Hillary's New Health Crusade

In a major speech, the Secretary of State declared women’s reproductive rights a priority abroad. Michelle Goldberg on why the Obama administration is feminist after all.

For weeks, pro-choicers have been despairing over the way abortion rights are being sold out in health care reform. But the speech Hillary Clinton gave on Friday at the State Department, to an audience full of international women’s health advocates, was a reminder of the fact that if this administration hasn’t done much for choice at home, it’s done quite a bit for reproductive rights abroad.

Over the last few decades, American elections have had an even more profound effect on reproductive rights outside the United States than inside it. Unconstrained by Roe v. Wade and a deadlocked Congress, presidential administrations can make radical foreign policy changes affecting access to contraception and safe abortion in poor countries. In fact, perhaps nowhere else is the difference between recent Democratic and Republican administrations quite so stark. Yesterday, after years in which the United States spread its anti-abortion ideology worldwide, Clinton declared that the United States will once again become a leader in promoting reproductive rights globally. “There’s a direct connection between a woman’s ability to plan her family, space her pregnancies and give birth safely, and her ability to get an education, work outside the home, support her family and participate fully in the life of her community,” she said.

Over 20 million unsafe abortions are performed annually. I’ve been to hospitals in cities like Nairobi and Addis Ababa where doctors in ob-gyn wards are forced to spend most of their time dealing with botched abortions.

The purpose of the speech was to recommit the United States to a goal we abandoned during the Bush years--upholding The Cairo Programme of Action, a 15-year old agreement that declares reproductive rights to be universal. Cairo calls on governments to make family planning and reproductive health services available to all their citizens. All governments, it says, need “to deal with the health impact of unsafe abortion as a major public health concern.” Adolescents, it says, should be given comprehensive sex education and reproductive health services. Female circumcision should be banned, and coercive population control jettisoned.

Americans aren’t used to thinking about reproductive rights as a global issue—usually, they’re seen as the quintessential domestic political football. But struggles over abortion and contraception are being waged all over the world, and it matters a lot where the United States comes down. A great many women’s lives are at stake: As Clinton said in her speech on Friday, over 20 million unsafe abortions are performed annually. I’ve been to hospitals in cities like Nairobi and Addis Ababa where doctors in ob-gyn wards are forced to spend most of their time dealing with botched abortions. According to a recent Guttmacher Institute paper, more than 40 percent of recent births in nations including Kenya, Namibia, South Africa, and almost all Latin American countries are unwanted. And, as Clinton reminded us, “one women dies every minute of every day in pregnancy or childbirth, and for every woman who dies, another 20 suffer from injury, infection or disease every minute.”

What’s that got to do with the United States? For a start, Republican presidents since Reagan have been instituting the “global gag rule,” which prevents American funding from going to organizations that so much as mention abortion as an option to their clients. That meant that even though the United States remained the world’s foremost provider of contraceptives, supplies weren’t going to organizations that had the infrastructure to deliver them. Toward the end of the Bush administration, Sara Seims, the director of the population program at the Hewlett Foundation, told me that in many poor countries access to birth control was worse than it had been when she entered the field in 1979. The United States defunded organizations that, in many cases, were the only ones providing reproductive health services in their areas. That meant a loss of prenatal care, emergency obstetrics and cancer screening.

But the American role is about more than just money. The United States has a lot of power in determining international norms regarding reproductive rights. One of the great untold stories of the last decade is the way reproductive rights have entered international law, creating some of the same tensions as Roe v. Wade has in American politics, but on a planetary scale. In the last few years, the UN Human Rights Committee and the European Court of Human Rights have both ruled in favor of women who claimed their human rights were violated when they were denied medically indicated abortions. In 2005, the Colombia Supreme Court struck down its total abortion ban, partly on the grounds that it violated international law.

The Cairo Programme of Action cemented these principles. It was a hard-fought agreement, and it wouldn’t have happened without American leadership. A coalition of religious conservatives, led by the Vatican and including a number of Muslim countries, put up furious opposition. At one point, the pope’s emissaries even offered to help Libya shed its post-Lockerbie pariah status in exchange for its support against the Cairo program. Iran, at first, joined the allied itself with the Vatican as well. But the reactionaries lost. At the conference, when the Cairo program was finally adopted after grueling negotiations, women from around the world danced in the aisles.

During the Bush years, the United States went from being a major force for women’s rights worldwide to the most powerful member of the fundamentalist alliance. Indeed, at a time when the United States was excoriating Iran as part of the axis of evil, it was grimly ironic to watch American diplomats collaborate with that regime against women’s rights at various UN gatherings.

That’s why it was such a joy to hear Clinton enthusiastically reaffirm Cairo’s goals. “When I think about [Cairo], and the thousands of people who were part of it, who came together to declare with one voice that reproductive health care is critical to the health of women, and that women’s health is essential to the prosperity and opportunity of all, to the stability of families and communities and the substantiality and development of nations, it makes me nostalgic for conferences that are held that actually produce results,” said Clinton. She continued, “There is no doubt in my mind that the work that was done and the commitments that were made in Cairo are still really the bulwark of what we intend to be doing and are expected to do on behalf of women and girls.”

There’s an enormous amount of work to be done just to repair the last decade’s damage. The administration will have to follow up Clinton’s words with funding and diplomatic pressure. But if it acts on these priorities, it will save the lives of women all over the world.

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Michelle Goldberg is the author of The Means of Reproduction: Sex, Power and the Future of the World and Kingdom Coming: The Rise of Christian Nationalism. She is a senior correspondent for The American Prospect, and her work has appeared in The New Republic, The Nation, the Los Angeles Times, Glamour, and many other publications.