What Counts as Global Health? The Case of Clandestine Abortion Access Activist Networks

Margaret Macdonald

doi:10.18357/anthropologica66120242688

Authors

Margaret Macdonald https://orcid.org/0000-0002-8432-5544

DOI:

https://doi.org/10.18357/anthropologica66120242688

Keywords:

medication abortion, global health, global maternal health, pharmaceutical activism, sexual and reproductive health and rights, unsafe abortion, Women on Waves

Abstract

Safe abortion access is an essential aspect of reproductive justice and key to reducing global rates of maternal mortality, yet within the global heath enterprise, the rhetoric of sexual and reproductive health and rights has not yet been realised in practice. Access to safe legal abortion remains inequitable globally and within nations and deaths due to unsafe abortion take their highest toll in the Global South in jurisdictions with restrictive laws. Clandestine abortion access activist networks have been filling this gap offering life, dignity and futures to the people who seek their services. What should we make of clandestine activist networks around the world that help people access medication abortion? Such groups have been important players in women’s reproductive health in many jurisdictions for decades – but have typically, by necessity and design, flown under the radar. If visibility, accountability and humanitarian appeal are essential characteristic of global health work, how do we acknowledge and understand the work of clandestine abortion access activist networks? Does it count as global health? In this essay I offer the notion of ‘critique in action’ to further our understanding of such networks and also consider the idea of abortion access activist networks as an anti-regime of global health.

Downloads

Download data is not yet available.

References

Adams, Vincanne. 2016. Metrics. What Counts in Global Health. Durham, NC: Duke University Press.

Aid Access. https://aidaccess.org/ (accessed 24 January 2024).

Bart, Pauline B. 1987. “Seizing the Means of Reproduction: An Illegal Feminist Abortion Collective—How and why it worked.” Qualitative Sociology 10(4): 339–357. https://doi.org/10.1007/BF00988383.

Biehl, Joao. 2016. “Theorizing Global Health.” Medicine Anthropology Theory 3(2): 127–142. https://doi.org/10.17157/mat.3.2.434.

——. 2009. “The Brazilian Response to AIDs and the Pharmaceuticalization of Global Health.” In Anthropology and Public Health, edited by Robert Hahn and Marcia Inhorn, 50–70. Oxford: Oxford University Press.

Brown, Theodore, Marcos Cueto, and Elizabeth Fee. 2006. “The World Health Organization and the Transition from ‘International’ to ‘Global’ Public Health.” American Journal of Public Health 96(1): 62–72. https://doi.org/10.2105/AJPH.2004.050831.

Canadian Institute for Health Information. n.d. Induced Abortions Reported in Canada in 2021: Update. Ottawa: Canadian Institute for Health Information (accessed June 2023).

Caulkin, Sydney. 2023. When Abortion Pills Go Global. Reproductive Freedom Across Borders. Berkeley: University of California Press.

Centre for Reproductive Rights. n.d. https://reproductiverights.org/kenya-abortion/ (accessed January 2024).

Childerhose, Janet and Margaret MacDonald. 2013. “Health Consumption as Work: The Home Pregnancy Kit as Domesticated Health Tool.” Social Science and Medicine 86: 1–8. https://www.sciencedirect.com/science/article/abs/pii/S0277953613001287.

Chu, Justin J, Adam J Devall, Leanne E Beeson, Pollyanna Hardy, Versha Cheed, Yongzhong Sun et al. 2020. “Mifepristone and Misoprostol versus Misoprostol Alone for the Management of Missed Miscarriage (MifeMiso): a Randomised, Double-blind, Placebo-Controlled Trial.” The Lancet 396(10253): 770–778. https://doi.org/10.1016/S0140-6736(20)31788-8.

Costa, S.H. 1998. “Commercial Availability of Misoprostol and Induced Abortion in Brazil.” International Journal of Obstetrics and Gynaecology 63 (1): S131–9. https://doi.org/10.1016/s0020-7292(98)00195-7.

Cueto, Marcos. 2013. “A Return to the Magic Bullet? Malaria and Global Health in the 21st Century.” In When People Come First: Critical Studies in Global Health, edited by Joao Biehl and Adriana Petryna, 30–53. Princeton, NJ: Princeton University Press.

Dao, B., J. Blum, B. Thieba, S. Raghavan, M. Ouedraego, J. Lankoande, and B. Winikoff. 2007. “Is Misoprostol a Safe, Effective and Acceptable Alternative to Manual Vacuum Aspiration for Postabortion Care? Results from a Randomised Trial in Burkina Faso, West Africa.” BJOG: An International Journal of Obstetrics and Gynaecology 114: 1368–1375. https://doi.org/10.1111/j.1471-0528.2007.01468.x.

de Zordo, Silvia. 2016. “The Biomedicalisation of Illegal Abortion: the Double Life of Misoprostol in Brazil.” História, Ciências, Saúde-Manguinhos. 23(1): 19–35. https://doi.org/10.1590/S0104-59702016000100003.

Drabo, Seydou. 2021. “The Domestication of Misoprostol for Abortion in Burkina Faso: Interactions Between Caregivers, Drug Vendors and Women.” In Anthropologies of Global Maternal and Reproductive Health: From Policy Spaces to Sites of Practice, edited by Lauren Wallace, Margaret MacDonald, Katerini Storeng, 57–72. Chams: Springer.

Epstein, Steven. 1995. “The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials.” Science, Technology, and Human Values 20 (4): 408–437. https://www.jstor.org/stable/689868.

Farmer, Paul. 2004. “An Anthropology of Structural Violence.” Current Anthropology 45(3): 305–325. https://doi.org/10.1086/382250.

Fassin, Didier. 2012. Humanitarian Reason. A Moral History of the Present. Berkeley: University of California Press.

Foucault, Michel. 2010. The Birth of Biopolitics: Lectures at the College de France, 1978–1979. New York, NY: Picador.

Ganatra, Bela, Caitlin Gerdts, Clémentine Rossier, Brooke Ronald Johnson, Özge Tunçalp, Anisa Assifi, Gilda Sedgh et al. 2017. “Global, Regional, and Subregional Classification of Abortions by Safety, 2010–14: Estimates from a Bayesian Hierarchical Model.” Lancet 390(10110): 2372–2381. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31794-4/fulltext

Johnson, C. 2021. “The End of the Maternal Health Moment: An Examination of Canada’s Evolving Global Reproductive Policy Commitments.” International Feminist Journal of Politics, 25(1), 54–75. https://doi.org/10.1080/14616742.2021.1997150.

Jones, Rachel K., Elizabeth Nash, Lauren Cross, Jesse Philbin, and Marielle Kirstein. 2022. “Medication Abortion Now Accounts for More Than Half of All US Abortions.” https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions (accessed 10 January 2024).

Kaplan, Laura. 1997. The Story of Jane: The Legendary Feminist Abortion Service. Chicago: University of Chicago Press.

Kumar, R., Birn, A., and McDonough, P. (2016). “Agenda-Setting in Women’s Health: Critical Analysis of a Quarter-century of Paradigm Shifts in International and Global Health.” In Handbook on Gender and Health, edited by Ramya Kumar, Anne-Emanuelle Birn, and Peggy McDonough, 25–44. Cheltenham, UK: Edward Elgar Publishing. https://doi.org/10.4337/9781784710866.00012.

Lakoff, Andrew. 2010. “Two Regimes of Global Health.” Humanity: An International Journal of Human Rights, Development, and Humanitarianism 1(1): 59–79. https://resolver.scholarsportal.info/resolve/21514364/v01i0001/59_trogh.xml.

Littlefield, Amy. 2024. “The Abortion Pill Underground.” The Nation. 7 May. https://www.thenation.com/article/society/telehealth-abortion-shield-laws/

Lowy, Ilana and Marilena Cordeiro Dias Villela Corrêa. 2020. “The ‘Abortion Pill’ Misoprostol in Brazil: Women’s Empowerment in a Conservative and Repressive Political Environment.” American Journal of Public Health 110: 677–684. https://doi.org/10.2105/AJPH.2019.305562.

MacDonald, Margaret. 2017. “The Making of Informed Choice in Ontario Midwifery: A Feminist Experiment in Care.” Culture, Medicine and Psychiatry 42(2): 278–294. https://doi.org/10.1007/s11013-017-9560-9.

——. 2020. “Misoprostol: The Social Life of a Life-saving Drug.” Science, Technology and Human Values 46(2): 376–401. https://doi.org/10.1177/0162243920916781.

McGovern, Terry, Marta Schaaf, Emily Battistini, Emily Maistrellis, Kathryn Gibb, and Sara E. Casey. 2020. “From Bad to Worse: Global Governance of Abortion and the Global Gag Rule.” Sexual and Reproductive Health Matters 28(3): 54-63. https://doi.org/10.1080/26410397.2020.1794411.

Oti, SO, and J. Ncayiyana. 2021. “Decolonising Global Health: Where are the Southern Voices?” BMJ Global Health 6(7). https://doi.org/10.1136/bmjgh-2021-006576.

Prata, Ndola, Amita Sreenivas, Farnaz Vahidnia, and Malcolm Potts. 2008. “Saving Maternal Lives in Resource-poor Settings: Facing Reality.” Health Policy 89(2): 31–148. https://doi.org/10.1016/j.healthpol.2008.05.007.

Redfield, Peter. 2013. Life in Crisis: The Ethical Journey of Doctors without Borders. Berkeley: University of California Press.

Richardson, Eugene. 2019. “On the Coloniality of Global Public Health.” Medicine Anthropology Theory 6(4): 101–118. https://doi.org/10.17157/mat.6.4.761.

Say, Lale, Doris Chou, Alison Gemmill, Özge Tunçalp, Ann-Beth Moller, Jane Daniels et al. 2014. “Global Causes of Maternal Death: a WHO Systematic Analysis.” Lancet Global Health 2(6): e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X.

Sedge, Gilda, Susheela Singh, Iqbal H Shah, Elisabeth Ahman, Stanley K Henshaw, and Akinrinola Bankole. 2012. “Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008.” The Lancet 379(9816): 625–632. https://doi.org/10.1016/S0140-6736(11)61786-8.

Shah, Iqbal H., E. Åhman, N. Ortayli. 2014. “Access to Safe Abortion: Progress and Challenges since the 1994 International Conference on Population and Development (ICPD).” Contraception. 90:S39–48. https://doi.org/10.1016/j.contraception.2014.04.004.

Singer, Merrill and Barbara Rylko-Bauer. 2021. “The Syndemics and Structural Violence of the COVID Pandemic.” Open Anthropological Research 1(1): 7–32. https://doi.org/10.1515/opan-2020-0100.

Storeng, Katerini and Dominique Behague. 2014. “‘Playing the Numbers Game’ Evidence-Based Advocacy and the Technocratic Narrowing of the Safe Motherhood Initiative.” Medical Anthropology Quarterly 28(2): 260–279. https://doi.org/10.1111/maq.12072.

Suh, Siri. 2021. Dying to Count. Post-Abortion Care and Global Reproductive Health Politics in Senegal. New Brunswick, NJ: Rutgers University Press.

Tang, J., N. Kapp, M. Dragoman, and J.P. De Souza. 2013. WHO recommendations for misoprostol use for obstetric and gynecologic indications. International Journal of Gynecology and Obstetrics, 121(2): 186–189. https://doi.org/10.1016/j.ijgo.2012.12.009.

Terry, Fiona. 2002. Condemned to Repeat? The Paradox of Humanitarian Action. Ithaca, NY: Cornell University Press.

Women on Waves. “How to Do an Abortion with Pills (misoprostol, Cytotec)” https://www.womenonwaves.org/en/page/702/how-to-do-an-abortion-with-pills--misoprostol--cytotec (accessed October 2023).

World Health Organization. 2023. Self-care interventions for sexual and reproductive health and rights to advance universal health coverage: 2023 joint statement by HRP, WHO, UNDP, UNFPA and the World Bank. Geneva: World Health Organization.

——. 2008. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality 6th Edition. Geneva: World Health Organization.

——. 2018. Abortion. https://www.who.int/news-room/fact-sheets/detail/abortion. (accessed 24 January 2024).