Much More Than Language: How the US Denied Survivors of Rape in Conflict Lifesaving Care

Excerpt of Women Under Siege op-ed by GJC Deputy Legal Director Grant Shubin.  

On Wednesday, April 23, 2019, the UN Security Council adopted Resolution 2467 during the Council’s annual Open Debate on Conflict-Related Sexual Violence. .

After months of German-led negotiations, passage of the Resolution ultimately came down to sexual and reproductive health (SRH)—specifically, whether the U.S. would veto its inclusion in the final text.

The U.S. justified its position by claiming that SRH is a euphemism for abortion services. Not only is this not true—SRH includes, among other things, contraception, safe abortion services, HIV prevention, and prenatal healthcare—but even if it were, abortion services for survivors of sexual violence save lives.

Unsafe abortion causes the deaths of 47,000 people each year and leaves another 5 million with some form of permanent or temporary disability. They may suffer complications, including hemorrhage, infection, perforation of the uterus, and damage to the genital tract or internal organs. In fact, the consequences of denying abortion services have been found to be so severe that it can amount to torture and other inhuman or degrading treatment.

The international community cannot become accustomed or complacent to the Trump administration’s use of domestic politics to hold international rights hostage. Because it is more than just words that are given up last minute on the floor of the Security Council—it’s women’s lives.

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Protecting safe abortion in humanitarian settings: overcoming legal and policy barriers

GJC Vice-President, Akila Radhakrishnan, GJC Legal Fellow, Elena Sarver and GJC Staff Attorney, Grant Shubin published an article in Reproductive Health Matters.

Abstract:

Women and girls are increasingly the direct and targeted victims of armed conflict and studies show that they are disproportionately and differentially affected. However, humanitarian laws, policies, and protocols have yet to be meaningfully interpreted and adapted to respond to their specific needs, including to sexual and reproductive health services and rights. In particular, safe abortion services are routinely omitted from sexual and reproductive health services in humanitarian settings for a variety of reasons, including improper deference to national law, the disproportionate influence of restrictive funding policies, and the failure to treat abortion as medical care. However, properly construed, abortion services fall within the purview of the universal and non-derogable protections granted under international humanitarian and human rights law. This commentary considers the protections of international humanitarian law and explains how abortion services fall within a category of protected medical care. It then outlines contemporary challenges affecting the realisation of these rights. Finally, it proposes a unification of current approaches through the use of international humanitarian law to ensure comprehensive care for those affected by armed conflict.

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Ninety humanitarian and human rights groups call on European Commission to provide abortion services to women and girls in war zones

FOR IMMEDIATE RELEASE -November 23, 2017

[NEW YORK and GOMA]– On Saturday, the world celebrates the International Day for the Elimination of Violence against Women. In anticipation of this day, a global coalition of ninety civil society organizations calls on the European Commission to ensure that abortion, a medical procedure, is included in the medical care offered to women and girls, particularly in areas where rape is used as a weapon of war. 

US Abortion Restrictions: An Explainer

President Trump’s expanded Global Gag Rule is being implemented through standard provisions issued by all affected agencies and sub-agencies, including:

Except for some small non-material language, these regulations are substantially the same across agencies. To provide context, GJC has annotated USAID’s Standard Provisions for Non-US Non-Governmental Organizations (ADS 303), which is the primary vehicle through which this censorship is being effected. These regulations also include provisions which implement other US abortion restrictions on foreign assistance, including the Helms and Siljander Amendments, which restrict the activities of all recipients of US foreign assistance.

This annotation highlights, explains and contextualizes the laws and policies that restrict or place restrictions on U.S. funding of abortion or family planning services abroad.

Background: After the US Supreme Court’s landmark ruling in Roe v. Wade (which held that the U.S. Constitution protects a woman’s decision to terminate her pregnancy), Congress began restricting abortion access through funding restrictions both domestically (Hyde Amendment) and abroad (the Helms Amendment). Over the years, the funding restrictions on foreign assistance have grown and now encompass all US foreign aid through their incorporation into annual appropriations acts, which are then implemented by agencies providing foreign aid, primarily USAD and the State Department. These congressional restrictions limit what can be done with US funds.

 In 1984, President Reagan expanded these restrictions on foreign NGOs through the “Mexico City Policy” (or Global Gag Rule) and began limiting with those organizations could do with their funds from any donor. The Gag Rule was rescinded by President Clinton, reinstated by President Bush, rescinded by President Obama and reinstated and expanded by President Trump.

Today, all entities receiving US foreign aid cannot speak about or provide abortions with US funds in any circumstances, including rape, life endangerment and incest. Furthermore, foreign NGOs receiving US global health assistance aid must now certify that they will not actively promote or provide abortion services as a method of family planning with funds from any donor and all NGOs receiving US global assistance funds cannot partner with or sub-grant to any foreign NGO that won’t certify the same. As a result, today, the United States is denying necessary and safe medical care to women and girls around the world in violation of their rights under international law.

This annotation seeks to demystify US abortion restrictions and map how and where they are put into place.  

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International Humanitarian Law And Access to Abortions: Compilation of Citations

Sexual violence in today’s armed conflicts is systematically used against civilians to demoralize, destroy, terrorize, and even change the ethnic compositions of entire communities. For instance, the ongoing Syrian civil war has seen an estimated 50,000 rapes. Women there describe being drugged, blindfolded, and raped in groups. In Iraq, ISIS has systematically abducted girls and women, held them in captivity, and repeatedly subjected them sexual violence including rape and sexual slavery. In Darfur, Sudan, where sexual violence has been used as a tactic of war for over 12 years, a 2015 attack in Tabit included the mass rape of over 200 women and girls in the span of three days. Finally, in Nigeria, Boko Haram openly targets young girls for kidnappings, forced marriage, rape, sexual slavery and other forms of gender-based violence.

Today, thousands of girls and women raped and impregnated in armed conflict are routinely denied abortions with devastating consequences. A girl or woman who is a victim of war rape and is denied an abortion when she wants one often has three options: (1) undergoing an unsafe abortion; (2) carrying to term an unwanted pregnancy; or (3) committing suicide. The denial of abortion services to these victims is both illegal and inhumane. 

In the context of armed conflict, the rights of war victims are protected under international humanitarian law. Specifically, victims of war rape are part of a special class of people called “wounded and sick in armed conflict.” This status means they are entitled to comprehensive and non-discriminatory medical care provided solely on the basis of their condition. Failing to provide–or denying–a medical service needed only by one gender (i.e. abortion) violates these absolute rights.

Abortion as protected medical care under international humanitarian law has increasingly been recognized by states, international policy makers, and legal experts on international humanitarian law. This document complies language and citations of laws, policies, authoritative declarations of public officials, and legal treatises, that affirm abortion as protected medical care for girls and women raped in war under IHL.

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Eliminate the Chilling Effect

A Hindrance on Abortions to Rape Victims

by Eva Marie Wüst Vestergaard

US abortion restrictions constrain abortion speech and services around the world. Under a Trump administration, it is likely these restrictions will be expanded, causing confusion for providers and harming women raped in war.

For the past six years, the Global Justice Center has worked to lift the US abortion ban on foreign aid. The Helms Amendment stipulates that US funding cannot be used for any kind of abortion speech and services. However, this does not constrain foreign organizations from using other funding for abortion activities as long as their funding is segregated. This latitude is not well known and in the aftermath of the US election, it is now also imperilled.

The Mexico City Policy or the Global Gag Rule (GGR), imposed by Reagan, requires that foreign organizations receiving US funds for family planning activities cannot perform nor actively promote abortion as a method of family planning. Foreign organizations under GGR are allowed to spend other funding for abortion speech and services in the cases of rape, incest, or if the “mother’s life would be endangered if the fetus were carried to term”, as these are not methods of family planning.

The GGR has continuously been rescinded under democratic presidencies and reinstated under republican presidencies. It was rescinded by President Obama eight years ago and will most likely be reinstated by Trump. When the GGR is reinstated it produces a “chilling effect” on providers of abortion services around the world.

The chilling effect refers to the fact that US abortion restrictions are so complicated and incomprehensible that providers avoid any activity on abortion as a preventive measure to avoid the risk of losing funding. It is, for example, a common misconception that the Helms amendment is a total ban on abortion speech and services, whilst the ban only covers US funding, not alternative segregated funding.

Should a reinstatement of the GGR become a reality, foreign organizations may be likely to disregard abortion services in spite of having autonomy to provide them to rape victims and other cases that are not defined as family planning. Therefore, it is vital to be fully informed of what these restrictions entail, be wary of misconceptions, and eliminate the chilling effect that hinders raped women’s right to abortion around the world.

Growing International Consensus that US Must Lift Abortion Ban

by Liz Olson

Denying women raped in war zones access to abortions is a violation of their fundamental human rights ­­-- yet the US continues to do so in the face of growing international criticism. Under the Geneva Conventions, women raped in war zones fall under the category of the “wounded and sick,” meaning that they are entitled to all necessary medical care to treat their condition. Failing to provide abortion access to these women not only violates their rights under International Humanitarian Law, it subjects them to further trauma, as they are again stripped of control over their bodies.  These women, forced to carry the children of their rapists, face additional pain, suffering, and stigma.

The Helms Amendment, enacted in 1973, prohibits US humanitarian assistance funds from being used to pay for abortions “as a method of family planning.” Since then, the law has been incorrectly interpreted as a blanket ban on abortion services, even in cases of rape, incest, or life endangerment.  By denying women and girls raped in war zones access to this necessary medical procedure, the US is violating the “principle of adverse distinction” under the Geneva Conventions, which stipulates that IHL cannot be implemented in ways that are less favorable for women than for men. Men and women wounded in war must be provided with all necessary forms of medical care. For women raped in was zones, this includes access to abortion services.

Access to abortion service has been increasingly recognized by the international community as a right under humanitarian law, and the US ban has come under growing criticism. The United Nations, United Kingdom, France, the Netherlands and the European Union have all come out in strong support of providing safe abortion access to women raped in conflict zones, and it is time for the US to follow suit.

Thinking of Yazidi Women and Girls on the International Day for the Elimination of Sexual Violence in Conflict

On June 19, as the international community observes the International Day for the Elimination of Sexual Violence in Conflict, rape remains a central reality of war for women and girls around the world.

War rape is both a historical and contemporary part of war: it is not simply a byproduct of fighting but often serves as a central military tactic. In Yugoslavia in the 1990s, “the systematic rape of women … [was] in some cases intended to transmit a new ethnic identity to the child.” Yugoslav women were “often […] interned until it was too late for them to undergo an abortion,” thereby ensuring the creation of a new ethnic reality.

Today, in ISIS controlled territories, ISIS leaders “elevate and celebrate each sexual assault as spiritually beneficial, even virtuous.” Multiple accounts by former ISIS captives detail month-long rapes, severe physical and mental trauma, and forced pregnancies.

War rape thus serves to traumatize and create fear in the short term and to extend genocidal effects by producing new ethnic identities in the long term.

Yet despite the horrific psychological and biological results of war rape the United States’ Helms Amendment precludes any US humanitarian aid from being used for abortion services.

Denying abortions to war rape victims endangers innocent women’s lives, helps to perpetuate genocide and its effects, and violates the Geneva Conventions.

Even though the Hyde Amendment, a similar domestic amendment to the Helms Amendment, includes exceptions for rape and cases in which the mother’s health is in danger, foreign victims of war rape are not afforded these rights.

In 2015, Obama noted that the “Golden Rule,” that “seems to bind people of all faiths,” is to “treat one another as we wish to be treated,” — to “love thy neighbor as thyself.” If victims of war rape are to receive the medical care they deserve, the Obama Administration must apply this Golden Rule not only to domestic victims of rape, but to war rape victims in other countries as well.This involves recognizing their rights to non-discriminatory medical treatment and issuing an executive order that limits the scope of the Helms Amendment.

On Anniversary of Roe v. Wade, US Can’t Forget Women Overseas

Forty-three years ago today, the Supreme Court deemed abortion a constitutionally protected right for women in the United States in Roe v. Wade, taking a huge step forward for women’s equality. Since then, anti-choice lawmakers at the federal and state-level have been working concertedly to render this right meaningless by restricting access to abortion.

The Guttmacher Institute recently found that states have enacted 1,074 abortion restrictions since 1973.  One of the longest-standing restrictions is the Helms Amendments, which has been in place since December 1973 and prevents the use of U.S. foreign aid to pay for abortion services, even in the case of rape, incest or life endangerment.  

Shutting down federal funding for abortion services exacerbates one of the longest-standing barriers to abortion access: the cost. As anti-choice lawmakers have known for the past four decades, if the right to abortion can’t be eliminated, the next best thing is to make abortion access practically impossible.

The Helms Amendment impacts some of the most vulnerable women and girls in the world; those raped in war. Through the continued imposition of the Helms Amendment without exceptions, the U.S. is denying abortion access to women enslaved and raped by groups like ISIS and Boko Haram, and to girls as young as 12 raped in the Democratic Republic of Congo.

The U.S. is laudably the world’s largest provider of development and humanitarian aid. Through this aid, the U.S. funds a variety of initiatives around the world, including health care services in conflict zones. But when girls and women present at these U.S. funded health centers for medical care, while they may have access to a wide range of services, safe abortion is not one of them. Insultingly, if these women seek out an unsafe abortion and have medical consequences, they can go to a U.S. funded health care provider for post-abortion care, but only after they have put their own life in danger. Not only is this policy illegal under international law, its consequences are dire and often deadly.

Yesterday, in a receiving line at a town hall in Iowa, Hillary Clinton was asked by an activist whether she would “help fix the Helms Amendment” as president, to which she gave a resounding yes.   There has been no stronger advocate of women’s rights and abortion rights in the current presidential campaign than Clinton. Rightly framing abortion as a class and racial issue, she’s drawn attention to the fact that making abortion unaffordable essentially renders the right to it meaningless, in particular for low-income women.  However, Ms. Clinton, as a part of the Obama Administration, had ample opportunity to act on the Helms Amendment but failed to do so.

During her tenure as Secretary of State, the Helms Amendment’s impact of women raped in war was raised with the Obama Administration multiple times, including during the 2010 Universal Periodic Review of the United States. However, despite the fact that President Obama can take steps through executive action to limit the impact of the Helms Amendment, he and his Administration have continually failed to take any action—to the detriment of countless women around the world.

Like Roe & the U.S. Constitution, a variety of international instruments, including the Convention on the Elimination of All Forms of Discrimination against Women, the Geneva Conventions, the Convention against Torture, and the International Covenant on Civil and Political Rights, enshrine and protect rights to abortion for women around the world. However, as long as the U.S. remains the world’s largest donor of development and humanitarian aid, abortion restrictions on foreign assistance, such as the Helms Amendment, will continue to impede the ability of women around the world to exercise their right to abortion services.  

Today, as we reflect on the legacy of Roe, and sit on pins and needles as we anticipate the arguments and Supreme Court decision in Whole Women’s Health v. Cole, let us also reflect on the idea that the right to abortion is nothing without the protection of actual access to these services, including through public funding. And that policymakers in Washington D.C. shouldn’t be the reason that women are unable to exercise their rights around the world.

 

Akila Radhakrishnan is the Legal Director at the Global Justice Center. She has published articles in The Atlantic, Women Under Siege, RH Reality Check, Ms. Magazine, the Denver Journal of International Law and Policy and Reproductive Laws for the Twenty-First Century.