The BMJ Today: When the worst choice is no choice at all

You would think that any woman raped as an act of war would be given access to a safe abortion by an international organisation providing aid. Sally Howard’s Feature on reveals that, astonishingly, this is often not the case.

I would highly recommend reading this article. It explains that the 1973 Helms Amendment to the United States (US) Foreign Assistance Act has resulted in “an outright ban on US aid funds being used for all abortion related activities, other than post-abortion care.” Although the amendment applies to aid from the US, aid workers have warned that, more broadly, the absence of abortion provision in humanitarian responses to conflict could be “squarely attributed” to US foreign aid policy. If you want to learn a bit more about the number of women who have undergone unsafe abortions there is an informative infographic here.

Surely the UK wouldn’t allow its aid to be restricted in this way? Well sadly, the UK, along with France, Germany, and Japan, has remained “conspicuously silent” on the issue, Howard says. This is due in part to the UK’s partnership with the International Committee of the Red Cross, an organisation that is heavily dependent on US aid. Only Norway, Sweden, and the Netherlands, Howard says, have taken a stand, calling for an end to the “draconian implementation” of the amendment.

Although this small voice of descent seems to bring some hope, there is in fact worse yet to come. In the US, pro-life groups are calling for a reinstatement of the more restrictive Mexico City gag rule. This rule requires all non-governmental organisations that receive any US aid funding to “refrain from performing or promoting abortion services as a method of family planning with non-US government funds even where these services are not funded by US aid,” Howard says.

Perhaps unsurprisingly, it appears that male domination of women’s right to choose is not restricted to the US. Ingrid Torjesen reports that vasectomies, female sterilisation, and the advertising of birth control are to be banned in Iran.

Last year Ali Khamenei, the supreme leader of Iran, called for more babies to be born in the country, and in May this year he appealed to Iranians to “save yourselves from this ominous culture of one child or two children nonsense.” He also recommended that Iran women should have as many as 14 children.

It is a little difficult to understand the motivation behind the new ban since, as Torjesen reported, in the 1990s Iran introduced a birth control programme, which included subsidised male sterilisation surgeries and free condom distribution, under the banner of “fewer kids, better life.”

 Abi Rimmer is BMJ Careers news reporter.