How US Abortion Policy Harms Rape Survivors in Conflict Zones

Rape and other forms of sexual violence have been reported by health workers, human rights observers, and civilians in conflict zones, including Rwanda, Bosnia, Tigray, and Myanmar. Yet, survivors of these human rights abuses are rarely provided the sexual and reproductive healthcare they need. Jill Filipovic, freelance journalist and author of The H Spot: The Feminist Pursuit of Happiness and OK Boomer: Let’s Talk How My Generation Got Left Behind, talks to us about how U.S. foreign policy has prevented the support and care of women who have endured sexual violence in conflict zones.

U.S. foreign policy, such as the global gag rule and the Helms amendment, have prevented U.S. dollars to fund safe abortions for rape survivors and refugees even in areas where abortion is legal. In fact, the Helms amendment dictates that no U.S. funding can be spent on abortion as a method of family planning. Even though the Helms amendment’s wording should exclude abortions needed as a result of rape or abortion for those whose lives and health are threatened, U.S. federal dollars still do not fund safe abortion care. The global gag rule prevents U.S. funding for family planning abroad from going to groups that perform abortion with their own non-U.S. money, advocate for abortion, or refer people for abortion care. The rule has a broad “chilling effect”, stigmatizing the procedure and preventing groups that receive U.S. funding from engaging in abortion-related activities. While the Biden/Harris admin has rescinded the global gag rule it is not a light switch, just because the policy is gone it does not mean its impacts are. (Learn more about why we must permanently repeal the global gag rule by checking out this episode of rePROs Fight Back from earlier this year).

As a result of U.S. law, many medical providers in conflict settings are able to offer post-abortion care—via the same medical machine or the same set of medications— but cannot offer an elective abortion, itself. Because women cannot access an elective abortion at the time needed, they may seek unsafe options and return to the medical provider for post-abortion care, after. This leads to increased rates of problems in pregnancy and childbirth, injury and death, loss of fertility, and more. Under the Trump administration, post-abortion care in conflict settings was scaled back, as well as radically expanded the global gag rule during the administration’s four years.

Those who have experienced this trauma, which is rooted in a loss of control over one’s own physical safety and bodily autonomy, deserve control and ability to make personal decisions in the aftermath of a sexual assault. Ultimately, the U.S.’s policy must change to center the safety, health, and wellbeing of women and girls in conflict zones and to adhere to the principles outlined in the Women, Peace, and Security Agenda.

Links from this episode

How US Abortion Politics Distorts Women’s Lives in Conflict Zones
Jill Filipovic on Twitter
Additional information on the Women, Peace, and Security Agenda

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, so much has been happening since the last time we talked. Mississippi's abortion ban went up before the Supreme Court, the Supreme Court made a decision in the Texas abortion case. So many abortion things. So I guess we'll start maybe at the beginning with the Mississippi case. So we talked about it on the podcast before; Mississippi has a 15 week abortion ban. Basically, they're gonna take one of the core holdings that's like a central tenant to Roe, which is pre-viability. Abortion bans are unconstitutional and sounds like they might be okay with it. This would be terrible, right? Like this would just lead to a race to the bottom of like, okay. 15 weeks. Cool. Okay. What about 10? What about eight? Oh, right. Well what about six? I guess it takes us to Texas. So they released their decisions on Texas. They dismissed the us case in US v. Texas. So that's not great. They also said that Texas abortion providers can challenge some parts of SB 8 for some of the state licensing, but not for everybody that they were trying to be able to sue. So that's not super great either. Like it's great that they can continue to sue to try and stop it, but they can't sue everybody that they were needing to sue to be able to block this law. And the Supreme Court is letting this law stay in a place until, you know, later if they strike it down at all. So right now I'm recording this on Friday, December 10th. Basically, people haven't been able to get abortion for over a hundred days in Texas. And like, just to give you a scope of like what that is-- and I'm saying women, because that's what the data is-- 1 in 10 women of reproductive age lives in Texas. So that means 1 in 10 women in the US live without the ability to access abortion without traveling out of their state. And like that is unreal. 1 in 10… that is so many people that are not able to exercise their constitutional rights to exercise their human rights. It's just so terrible. And I, my heart just breaks for all of those people who are put in these situations. You know, another thing that really just was like the cherry on top of the cake for this Supreme Court ruling is, you know, they made this ruling that is going to continue to violate human rights of so many people living in Texas on Human Rights Day… mm-hmm, that's right, December 10th, this is Human Rights Day. And so they issue a ruling basically violating people's human rights on Human Rights Day and allowing this just unimaginable human rights crisis to continue. Just so many people need access to abortion care in Texas right now that are not able to get it. Like not everybody is going to be able to travel out of state to get the care they need. And it's just heartbreaking. And again, we're really lucky that we had another really fire descent from Justice Sotomayor and you know, it's really great. You should all read it in, uh, in its entirety, but um, just, she has a lot of fire in it. Like “…the court should have put an end to this madness months ago before SB8 went into effect, it failed to do so then, and it fails to do so again today.” Yeah. Like this has got to stop. This is I just, people need to access abortion care. It is time sensitive, and people need it. And you know, in the previous episode we talked to Dr. Foster about the Turnaway study and what that showed and you know, it really shows that things like this really just stop people from getting abortion and this has long-term implications on their lives. And so yeah, we, we need this to stop. The fight will go on. We will keep fighting. It's just infuriating. And in the meantime heartbreaking, unfortunately. Sorry, y'all, another heavy introduction. I was really hoping to do something light because we do have a heavy episode.

Jennie: So I guess I'll stick the light in here as well. And that is, this little baby is turning four! It’s our birthday; we released the podcast for the first time on December 19th, 2017. I cannot believe this podcast has been going on for four years. We've released 126 episodes. I… what!? If you had told me when, when we started this podcast that it would still be going 126 episodes and four years later, I don't know that I would've believed you. And, and I don't know that it's, that I thought it wasn't gonna be a success or that people wouldn't listen. I just… wow. Thinking that we would still be doing it four years later is wild to me. And I think I've told this story on here before, you know, I was a little reticent to start it uh, so I'm very grateful to my boss who may be pushed me out of my comfort zone. My comfort zone would not be being on mic talking to all of you, but I'm really glad he pushed me to do it. And so even though I did get a little bit kicking and screaming into doing this, I am just so grateful that he pushed me. So thank you, Bob. Thank you for getting me to do it. And then giving me the freedom and the autonomy to create my own vision of what this podcast could be and letting me talk about whatever issues we wanted on this podcast ss long as they related to sexual reproductive health and rights. I just am so grateful that I had the autonomy to create the show the way I wanted. And I'm really proud of the product that we have worked so hard to put out. I am so grateful for my friends who pushed me as well. When I was first talking to people when this was just like a little baby of an idea and I was still unsure if this was a good idea, I had some amazing cheerleaders who were really pushing me and really cheering me on that this was a great idea and we should do it and I'm always gonna be grateful to them for pushing me. So thank you, Nina and Lana and Lisa, and so many others that gave me that push I really needed in the early days.

Jennie: Thank you to Meg who always does the most to make me sound the best, for being a great editor and helping me get the podcast started with all the technical things like how do I record? And all of the things she has been there since day one, helping me do all of this and to make this sound the best. And I really appreciate her. And it goes double for like making me still sound good as for the last, I mean, almost two years now, since I've been recording at home instead of the nice studio we set up at the office.

Jennie: And then just like a super, super huge thank you to Rachel. Yeah. She has been the heart and soul behind this podcast for like day one. She has helped me so much, whether it is… I'm struggling with what is the best way to create an outline for how we're going to walk through the interview for this particular topic. She's been there with me to help brainstorm the path. She is the one who makes our website look wonderful. She is the one who does all of our social media and graphics, and she helps so much. And I just could not imagine doing this podcast without all of her help. And she has been here since this was a little baby of an idea. She was here before launch. She just was here to help through so much and four years of a podcast and 126 episodes. Like I couldn't have done it without her. And even though you don't get to hear her on microphone, other than in our hundredth episode where she interviewed me, she is just as important to all of this as I am. So Rachel, thank you. Thank you. Thank you. And one more last and not at all, least I am so grateful for all of you who tune in and check out our episodes. I am just so grateful for everyone who takes time out of their day to listen to all of this. And thank you. We couldn't be doing this podcast without all of you. And you're so important to all of this. So thank you. And with that, I think we'll turn to this week's interview. So like I said, week's interview is a little heavy, so just a fair warning. So just a little bit of a trigger warning. It is about rape. It's about rape as a weapon of war, nothing graphic, but we do talk about it consistently throughout the entire interview, because that is what this interview is about. So if you are not place to listen to it, come check back later. If you are able to, if you need to skip it entirely, totally understand, just know we need to repeal Helms and we'll see you in our next episode. If you're able to listen, for those of you who are able to, I am so excited to finally be able to do this interview. I'm talking to Jill Filipovich. She is a freelance reporter who wrote this really amazing piece this summer on how US abortion politics distorts women's lives in conflict zones. It's a great piece. I will include links to it. It's really long. It's wonderfully reported. It's a great, hard, heavy read that you should absolutely check it out, but I am super excited to talk to Jill today. So with that, let's go to my interview with Jill.

Jennie: Hi Jill. Thank you so much for being here.

Jill: Hi, thanks so much for having me. We're both laughing because my cat just stuck his butt in my face. As soon as you’re like welcome!

Jennie: [Laughs] Before we get started, do you want to take a second and introduce yourself and include your pronouns?

Jill: Sure. My name is Jill Filipovich she/her pronouns, uh, and I'm a freelance journalist, a non-practicing lawyer, and the author of two books, The H Spot: The Feminist Pursuit of Happiness and OK Boomer: Let’s Talk How My Generation Got Left Behind.

Jennie: Perfect. I am really excited to have you here today, even though it's to talk about some pretty horrible things. You wrote this great piece over the summer. I am a losing track of time. I think it was late summer… that was in the New York Review of Books. That was just a really powerful piece; one everybody should read. So we'll include in our show notes, but it really kind of talked about rape as a weapon of war and how this is interacting with US abortion politics. So maybe we should start at the beginning and just talk a little bit about women's lives and conflict. You maybe want to start there?

Jill: Sure. So I ended up writing this piece because I had been doing a lot of reporting. I mean from all over the world, in the US for a long time. And then also in Latin America, Asia. Siberia, and Africa looking at women's rights and health from a variety of angles. And one thing that started to become very apparent spending a lot of time in these places was that a lot of the reporting on conflict and women in conflict has gotten a lot better over the last few decades, right? Especially women have made up more and more of the ranks of foreign correspondence and journalists. Generally, stories about conflict are not just about, you know, the bang bang, but they're also about what happens after-- how conflict affects other vulnerable populations and not just the, the focus is not entirely on the fighting itself. And so there's been much better coverage including [inaudible], including the genocide in Rwand,a of sexual violence against women, we saw pretty extensive coverage of sexual violence in the crisis where ISIS fighters were raping and in enslaving Yazidi women, we saw coverage of sexual violence in South Sudan. So I really think that journalism has undergone a pretty incredible shift in this regard. And that is mostly to the credit of female journalists. So I was seeing a lot of great reporting on that and I was increasingly seeing really great reporting on the outcome of rape and war, which is that a lot of women wind up getting pregnant when they really don't want to be. And often in really vulnerable circumstances in post conflict settings and refugee camps in settings where, you know, their male partners or family members or children may have been killed where they themselves are obviously survivors of, of pretty enormous trauma. But I noticed that much of reporting kind to stop there. You know, I would talk about children born of rape and it struck me that there was this, this huge gap because you know, in our current modern world, we have the tools to end unwanted pregnancies and to do so safely. And so I wanted to explore that gap, you know, why these stories weren't being covered and as essentially whether women were actually able to access safe abortions in crisis and post crisis settings. So that was the genesis for the projects, to kind of dig into this space that I hadn't seen covered particularly well, you know, and it felt important in part because I think the way that we talk about abortion rights in the US especially is very much about abortion as this divisive political issue. In this story, I was really hoping to situate this question of abortion, not as one necessarily of politics, although it's certainly one of power, but of a question of essentially human existence and healthcare and sadly, a, a really normal thing that women go through, which is sexual violence and in conflict endemic and often, you know, planned out and weaponized sexual violence.

Jennie: I think you did a really great job of that. And, and it links to something you talked about earlier, which is a lot of the reporting would talk about, you know, women who would get pregnant and then the children that would result. But one statistic you brought in is that women in conflict, that's where you see the highest maternal mortality rates. So like when we're talking about these things, it's really not hyperbolic to say this is like life and death ability to access essential healthcare.

Jill: Yeah, it absolutely is. You know, and one thing that I think is heartening is we have seen not all and not even most, but a small handful of humanitarian organizations, kind of most prominent among them, Doctors Without Borders, taking on that same perspective. Right? Which is that every abortion is a lifesaving abortion. We know that in conflict, in crisis and post-conflict settings, you know, people are, have essentially seen their whole lives in everything that they thought was sort of normal and their whole future is obliterated, right? I mean, that's what conflict does. So when women are in those positions and are pregnant and are pregnant from a serious trauma, like a rape in war, what we see is that women do what women do everywhere in the world when they're pregnant and don't want to be right, which is that they seek ways to end that pregnancy. And if there are safe or somewhat safe ways for them to do it, they do it that way. And if safe ways aren't on offer, then they figure out what's available and what's possible. And a lot of those women die. And one thing that was really striking in reporting this piece is how bad the data gathering on a lot of this is right? Data gathering in post conflict settings has a whole series of obvious challenges, but we actually don't know how many women die of unsafe abortions in refugee camps. For example, we do know that maternal mortality in those settings is quite high. So we know that to carry a pregnancy to term is a very dangerous thing, whether that's by choice or by force and in most refugee settings, safe abortion is just not available even in countries where abortion is legal, right? So overwhelmingly it is by force or coercion that a lot of women are carrying pregnancies... So, you know, we know that unsafe abortion is really common in these settings. We know that some number of women… sorry, that's my cat yelling for pets. We know that some number of women and, and probably a large number of women are becoming seriously injured or dying from unsafe abortions. And we know that rape in conflict is endemic and that many women who are raped in conflict and that impregnated do not want to have babies resulting from that. And yet there has been this huge gap ever since, you know, the, the whole concept of a refugee setting was even established. There's been a huge gap in providing safe abortion services because even in humanitarian settings and even among these groups that are, you know, incredibly brave and forward thinking in a whole series of ways, abortion remains political and stigmatized.

Jennie: Yeah. And I, I think it's an extra not, I mean, it's always important to have this conversation because there's always unfortunately crises or conflict happening, but right now you're hearing the reports out of Ethiopia. You still hear things, from your article, highlights the DRC and you know, it, it just seems extra timely to be having a conversation about what is happening and what needs to change.

Jill: Yeah. I mean, the unfortunate reality is there at least, you know, as far as I know in the past a hundred years, more than that, there has never been a time where this issue is irrelevant. So you've mentioned if few sort of ongoing conflicts for sexual violence is being used as a tool, you know, we know that this is, that sexual violence has been a component of conflict for a very, very long time. And we know that when women are raped, some women get pregnant. And we know that when some women are pregnant from rape, they do not want to carry those pregnancies to term and will do anything or almost anything to prevent that from happening. And so it really is crucial that, you know, we take, when we are talking about this issue that we do take it out of this very American frame of pro-life versus pro-choice, right? Obviously I'm pro-choice, but, but I think that, that the idea that abortion is primarily a divisive political issue can be a really unhelpful way to approach these questions of humanitarian aid and development aid and what women actually need and what is actually happening on the ground. And unfortunately, you know, the US is the largest funder of development aid in the world. And obviously we're a huge funder of humanitarian aid to American politics to set the agenda for what women who have no right to vote in our elections, what they have access to. And I think we see this in the kind of starkest possible terms in this context of abortion access in refugee settings and in post-crisis settings, because essentially what happens is American abortion policy has made it so no US dollars go to fund safe abortions, not for rape survivors, not for refugees, even where it's legal in the country in which these women are. And even when under US law, US dollars should be able to pay for these procedures, but they don't. And that is largely because of the way abortion is treated as a contentious political and partisan issue in the US.

Jennie: Yes. So that brings us to the two policies that you really highlight in your story. So I guess let's start with the Helms amendment, which is the one you've just been referring to.

Jill: Yeah. So the Helms amendment, which is named after famous segregationist Senator Jesse Helms essentially says that no US dollars, no US aid and foreign money can be spent on abortion as a method of family planning. And so rights groups have interpreted that as saying, “okay, well, you can't essentially fund elective abortions, but abortion in the case of a threat to a pregnant woman's health or her life, abortion in the aftermath of rape, that that is not under that phrasing, and abortion primarily solely for a method of family planning and therefore US dollars should cover those abortions.” That doesn't happen. US dollars just never pay for abortions and abortion rights groups have been asking various presidents; they asked Barack Obama, they're currently pressuring Joe Biden on this, to simply issue a clarification, to just say, according to the flat out language of this amendment, US dollars can pay for abortions for rape survivors. They can pay for abortions that threaten a woman's life for her health. And even democratic presidents, President Obama, President Biden have refused to do that. Biden obviously is in office right now. He could still change his mind on that, but overwhelmingly even elected democratic Presidents have not been willing to do that. Very, very tiny thing that could make a huge difference for a lot of women. We have seen a whole group of women in Congress trying to pass a law that would essentially overturn the Helms amendment. As far as I understand, that is really, really unlikely to happen. There's a separate effort to permanently repeal the global gag rule and that one seems to have more legs. So that's some good news, but the efforts to kind of, to stop Helms in its tracks don't seem to be gaining any steam and from everything that I've seen and heard seem unlikely to come to fruition. So, you know, Joe Biden could do a lot here. He has. So the, the Hyde amendment is essentially the domestic version of Helms, is kind of the easiest way to say it. The Hyde amendment says that Medicaid, which is the US program that funds healthcare for low income Americans, that federal Medicaid dollars cannot pay for abortions under the Hyde amendment. And the Biden administration has made some efforts to strip the Hyde amendment out of its budgets. So that's good. They could do that with Helms. They haven't wanted to expend that political capital, you know… which, I did an interview with Sarah Sipple a couple months ago. And she phrased that as this like kind of democratic America-first view, which I found to be very compelling so yeah, the Biden administration has just so far really refused to do anything about Helms has refused to do anything to stand up for the basic rights and frankly, the, the lives of women who have survived sexual assault overseas.

Jennie: Yeah. I would say there's definitely been this big push to repeal Hyde…which is much further along than the push to repeal Helms. And yeah, the groups are really pushing to be like, we need to get rid of Helms. But in the meantime, like the, the bare minimum of what you can do to make sure that women in these situations are able to exercise their right to abortion. And these exceptions appear everywhere else within, uh, US policy. Right? So the Hyde amendment has life, rape, and incest exception. They're not super easy to use, but they're there. And so it's really just trying to get it on that same level playing field at the minimum while we're waiting for repeal.

Jill: Right. Exactly. And yeah, I mean, I, I think the law does need to be repealed. Obviously, it's, it's hugely detrimental, but it is pretty shocking is perhaps not the right word, but disappointing. And I think offensive that Biden won't even issue a basic clarification, you know, that is like such a tiny, small thing. And on something that the vast majority of Americans are aligned on, including a lot of Americans who self-identify as pro-life, you know, obviously the sort of extremists who have control over pro-life organizations and the Republican party do not want to allow safe abortions for rape survivors, but many kind of average Americans who self-identify as pro-life do understand or do believe that this is a little more complicated, and this is something that most people would want to allow an exception for. And so it's very frustrating that, you know, Biden is again seeing this as, uh, sort of political capital he has to spend rather than not wanting to spend it here, you know, rather than just doing, using the power he has to do the right thing.

Jennie: Yeah. And I think one thing that I, your article also did a really great job of illustrating was, um, talking to the, the doctors or people in the camps who were talking about, you know, we can provide post-abortion care once that woman goes and gets an unsafe abortion, but we had to turn her away from getting the safe one because we couldn't provide it. And like, that just seems, just devastating.

Jill: Yeah. I mean, this is one of those just like total absurdities about the way that the US handles the question of unsafe abortion, is that the US has for many years now dedicated quite a bit of funding and training to what's called post-abortion care. And post-abortion care…listeners to this podcast probably know what this is, but in case you don't, post-abortion care is essentially a set of procedures that help to complete an unsafe abortion and save women's lives. And so it can look like a lot of different things, but kind of the most common two are either using medical equipment to complete an abortion or using what is essentially medication abortion pills to complete an abortion. This is also the same treatment for an incomplete miscarriage, which is a pretty common thing that can also threaten women's lives. So post abortion care, what you offer a woman who has tried to self-use her own abortion, or has gone to a local freelancer and it hasn't worked, the care that a medical provider will offer to her is, is pretty much the same thing as an elective abortion, right? It's the same machine or it's the same set of drugs. So anyone who's trained in post-abortion care, which at this point, unsafe abortion is so common in humanitarian and development settings that a lot of people are trained in post-abortion care. Anyone who is trained in post-abortion care can also give a woman a safe abortion, right? And because unsafe abortion is so common in humanitarian and refugee settings, you have a lot of healthcare providers in those settings who have the, a skillset, right? And so it'd be very easy to just say to those folks, you know, if a woman comes in seeking an abortion in the first place, you can offer it to her. Instead, what US law requires is that those healthcare workers who know how to perform safe abortions, who have all the tools, who have the drugs, who have the training have to tell her, “no, we can't do this for you here.” And then if she predictably go somewhere else to seek out an unsafe abortion and comes back, they can then do the exact same procedure they would've done in the first place to help her complete the unsafe abortion and not get seriously injured or die. And so the cost of that obviously is women who are badly traumatized. Some number of women who die, a larger number of women who are badly injured, women who lose fertility, women who are then going to go on to have more issues in childbirth because unsafe abortions can be very damaging. It's sort of the worst of all worlds, right? There isn't much evidence that it actually prevents abortions. There is a lot of evidence that it fuels a much higher number of unsafe abortions, which are then, you know, obviously harder to treat when women come back in. So it is this really, really perverse set of rules. You know, one thing that was, I think this did not actually make it into the piece because it was just getting a bit too far afield. But you know, one thing that I find very scary is that, you know, post-abortion care under George W. Bush was a pretty well funded endeavor. And it was something that even abortion opponents agreed was important. Under the Trump administration, there was actually kind of a curtailing and scaling back of post-abortion care and many folks in the anti-abortion movement who had the ear of that administration have begun to see even post-abortion care as, as suspect, which, you know, I think kind of calls in to question how accurate that the pro-life moniker is for them when the idea of saving women's lives is unpopular. Just because the method by which you have to do it is the same way as an elective abortion. So, you know, it is this absurdity in how the US treats pregnant women and women seeking abortions, which is that “we will help you out if you've tried to do this yourself and if your life and your health are at risk, but we will not just in the first place help you to do this safely.”

Jennie: Well, I think that brings us perfectly to the next policy…since you brought up Trump, the global gag rule, which was around before him, but got much worse under Trump.

Jill: Yeah. So the global gag rule has been around since the Reagan 80s. And back then it was called the Mexico City policy. And in its, uh, sort of changed under various Republican presidents, but in kind of its initial iteration, it applied to US funding for family planning services overseas. And it said that that funding could not pay for abortions. That's been true since the 70s, but it couldn't go to any advocacy for abortion rights. It couldn't go to groups that advocated for abortion rights. It couldn't go to groups that referred women to safe abortions. And it couldn't go to groups that perform safe abortions with their own non-US money. So that was always, that was, that was bad um, and that rule was in place under every Republican president from Ronald Reagan going forward until the present time. And it has been rescinded by every democratic president. Although, you know, again, to clarify, even under democratic presidents, not a single dollar of US foreign aid money could be spent on abortion procedures. So, you know, the part of the problem with the global gag rule generally is that it does have this very broad chilling effect. It puts abortion in this category of healthcare that is stigmatized, that is considered kind of separate from all other reproductive health services. And it makes it in practice so that many of these organizations that receive US funding just don't touch the abortion issue because you're really not going to be able to change an entire organization's policies every four years, depending on, on who's in office. And when you're talking about the folks that are actually meeting with women and with patients one on one, you know, you're talking about folks who are mid-level midwives in rural Ghana, right? And whole teams of these folks who do incredible work, but whom it is just not realistic to retrain every single time US policy changes. Right? And so one outcome of the global gag rule is that even when it's not in place, many organizations still operate as though it is just because it's untenable to kind of do otherwise. Right? So, and some don't, to their credit, but many of them do because there, there just really isn't much of, of another choice. So the Trump administration made the gag rule much worse, you know, in part because they expanded it beyond just family planning funding and into all US aid dollars abroad. So any organization working on anything at all then had to treat abortion as this kind of highly stigmatized blacklisted, you know, “don't talk about it or you lose US money” issue, which you know, is a huge problem when the US is such a major funder of development and humanitarian aid overseas. So, you know, the gag rule again… it really does need to be permanently repealed because the reality is that yes, when the gag rule is not in place, more dollars flow into organizations that fund contraception, right? And that's great. The gag rule really does mean that groups that are doing really important public health work don't get US funding when they need it. But the gag rule, even when it is not in place, still kind of functionally casts a shadow, especially over a lot of smaller organizations and especially over how things operate on the ground. So repeal of the gag rule is really, really crucial. And again, even if it is appealed, not a single dollar, of US money will go to fund abortions, but it will mean that organizations that provide healthcare in countries where abortion is legal can tell women that that's an option.

Jennie: Yes. And like you said earlier we’re actually very close to making sure that-- it's often referred to as a light switch, although as you just showed, it's still like, even when it's not an effect, maybe we can end it for good-- the hope is to get it done this year through appropriations and it's so close to happening, I can taste it. So everybody, uh, keep letting people know it needs to happen. Okay. So now we have the idea of these two policies that need to go, what do we need to do to kind of fix it and what is a good example? Cause I think you talk about the Rohingya crisis and how that didn't kind of repeat some of those same problems.

Jill: Yeah. So one sort of inadvertent outcome of the Trump administration is that, you know, his, that administration's attacks on reproductive rights, on women's rights on LGBT rights, on democratic norms, you know, on, on all of it, uh, was a real shock to the system. I think for a lot of countries around the world and particularly for kind of more progressive and feminist minded ones. And a lot of those countries decided essentially to go it on their own without the US to say, “okay, the US does have a huge amount of money and power and influence, but perhaps the rest of us can kind of band together and try to fill the gap that, that they're leaving.” So you saw this in, for example, the She Decides effort, which was a bunch of Nordic countries and then kind of other European countries who decided to expressly attempt to fund safe abortion where the US would've. And you've seen it among humanitarian aid organizations that don't take US dollars. And so in Bangladesh, which is where, you know, close to a million Rohingya refugees came in from Myanmar fleeing a genocide, a hallmark of which was mass rape, you saw for the first time in a refugee setting, a concerted effort to provide safe abortion services. And in, in sort of in the process of hundreds of thousands of refugees fleeing, a lot of the reporting was on the, these rapes. And there was a lot of preparation for what people expected to be kind of a whole mass of essentially abandoned infants nine months after the first wave of refugees came to Bangladesh. And that actually didn't come to pass. A lot of women were able to get safe abortions through organizations like MSI, through clinics, formal clinics set up in the camp. And a lot of women were able to procure abortion-inducing drugs from kind of more informal pharmacies that were set up in the camps. And so, you know, those procedures are not as safe as procedures done in a formal clinical setting with a trained medical professional, but they're a lot safer than the kind of old way of doing things, right? Which was like putting a stick in your, through your cervix. You know, the kind of in the US, the, the sort of coat hanger model. Misoprostol is widely available. It's a drug that induces miscarriage or abortion. It is a drug that is very cheap and it was widely available in the refugee camps in Bangladesh and a lot of women made use of it. And so that really is the first time where safe abortion and kind of moderately safe abortion has been widely available for rape survivors in a refugee setting. And what we saw as it was a huge demand for it and that women used it. And you know, again, there's still serious data gathering issues here, but that what you didn't see was, you know, a whole bunch of women seriously injured or dying from unsafe abortion. And what you didn't see was kind of the expected wave of abandoned infants from women who felt unable to raise a child of somebody who would attack them in a community that's really, really conservative. And where in doing that, you know, you would sort of make yourself a pariah for the rest of your life.

Jennie: I really love that this was how you, it was towards the end of the piece, if it was not the very end, because it just this like hope of like what having access to safe abortion in these camps for all these displaced people would mean after just so much just tragedy before it, right? Like it was just so upsetting. And to end on this vision of a better world that was still fleeing mass rapes and stuff, but at least, you know, they were able to access safe abortion care. And it was a hopeful end.

Jill: Yeah. I mean, I, I found the, the provision of safe abortion care in Bangladesh in that setting to be heartening. You know, it's, I think what's important to emphasize is that, you know, it's, it's not that women in these settings being able to access safe abortion, like then makes their lives 1 million times better, right? These are women for whom life has already gotten really, really bad and who need a, who need much better services, kind of all in, like 360, right? They need the legal right to be somewhere, need the right to work, need the right to safe housing, need the right to physical safety. You know, there's a very, very long list of folks who are waiting to be resettled in safe countries and most countries in the world, I would say every country in the world, doesn't quite take on their fair share of refugees who need safe haven and many countries also put tremendous burdens on refugee communities and, you know, don't give folks what they need to start building their lives back. So, you know, it's not like abortion is this magic wand that you then wave and, you know, then women wind up fine. It is one tool that prevents women who have already seen their whole lives devastated. It's one tool that allows those lives to not get even worse against their will. Right? You know, these are women for whom control over their lives, over their physical bodies has already been taken away in sort of the most shocking and traumatic and violent way possible. And then to be told that they also don't have control over the aftermath. Uh, it's a, I think kind of unforgivable compounding of that cruelty and that trauma, you know, and, and frankly, I would argue that the, the impulse to rape women, to sexually violate, stems from the same impulse as the impulse to control what women do with their bodies generally, and to force women into birth against their will; to force women, to continue pregnancies against their will. You know, there are not the same things, but I think they exist on the same continuum of violence against women, and certainly forcing women to, to continue pregnancies that were forced upon them by rape is just one of the cruelest things that I can think of. And so offering women safe, abortion services does not undo the initial trauma. It does not fix all that is wrong in the way that we treat refugees, in the way that we treat sexual violence, survivors in the way that we treat, you know, everyone impacted by conflict and crisis, but it does allow women to maintain a tiny bit of control over their own lives and over their own bodies in a context in which that control has been stripped out in every other aspect of their lives.

Jennie: Okay. So now that our audience knows more about these situations and the policies that are not helping in these situations, what actions can our audience take to make sure that the stops or at least these policies stop?

Jill: Yeah. And I think putting pressure on the Biden administration, any administration to improve policies, both on safe abortion access, right? So overturning Helms, repealing the global gag rule. Those are two big ones, but also on just better refugee policy generally. So, you know, more robust funding for humanitarian work, radically raising the refugee resettlement cap in the US, pushing other countries to also open their doors to refugees. I think those, those are really big ones. And also just being mindful of, you know, which organizations are giving your money to and supporting, you know, whether those are in the humanitarian or development space and asking, you know, are these organizations that support a full range of reproductive health, uh, including safe abortion care, you know, and if, if they're not, I mean, part of this problem is that abortion is treated as a stigmatized issue, including by a lot of players in the humanitarian space. And so, you know, if, if organizations aren't supporting safe abortion or are silent on safe abortion asking whether that is the best way to spend your dollars, you know, or whether that money should go to groups that have a, a more holistic vision of what folks need on, then, yeah. And I would just add that, you know, the Women, Peace, and Security Agenda is something that is really important to the Biden administration. So making clear that this is part of that, right? Permanent Helms and permanent global gag rule repeal. But in the meantime, making sure that those in crisis settings are able to access safe, abortion is so important, and is part of that Women, Peace, and Security Agenda.

Jennie: Definitely. Well, Jill, thank you so much for being here. I really enjoyed talking to you.

Jill: Thank you so much for having me.

Jennie: Okay. Y’all, I hope you enjoyed my conversation with Jill. Like I said, it was a really heavy topic, but it was so important that we talk about all of this. So, you know, you get a really clear vision of why Helms needs to go. And until then, like until we can get Helms completely gone, it's really important that the US government does not continue to enforce Helms as a complete ban. Right? We need to make sure that people who are victims of rape are able to access safe abortion care, and the US needs to quit being a barrier to that. So Helms needs to go. I guess, with that, this is our last episode before the holidays. So happy holidays. I hope everybody has a wonderful holiday season. I'll see you with one more with our end of the year episode, it's going to come up before the new year.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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