Why Can't Women Raped in Conflict Access Safe Abortions?

How the US exported its abortion wars

A seventeen-year-old Congolese woman with her three-year-old daughter and her fourteen-year-old sister, in the church she sings at in the Kyangwali refugee settlement, Uganda, June 5, 2019. All photos by Nichole Sobecki.

I have a piece out in the New York Review today exploring why women raped in conflict overwhelmingly cannot access safe abortions — even though we know that rape in conflict is common, that many women get pregnant from rape, and that many of those women seek out unsafe abortions when safe ones aren’t on offer. It’s a story I’ve been working on for four years, and reported from Colombia, Bangladesh, and Uganda along with exceptional photographer and friend Nichole Sobecki.

Much of the reporting was story-gathering: Sitting down with women, listening as they told me about the worst things that had ever happened to them. Only a handful of these stories actually made it into this piece; the others live in notebooks. I hope it’s useful to know that the women’s voices you hear in the piece are just a tiny sliver of a much larger whole.

Reporting this story has been equal parts gratifying and heartbreaking. I kept most of the really awful details out of the final piece because they felt prurient and excessive, but the hardest part of doing this kind of work is having a front-row seat to the worst things human beings do to each other — things I’d prefer stayed unimaginable. Women’s bodies are the scenes of war crimes, and then the health care those women need is limited and politicized by misogynist laws and neglectful men who think they know better.

That’s the heartbreaking part. But there’s always the hopeful, too. At every stage of reporting this story there were helpers: The people advocating for women they had never met; the midwives getting “radical,” as one put it, by what they were seeing; women sharing their toughest stories and their biggest secrets with a stranger, solely on the hope that maybe it would make a difference for someone else someday.

When I conduct interviews with women who have lived through incredible trauma, the conversations are long and they are difficult and they are almost always tearful. Part of my goal, always, is to understand a woman as more than just the worst thing that she’s lived through; to understand where she comes from, her hopes and dreams, what brings her pleasure and joy, and where she wants her life to go. That’s easier in some situations than others — women who are trapped in refugee camps with no safe home to return to aren’t usually optimistic about their futures. But what I often hear from the women I talk to is that, even if the past was brutal and the future looks bleak, they carry a sense of pride in still being here and refusing to give up. “There is not that much I am proud of,” a Rohingya woman who was raped by soldiers, fled Myanmar, and figured out how to get a safe abortion in a Bangladeshi refugee camp told me. “But still I am alive after all that happened to me. I tried to save my own life. I am proud of that.”

In the coming weeks, I’ll share some of the stories that didn’t make it into this piece, and more details about how the US shapes the lives and options of women who don’t get to vote in our elections. For now, I hope you’ll read the piece (you have to register with your email address, but the piece itself is free to read). Below is a little bit of it:

At nineteen, Majeda worried that her life was over before it had really begun. Like so many other Rohingya Muslims, she had fled her home in Myanmar in 2017 and was living in a refugee camp outside the Bangladeshi city of Cox’s Bazar. When the military had come to her village in Myanmar and began beating people and burning homes, Majeda tried to run away—but she was caught, brought to an empty house with several other women, and gang-raped. That night, she got away, walking through the forest with family members to the border. It took them another four or five days, on foot and by boat, to reach Bangladesh. Eventually, she wound up in a crowded camp called Kutapalong.

After a month there, Majeda was feeling nauseated and uncomfortable. A health outreach worker she spoke to took her to an MSF clinic. Even getting there was tough. “We are not much able to go outside without burqas and hijabs,” Majeda told me. “We don’t even go to each other’s homes.”

In her conservative Rohingya community, marriage is the one and only path to social acceptance and motherhood; girls typically marry as teenagers. Majeda was already getting too old to marry well, and she was poor, which also hurt her chances. “I have seen a lot of men getting married to two or three women, and I don’t want to be in a situation like that,” Majeda said. But the situation she was in when MSF confirmed she was pregnant was, she knew, worse yet—to be an unmarried mother raising the child of a man who had raped her would make her a permanent outcast.

When Majeda told the health care workers that she didn’t want to have a baby, one gave her pills to take. Within a few days, her pregnancy was over, and she felt huge relief. “There is not that much I am proud of,” she said, “but still I am alive after all that happened to me. I tried to save my own life. I am proud of that.”

The majority of refugees from Myanmar arrived in Bangladesh within a catastrophic two-week period beginning on August 25, 2017. It was the fastest recorded influx of refugees in history, an exodus so immense that, almost four years on, Kutapalong remains the largest refugee camp in the world. Newcomers spill out into adjacent camps, using salvaged wood and UNHCR-provided tarps to build makeshift homes. Taken together, there are nearly 860,000 refugees living in the camps in the Cox’s Bazar district.

The Rohingya were fleeing mobs of Burmese soldiers and police officers and Buddhist monks, who swept through Rakine state bringing arson, torture, and murder in a brutal campaign of ethnic cleansing. As the marauders went through Rohingya villages, sexual violence was so prevalent that, nine months after the first refugees arrived on Bangladeshi shores, humanitarian workers feared an epidemic of abandoned, murdered, or neglected babies. UN Assistant Secretary-General for Human Rights Andrew Gilmour said that the earlier “frenzy of sexual violence” meant that by May 2018 aid groups were “expecting a surge of births.”

The dire predictions did not come to pass—but only because, for the first time in a major crisis, comprehensive abortion care had been folded into a humanitarian response from the start. Given the option of safe abortion, a great many women took it.

“This is the only place where [abortion] has been implemented in an acute emergency, has been implemented at scale, and has been integrated as a normative part of maternal health care,” said Tamara Fetters, a senior researcher at Ipas, a US-headquartered global reproductive health organization. “There were people who said that this community is too conservative, they do not want to limit their fertility, and there will be riots. And none of that really proved to be true.”

Within a month of the initial refugee arrivals, eight facilities in the camps offered safe abortion, euphemistically called “menstrual regulation” in Bangladesh. By the middle of 2019, some three hundred health care providers working at thirty-seven facilities in the Cox’s Bazar camps had been trained in safe abortion provision, as well as in postabortion care, and had provided that care to about eight thousand Rohingya women, of whom about six thousand had safe, legal, elective abortions. To date, health workers have provided more than 21,400 safe abortions and more than 7,800 postabortion care treatments in the Cox’s Bazar camps.

In many ways, Fetters said, this was the result of a discrete set of circumstances. Ipas had been working in Bangladesh for years on safe abortion provision. When the crisis came and other agencies were delayed by Bangladeshi bureaucracy, Ipas was there—and it moved fast. “If those other organizations that have more resources, that are able to mobilize more quickly, had been there in our seats,” Fetters said, “I don’t think we would have ever had the first program that provided safe abortion care up to scale in a humanitarian setting.”

The whole story is here. Thank you for reading.

xx Jill