June demonstration against Malta's total ban on abortion outside Parliament House in Valletta, Malta22 June: People demonstrate against Malta's total ban on abortion outside Parliament House in Valletta, Malta. [photo: REUTERS/Darrin Zammit Lupi via Alamy ]

Last month’s ruling by the US Supreme Court reversing the 49-year-old Roe v Wade judgment, which guaranteed American women the constitutional right to abortion, has proved nearly as controversial abroad as it has within the United States and has put reproductive rights globally under the spotlight.

As 13 US states outlawed abortions, a glimpse of what lies in store for millions of women (and was already forced on a 10-year-old rape victim) was graphically detailed in an American tourist’s ordeal in Malta, one of only six countries globally, and the only one in the European Union, to completely criminalise abortion. Andrea Prudente, who was pregnant, was on holiday in Malta when she began to miscarry. Doctors in the Mediterranean island state refused her a potentially life-saving termination or to certify her as fit to travel. Eventually, she was medically evacuated to Spain for the procedure. ‘If you are a woman,’ her partner said later, ‘don’t go to Malta.’

Women who undergo abortions in the overwhelmingly Roman Catholic country face up to three years in prison and doctors who perform them can be imprisoned for four years. After Prudente’s tragic crisis, 135 Maltese doctors signed a ‘judicial protest’ demanding a review of the abortion ban. Prof Isabel Stabile, a gynaecologist, said several women every year in Malta went through the same nightmare as Prudente, but stressed: ‘Most women living here do not have private insurance to help them evacuate to get their much-needed treatment abroad. Our laws are neglecting these women, risking their lives needlessly.’

‘Attack on everyone’s rights’

The Canadian prime minister, Justin Trudeau, responded unequivocally to the US Supreme Court decision. ‘Today is a difficult day,’ he announced. ‘The judgment coming out of the United States is an attack on women’s freedom and, quite frankly, it is an attack on everyone’s freedom and rights.’

In stark contrast to its southern neighbour, Canada has no restrictions at all and is the only country with no legislation on abortion. Many pro-choice activists now want it to be written into law to safeguard those rights that have been shredded in the US. However, others believe that women’s rights should be entrenched by expanding access to abortion but Daphne Gilbert, a law professor at the University of Ottawa, said: ‘There’s a lot of talk right now about whether or not the Canadian government should pass a proactive law protecting our right to abortion – a pre-emptive strike, if you will. That would be a big mistake.’ She believes that enshrining those rights in law would paradoxically make it easier for anti-abortion activists to overturn those rights.

Even in other Commonwealth countries, such as the UK, where access to abortion had apparently been secured long ago, those rights depended on where you lived until very recently. The British government had to force the authorities in Northern Ireland to allow abortions last year after health officials stalled on implementing services two years after terminations were decriminalised in the territory.

Guided by ‘Victorian morality’

Like Northern Ireland, where entrenched Catholic and Protestant beliefs held back constitutional change for decades, conservative Muslim Pakistan has long turned a blind eye to illegal abortions. It has one of the world’s highest abortion rates – about 50 in every 1,000 pregnancies, according to a 2012 report – and, like most countries where abortions are illegal, they are mostly administered by untrained practitioners, leading to complications and high numbers of gruesome deaths. The rise of political Islam in recent decades has made abortion law reform almost impossible, however.

In India, there was dismay at the US ruling, which one activist said was guided by ‘Victorian morality’. Dr Veena JS, who teaches medical ethics, called it ‘a huge step back for women’s rights’. She said: ‘America is generally a model for the world and I fear, at some point, India could take a cue from them and bring in a similar legislation. And we will be forced to raise children we don’t want.’

The US turning the clock back 50 years on reproductive rights is in contrast to the global trend towards liberalising laws. As Foreign Policy noted, it put the US in the company of Iran, Russia and North Korea in restricting women’s right to choose. Two Commonwealth states were among only four African countries it listed as broadly allowing abortion – Zambia and South Africa, which saw a 90% fall in deaths from abortions in the seven years after it was legalised.

In Kenya, the US Center for Reproductive Rights won a key legal battle for abortion rights in 2019 after suing the health ministry in 2015 on behalf of a pregnant girl raped at 14. Unable to access a safe termination, she got a backstreet abortion and died from complications. Seven women and girls die like this in Kenya every day, the CRR said.

Progressive reform

In Sierra Leone, the cabinet has just unanimously backed a bill to decriminalise abortion, Africa News reported. The penal code, which only allows the procedure if the mother’s life is at risk, dates from 1861. Beyond decriminalising abortion, the bill also covers maternal health, expanding access to contraceptives, post-abortion care and other reproductive health services.

Speaking at the 10th Africa Conference on Sexual Health and Rights in the capital, Freetown, President Julius Maada Bio said: ‘At a time in the world when sexual and reproductive health rights for women are either being overturned or threatened, we are proud that Sierra Leone can once again lead with progressive reform.’

Women’s rights campaigners said the World Health Organization’s recommendations on abortion had guided the process. Sierra Leone has the world’s third-highest rate of maternal mortality, according to the WHO, with 1,120 mothers dying for every 100,000 births in the country. Health authorities estimate that abortions cause about 10% of maternal deaths in the west African country.

Reproductive rights, and access to abortion, are human rights. It is a principle increasingly accepted in all but the world’s most retrograde states. But despite the Charter committing the Commonwealth and its members to upholding such fundamental rights, and though it has its first female secretary-general, there is no sign that the organisation is prepared to speak out on this most vital of topics. If it cannot stand up for this, what does it stand for?

Oren Gruenbaum is a member of the Round Table Editorial Board

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