How US policy denies life-saving care to women raped in war

By — August 12, 2013

Angelina Jolie doesn't mince words.

“Let us be clear what we are speaking about,” the award-winning actress and humanitarian said in June as she addressed the United Nations Security Council session on sexualized violence in conflict. “Young girls raped and impregnated before their bodies are able to carry a child, causing fistula; boys held at gunpoint and forced to sexually assault their mothers and sisters; women raped with bottles, wood branches, and knives to cause as much damage as possible; toddlers, even babies, dragged from their homes and violated.”

Children gather in a makeshift camp in the Democratic Republic of Congo. (Julian Harneis)

For years, Jolie has been a spokeswoman for refugees forced to leave their homes, and for the survivors of sexual assault in conflict. But while sexualized violence in wartime affects several populations and has a variety of consequences, one of its major, and often unaddressed, consequences, particularly for young girls, is unwanted pregnancy that can result from rape.

This is why the Global Justice Center created the August 12th Campaign, which seeks to ensure access to safe abortion services for girls and women raped in armed conflicts. August 12 is the anniversary of the Geneva Conventions, which guarantees that war victims receive all the medical care required by their condition—medical care that should include the option of abortion for women who are pregnant from rape.

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Reliable statistics on pregnancy from rape can be hard to come by. In a 1996 report, U.N. Special Rapporteur on Rwanda Rene Degni-Segui estimated that between 250,000 and 500,000 women were raped in the 100-day Rwandan genocide. An exhibition, “Intended Consequences: Rwandan Children Born of Rape,” put on by the Paley Center for Media in 2011, estimated that approximately 20,000 children were born from rape in that time. In Bangladesh, during the 1970s, approximately 25,000 children were born from rape, according to reports citing official sources.

Several studies have found that pregnancy from rape in wartime compounds the physical, psychological, and social consequences for the survivors. These consequences are severe, even deadly for young girls whose bodies have not adequately matured to deliver a child.

“Pregnancy is a leading cause of death among girls aged 15 to 19, most frequently due to complications of delivery and unsafe abortion,” according to “Adolescent Sexual and Reproductive Health Toolkit,” a joint report published in 2009 by Save the Children and the UNFPA. “Adolescents aged 15 to 19 are twice as likely to die during pregnancy and childbirth—as are those in their twenties—and very young adolescents, under 15 years of age, have a fivefold increase in risk of death during pregnancy and childbirth compared with women 20 and older.”

The report points out how young pregnant women are a high-risk group particularly in emergency situations, including conflict zones, when family and social support systems are disrupted. The report also says that countries that “have experienced recent war or civil unrest have especially high rates of newborn mortality.”

In addition to these serious physical consequences, the social stigma associated with becoming pregnant from rape is also severe—and for young girls, this can have a long-term impact. According to Save the Children’s 2013 report, “Unspeakable Crimes Against Children,” girls, particularly those who become pregnant from rape, “will often be forced to drop out of school, be prevented from accessing vocational training and face social exclusion and stigmatisation. Their chances of further education, livelihoods and marriage are severely diminished or completely eliminated.”

One girl, 18-year-old Marianne, spoke to the writers of a 2012 article, called “Women and Children Bearing Children through Rape in Goma, Eastern Congo: Stigma, Health and Justice Responses,” published in the Itupale Online Journal of African Studies. Marianne, who bore a child through rape in the Democratic Republic of Congo, described her perceived value as a woman:

“I have nothing to give the child. How can I return to school? I am a woman with a bad reputation. I am a woman without value, they look down on me, are disgusted with me. How can I get rid of this bad reputation I have no future. I cannot go to study anymore. I am a woman without a future.”

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While experts have acknowledged that pregnancy from rape can exacerbate the consequences of the rape, little has been done to actually address and resolve this problem. The vast majority of women who become pregnant from rape in conflict lack access to safe abortion services. These women could resort to non-sterile or non-medical methods, which can lead to scarring, infection, sterilization, or death.

One girl, Angeline, told the writers of the Itupale Online Journal article about her attempts to induce an abortion.

“When I came from the forest I had the idea of aborting the pregnancy as I also had other children so I could not afford feeding them. My decision was to abort and stay with the other children. I had friends who advised me to take some tablets. I can’t know the name of the medicine. There is also Aloe leaves which I took but I did not abort unfortunately. I was not happy as my decision was to abort and stay with the other children as at the time I was unable to take care of them and it was what I wanted to do but it wasn’t successful and I was hurt.”

Angeline is not alone. Research has shown that women who have become pregnant from rape do sometimes attempt to administer their own abortion. In Bangladesh, according to Susan Brownmiller, author of a groundbreaking book on rape, women who became pregnant from rape would “put up their babies for adoption … [or] resorted to crude self-administered abortions, suicide, or infanticide.”

In the majority of cases, the humanitarian response has been simply to include the provision of emergency contraception. But this has often proved inadequate due to the very short temporal window in which it can be administered. In order for the emergency contraception to be efficacious, the woman must present up to 72 hours to 125 hours after the rape. Yet research has shown that very few women are able to present to a medical facility within this period.

An in-depth study of women raped in the Democratic Republic of Congo, for instance, found that the percentage of women who sought medical care within 72 hours ranged from 0.6 percent to 3.2 percent. The study, which was conducted from 2003 through 2009, showed that the majority of victims of rape in wartime who seek medical care, or wish to prevent or terminate an unwanted pregnancy, would not be able to benefit from emergency contraception.

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These stories underscore the importance of providing safe abortions from a practical—not to mention humanitarian and legal—perspective. The Global Justice Center’s August 12th Campaign has been working with major humanitarian donor states, including the UK and the Netherlands, to ensure that their aid can be used to provide safe abortion services. Access to safe abortion services, after all, is a right under the Geneva Conventions for girls and women who have been raped in wartime.

The Conventions, also known as the laws of war, includes the right to be provided with comprehensive and non-discriminatory medical care and to be free from cruel treatment and torture. What this means, in practice, is that as war victims, girls and women must be offered all necessary care as dictated by their condition. In the cases of girls and women who become pregnant from rape, this should include the option of abortion.

But despite the existence of this right under the Geneva Conventions, and despite the humanitarian imperative to provide access to safe abortion services, such services are rarely, if ever, available during times of conflict. In places like Bosnia and Sierra Leone, women were deliberately held until it was too late to obtain an abortion or were denied abortions in order to effect forced pregnancy.

A major obstacle to the provision of safe abortion services in conflict zones are U.S. abortion restrictions on foreign assistance, including on humanitarian assistance to war victims. These restrictions, which originate from Congress, can be interpreted to include exceptions for life, rape, and incest, because the restrictions apply only to “abortions [provided] as a method of family planning.” 

But the Obama administration imposes these restrictions on all foreign assistance funds without the permitted exceptions (continuing a policy that was administratively put in place by the Bush administration).

And they don’t have to.

President Obama is well within his authority to take executive action to include these exceptions—exceptions that are generally, albeit grudgingly, also included in amendments by opposing policymakers in their efforts to curb abortion access domestically. The U.S. leader has already made the prevention and response to gender-based violence a cornerstone of his administration’s foreign policy.

In 2011, President Obama signed an executive order for the institution for a National Plan of Action on Women, Peace, and Security, pledging to “respond to the distinct needs of women and children in conflict affected disasters and crises, including by providing safe, equitable access to humanitarian assistance.” More recently, in February, the U.S., as the penholder on sexualized violence in conflict at the Security Council, was integral in drafting and passing a resolution that called on all donor countries to provide “comprehensive and non-discriminatory” medical services to girls and women raped in armed conflict.

The August 12th Campaign calls on President Obama to lift these abortion restrictions on humanitarian aid for war rape victims, ensuring that girls and women are granted their rights under the Geneva Conventions. The administration’s admirable pledges should translate to helping girls and women in conflict zones and providing them with a choice they deserve after they have been raped. Yet current U.S. policy denies life-saving care to these women.

The U.S. is laudably one of the world’s largest and most committed humanitarian donors. President Obama, it is within your power to end this inhuman policy. What are you waiting for?