A moral question
When does a foetus become a baby?
What happens when the choice is between the life of a mother and the life of the unborn?
Janet Hadley looks at both sides of the abortion debate.
HERE is a brain-teaser.
It happens around 55 million times a year. Sometimes it is a surgical operation, sometimes not. Sometimes it is legal, sometimes a crime; sometimes it is even referred to in a national constitution. It is viewed by one group of people as 'callous and brutal murder' and by their opponents as 'the key to a new world for women'.
We are talking about abortion. If it all sounds bewildering to you, imagine the thoughts and feelings of a pregnant 14-year-old girl, who wanted to end her pregnancy and found herself forbidden to leave the country because of courts of law citing the constitution of the Republic of Ireland.
Abortions are illegal in Ireland. But ever since 1967, when abortion became legal in Britain, thousands of Irish women have been coming to England every year to end unwanted pregnancies. The schoolgirl, raped by a school-friend's father in his car, pleaded with her parents to take her to London for an abortion.
Because of the pending trial for rape, the family had told the Irish police of their planned trip to London and its purpose. This tip-off sparked a furore in 1992 which swept Ireland into months of political crisis and instability.
The family were in London when the Irish police phoned them. 'You have to come home,' they ordered. The girl talked of suicide. The police officer said that going ahead could mean prison. The threat had been prompted by a Dublin High Court ruling that was based on the fact that the Irish constitution defined abortion as an illegal act. 'Miss X', as she was known to the public, found herself caught up in a nightmare, as Ireland's top lawyers wrangled about the Irish constitution and the rights of a raped child threatening to kill herself.
The world - and indeed the Irish public - watched with absolute horror. Many of those who had voted for the special constitutional ban on abortion - a much more far-reaching step than making it simply a crime - had never imagined that it would result in such cruelty. After weeks of courtroom argument the girl was permitted to leave the limelight and to end her pregnancy.
The crisis which her case provoked could only happen because there is a worldwide controversy about abortion. The Irish teenager is one of thousands of girls and women who find themselves pregnant and do not want to continue the pregnancy. They do not seek the experience of abortion, they would far rather not have become pregnant in the first place. But so desperately do they wish not to bear a child (for whatever reason and there are many) that they choose abortion. And they do so whether it is legal, safe and affordable as it is in some countries or illegal, dangerous and costly, as it is in many other places.
It is impossible to detach abortion from the question of women's reproductive rights. A quarter of the world's population lives in countries in which abortion is severely restricted or is defined as a crime. The World Health Organization estimates that 55 million abortions take place every year and around half are performed in unsafe conditions, usually because abortion is illegal or inaccessible.
Pain and danger are the hallmarks of unsafe abortion - as many as 550 women die every day from trying to end unwanted pregnancies. Their deaths are needless and preventable. When abortion can be performed early in pregnancy by a skilled person using modern techniques, it is safer than having your tonsils out. Laws against abortion only succeed in making it painful and dangerous. They do not stop it happening.
Yet all over the world the campaign against abortion continues.
In Poland, the end of the communist regime in 1990 brought an end to an abortion law which had been amongst the most permissive in the world. All but three per cent of the operations which were previously allowed are today a crime. People came out on huge demonstrations for and against abortion rights. Parish priests threatened to withhold Catholic sacraments from anyone who did not sign their petitions against 'killing innocent children'.
The fundamental argument of those who oppose abortion anywhere is deceptively appealing. Its simplicity is precisely what makes it unsuited to being translated into law - as the Miss X case so blatantly highlighted. The basic anti-abortion argument boils down to a moral question. There are also anti-abortion arguments concerning the safety of abortions - abortion makes women ill, even mad, say the campaigners. And there are 'feminist' anti-abortion arguments: abortion allows men to evade their responsibilities towards women whom they have made pregnant.
But the bottom line of the case against abortion is always the same. Foetuses should have the same moral claims as women because the foetus, from the moment of conception, is a live human person - and so abortion is no different from murder.
Keeping the focus on the foetus has been the constant theme of opposition to abortion. Of course, from the moment of conception there is life as well as a potential person.
But is an embryo or a foetus the same as a person? Does it enjoy full moral rights, equivalent to those of a seven-year-old child or an unwillingly pregnant seventeen-year-old woman? You either believe that is so or you do not. Scientists cannot agree.
Prenatal technology - ultrasound, hi-tech photography - can now provide us with fantastic inside-the-womb images as the foetus grows and develops. The campaigns against abortion have exploited these images and isolated them. We're shown pictures of brilliantly lit foetuses - floating as if they were space-walking and (this is very important) as if they were somehow alone, or just happened to be inside a woman's body. The point of such images is not only to make them resemble fully developed babies. Foetus = baby. It is also to deny the role of the mother - who becomes nothing more than a kind of animated container in which the foetus happens to be growing.
But women do not carry foetuses around hidden, like keeping something in the trunk of the car for nine months and then remembering it. So, in order to complete the picture, abortion opponents have to portray women as cold, self-centred, silly baby-haters, who are 'the enemy'. Calling women murderers does the job nicely - it is the most common abuse hurled at women outside abortion clinics in the United States.
There is no middle ground, no halfway point where 'the moral truth' is waiting to be discovered. That is why the debate over abortion is more often a slanging match than a dialogue. Because the arguments about abortion usually centre on the 'rights of the unborn', defending women's right to have access to abortion is hard and therefore, politically unpopular. It is not easy to argue that making abortion safe, legal and affordable is the only way forward and that making abortion a crime is doomed to fail because it not only doesn't save 'babies', but it also kills women. Not many votes to be won down that road.
But doesn't making abortion legal and safe make it too easy and lead to high abortion rates? Sounds logical. Except that the safest and easiest place in the world to get an abortion is the Netherlands, which also has the lowest abortion rate in the world. The reason for this is an extensive use of reliable contraception. It is a paradox that so many of those campaigners who condemn abortion also condemn contraception and especially giving contraceptives to young, single people.
Here's something else that sounds logical. You often hear people say that no-one should need abortions, because contraception makes it unnecessary. They point to places like Russia where abortion is legal but modern contraceptives have been almost unavailable. Women there have abortions again and again because it is the only way they can limit their family size. Now that contraception is being introduced more widely the number of abortions is falling. It sounds compelling.
But there is no such thing as a 100-per-cent reliable contraceptive. You could make abortion a crime and throw contraceptives around till people were knee-high in pills and condoms. But a third of all abortions would still happen, even if everybody used the most 'reliable' kinds of contraception. (And the most 'reliable' kinds are not always the most suitable for a particular woman's health.) People who use contraception do so because they want to plan their families, to have children when they can afford it, and to feel that their children are wanted and welcomed in every sense. That is widely regarded as responsible behaviour. If it is, we cannot force those who are unlucky with their contraception (or maybe even a little careless) to continue with unwanted pregnancies.
Banning abortion is a fool's errand. In Poland, within months of making abortion a crime, there were clear signs that women were still finding ways of ending unwanted pregnancies. Better-off women were paying to travel abroad - to Russia or if they could afford it to Germany or Holland. Poorer women paid with their health or even their lives. The police mortuaries began to receive bodies bearing witness to botched abortions. Dead newborns began to turn up in fields and woods and reported miscarriages increased.
Even where the laws severely frown on abortion, as in the Philippines, opponents want to make the rules even harsher. Despite laws which already make abortion a crime and enshrine in the constitution for the foetus's right to life, estimates are that 17 per cent of women in Manila have had an abortion. Post-abortion medical complications rank as the top reason for women's admission to hospital. Now, in a new bill which places abortion on a par with murder or rape, the perpetrators of illegal abortions, and the women who undergo them, may face the death penalty.
The law itself can neither get rid of abortion, nor guarantee that women will have access to safe, affordable methods of ending their unwanted pregnancies. In India, for example, abortion has been legal since 1971. But acute shortage of medical facilities and doctors means that for a great many of Indian women safe abortion is still beyond reach. Illegal abortions outnumber legal operations.
Access to safe abortion is also fraught with difficulties in the United States, thanks to the fanatical anti-abortion lobby there. Although the right to early abortion is protected under the US constitution, the majority of individual states have imposed restrictions on teenage access to abortion. A pregnant teenager rarely has money to pay for an abortion and wouldn't know where to go if she did. No wonder the main effect of the restrictions is later and riskier abortions for those who can overcome the hurdles.
The rates of unwanted pregnancy among young, single women are rising worldwide. In Latin America, that most Catholic of continents, as many as 60 per cent of pregnancies among women under 20 are unwanted and one in five deaths among Brazil's young women is caused by illegal abortion. Outlawing abortion does nothing to stem this tide of death and ill-health; sermons against 'teenage promiscuity' do not stop young girls getting pregnant.
Any day now an 11-year-old Brazilian girl known as M, pregnant as a result of rape by a 38-year old man, is about to give birth. She has become as a much of a pawn in Brazil's abortion controversy as 'Miss X' was in Ireland. M hid her condition from her father, but when he found out he petitioned for an abortion - which was allowed by law because of the rape and the dangers of giving birth at 11 years of age. He said he feared carrying and delivering a baby would kill her. The case became national news. The day before the operation anti-abortionists marched on the town where M and her father lived, noisily reminding them that the Pope had called abortion 'an abominable crime' and persuading the father that his daughter's life is not at risk.
All over Brazil the campaigners have kept up their pressure so that even when an abortion has been sanctioned by the courts, many state hospitals turn away the women who seek help. Thousands turn to illegal abortion services, thousands more give birth to children they neither wanted nor can afford. Many, like M, are still children themselves.
What really counts for women, anywhere in the world, is to know that a sympathetic and accessible abortion service is there if they need it. Like all good healthcare, we desire it but we hope we won't have to use it. Abortion is a health issue: of that there is no doubt. It is also a moral issue. Women decide on abortion aware that they destroy life, but also aware that they have responsibilities which they know they cannot meet if the pregnancy continues - to the child that would be born, to other children, even to themselves. It is also a political issue - a matter of women's sexual and reproductive freedom. So despite the Pope's denunciations, despite mass handouts of contraceptives, abortion will take place. Its denial is a punishment of women - for having sex.
Janet Hadley is writer on women's health issues and the author of Abortion: between freedom and necessity (Virago 1997).