economic and educational opportunities. Birth control also provides women with needed protections from various ailments and conditions. Given the obvious need for access as seen in statistics mentioned earlier as well as contraception deserts and economic restrictions to obtaining birth control, as well as religious infringes, the United States needs to pass comprehensive legislation protecting and expanding women’s access to birth control. The approval by the FDA of Natural Cycles is an excellent start that will affect many women, yet women who chose other methods or need other methods to curtail personal conditions are not protected. Federal legislation should be pursued to include the following:

Allow pharmacies to write prescriptions

Allowing pharmacies to write birth control prescriptions ensures that women have an ease of access to vital medicine while still receiving a consultation. If a woman has any questions on birth control types or situations, she has a trained professional to ask who won’t cost her. This method is also necessary for contraception deserts where alternative medical professionals are not available.  

Allow prescriptions to be sent via mail

Contraception deserts tend to be in rural areas, away from many medical professionals and urban areas. Women in these areas must be allotted the same rights to birth control as women elsewhere, and thus should be able to revenue medication through the mail. Mail prescriptions have already been proven to be highly affected in these areas, and the opportunity should be afforded to all American women.

Restore protections to birth control under all health care plans irrespective of  the provider

Companies that refuse to provide their employees with access to birth control are not only overstepping their bounds as a capitalist business but are also imposing their beliefs on their employees. All Americans are free to pursue their own belief system and to not be coerced into a certain religion. The federal government should protect this right by imposing a level rule over health care: companies should not be able to opt out and disproportionately affect their employees. Furthermore, this precedent opens door to refusing such services as antidepressants and anesthesia, to name two medications opposed by various religions.

Conclusion

Birth control is a divisive topic in America, yet it helps both individual women and the enhancement of the American society and economy. Certain companies and states are making headway via online access with enormous success, and should be considered an ideal for the future, yet the government needs to act to apply these benefits across all 50 states. To best serve American citizens and to yield the highest possible results for the country, birth control should be made more accessible through health care protection and ease of access.

A Changing Ireland: Catalysts and Social Revolutions

The Republic of Ireland is in the middle of a massive social upheaval that is projected to change the county in an unprecedented way. Ireland is historically and culturally steeped in the Catholic religion, yet the Irish people seem to be finding a more modern interpretation of their faith. In past years the Irish people have not only voted to legalize marriage equality by popular vote, but have also elected an openly gay Prime Minister and repealed their Eighth Amendment: a law defining most cases of abortion illegal. These changes are unprecedented and were thought to never occur in the highly religious country. Some are painting Ireland as the new liberal “darling” of the world. Indeed, it is a marker of the changing social sphere of Ireland that these changes are taking place. Such changes are occuring amidst and in reaction to various scandals within the Catholic Church and increasing economic globalization. To understand the phenomenon and potential future effects it is first important to understand the marker of change that have already taken place.

Repealing the Eighth Amendment

On May 25th, 2018 Ireland voted to repeal the Eighth Amendment. The Eighth Amendment, or Article 40.3.3 of the Irish Constitution, prohibited abortion - the only exception being in cases where the mother’s life was at risk. The amendment did not allow abortion in cases of rape or incest.  The consequence for women looking to bypass this law by purchasing abortion pills online was a 14-year jail sentence. Many women, instead, opted to travel abroad, an option legalized by the Irish legislature in 1992. This law has been described by some as “outsourcing abortion” and placed an economic barrier to entry on women seeking this option. The travel option worked for 168,703 women who traveled to England and Wales from 1980 (prior to the legalization of the travel decision) to 2016. In 2016 alone, 724 women traveled to England or Wales for abortions. This number only includes women who used an Irish address and does not include women who traveled to other nearby countries such as the Netherlands; the true number of Irish women traveling abroad for abortions is likely much higher than the number above. Furthermore, the number of women who bought abortion pills online is unknown. Given these numbers, it is surprising that abortion was not legalized earlier. However, what the numbers do not disclose is the stigma surrounding women seeking abortions. While more women have been speaking out about their experiences and needs in recent years, the public had not reached a consensus prior to the referendum. Ultimately, the vote went 66% in favor of repeal with a 64% voter turnout rate. Many were surprised by the vote as one fifth of voters were undecided in early polls. More surprising, however, is that abortion is now legal in a Catholic country. The vote’s passage is a marker of the radically changing social climate in Ireland. Should the vote have been a few years earlier, it might have resembled the 1983 referendum which struck down abortion rights by a large margin. This change calls in question a number of significant events that helped prepare Ireland for this change.

A number of high profile abortion cases affected the public perception of state-controlled abortion. Two cases in particular were used by the pro-choice movement to highlight the necessity of repeal. The X Case in 1992 was the legal case of a 14-year-old girl who had been raped and became pregnant. The girl and her parents applied for her to travel to England to undergo an abortion. The case was appealed to the High Court by the then Attorney General, who intended to ban the child from traveling. Ultimately, the girl was allowed to travel, but not before the case sparked outrage on both sides. A second case symbolically used by the pro-choicers is that of Savita Halappanaver, a woman who asked to terminate her pregnancy when complications arose. The hospital she was a patient at refused to comply and Savita later died from a septic miscarriage.

A mural of Savita Halappanavar in Dublin.

These cases, amongst many others, rose to the forefront of the movement in recent years. The women affected, and those supporting them, connected with the increasingly supportive public. The movement gained in momentum in recent years, with more women speaking out publicly and through art. The movement also gained from support by newly elected Taoiseach Varadkar, a supporter of the repeal movement.

Taoiseach Varadkar

In 2017 Ireland elected its first openly gay Prime Minister, Leo Varadkar.  Taoiseach Varadkar (as traditionally titled in the Irish language) is both Ireland’s and the world’s first gay world leader, marking an enormous change in global and Irish sociopolitical psyche.  Varadkar is widely recognized as the embodiment of the liberalization of the country. He openly supported the repealing of the Eighth Amendment long before the recent referendum. As a trained physician, he stated that the Irish should “trust and respect women to make the right choices and decision about their own healthcare.” Varadkar was formerly the health minister and  supported repealing the eighth amendment during his duration in the office. He spoke out on two cases in particular that changed his mind on the Eighth Amendment. One such case involved an asylum seeker who, when she traveled to England for an abortion, was denied access to the country. The woman had no other options and became suicidal; Varadkar recognized that in cases like this, the constitution was failing women.

Following the referendum vote, Varadkar celebrated by saying “what we have seen today really is a culmination of a quiet revolution that’s been taking place in Ireland for the past 10 or 20 years.” He continued by saying that “this has been a great exercise in democracy, and the people have spoken, and the people have said: We want a modern Constitution for a modern country.” Indeed, the Irish people have been proving time and time again that they want a more modern and progressive country. Changes began in the country in the 1990s, when divorce was legalized and homosexuality was decriminalized. On May 22nd 2015 Ireland became the first country to legalize same-sex marriage by popular referendum. With global attention honed on Ireland, Varadkar was elected just two years later by Fine Gael (the majority party) to become the first openly gay world leader, and last month, just one year later, the Eighth Amendment was repealed. A number of factors contributed to this surprising timeline including the disillusionment amongst the Irish people with the Catholic Church.

Declining Religion

Ireland is a historically Catholic country, with the church considered a pillar of the nation. Some have related the Church's influence to that of England prior to Irish Independence. The Irish, however, attend mass in steeply declining numbers. In 1980, 85% of the population attended weekly mass. Today just 30% of the Irish population attend mass regularly. While 74% of voters in the referendum still identify as Catholic, 27% attend just a few times a year and 29% hardly ever go to mass. The Church, it seems, is no longer a cornerstone of Irish society.

A number of factors led to this decline, one being the number of church scandals uncovered in recent times. Across the world, religious and nonreligious individuals were shocked at the volume and nature of child abuse cases. Ireland, with its intimate connection to the church, was particularly taken back. In Ireland 90% of state funded primary schools are controlled by the church and in 2009 a study found that tens of thousands of children were abused in school. This number is especially alarming in comparison to the 4.5 million population. It is evident that Ireland has been quietly suffering at the hands of the church for many years.

In a more public offense, Bishop Eamonn Casey was found to have fathered an 18-year-old son with Annie Murphy. The Bishop was once a prominent member of the Catholic Church in Ireland and his betrayal of his faith, in addition payments made to the mother from his diocesan accounts, shocked to the country. Situations like this, alongside past instances of abuse and public shaming, helped the Irish public to move away from the Church’s doctrines in their own thinking and beliefs. Bishop O’Reilly stated that “[Ireland has] the reality that many are now cultural Catholics” and that there is a “new reality in Ireland where the Church is no longer the dominant voice in society.” It is true that Ireland today no longer follows the Church as it once did.

Professor McElroy of Trinity College Dublin described the effect of the repeal vote on the Roman Catholic hierarchy as the “final nail in the coffin.” This is evident both in the recent referendum and in political leanings which are increasingly liberal. Former Deputy Prime Minister and Professor Gilmore said that Ireland is changing due to the influence of “a more open and growing economy; the diminishing influence of the Catholic Church, partly as a result of the sex abuse scandals; [and] growing support for the Liberal Agenda” amongst other factors.

Ireland’s Future

Recent legislative changes reveal that Ireland’s social sphere is changing. The significant legal changes on a relatively short timeline are evidence of a meaningful social change. The Catholic Church’s influence is lessening both because of various scandals and decreasing popular participation. The Irish people are less focused on religion to find guidance and are increasingly interested in personal stories of those affected by laws written for an age that has long past. The repeal movement found great success in using the stories of women wronged by past laws to change the hearts and minds of the voters. Indeed, similar methods worked in legalizing same-sex marriage. Considering the remarkable social leaps that Ireland has taken, and the success rate of newfound methods of campaigning for change, it will be interesting to see what comes next for Ireland.

A Shift in Abortion: from Surgical to Medicinal

Since the Supreme Court’s decision in 1973 to legalize abortion in all 50 states in the case of Roe v. Wade (410 U.S. 113), millions of abortions have been performed, most through surgical methods. Recent studiesshow that medication abortions are starting to rival surgical abortions in the United States, a phenomenon that has been occurring in Europe for some time. The FDA has developed a new evidence-based regime for the drugs used in medication abortion, but regulations in some states keep the rate of medication abortions around 43%, while states like Iowa and Michigan with no restrictions have higher rates, around 55-65%. Before discussing these state restrictions, it is important to know what exactly medication abortion is, as well as any issues surrounding it.

Mifepristone and Misoprostol

The two drugs used to perform medically induced abortions are Mifepristone and Misoprostol. Mifepristone (approved in 2000 by the FDA) is given at the clinic where the patient choses to have their abortion. The drug, according to Planned Parenthood, “works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down, and pregnancy cannot continue.” Next, the patient takes Misoprostol at home, where they may be alone or with a loved one. Misoprostol causes the uterus to empty and complete the abortion.

Anti-abortion groups have labeled the medicinal abortion option as dangerous. They especially disagree with the new FDA regulations that make the drug easier to acquire. The President of “Operation Rescue,” an anti-abortion group in Kansas, said that “pharmaceutical companies will use the FDA’s decision to persuade more ‘vulnerable pregnant women’ to use the ‘unpredictable’ drug.”

The facts disagree with this “unpredictable” label. A study by the University of Illinois at Chicago regarding the effects of medication abortion on university students showed that the medication is safe and reliable. The researchers found very few difficulties with the procedure and concluded, “Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.”

Side by side with the surgical abortion option, medical abortion is just as safe as surgery with some minor tradeoffs. With the medication option, there is less chance for cervical or uterine injury due to the lack of medical instruments in proximity to the reproductive area. There are some minor downsides including more office visits, more bleeding for the patient (although the surgical option will cause bleeding as well), and 1-3% more women will have to redo the procedure as compared to surgical abortion. However, a major advantage of the medication is that the procedure can be done in the privacy of the woman’s own home with a loved one if she so chooses.

The State of the States

As previously stated, the prevalence of medication abortions as a method varies across the states due to differing regulations. The new FDA regulations have helped surpass some of these regulations. Specifically, the regulations allow the medication to be taken for 70 days after the start of the woman’s most recent menstrual period, up from 49 days under previous regulations. The prescription process was also simplified. So, following these new regulations, what is the current condition of the states’ laws surrounding the medication abortion process?

There are three broad categories of regulations, and some states overlap containing more than one type. Three states (Texas, Ohio, and North Dakota) reject the new FDA regulations and follow the old, outdated, and more rigid regulations. Nineteen states require the clinician to be present when the medication is taken, taking away the home privacy aspect of the procedure. Lastly, 37 states require clinicians who “perform medication abortion procedures to be licensed physicians.” This last category severely restricts the supply of medication abortions. These regulations are a primary reason why the U.S. is not on par with Europe on the overall percentage of abortions completed with medication as opposed to surgery.

Implications and Future Trends

The public opinion on abortion has remained relatively the same (within 1-9 percentage points) since 1998. The majority has fluctuated between pro-life and pro-choice about 5 times since that date, with the pro-choice camp at roughly 47% and the pro-life camp at roughly 46% in 2016. This is a unique case for a social issue, given that many other social issues such as gun control, healthcare, same-sex marriage, and the death penalty have shifted left since the 1990’s.

I offer a suggestion as to why medication abortions may possibly shift public opinion towards the pro-choice camp. The main factor for my reasoning is the private aspect of the medication route. Allowing women to perform the abortion at home takes the procedure out of the public view. This means that the concerns over graphic images of late term abortions and unsafe procedures are minimized. If this more private form of abortion does not shift public opinion, it may still allow women to avoid the scrutinizing eyes of the pro-life camp just enough to mitigate further regulations and restrictions.

Reproductive Rights and Violence against Women in Latin America: Spotlight on Paraguay

As the pro-choice versus pro-life debate surrounding abortion continues in the United States, the status of reproductive rights in Latin American remains highly restricted. The politically conservative and predominately Catholic continent generally restricts access to contraceptive and family planning services, and denies abortions except when the mother’s life is in immediate danger.

The cultural and legal taboo of abortion is exemplified by the tragic case of an eleven-year-old Paraguayan girl who gave birth in 2013. According to Amnesty International, the girl was taken to the hospital by her mother in April, when she was then only ten-years-old, and was found to be 21 weeks pregnant. The father of the child is alleged to be the girl’s own stepfather, who raped her on several occasions. An international outcry among human rights groups and pleas from the girl’s mother to terminate the pregnancy proved unsuccessful. In Paraguay, abortion is restricted only in cases of serious danger to the mother’s life. The girl carried the pregnancy to full term, and was placed in a center for young mothers. The girl’s mother has been arrested and charged with negligence, despite reporting the sexual abuse of her daughter in 2013. Her stepfather has been arrested, though he denies the allegations, and it is unclear whether he will face time in prison.

This case hinges on the fact that, despite the girl’s young age, doctors ruled that she did not face immediate physical danger from carrying the pregnancy to full term, the only permissible reason for abortion under Paraguayan law. However the risk of maternal death in Latin America is four times higher among girls under sixteen years of age than among women in their twenties. This is due to complications of underdeveloped reproductive organs and physical immaturity among younger girls. Paraguay’s record for maternal and reproductive health is troubling, especially in comparison to regional, albeit more developed, neighbors.

The maternal mortality rate is extremely high, with 132 deaths per 100,000 live births, compared to 22 in nearby Chile and 14 in the United States. Infant mortality is in the double digits, at 18 per 1,000 live births, compared to a rate of seven in Chile and six in the United States. Instances of infant and maternal mortality are even more likely among younger mothers. It is crucial that women have access to quality health care to reduce these rates--especially family planning services and prenatal care.

Contraceptive prevalence in Paraguay was 79 percent among married women ages 15 to 49 in 2008. While 79 percent represents relatively good access, there are many problems with this indicator. First, it only includes married women. Most statistics regarding contraceptive prevalence only measure married populations, making it difficult to estimate prevalence among single, or cohabiting populations. This is a group that has an arguably higher demand for contraceptives because they are not in a traditional union that signals a readiness to settle down and have children. This group may also face greater stigma and challenges in obtaining and using contraceptives. This indicator also does not include access or availability of emergency contraception, such as the “Plan B” pill, which is often outlawed in Latin America. Finally, this indicator does not capture girls younger than fifteen who are likely survivors of rape and sexual assault, such as the eleven-year-old girl mentioned previously. In order to address the contraception needs of a modern and diverse population, better indicators must be developed to uncover and close the gaps. Survivors of sexual assault and rape should be offered every possible option -- including emergency contraception and abortion, or pre-natal care if she chooses to continue the pregnancy.

The measures of physical health determined by Paraguayan doctors in evaluation of eligibility for an abortion do not take into consideration the mental health of these mothers, who may be victims of rape and sexual assault. According to Amnesty International spokesperson Guadalupe Marengo, in the case of the Paraguayan girl, “the physical and mental repercussions of continuing with…high-risk pregnancy could be devastating and are akin to torture.” The World Health Organization finds that violence, including sexual violence, by an intimate partner is related to higher instances of injury and death, depression, alcohol abuse, sexually transmitted infections, unwanted pregnancy, and low birth-weight babies. Among women in Paraguay who had experienced partner violence in the past twelve months, 68 percent reported severe anxiety or depression and 14 percent had considered or attempted suicide.

Systematic denial of quality health care services and reproductive rights in Paraguay is related to the larger crisis of violence against women. Violence against women is a form of gender-based violence and “refers to any act that results in, or is likely to result in, physical, sexual and psychological harm to women and girls, whether occurring in private or in public.” It is a not unique to Paraguay, and plagues societies all around the globe. Sexual violence can cause unwanted and unintended pregnancy leading to devastating results if women cannot access health care that prioritizes their psychological and physical health, as well as their quality of life.

It is estimated that one in three women ages 15 or older in Latin America has experienced physical or sexual violence in their lifetime. Most of these transgressions are not committed by strangers in dark alleyways, but rather by men who have close relationships to the survivor. In Paraguay, prevalence of intimate partner violence is highest among girls aged 15 to 19, and this trend is fairly consistent across Latin America. The 20 to 24 age bracket also experiences high levels of intimate partner violence. As can be seen, violence against women starts disturbingly young. Among women ages 15 to 24 who have had sexual intercourse, 2.2 percent reported that their first experience was forced or rape, and 14 percent reported that their partner “convinced them.” Power inequality dominates young women’s intimate experiences, and it persists throughout their lives.

According to a report by WHO/PAHO, almost 8 percent of women in Paraguay reported unwanted sexual intercourse with a partner out of fear of what he might do if they refused. Even more troubling, only 12 percent of women sought help in dealing with sexual assault from police, a hospital, a religious group, or a women’s organization. The most common reasons women did not seek advice or assistance were that they “thought she could solve it alone,” “shame,” and “fear of retaliation.” These last two responses are indicative of the social stigma placed on survivors of assault. Women who seek help or report the crime often face humiliating questioning by officials who do little to investigate. Perpetrators then benefit from high levels of impunity. Cases of sexual assault are frequently characterized by victim blaming and “he-said-she-said” adage. Although Paraguay’s parliament passed a law against domestic violence in 2000, it does not outline avenues for justice by including criminal repercussions. Without proper institutional support and policies that act in the survivor’s best interest, it is unlikely that assault reporting will increase and impunity will be reduced.

As stated previously, limited reproductive rights and violence against women is not unique to Paraguay. The situation is similar across the Americas. Latin America has the highest rate of maternal death (an estimated 2,000 women annually) from attempting to obtain an unsafe abortion. Only three regional bodies-- Cuba, Uruguay, and Mexico City-- permit abortions within the first term of pregnancy for any reason. On the other hand, El Salvador, the Dominican Republic, and Chile prohibit abortion under all circumstances, including risk to the mother’s life, rape, and unviable fetus. El Salvador has come under scrutiny for imprisoning women who have miscarried naturally, under allegations that they induced an abortion. In Honduras, it is even illegal to provide women with information about emergency contraception (which does not terminate an already fertilized egg) and abortion. Millions of women experience physical and sexual abuse each year across the region, with high rates of impunity and few options to bring their abuser to justice.

The case of the eleven-year-old Paraguayan girl who was denied an abortion is just one example of the perils of allowing violence against women to persist while systematically stripping them of their right to chose how, when, and if they have children. Regardless of an individual’s view on the morality of abortion (which is outside the scope of this article), it is morally unquestionable that women should be provided with quality healthcare that prioritizes their health and wellbeing, as well as resources for support and justice in the case of rape or assault. Paraguay, along with the rest of the region, should work to improve the lives and health of its women by introducing effective legislation that condemns gender-based violence, and providing resources for women to control decisions about their bodies and health.