Gardasil vial, via Wikimedia Commons. This is what we

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections. HPV symptoms include outbreaks of genital warts, and several of the strains (primarily types 16 and 18, which account for roughly 1 in 20 infections according to CDC statistic) are responsible for the majority of cervical cancer cases. Cervical cancer is the second leading cause of cancer deaths amongst women worldwide, particularly in developing nations.

So when vaccines that protect against the high-risk strains of HPV became available in 2008 it was a good thing, yes? A concerted vaccination program would reduce new infections, see a decrease in cervical cancer diagnoses over the next 15-20 years, and save millions of pounds in public health spending on pap smears, right? Well, sort of. The issue here is that there are two vaccines available, Gardasil from Merck and Cervarix from GlaxoSmithKline. Whilst both protect against strains 16 and 18, Cervarix does not provide any protection against the non-cancerous strains responsible for genital warts. Gardasil, by contrast, also protects against strains 6 and 11, which cause 90% of genital wart cases. Gardasil also has a rather high list price of £240 per person, whereas the makers of Cervarix have significantly undercut their list price in an unreleased contract with the NHS.

In countries such as Australia, that have taken up Gardasil, there has been a 75% decrease in new cases of genital warts over the last three years; the UK, over the same period, has seen no difference in the number of new cases. Whilst women aged 16-19 are the group most affected by this, the issue is one that matters to everybody: greater uptake of the vaccine increases herd immunity, protecting those who haven’t been vaccinated as well (for the same time period cases in unvaccinated heterosexual males fell by one third in countries using Gardasil).

So, and this is the problem, we’re now offered a vaccine that provides no protection against genital warts, and almost no information about the alternative (I could find just one mention of Gardasil on the NHS’s HPV vaccination page here ). Those in the know are seeking out Gardasil through private clinics, whilst the majority, arguably including those most at risk of infection, are left in the dark.

“We, as consultants in sexual health, have been told to say nothing publicly that would damage the current vaccine programme, as the Cervarix vaccine has already been purchased. We have had to be circumspect in public but in private we have all purchased Gardasil for our own children and advised colleagues to do the same.” – Dr. Colm O’Mahony and Dr. Steve Taylor

This is leading us into a split system whereby those who can are taking the greater protection of Gardasil, and everyone else is getting Cervarix. This is, I think, neither a reasonable nor efficient use of NHS funding, and somewhat gives the lie to health secretary Andrew Lansley’s promise of “no decision about you without you.”

Treatment of genital warts costs the NHS £31 million annually and takes trained staff away from time that could be spent on other serious conditions. It is difficult to gauge how this balances against the savings from sticking with the cheaper Cervarix, because the NHS will not release the details of their contract with GSK. With the contract coming up for renewal now is the time when Lansley needs to reveal the details of the contract, involve the public in the decision, and provide more accessible information regarding Gardasil.

Why is this relevant on a feminist blog? Fair access to this information (and related sexual health matters) is vitally important to women (and indeed to men). We all need to be equipped to not only make the best decisions for our own sexual health but also to campaign for those in the most at risk groups — who are currently being let down by the lack of information provided by the NHS. The choice of vaccine is an important issue that will effect tens of thousands of lives every year, and it is one the public needs to be involved in.

(Here’s the British Association for Sexual Health and HIV’s press release on the issue, which has links to some relevant papers.)

I asked some leading UK pro-choice campaigners whether the US reproductive justice approach introduced in Part 1 is relevant to their work, and what – if anything – might be gained from creating a similar movement in Britain.

Shaming black women

Black British women are, according to Department of Health statistics, more likely to have an abortion than their white counterparts (source).  On the other side of the Atlantic there has been some especially poisonous anti-choice campaigning based around a similar difference. Georgia Right to Life posted 80 billboards around the city of Atlanta proclaiming “Black people are an endangered species”, with a website address: toomanyaborted.com. Loretta Ross, National Co-ordinator of SisterSong, described it as:

a misogynistic attack to shame-and-blame black women who choose abortion, alleging that we endanger the future of our children… Our opponents used a social responsibility frame to claim that black women have a racial obligation to have more babies – especially black male babies — despite our individual circumstances.

Alarmingly, the UK anti-choice movement has already begun to adopt some of the US campaigning messages about the ‘black genocide’. Lisa Hallgarten, Director of Education for Choice, reported that “the Marie Stopes International clinic in Brixton is routinely picketed by antis who claim that MSI is trying to kill black babies. I have seen leaflets that claim that Brook is a eugenic organisation.” This is just the latest trend in a pattern of UK anti-choicers adopting US campaigning tactics.

Reproductive rights

I wanted to know whether the broader ‘reproductive rights’ approach had been adopted in the UK at all, by which I mean looking at contraception, sex education, adoption and the socioeconomic factors which impact on women’s decisions about whether or not to have children alongside calling for the right to safe, legal abortion.

Darinka Aleksic, Abortion Rights Campaign Co-ordinator, said that “because British women do not experience the extremes of health inequalities on ethnic or economic grounds that women in the US do (although I’m not minimizing those that exist), the repro rights approach has not, in my opinion, been quite so vital or so relevant to our situation.”

Lisa agreed that a rights-based approach hasn’t been widely adopted: “Since UK policy can be made or broken by the Daily Mail it is hard to take an abstract political or human rights approach to these things”. But she was clear on some of the problems with the existing situation, including the emphasis on abortion as a medical issue:

The public health approach is fundamentally limited and limiting because it relies on scientific evidence supporting the role of abortion in public health. For me there is a point where personal autonomy may trump public health and we should always keep our commitment to autonomy at the forefront of discussion.

And the absence of universal high quality sex education:

Lack of sex education is a clear obstacle not just to the people who are young at that point in time, but to society getting better at talking about sex. I think, realistically, that some fundamental work needs to be done on coming to terms with human sexuality as a society before anyone will have the courage or funding to stand up in government and take a reproductive justice approach to these things.

Abortion rights and social justice

Finally I asked Lisa and Darinka if it would be helpful to put the campaign to protect and extend abortion rights in the UK in a wider context of social justice, and whether there was a risk of losing support in the medical establishment if it came to be seen as a campaigning issue rather than a question of health policy.

Lisa said that:

Our whole law was put in place to medicalise the procedure, put it under doctors’ control and protect doctors. I think there is a big danger of losing their support if they don’t feel ownership of it.

However, the greater danger is that we don’t have a broad grassroots movement to protect abortion rights in this country. If we built a reproductive justice movement we would have a much more broad-based constituency to come out fighting when our rights are up for grabs in the Commons.

Darinka explained that “Abortion Rights’ primary role is to defend the 1967 Abortion Act.” But also that:

As an organization that has strong links to the trade union movement, we are inclined to stress the importance of abortion access as an economic issue. It has always been working class women who have suffered from a lack of access to safe, legal abortion.

Public service and spending cuts are going to hit women hardest and the reorganization of the NHS raises real questions about how access to abortion and contraception services will be maintained. So we are campaigning against the cuts alongside other organizations on a broader social justice basis.

Reproductive justice for the UK?

After talking to Mara, Lisa and Darinka it became clear that there are opportunities for the UK pro-choice movement in the reproductive justice approach, although simply importing the US model wouldn’t work. In Britain public and medical establishment support for the right to choose is far greater, there are fewer differences in access to healthcare along lines of race or sexual orientation, and there is more state support for families.

However, the British sexual and reproductive health landscape is shifting. While the usual attacks on the Abortion Act are being launched in Westminster (and Abortion Rights tirelessly resists them) a few more developments have been added to the mix over the last year – including controversy around the sterilisation of drug addicts and those with severe learning disabilities, the end of the Teenage Pregnancy Strategy, mass popular protests against the Pope’s visit, the crisis in midwifery, and health professionals calling out shoddy sex education in the media.

While there are a whole range of fantastic organizations working variously to defend and extend abortion rights and access, to improve sex education and sexual health, to support families and advance LGBT and women’s rights, to fight racism and inequalities in access to or influence on public services, this work doesn’t take place under a shared banner of Reproductive Justice.

I am a campaigner; I understand the need to choose your battles and your targets carefully. But as the ideological reforms of what is essentially a Tory government start to bite, I wonder if the battle may be coming to us. Perhaps it’s time to build a movement and raise the flag.

• With thanks to Education for Choice, Abortion Rights and the Abortion Support Network: three amazing charities that deserve your support.

Towards the end of the film there was a section about the ‘reproductive justice’ movement. The interviews intrigued me. It looked exciting, radical, inclusive and even kinda fun. The film featured an endearing group of smart, funny, young activists that reminded me of the Itty Bitty Titty Committee, which is no bad thing in my book. After a few aspirin I was inspired to find out more…

Creative Commons picture by Brooke Anderson, 2006

What is reproductive justice?

Reproductive justice is a holistic, inclusive and intersectional campaign for reproductive rights and the conditions necessary for women to realize them. It is a movement led by women of colour, which addresses the right to have children as well as the right not to have children, expanding the focus out from abortion to include wider questions of sex education, sexuality, birth control and the impact of poverty and violence.  This video is a good introduction: What is Reproductive Justice?

And here it is on Wikipedia for good measure.

I had a quick look online for UK reproductive justice groups or networks, but couldn’t find anything, although the US movement has been around since the 1990s. Of course it’s different terrain – here’s an F Word post about some of the differences between the US and UK around abortion and sex education – but is the reproductive justice approach relevant to the UK at all?

Realising reproductive rights

A key aspect of the reproductive justice approach is integrating pro-choice activism into a wider social justice movement. This is from SisterSong’s document ‘Understanding Reproductive Justice’:

Abortion isolated from other social justice/human rights issues neglects issues of economic justice, the environment, immigrants’ rights, disability rights, discrimination based on race and sexual orientation, and a host of other community-centered concerns directly affecting an individual woman’s decision making process.

By shifting the definition of the problem to one of reproductive oppression (the control and exploitation of women, girls, and individuals through our bodies, sexuality, labor, and reproduction) rather than a narrow focus on protecting the legal right to abortion, we are developing a more inclusive vision of how to move forward in building a new movement.

While defending the rights we are lucky enough to have protected by law is vital, the rights become meaningless if people can’t access them, and in many areas social and cultural change and economic equality are needed for people to realise their rights.

How might this be relevant to the UK pro-choice movement? Although abortion has been legal since 1967, and in theory it is freely available on the NHS, there are major inequalities in access. I spoke to Mara Clarke, founder of the Abortion Support Network, who explains some of the problems:

Abortion is available on the NHS, but only if you obtain two doctors’ signatures. This can be difficult if you live in an area with only one GP who is anti-abortion. Access to abortion services can be as much of a postcode lottery as any other service in the UK… This can make things more difficult for women as not only does the procedure become more invasive the further into pregnancy one gets, but not all clinics perform abortions up to the legal limit. This means some women opt to pay privately for abortions to avoid wait times, where other women have to wait until further in pregnancy and/or travel great distances to obtain the care they require.

Thanks to investment and prioritisation by the previous government, things have improved: 94% of abortions are now funded by the NHS, and waiting times have been drastically reduced. However, these achievements, like many others, are likely to be lost as vicious spending cuts unravel years of positive work.

And in both Northern Ireland – despite being part of the UK – and the Republic of Ireland, abortion is illegal except under extremely restricted circumstances. So every year in order to access safe and legal abortion thousands of women are forced to travel to England and pay anywhere between £400 and £2,000 for the cost of the procedure, travel, childcare and time off work. Abortion Support Network works to help these women by providing financial assistance, information, a meal and a safe place to sleep, but they can’t meet the need on their own.

There’s also a major problem around lack of unbiased information and impartial support around sexual health and pregnancy choices for young people, especially about abortion. Many young women are effectively prevented from making an informed decision because they are misinformed at school, or receive biased advice from bogus counselling services. Education for Choice work to make sure young people have the facts, but they are a tiny organisation fighting a wealthy anti-choice movement.

Abortion and race

The reproductive justice movement particularly addresses the experiences and needs of women of colour around sexual health, parenthood, pregnancy and abortion. While there are not such large differences in access to healthcare by ethnicity in Britain as in the US, there are some patterns. For example, according to Department of Health stats, black British women are almost three times more likely to have an abortion than white women (source).  It’s not clear why this is, but when I asked Darinka Aleksic, Abortion Rights Campaign Co-ordinator, she suggested an economic explanation:

The argument advanced in the US is that because minority ethnic women are more likely to experience poverty and economic disadvantage, the abortion rate among these communities is therefore higher. The Department of Health in England and Wales does not include income levels in its abortion statistics, but Scotland does, and their figures regularly show that abortion rates are higher in economically disadvantaged areas.

As Darinka points out, there is a similar discrepancy in US abortion statistics, and there’s more in Part 2 about how this is being used by the anti-choice movement in America and starting to be used by our own merry band of anti-choicers.

• With thanks to Education for Choice, Abortion Rights and the Abortion Support Network: three amazing charities that deserve your support.

Come back tomorrow for Part 2