Women on Waves: Where Next for the Abortion Boat?

Abstract

Abstract

Women on Waves was founded to contribute to the prevention of unwanted pregnancy and unsafe abortions throughout the world by direct action. Because national penal laws, including those governing abortion, generally extend only as far as territorial waters (12 miles), Women on Waves made plans to provide reproductive health services on a ship with a mobile clinic, including abortions, outside the territorial waters of countries where abortion is illegal. We went to Ireland first because it was nearby and there was a dedicated pro-choice community with immediate interest in and commitment to the project. Although we encountered problems that meant we could not do abortions, we were contacted by more than 300 women in five days and provided reproductive health information, contraception, workshops and information on where to obtain legal abortions in Europe. In many parts of the world an anti-abortion backlash is taking place. To safeguard our reproductive rights in the face of anti-abortion activities, it is crucial to recapture a pro-active, pro-choice role. Women on Waves helped to make visible the need for legal abortion services in Ireland, and the extensive class and other differences between women able to access abortions abroad and those who could not. We are currently attempting to resolve our status under Dutch law, but until women everywhere have the right to reproductive freedom, we will continue to make waves.

Résumé

L'association $\ll$ Women on Waves $\gg$ souhaite prévenir par l'action directe les grossesses non désirées et les avortements à risque. L'association fournit des services de santé géné sique, y compris des avortements, sur un bateau-clinique hors des eaux territoriales des pays où l'avortement est illégal. Le bateau s'est d'abord rendu en Irlande en raison de la proximité et parce qu'il y avait une forte communauté favorable à l'avortement intéressée par le projet. Malgré les problèmes qui nous ont empêchés de mener des avortements, nous avons été contactés par plus de 300 femmes en cinq jours et nous avons donné des informations sur la santé génésique et la contraception, organisé des ateliers et renseigné sur les avortements légaux en Europe.

Resumen

Women on Waves (Mujeres sobre las olas) fue creado para contribuir a la prevención del embarazo no deseado y el aborto inseguro en todo el mundo por medio de la acción directa. Women on Waves hizo planes para proveer servicios de salud reproductiva, incluido el aborto, en un barco equipado con una clı́nica móvil fuera de las aguas territoriales de los paı́ses donde el aborto es ilegal. Fuimos primero a Irlanda porque nos quedaba cerca y porque allı́ habı́a una comunidad dedicada al derecho a decidir con un interés inmediato y el proyecto. A pesar de en dificultades que significaban no poder proveer servicios de aborto, nos contactaron más de 300 mujeres en cinco dı́as, y proporcionamos información de salud reproductiva, anticoncepción, talleres e información acerca de lugares en Europa donde se puede obtener un aborto legalmente.

Key Words:

• abortion law and policy
• abortion providers and services
• Ireland
• Netherlands

On a beautiful afternoon on 11 June 2001, Women on Waves set sail from the Netherlands with an almost entirely female crew for the Republic of Ireland, a country with the most restrictive abortion law in Europe. The aim of the trip was to highlight the hypocrisy of the Irish abortion situation; catalyse efforts to liberalize the abortion law there; build coalitions for legislative reform; and test the feasibility of using a ship as a reproductive health clinic. The trip was made at the invitation of the Dublin Abortion Rights Group and Cork Women's Right to Choose group. Our plan was to provide reproductive health services on a ship, including the abortion pill, outside Ireland's territorial waters, and through that activity to publicise the fact that approximately 6500 women from the Irish Republic travel to Britain for abortions each year.

Induced abortion is the single, most often performed medical intervention in the world; however, it is estimated that 20 million of the 53 million abortions every year are performed under unsafe and illegal conditions, resulting in the deaths of approximately 80,000 women. In response to these unnecessary deaths and the violation of women's human rights, Women on Waves was founded in 1999. It is our mission to contribute to the prevention of unwanted pregnancy and unsafe abortions throughout the world by direct action. Working in close co-operation with local organizations, Women on Waves aims to empower women to exercise their right to safe, legal abortion and other reproductive health services. Because national penal laws, including those governing abortion, generally extend only as far as territorial waters, Women on Waves made plans to provide reproductive health services, including abortions, on a ship outside the territorial waters (12 miles away from the coast) of countries where abortion is illegal.

We developed the idea of chartering a ship and fixing a mobile clinic to its deck. The artist Joep van Lieshout designed a state-of-the-art, mobile, gynaecological treatment room and the idea for a seagoing reproductive health clinic became a reality.

Ireland: our pilot project

We decided to go to Ireland first for several reasons. Most importantly, Ireland has a dedicated pro-choice community whose members expressed immediate interest in the project. With the participation of more than 100 Irish volunteers, Women on Waves Ireland was formed. They took charge of all the logistics necessary for the ship's visit and organized workshops with doctors, lawyers, artists and writers. They worked with impressive commitment and continuous energy, making it possible to receive hundreds of visitors on board. Ireland is only two days' sailing from the Netherlands, which made it a feasible place for a pilot project, and to raise this issue within the European Union before sailing to other parts of the world.

However, this was the first such effort by Women on Waves and we encountered some problems. We were sailing a Dutch ship and according to Dutch abortion law a clinic needs a special licence to provide terminations after 45 days of pregnancy. The abortion pill, mifepristone+misoprostol, has been registered only for use up to 49 days of pregnancy in the Netherlands, which means its use falls outside the requirement to get authorization to provide the service under Dutch law. Nevertheless, in March 2001 we applied for a licence, so as to forestall any concerns about patient safety on board. The treatment room had been set up to comply with the requirements of Dutch abortion law. However, three days before sailing, the Ministry of Health in the Netherlands announced that it would inspect the `A-Portable' at a date three weeks after the planned Irish trip, to determine whether it could be licensed for first trimester abortion provision.

Then, when the ship was well out to sea and on its way to Ireland, a debate was started in the Dutch Parliament about Women on Waves and its licence, under pressure of questions posed by members of the Christian parties. Although the tone of that debate was generally positive, and the Minister of Health expressed her confidence in the doctors on board the ship, it left Women on Waves with serious worries about whether we would be prosecuted once back in the Netherlands. In the meantime, we were informed that the Irish port authorities required us to have an Irish passenger licence.

Irish women's response to the ship

By the time we arrived in Ireland we had received 80 calls from women requesting abortion services. We did not have enough mifepristone pills on hand to meet this demand. In fact, the extent of demand surprised everyone, including our Irish partners, who assumed that Irish women would prefer to travel to Britain. All these obstacles forced us to abandon our original plan to provide the abortion pill, which we deeply regretted. Even after it was announced that we would not provide the abortion pill, phone calls kept coming in.

After five days, 300 women had contacted the ship's hotline. They included women who had been raped, schoolgirls who could not find a feasible excuse to go to England for a couple of days, mothers who could not pay for childcare during their journey to England, and political refugees who did not have the papers to travel. While some women who called the hotline sought counselling, many others had already made up their minds and simply needed accurate information about clinics abroad. The medical staff on board provided the telephone numbers of clinics in England and the Netherlands, together with advice on how to make arrangements to get there. At the same time, women began visiting the ship. We counselled women with unwanted pregnancy, did pregnancy tests, did ultrasound scans to establish duration of pregnancy and provided information. We also distributed contraceptives of all types and the morning-after pill. There were always visitors on board – to support the initiative, to join workshops or just to see the clinic.

While the medical staff were constantly at work in the treatment room and took turns answering the hotline, the different workshops that had been organized took place on board. The ship was used for exchange of information and expertise and as a platform to create dialogue, reflection and debate about issues of choice. At the end of the medical and legal workshops, the participants decided to set up the organizations `Doctors for Choice' and `Lawyers for Choice'. All the workshops were well attended, not only the more obvious legal and medical ones but also for artists and writers, in order to broaden the context of the problem concerning abortion rights. One of the most basic human rights is the right of women to choose, to be able to control our own minds and bodies. This is linked very closely with all forms of artistic expression as well.

We had anticipated that there might be violence against the ship or its crew, and extensive security measures were taken. Research by the Feminist Majority Foundation (FMF) suggested a strong connection between violent anti-abortion terrorists in the USA and Irish anti-abortion groups. The FMF therefore trained all the volunteers before the ship arrived and as an additional measure to safeguard the security of the ship and its crew, they sent three women staff members to Ireland for the ship's visit. However, the only visible sign of protest was a medium-sized cruiser, organized by the Irish branch of Human Life International, named `Baby Watch'. We did, however, receive a number of threats, mostly bomb threats, by telephone and e-mail.

A pro-active, pro-choice role: taking charge of the agenda

The visit to Ireland created front-page news all over the world, from Brazil to Japan, and was covered by BBC World, CNN and numerous other news agencies. An online opinion poll by CNN with 16,500 participants showed that 49% were in favor of the ship's activities. This, in our opinion, is a surprisingly positive outcome for such a controversial action. In Ireland as well, the press coverage was unexpectedly positive.

“Ireland needs women like this to rock the State's boat” (Irish Examiner, 18 June 2001)

One journalist even apologized for her middle-class mentality as she had assumed in an earlier article that all Irish women could easily travel to Britain and that there would be no need for the ship.

In many parts of the world an anti-abortion backlash is taking place. The USA is the most blatant example, with the reinstallment of the Global Gag Rule. But also in Austria and Italy, leading politicians are calling for regulations to restrict women's access to abortion at this very moment. In Switzerland anti-abortion groups have succeeded in calling a referendum on the newly liberalized abortion law, while in Portugal the prosecution of 43 people, including 17 women who had abortions, has just ended. Along with Portuguese abortion rights organizations, Women on Waves used the opportunity of a major exhibition on “Women Building/New Narratives for the 21st Century” in Porto to call attention to the restrictive laws in Portugal and these prosecutions. At the opening of Exhibition we started a signature campaign to support those being prosecuted.

To safeguard our reproductive rights in the face of anti-abortion activities, it is crucial to recapture a pro-active, pro-choice role. This is exactly what Women on Waves set out to do.

We helped to make visible the problem and the need for legal abortion services in Ireland, even though we were not able to perform abortions as we intended. Everybody was surprised by the reality behind the lack of access to abortion within Ireland. Through the large numbers of women contacting the ship, people became aware of the extensive class differences between women able to access abortion abroad and the dramatic impact on less-informed women and those living in rural areas. Women living in poverty, young women and asylum seekers are suffering most under restrictive abortion laws – even in Ireland and even though Britain seems so close.

Women on Waves has contributed to building international and national pro-choice coalitions and helped to put the issue of illegal abortion and women's reproductive rights back on the international agenda. As part of a creative, pro-active, pro-choice movement we are taking charge of the agenda. The Irish journey has received a great deal of praise and Women on Waves has received many invitations from groups all over the world. The Irish pro-choice community has been activated and grown tremendously in the course of the preparations for the ship's visit, and was prepared for the new abortion referendum on 6 March 2002. Happily they won the vote by a narrow margin and this prevented abortion law in Ireland from getting worse.

The future: where next?

We are now working on resolving our legal status in the Netherlands. In February 2002, the Dutch Ministry of Health denied our request for a licence. Our lawyers have concluded that the basis of the decision was remarkably weak, so we have decided to appeal the decision. Our sense is that we have a good chance of winning. The government concluded that our treatment room satisfied all the necessary medical requirements and that the quality of care we could provide was good. But the inspectors expressed concerns about follow-up care in case the abortion pill failed and that they would not be able to inspect us when we were out of Dutch waters. The licence was denied on these grounds only.

Our handbook explains how we would provide follow-up care: We would have the woman return to the ship 3–7 days later for an ultrasound scan to ensure the abortion is complete. If the abortion is not complete or in the very unlikely case of an ongoing pregnancy (according to the literature less than 0.3%) we are fully equipped to perform a vacuum aspiration, including at sea. Complications are rare but we are able to treat them in the treatment room, and we will also always work together with local medical doctors where possible. Or we can fly the woman to the Netherlands if necessary. Most importantly, there will always be a gynaecologist on board, a standard of care that no other abortion clinic in the Netherlands provides.

Concerning the problem of the government inspecting us, we stated that we would inform them where we are and pay for the tickets for them to come to inspect us. A seagoing country like the Netherlands must be able to inspect its ships all over the world. The report of the inspection ignores these facts; it assumes that hospitals in the countries we visit will need to do the after-care (which many by the way can do very well). We stated that Women on Waves will do the after-care, and work with local doctors and women's organizations to provide continuity of care.

During the 10-month period while we awaited a decision, we spoke with the Minister of Health and others, and received what we thought were signals that we would receive authorization to provide early abortions. In the end, we did not get that; this too provides good grounds for appeal. The Minister of Health, Els Borst, stated that she appreciated the goals of Women on Waves and wished us success with our information and prevention activities. However, to help women in need, we must be able to perform abortions. We expect a decision at the end of May 2002 on the appeal.

In conclusion, despite the problems, the project has demonstrated the enormous potential of using a ship as a reproductive health facility and, most importantly, to draw worldwide attention to the issue of illegal and unsafe abortion and the heavy demand for services. By presenting an innovative and active project, Women on Waves has created new hope among pro-choice activists worldwide. We have shown that health care and advocacy can be successfully combined. We will continue to be a catalyst for legislative reform. We will continue to seek to re-energize pro-choice organizations. And until women everywhere have the right to reproductive freedom, we will continue to make waves.

Acknowledgements

An earlier version of this article was published in Choices: Sexual and Reproductive Health and Rights in Europe. Autumn 2001 and is reprinted here with kind permission of IPPF European Network.