Examination of Witnesses (Questions 240
- 247)
WEDNESDAY 5 DECEMBER 2007
DR GILL
GREER
Q240 Ann McKechin: You mentioned
how it took over 30 years to legalise abortion in Nepal. How was
it eventually achieved and to what extent did civic society play
a role in that?
Dr Greer: As I said, they held
their first workshop back in 1971. After Cairo in 1994, they held
another series of workshops with parliamentarians, civil society
and others and working with other partners. In 1997 they had the
first draft Bill. In 1999, you may remember, there was a major
outcry around the world about a 14-year old who was imprisoned
after she had been raped by her uncle, reported by her father,
and nothing happened to the uncle. There was a call by IPPF, together
with donor governments, to have this life sentence reversed, and
this was done. Not long after that it really gathered impetuous.
She, in fact, now works for the Member Association which received,
ironically, an award from the Government this year and they then
worked again with a wide range of civil society and with people
interested in the Government so that the draft Bill ws passed
into law in 2002. There are 165 providers. Our organisation has
13 clinics and is hoping to build another six, and they are working
very closely with the Government to address the issue, but there
are still a number of unsafe abortions being carried out.
Q241 Ann McKechin: I was going to
ask you that, because I noticed in your submission that you did
not actually state what the actual reduction had been in maternal
deaths?
Dr Greer: There is a reduction
in maternal deaths and it is a dramatic reduction, and it has
been basically halved. About 48 % is the reduction.
Q242 Ann McKechin: I have also noticed
there has been a very dramatic reduction in the fertility rate
over 10 years from 5.1 to 3.1. Is it because there now is open
provision of family planning or are there any other issues, like
marriage age, which have been altered?
Dr Greer: I think that has certainly
contributed to it, and there is a law against child marriage,
although it is inconsistently applied and the sanctions are not
as rigorous as one might hope for: because, without a doubt, child
marriage is a driving factor in increasing rates of maternal mortality
and particularly maternal morbidity, and I think that is what
we must not forget. For every one of those half million who die,
another 30 women are disabled or injured or ill as a result, and
in Nepal in particular, as a result of early marriage, of child
marriage, we see a lot of pro-uterine prolapse, which it is very
difficult to get funding to address. We have tried a couple of
times unsuccessfully.
Q243 Ann McKechin: Which countries
apart from Nepal have seen a drop in maternal deaths following
legalisation of abortion? Has that been a universal consequence?
Dr Greer: I think, yes.
Q244 Ann McKechin: Are there other
measures?
Dr Greer: If you take, for example,
Eastern Europe, Romania, which is the classic example because
it has been backwards and forwards now several times, yes, we
have seen a real demonstrable drop in countries where abortion
has been legalised.
Q245 Ann McKechin: Lastly, can I
ask you how significant was DFID's role in reducing maternal mortality
in Nepal? Was their particular intervention a catalyst for change
and how easily could they actually replicate that approach in
other countries in which they operate?
Dr Greer: I think it has been
a major success. I understand that at the beginning perhaps there
were queries about who was accessing and whether it was the neediest
who were accessing, and that has been addressed and I think, with
those lessons learned, it can certainly be built on and replicated
as, indeed, DFID projects in terms of increasing the number of
health workers, trained birth attendants in countries like Uganda,
Malawi, but I am really critical, and I do think one of the things
we need to think about is very much the role of volunteers, of
lower level health workers in maternal health in particular and
the impact too, if I can add very quickly, of micro-credit. I
am thinking of a scheme, for example, in India where women purchased
a taxi. They make money from the taxi but when anyone needs emergency
care because of problems during labour, they use the taxi, and
they have also managed to get cell-phones so that they have a
method of contacting each other to get a woman to care in time.
Q246 Chairman: Can I ask you on this
issue of family planning and abortion and maternal mortality how
aggressive you feel you can be in promoting your case? These are
sensitive issues, there are faith issues and there are moral issues.
You put it starkly on the basis of the figure you gave before.
What you are really saying is that more than 100,000 women a year
are dying in childbirth because they have been denied access to
contraception, yet you cannot get money from the United States
and there are other organisations, churches and the like, who
say we cannot do that. How aggressive do you feel you can be in
saying, "Actually these organisations are condemning women
to death by denying them access to these facilities?
Dr Greer: It is similar to saying
that condoms are not effective against HIV and AIDS when they
are 98% effective. It is denying people in that case information
and a method to protect themselves. IPPF describes itself as a
leading advocate on sexual and reproductive health and we believe
that that is absolutely what we must do. We recognise that in
those 152 Member Associations they are working in differing country
contexts and there is no doubt that, unfortunately, morality and
mortality become intertwined all too often, and so they need to
choose their own strategy for working. Somebody said to me recently,
they could understand that it was difficult for a particular association
or particular country because it was a Muslim country, as was
theirs, and I said, yes, as are most of the countries in which
we work in in South Asia, many in South East Asia, many in Africa
and, of course, in the Arab world, and those that are not will
often have a very strong Roman Catholic tradition or sometimes
a new fundamentalist tradition, but if we do not speak out and
say that no-one should die as a result of sex, that pregnancy
should be a cause for celebration and joy, not for despair, and
that women should not die needlessly, if we are not brave enough
to say that after 50 years, or 60 years, who is going to say it?
So, we do expect our organisations to be brave and angry and effective
and accountable. It is what Gloria Steinem used to call "intelligent
rage". It is no good just getting in and shouting about it,
although that has its part to play. It is about showing the data,
telling the stories of those who die needlessly. I do not believe
that anyone really wants to see women die. We have seen changes,
and we can make change. It will take time, but we can do it, with
support.
Q247 Chairman: Thank you very much
for that. I am glad I asked you that question. Thank you for coming.
Dr Greer: Thank you very much.
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