羅訴韋德案 (Roe vs. Wade) 的倒下對世界其他地方意味著什麼
資料來源：DAYNA KERECMAN MYERS / 2022 年 11 月 18 日 / aidsmap / 財團法人台灣紅絲帶基金會編譯
DAYNA KERECMAN MYERS，總編輯
泰國芭達雅——圍繞美國羅訴韋德案 (Roe v. Wade) 的倒台如何影響世界其他國家的弱勢群體的問題，在本週的國際計畫生育會議上聚集的計畫生育倡導者、研究人員和提供者中佔據重要地位——他們與一些人分享說，已經看到大膽的墮胎權反對者推動了一些轉變。
與許多其他鬥爭一樣，他們擔心貧窮國家的婦女和女童將遭受最大損失。
現實是，每年有 2,500 萬例不安全墮胎——絕大多數不安全墮胎發生在貧窮國家的婦女和女孩身上，PSI 非洲高級臨床顧問 Milly Kaggwa 醫學博士在全體會議後的新聞發布會上說，星期三的標題是「在 Roe v. Wade 案之善後捍衛墮胎權」。
「我們知道它來了。 我們知道它已經存在很長時間了」，Ipas 總裁兼首席執行官 Anu Kumar 博士、公共衛生碩士在談到美國最高法院去年 6 月的裁決時說，該裁決取消了對美國人墮胎權的保護。「坦率地說，這只是反維權行為者為遏制和壓製女性、LGBTQ 人群、黑人和棕色人種而建造的另一塊牆磚——並且產生了全球連鎖反應」，她說。
Kumar 還指出，美國在限制墮胎的法律依據方面與世界其他大部分國家不一致，其他數十個國家正在努力擴大墮胎的範圍。 在拉丁美洲，包括墨西哥、阿根廷和哥倫比亞在內的國家都已開始擴大權利； 在非洲，就在本週，貝寧也開始擴大對墮胎照護的保護。
這些限制也與大多數美國人格格不入。 Kumar 指出，根據 Ipas 的研究，十分之九的美國人不支持禁止墮胎。 無論如何，庫馬爾說，「我們知道反對派膽子很大，他們以此為藉口破壞長達數十年的努力」。
MSI Reproductive Choices （註1）的政策和宣傳官 Namakando Simamuna 分享了她的國家甘比亞的情況。 「我們已經看到以錯誤信息為特徵的反選擇活動有所增加，並試圖推翻積極的政策勝利。 當我們在提供服務的第一線工作時，我們看到這如何影響服務的獲取，並了解這最終如何導致孕產婦死亡率上升……法律和政策限制如何使婦女和女童邊緣化並造成脆弱性和品質和獲取方面的下降」。
相較之下，Simamuna 說，在 MSI 放寬墮胎限制的國家，情況有了顯著改善，例如尼泊爾，在放寬墮胎法後，產婦死亡率下降了 50%。
另一位小組成員、IPPF （註2）哥倫比亞成員協會 ProFamilia 的執行董事 Mara Royo 指出，即使權利受到法律保護，也有許多力量在阻礙人們獲得生殖保健。
在哥倫比亞，儘管有法律保護，但由於該國正遭受大量暴力和動盪，因此服務取得仍存在挑戰。「去年，有 100,000 名少女懷孕，其中 34% 是 14 歲以下的兒童。這在哥倫比亞就是強姦。在過去的 6 個月中，我們還報告了 15,800 起 15 歲以下女孩遭受性虐待的案件」，Royo 說； 提供及時、優質、墮胎，在這場暴力中變得非常困難」。
小組成員對拉丁美洲地區的其他國家表示嚴重關切——尤其是尼加拉瓜、薩爾瓦多和洪都拉斯，這些國家已經對墮胎照護的提供者和接受者處以監禁； 羅約表示，這些國家的統治者可能會將美國的權利倒退視為「綠燈」進一步降低最弱勢群體的人權。
Ipas Africa 的臨床主任安吉拉·阿科爾 (Angela Akol) 表示，接受美國外援的國家在獲取服務方面也面臨著加劇的挑戰，她說肯亞和其他非洲國家已經看到反對力量不僅針對墮胎權，還針對全面的性教育和 LGBTQ 權利。
國際計畫生育基金會全球宣傳臨時主任兼美國代表貝絲施拉赫特警告說，反對墮胎權的同一批人也在針對著提供避孕措施上的努力：「因為避孕實際上是關於自由，他們終級上就反對婦女、兒童、窮人、有色人種等墮胎上的自由，他們更投注於更多的力量。 如果我們不將避孕和墮胎視為權力問題，那麼我們就會錯失大局，我們會打錯了仗」，她說。
但就尋找解決方案而言，施拉赫特建議嘗試推進「基於價值觀圍繞在福祉和意圖上的對話」，並試圖擺脫過去的標籤和詞語——例如全面性的性教育、支持選擇、支持墮胎——這些標籤和詞語往往會推動「每個人的圍牆以某種方式出現」。 相反地，她建議在我們共同的人類價值觀、我們關心他人的願望（包括 14 歲懷孕兒童的需求）中尋找共同點，並將「這種理解納入政策和立法、關懷和服務，最終以為我們所有人提供福祉的方式」。
註1：MSI Reproductive Choices，在 2020 年 11 月之前名為 Marie Stopes International，是一個國際非政府組織，在全球 37 個國家/地區提供避孕和安全墮胎服務。 MSI Reproductive Choices 作為一個組織遊說支持墮胎，並在英國和其他合法的國家提供各種性和生殖保健服務，包括建議、輸精管切除術和墮胎。 它位於倫敦，是一家根據英國法律註冊的慈善機構。
註2：國際計畫生育聯合會（英語：International Planned Parenthood Federation, IPPF），是一個旨在促進性與生殖的健康、提倡家庭計畫中自我選擇權、亦服務於未婚懷孕的母親等急需援助人士的非政府組織。於1952年成立於印度孟買，總部設在倫敦，國際計畫生育聯合會現分6個區域，現有149個成員工作在189個國家或地區。
What the Fall of Roe vs. Wade Means for the Rest of the World
DAYNA KERECMAN MYERS / NOVEMBER 18, 2022 / aidsmap
DAYNA KERECMAN MYERS, MANAGING EDITOR
PATTAYA, THAILAND—Questions surrounding how the fall of Roe v. Wade in the US could affect vulnerable people in other countries around the world featured heavily among the family planning advocates, researchers, and providers gathered for this week’s International Conference on Family Planning—with some sharing that they are already seeing some shifts driven by emboldened abortion rights opponents.
And as with so many other struggles, they worry that women and girls in poor countries stand to lose the most.
The reality is that there are 25 million unsafe abortions each year—and the overwhelming majority of unsafe abortions happen to women and girls in poor countries, PSI senior clinical advisor for Africa Milly Kaggwa, MD, said at a press conference following a plenary session on Wednesday titled “Standing up for abortion rights in the aftermath of Roe v. Wade.”
“We knew it was coming. We knew it had been coming for a long time,” Anu Kumar, PhD, MPH, president and CEO of Ipas, said of the US Supreme Court ruling last June that erased protections for abortion rights for Americans. “This is frankly just another brick in the wall that anti-rights actors are building to contain and silence women, LGBTQ people, black and brown people—and there’s a global ripple effect,” she said.
Kumar also pointed out that the US is out of step with much of the rest of the world in restricting legal grounds for abortion that dozens of other countries are at work to expand. In Latin America, countries including Mexico, Argentina, and Colombia have all moved to expand rights; in Africa, just this week, Benin moved to expand protections for abortion care as well.
The restrictions are out of step with a majority of Americans, too. According to Ipas research, 9 out of 10 Americans do not support a ban on abortion, Kumar noted. Regardless, Kumar said, “We know the opposition is emboldened and they’re using it as an excuse to undermine decades-long efforts.”
Namakando Simamuna, a policy and advocacy officer for MSI Reproductive Choices shared what that looks like in her country, Zambia. “We’ve seen a rise in anti-choice activities characterized by misinformation, and attempts to roll back positive policy wins. As we work on the frontlines of service delivery, we see how this affects access and understand how this eventually leads to a rise in maternal mortality … how the legal and policy restrictions marginalize women and girls and create vulnerabilities and dips in quality and access.”
In contrast, Simamuna said, countries where MSI works that loosened abortion restrictions saw dramatic improvements—such as Nepal, which saw up to a 50% decline in maternal mortality after abortion laws were liberalized.
Another panelist, Mara Royo, the executive director of IPPF’s Colombia Member Association, ProFamilia, pointed out that even when rights are protected legally, there are many forces at work that obstruct access to reproductive health care.
In Colombia, despite legal protections, there are challenges to access, as the country is suffering from a great deal of violence and upheaval. “Last year, there were 100,000 adolescent pregnancies, of which 34% were children below the age of 14. That’s rape in Colombia. We also have in the last 6 months 15,800 cases of reported sexual abuse in girls below the age of 15,” Royo said; providing access to “timely, quality, abortion, in the middle of this violence has become really hard.”
Panelists expressed grave concern for other countries in the Latin America region—especially Nicaragua, El Salvador, and Honduras, which already punish providers and recipients of abortion care with prison time; Royo said the rulers in these countries may see the rollback of rights in the US as a “green light” to further degrade human rights for the most vulnerable.
Countries that receive US foreign aid also face heightened challenges to access, according to Angela Akol, Ipas Africa’s clinical director, who said that Kenya and other African countries are already seeing opposition forces targeting not only abortion rights, but comprehensive sexuality education and LGBTQ rights.
Beth Schlachter, the International Planned Parenthood Foundation’s interim director of global advocacy and US representative, warned that the same actors opposing abortion rights are also targeting efforts to provide contraception: “Because contraception is honestly about freedom, and they’re ultimately against the freedom of women, children, poor people, people of color, and they are invested in their own power. If we don’t look at contraception and abortion as an issue of power, then we’re going to be missing the larger picture and we’re fighting the wrong battle,” she said.
But in terms of finding solutions, Schlachter suggested trying to advance a “values-based conversation around wellbeing and intentions,” and trying to get past labels and words—such as comprehensive sexuality education, pro-choice, pro-abortion—that tend to push “everyone’s walls to come up one way or another.” Instead, she suggests seeking out common ground in our shared human values, our desire to care for people—including the needs of a 14 year-old child who is pregnant—and “bring that understanding to policies and legislation, and care and services, in a way that ultimately provides for the wellbeing of all of us.”