Archive for December, 2013

December, 2013

Peace on earth?

Heather Buckingham

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When buying Christmas cards, I am sometimes tempted to go for the ones that say ‘Peace’. Why? Perhaps it is because I feel they strike a balance between being slightly less offensive to those for whom this is a period of celebration – but not of the birth of Christ – whilst still offering something more than a ‘greeting’ associated simply with the time of year.

On reflection though, peace is far from inoffensive. The peace that’s associated with Jesus in the New Testament of the Bible is not simply about the absence of conflict or loud noise: its meaning reflects that of the Hebrew word ‘shalom’. One translation describes shalom as ‘social harmony, peace, prosperity, security and well-being’. In the book Generous Justice, Tim Keller describes it as:

‘complete reconciliation, a state of the fullest flourishing in every dimension – physical, emotional, social, and spiritual – because all relationships are right, perfect and filled with joy’.

Perhaps this doesn’t sound too controversial: some would dismiss it on the grounds of being too idealistic, but few would dispute that it’s an attractive vision. The offensiveness though, comes in the fact that it is relational. The prosperity it describes is about everybody having enough – maybe a bit more than enough – not some having plenty while others go hungry. The right relationships it describes may involve engaging with people some would rather neglect. It’s a demanding and costly vision.

What has this got to do with the third sector? Well quite a lot I think. Frequently, voluntary organisations are put in a box: they’re asked to do the bits of work that the government can’t or won’t; to provide the ‘glue’ in communities where that is lacking; to address the problems that families are unable to; to house those who are priced out by the markets; to feed those who are missed out by the benefits system. There is sometimes a sense in which these organisations are tasked with exercising compassion on behalf of the rest of society: making up for the lack of it in other sectors.

We might be able to get away with this if the problems in other parts of society weren’t so great. If the disparity between rich and poor was not so great, voluntary efforts might well be able to restore dignity and opportunities to a few who lacked them; if the benefits system were closer to being just, charities might well be able to pick up the few who fell through the gaps. But the reality is that the problems in our society are extensive. Expecting voluntary organisations to act as peacemakers between macro- economic, social and political systems and individuals suffering hardship is likely to be unrealistic unless both parties are willing and able to move towards each other. Voluntary organisations in deprived areas are struggling under huge burdens as demand rises and funding is cut ever more deeply. Even if volunteers and donors can summon up the strength, time and resources to keep everyone adequately fed and housed until the storm – we hope – passes, this will not be sufficient.

Wellbeing is relational in nature. That doesn’t just mean that we all need good relationships in our lives in order to be happy; it means that across every ‘sector’ of our lives and the economy, what we do affects other people. Much of our culture is orientated around individualism. Many organisations operate systems of targets, which – if achieved – denote success, regardless of their impacts beyond the immediate team or company. But the problem is that such a compartmentalised view is a wrong view, both of how things are, and of how they should be.

Institutions and organisations don’t work well if they don’t exercise care both for their clients and those that work within them: if employees and service users aren’t also understood to be parents, children, friends, and individuals. They also don’t work well if they are devoid of purpose beyond making money or meeting targets, or if there is a lack of public trust in them. These are amongst the reasons that politicians of all parties have given for turning to the third sector as a means of resolving the perceived crisis of the welfare state. However, the problem is that all sectors of the economy are inter-dependent. If more and more people become dependent on volunteers to feed and house them, more and more people will have to give up their jobs to do so. Then there will be fewer people paying taxes, and so on. Eventually, the people giving won’t have anything left to give… you see where I’m going.

We need to be willing to seek justice as well as wellbeing. At a time when millions are celebrating the life of Nelson Mandela and grieving his death, his story speaks poignantly of the costliness of forgiveness, reconciliation, and freedom. Making things right usually involves change in how things currently are. And change is often painful and uncomfortable: it upsets the status quo which, for many of us, is quite comfortable.

Let’s not be deceived that nice people who volunteer can sort it all out by themselves: they have jobs, families to care for and washing to do just like everyone else. There are people across all sectors of the economy who have the desire and potential – through different means – to make the world a better place. It is not that we need to delegate more and more responsibility for social needs to the third sector, but rather to ask what needs to change in the institutions of the state, markets, media, family and community life to reduce the incidence of these problems. Indeed, a key role for the voluntary sector could be in informing and supporting the processes of reflection, reconciliation and rebalancing that are needed. But if we want there to be peace on earth – or even just in the UK – attention will also need to be given to justice and mercy.

December, 2013

For such as time as this….

Heather Buckingham

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In this post I want to come back to the question I finished with on Tuesday: why aren’t we making more fuss about it?

The third sector has changed a great deal in the past twenty years or so. Under New Labour the sector’s income from governmental sources increased significantly; third sector involvement in contractual arrangements for public service provision became widespread; and competition, quality assurance, outcomes monitoring and cost efficiency all became increasingly prominent within the sector (or at least substantial parts of it).

Institutional isomorphism describes the way in which organisations become more like those that fund or have influence over them, either through coercion, mimicry, or due to normative pressures. For many third sector organisations (TSOs) that are involved in government contracts, the influence of marketisation in the statutory sector has had an impact on their own decision making and working practices.

Whilst New Labour emphasised both the service delivery and community-building roles of TSOs, retrospective analyses suggest that service delivery was the main focus of their policy-making and funding towards the sector. Whilst this may have been an effective way of delivering public services, at least for a time, it leaves us with some more difficult questions about the role of the third sector in a context where funding for these is declining rapidly.

Concerns have been raised that the emphasis on service delivery – and the consequent significance of government funding as an income source for the third sector – has led to the silencing of TSOs’ campaigning voices. Earlier this year The Panel on the Independence of the Voluntary Sector reported that self-censorship in the interests of survival was becoming problematic: individuals were afraid to speak out against the government for fear their organisations will have funding withdrawn.

But whilst government funding makes up a large proportion of the third sector’s total income, the majority of TSOs receive no funding from the state. According to data from the 2008 National Survey of Third Sector Organisations, only 36% of TSOs received government funding. This suggests that if TSOs are having difficulty articulating an independent voice and making it heard, other factors besides funding relationships are involved.

The third sector is sometimes touted as a repository for values. I don’t think this is a particularly helpful way of seeing things: values (good ones, and not so good ones) are found across all sectors of the economy and all aspects of public and private life. Similarly, tensions between personal values and organizational practices are reported in a whole range of professions and contexts. However, the expression of values has been identified as a key function of voluntary organisations, and identifying and articulating them is essential to the voice or advocacy role that many of such organisations have. Indeed, for charities, governing documents enshrining their charitable objectives provide an alternative benchmark against which success can be measured, outside of those offered by the markets or the state.

One explanation then for why it can be difficult for TSOs to find their voice is the dominance of particular state and market ‘rationalities’ in the public sphere, to the exclusion of alternative systems of thinking and organizing. Whilst increasingly blurred inter-sectoral boundaries make it difficult to distinguish the different logics of the market, state and third sectors, this may be partly a consequence of the dominance of neoliberalism and the market values associated with it.

Victoria Lawson, a Geographer the University of Washington wrote in 2007: ‘We live in times defined by the relentless expansion of market relations into almost everything. This deepening of market relations is reaching into arenas where the social good should (but often does not) take precedent over profitability and the efficient operation of markets… arenas such as health care, elder care, support for the working poor, environmental protection, and education’.

This may represent an oversimplified view of marketisation: there are possibilities for resistance, as well as instances where markets are managed for social good. Nevertheless, Maurice Glasman argues that ‘Individualism and collectivism have run out of road because both neglect the social, society, the body politic, the place where intermediate institutions promote a good that is neither market nor state based.  They both dissolve relationships when we need to nurture them.

Many TSOs place a strong emphasis on fostering relationships. Indeed, some of the tensions around government contracts have concerned insufficient recognition of the relational dimension of care, and the focus on measurable outcomes. Many TSOs that have kept their distance from state funding place a strong emphasis on cultivating relationships, particularly through volunteer involvement.

According to the UK Civil Society Almanac 2012, ‘by the end of the spending review period 2015/16, the voluntary sector is forecast to lose £1.2 billion in government income each year, a cumulative total of £3.3 billion’. Besides having a major impact on the sector’s work, this could lead to a major shift, with grass-roots, volunteer-orientated groups growing in influence and remit. Faith groups in particular are picking up much of the labour in terms of responding to food poverty, for example, yet (with some exceptions) there seems to be less interest in what the beliefs held by such groups might offer to broader political and economic debates about wellbeing.  However, as the cracks in our existing market and state based systems for securing wellbeing become more apparent, it may be time for TSOs to find the confidence to offer solutions that don’t seem to make sense within these systems as they currently stand, but can instead help to reshape and re-order them, rebuilding and rebalancing relationships and priorities within what is presently a very uneven society. As a society we may need to make more time and space to listen to voices from the margins.

December, 2013

The Inter-Connectedness-Of-Things

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One of the reasons that time and place are important is that they connect people: they are things we share with others, whether that’s through living in the same community or block of flats, being part of the same generation, using the same supermarket or health centre, having a shared cultural inheritance, or living under the same configuration of social and fiscal policies by dint of being resident in a particular country at a given time.

Basic social policy theory tells us about the inter-connectedness-of-things. The ‘welfare triangle’ gets at the idea that individuals derive their welfare from a combination of state, market and informal sector resources, the latter referring to family, friends and neighbours. To this we could also add the voluntary, or third sector.

The relative importance of each of these sectors varies from country to country, but also throughout the life course and between individuals. What is most helpful about this model though is that it debunks the idea that some citizens are ‘dependent’ while others are ‘independent’. Very clearly, human welfare is social: we are all inter-dependent.

But some forms of dependency are more visible than others, and some are more stigmatized than others. A product of neoliberal politics has been the elevation of competitive markets above other forms of provision and distribution; this is unsurprising given that – on a superficial level at least – this would appear to be the most individualized, choice-enhancing, and ‘independent’ route to wellbeing. (See Michael Rustin’s article, A Relational Society, for a deeper analysis, however).

 The Coalition government’s rhetoric – which still seems to reflect ‘Big Society’ principles, even if that label has been cast aside to some extent – is by no means exclusively market-orientated though. On the contrary, they expect families and communities to play a significant part in meeting social needs. This isn’t problematic in itself: paid work, families and communities can all make valuable contributions to human flourishing. However, besides the obvious point that people’s opportunities to benefit from these are not equal, there are also concerns that the relationships between the different means of meeting welfare needs are not being sufficiently recognized or responded to. In short, there is a failure to acknowledge the inter-connectedness-of-things.

Maurice Glasman, LMU academic and Labour peer, puts it this way: ‘[there is a] tension between the political economy of the Coalition – which encourages mobility, flexibility and competitiveness – and the mutuality, solidarity and sense of place required to make stable association a meaningful possibility in people’s lives. Active community life requires a resistance to the relentless commoditisation and mobility that the market demands.’

 If, for example, people are required to move to different parts of a city or the country because of the Bedroom Tax, they are in the process up-rooted from social networks that likely play an important part in sustaining them. In the long run the cost, both to that individual and to society might be greater than if the policy process had given proper attention to the significance of relationships, both at an individual level, and within the mixed economy of welfare.

 To some extent, the recession has highlighted that we are all vulnerable to the inter-connectedness-of-things. Many who thought their jobs were stable find redundancies looming, the visibility of homelessness and other social problems is increasing once more, average household incomes have fallen, and the cost of living has increased by 25% since 2008. But we are not equally vulnerable: education, financial resources, family relationships, local context, health and many other factors influence our resilience to changes in the ‘supply’ of support that we can access from any of the different sources within the welfare mix. It is perhaps unsurprising then that ‘building resilience’ has become a key word amongst funding bodies and for those involved in community development: the question in many areas will be to what extent any such resilience can be built or maintained in the face of cuts to local authority services and benefits emanating from central government policy.

December, 2013

On Place and Justice: Distribution matters

Behind the Conservative’s ‘Big Society, Not Big Government’ 2010 election campaign was the premise that we could look after ourselves better than the state could. Much emphasis was placed on the power of civil society, and this has since been reflected in the Coalition government’s decision making. One aspect of this has been the continued delegation of public service provision to third sector organisations, but as The Big Society Audit 2013 published yesterday by Civil Exchange points out, it is large private sector companies who now dominate public service outsourcing. Social enterprise and other forms of third sector activity have been promoted – particularly in the health care field, where professionals have been encouraged to spin-out social enterprises from the NHS – but in some senses, the greater responsibility accruing to the third sector is arising not through contracting, as in the New Labour years, but rather as cuts in local authority services and benefits coupled with rising demand leave more work for non-statutory organisations to pick up. 

One of the concerns that has long been held about relying on third sector organisations to provide public services is around the mismatch between needs and provision: social needs and third sector activity are both unevenly distributed geographically, and these distributions don’t match each other. Jennifer Wolch’s work on the Shadow State drew attention to this in 1990, as did the Wolfenden Report in 1978, but it is a premise that arguably underlay the very foundation of the state welfare and a redistributive taxation and benefits systems. So as the current government continues to roll back the welfare state, being aware of what lies beneath (and where) in terms of a third sector ‘safety net’ should be a pressing concern.

Research by David Clifford of the Third Sector Research Centre (TSRC) suggests that in the UK the number of local voluntary sector organisations per head is considerably higher in less deprived areas (1.6 organisations per 1000 population) than in more deprived areas (0.6 per 1000). However, when subsectors of voluntary sector activity are considered the patterns become more complex. While educational, cultural and leisure organisations are more prevalent in less deprived areas, this is reversed for organisations in the field of economic wellbeing. The paper points out that although in general less deprived areas have more organisations delivering public services than more deprived areas, when we look at the most deprived areas of all, the numbers increase again. So the situation is not clear cut.

One of the concerns voiced during the New Labour era was that contracting out public services to the third sector was a ‘Trojan horse’ for privatisation or worse, the dismantling of the welfare state. This may or may not have been the political intention, but public funding to the third sector increased significantly under New Labour. According to TSRC’s analysis of the 2008 National Survey of Third Sector Organisations, voluntary organisations in the most deprived parts of the country were nearly 4 times as likely to  report that the public sector was their main source of income than those in the least deprived areas. This suggests that governmental resources were at least being allocated in such a way as to alleviate rather than exacerbate spatial inequalities. But that was then: this is now, and the legacy of that scenario is that with local governments forced to make major budget cuts, many of these organisations in deprived areas are now facing resource crises, coupled with escalating social needs. Thus not only are individuals in deprived communities disproportionately affected by austerity measures, but the organisations seeking to help are themselves increasingly vulnerable. Indeed, The Big Society Audit notes that ‘The Big Society is also a deeply divided one, with cuts in public services hitting disabled and people living in poverty the hardest and trust – the glue that brings the Big Society together – failing to bind disadvantaged communities.’

But how has this situation arisen?

The decoupling of welfare and justice may have something to do with it. Addressing the Church Urban Fund’s recent Tackling Poverty Together conference, Archbishop Justin Welby argued that seeking the welfare – flourishing – of our cities and the people within them cannot be separated from the pursuit of justice. Similarly, the geographer David M. Smith, writes of justice as the ‘missing dimension’ that is required to rebalance needs for care with appropriate provision of it. There is much to be grateful for in terms of the living conditions that most of us in this country enjoy, and yes, to some extent people can look after each other, but we don’t live in a ubiquitously ‘big’ society, whatever that might mean. There are communities within the UK that have been economically and socially marginalised for decades while others have prospered: these will be amongst the hardest hit by government cuts which are in turn likely to necessitate greater dependence on voluntarism and ‘making do’. All of this begs the question: why are we not making more fuss about it?

Heather Buckingham

 

December, 2013

Dr Heather Buckingham. The last blogger of the week this term.

Heather Buckingham joined the Third Sector Research Centre at the University of Birmingham in September 2012. Her research interests include: shifts in the welfare mix and the influence of changing government-third sector relations; provision of services for vulnerable social groups; and the role of faith in social action and how this interacts with policy and culture. Her recent and current projects include research on: employment in the social economy; the legitimacy and policy leverage of national third sector leaders; and mental health commissioning and third sector organisations. She also contributed to TSRC’s Futures Dialogues series, which examined some of the key issues facing the third sector today.

Heather previously worked at the University of Southampton as a Research Fellow on the TSRC’s Geographies of Social Enterprise project. This project investigated factors contributing to the development and growth of social enterprises in contrasting urban areas. Prior to this she completed her PhD at the University of Southampton in the Division of Sociology and Social Policy. Her doctoral research explored the impact of government contracting – including competitive tendering and performance measurement processes – on third sector organisations working with homeless people. Alongside her work for TSRC, Heather is involved as a volunteer in a number of community projects in Birmingham.

December, 2013

Does distance make a difference?

Dr Heather Buckingham 

Third Sector Research Centre

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@gristGrist ‏@grist 8h Help good go viral tomorrow. Donate and be a part of #GivingTuesday http://bit.ly/186NiXk  pic.twitter.com/MBKMEGE3FD

A number of the articles I read during my time as an undergrad geographer had a significant impact on the way I view life, the world, and my work as a researcher. One of these was David M. Smith’s paper, ‘How far should we care? On the spatial scope of beneficence’.  Even the title has a good ring to it. Amongst other things the article notes how changes in communication and mobility over time have transformed the ‘geographies’ of both our awareness of human needs, and our propensity to respond to them. In the past, it claims, ‘lack of knowledge could justify the exclusion from ethical consideration of unknown others, with whom geography denied the possibility of a relationship’. In the age of social media and 24-hour news reporting, this justification is removed (although many groups, places and issues do not make their way into our headlines or twitter feeds), opening up further possibilities – and perhaps obligations – to care for ‘distant others’, but at the same time rendering individual and corporate decisions about where and how to care more complex.

The balance between caring for those nearest to us – whether that’s geographically, emotionally, relationally, or in terms of similarity – with those at a distance is a tricky issue to grapple with, and is one that surfaces in individual decision making, as well as national politics and international relations. In a previous Saving Humans blog, Andrew Jones reported on the ‘huge outpouring of global compassion’ towards the Philippines in the wake of Typhoon Haiyan. Britons donated £39 million during the first seven days alone of the Disasters Emergency Committee’s appeal. In the same week a record £31 million was given in support of Children in Need. That generosity seemed to prevail on both these scales, despite the financial challenges facing many UK households at present, points to great potential for solidarity in the face of suffering and difficulty.

In both cases, the media – and its celebrities – played an important role in urging individuals to give. Images and stories are communicated and taken seriously because the needs they portray are pressing, visible and great. Under certain circumstances, it seems, the spirit of generosity is readily released. It is not simply the monetary donations that seem significant – much hard work and careful stewardship will be required to translate those into improvements in people’s wellbeing both in the immediate and longer term – rather what is striking and encouraging is people’s willingness to release their own resources for the benefit of others. This is not to say such responses cannot be faulted: certainly, the severity of the loss and suffering being experienced in the Philippines and in many other contexts around the world does not permit any sense of complacency. Nevertheless, the generosity revealed in the public response is worth honouring: not something we generally do enough of as social scientists, I think.

But whilst these examples illustrate our propensity to extend care to others, both within the UK and over much greater distances, there is an uncomfortable juxtaposition between this generosity of spirit and action and the rather different climate that has tended to be fostered around persistent and growing un-met social needs within our own society.  Perhaps the long-term nature of entrenched deprivation in local communities prevents it from seeming anything more than mundane. Or perhaps the complexity and profound ramifications of addressing the root causes of social inequalities are such that we would rather concentrate our efforts on more instantaneous, less painful solutions to more readily ‘solvable’ problems. Undoubtedly this echoes the relative difficulty in securing development funding compared to humanitarian aid in the international context alluded to in Andrew Jones’ post. Whist events such as last weeks’ ‘Giving Tuesday’ may be a welcome antidote to Black Friday and Cyber Monday, the simplicity with which they frame the notion of giving leaves some considerable distance between the giver and the complex and enduring nature of many of the issues that third sector organisations seek to address.

The effects of the recession and welfare reforms are bringing the issue of poverty – including food poverty – closer to home for many people in the UK. But whilst for some, personal proximity may foster greater solidarity, changing attitudes to benefit claimants amongst the general population depends heavily on the climate created by the media and others in the public sphere. If it’s a climate in which individuals are held to be primarily to blame for their own wellbeing (or lack of it), we’re unlikely to see a ‘generous’ response: but if on the other hand it’s a climate that acknowledges the influence of time and place – and all their political, social and economic baggage – on individual prospects and livelihoods, then the outlook is perhaps more hopeful.

Further useful links

Giving Tuesday: http://community.givingtuesday.org/News

‘Why I hate giving Tuesday’: http://www.huffingtonpost.com/brady-josephson/why-i-hate-givingtuesday_b_4375886.html

Opening of the UK’s first ‘social supermarket’: http://www.theguardian.com/society/2013/dec/09/goldthorpe-social-supermarket-community-shop-food-poverty

British Food Poverty a ‘public health emergency’: http://www.independent.co.uk/news/uk/politics/food-poverty-in-uk-has-reached-level-of-public-health-emergency-warn-experts-8981051.html

David Smith Article referred to in the blog: http://phg.sagepub.com/content/22/1/15.abstract

Critical geography and super-philanthropy- Hay: http://phg.sagepub.com/content/early/2013/09/04/0309132513500893.abstract
Landscapes of Care- Milligan: http://phg.sagepub.com/content/34/6/736.abstract

 

 

December, 2013

TRAP (Targeted Regulation of Abortion Providers) Laws.

Sheelagh McGuiness

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TRAP laws are laws and regulations that have a restrictive aim rather than being aimed at the safety of the pregnant woman or the abortion procedure. A defining feature of these laws is that, although they use the rhetoric of ‘patient protection’, their reach extends far beyond this so as to have an obstructive effect. Strategically these laws have had a rise in popularity since the early 90s when anti-abortion campaigners identified their use as part of an incremental strategy to restrict access to abortion services. The strategic aim being through the successful implementation of TRAP laws to give rise to “an America where abortion may indeed be perfectly legal, but no one can get one”.[1]

In the most recent statistics available on TRAP regulations the Guttmacher Institute identify 28 states in the USA that “have laws or policies that regulate abortion providers and go beyond what is necessary to ensure patient’s safety”.[2] Examples of TRAP laws are those that specify the width of door frames and corridors; regulations requiring clinicians to admittance rights at local hospitals or specify the maximum distance from the clinics to the nearest hospital. Commonly TRAP regulations require abortion clinics to meet standards for ‘ambulatory surgical centers’ regardless of the fact that procedures carried out at abortion clinics are less invasive/ risky.[3] As a strategy for restricting access to abortion services TRAP laws have been and continue to be highly effective.[4]

So why should we be concerned about TRAP laws in the UK? Although there has not been a rise in regulations that apply to abortion clinics, there has been a rise in attacks on the trustworthiness of clinician ability to regulate abortion services. Therefore, I think it is clear that the ideological aims of TRAP regulations, obstruction and indirect restriction of service, has been adopted by anti-abortion strategists on this side of the Atlantic.

Abortion regulations in England, Scotland, and Wales have developed within a very medicalised frame. The Abortion Act 1967 was the result of a Bill introduced by David Steel called ‘The Medical Termination of Pregnancy Bill 1966’. The Act is an indication-based model of abortion regulation – this means that it sets out qualitative indicators that justify an abortion. The substance of these qualitative indicators has been left deliberately vague in order not to fetter the discretion of clinicians and it is the medical practitioner who bears overall responsibility for the abortion procedure and ensuring that one of the grounds in s.1(1)(a) of the Act has been met. The following quote from the judgement of Scarman LJ in R v Smith illustrates the importance of the doctor’s role in legitimating an abortion:

The [Abortion] Act, though it renders lawful abortions that before its enactment would have been unlawful, does not depart from the basic principle of the common law, … that the legality of an abortion depends upon the opinion of the doctor…. if they are formed in good faith by the time the operation is undertaken, the abortion is lawful. Thus a great social responsibility is firmly placed by the law upon the shoulders of the medical profession.[5]

It is my contention that recent efforts to undermine the confidence of the medical profession to discharge their responsibilities under the Abortion Act 1967 could impact negatively on the provision of care. The Act places a lot of trust in clinicians. If clinical confidence is undermined then it is likely that we will witness less service with abortions being more difficult to access. This is in keeping with the ideological aims of incrementally restrictive service while leaving any patient ‘right’ to access service in tact. I will pick up on this point in my next post when I discuss the recent attacks on abortion service.

[1] Barry Yeoman ‘The Quiet War on Abortion’ motherjones.com/politics/2001/09/quiet-war-abortion

[2] ‘Targeted Regulation of Abortion Providers’ http://www.guttmacher.org/statecenter/spibs/spib_TRAP.pdf

[3] ‘Targeted Regulation of Abortion Providers’ http://www.guttmacher.org/statecenter/spibs/spib_TRAP.pdf

[4]  Rachel Benson Gold and Elizabeth Nash ‘TRAP Laws Gain Political Traction While Abortion Clinics – And the Women They Serve – Pay the Price’ (2013) 16 Guttmacher Policy Review 7-12.

[5] [1973] 1 W.L.R. 1511

 

December, 2013

Reproductive Justice: Day One

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This week I will blog on the topic of reproductive justice, with a particular focus on access to abortion services. Each day I will blog on a particular strategic effort to restrict access to abortion services in the United Kingdom. As part of each discussion I will highlight how recent lobbying in the UK mirrors efforts to restrict access to abortion services in the USA. Each day I will suggest possible responses to these lobbying efforts. 

The themes explored in my blog this week stem from a workshop held at the University of Birmingham in March 2013. The workshop had the title ‘Beyond the Rights and Wrongs of Abortion: Access as a Question of Reproductive Justice’ and aimed to bring together interested individuals to: think of ways that academics, practitioners and third sector organisations can respond to efforts to restrict access to abortion services in countries where the procedure is allowed. 

Reproductive justice is a term used to describe the broadening out of the discussion on ‘reproductive rights’ with its focus on choice. Cook and Dickens summarise the move from reproductive rights to reproductive justice as follows:

The major contribution of judicial decisions to protect and advance reproductive health shows the success and wider potential of advocacy that moves from a reproductive choice paradigm to an emphasis on reproductive justice. [1]    

Those in the reproductive choice movement position themselves away from the privacy/choice framework and instead advocate for women’s interests and well-being in a broader context. The reproductive just movement connects reproductive choice with broader questions of social justice. As Loretta Ross summarises: ‘Reproductive Justice is the complete physical, mental, spiritual, political, social and economic well-being of women and girls, based on the full achievement and protection of women’s health rights.’[2] 

Situating access to abortion services within this framework allows us to understand abortion services, as a constituent element of women’s reproductive health needs. After all, the ability to control the timing and spacing of reproduction is key to women’s equality and a foundational aspect of social justice. 

In the last 24 months we have seen evidence of an increase in the number of attacks on abortion provision that are not directed towards questions of whether abortion is morally right or wrong but rather aim to restrict access to abortion services. They do this by focusing on efforts to restrict or hinder the activities of abortion providers. As mentioned each day I will pick a particular strategic effort that is mirrored in USA anti-abortion strategy. It is my view that in order to fully respond to current efforts to restrict access to reproductive services it is vital that we consider the impact of an increasingly ‘American’ strategy of lobbying that has been adopted by pro-life organisations in the UK. 

The influence of American pro-life organisations on lobbying in the UK has been the subject of several recent newspaper articles. Indeed it has been suggested that some of those who have been campaigning to restrict access to services in the UK have done so in conjunction with anti-abortion lobby groups in the USA.[3] This influence has been evidenced in attempts to restrict access to abortion through regulating abortion providers (e.g. the recent ‘pre-signing’ scandal) and increasing the threshold of activities needed to ensure that the consent of the pregnant woman is real (e.g. the recent discussion of ‘independent counselling’). During the legislative passage of the Health and Social Care Bill (now the Health and Social Care Act 2012) Nadine Dorries attempted to amend the Bill to include a clause that would require independent counselling for women who wished to have an abortion. During the debates she implied that abortion providers could not be trusted to provide women with impartial advice:

BPAS and other organisations would say that they do not have to meet targets and that they have no financial concerns. However, BPAS has advertised for business development managers, whose primary function is to increase its market share—those are its own words in the advert. If an organisation advertises that it wants to increase the number of abortions, can we trust it to provide vulnerable women who walk through the door with the counselling that they need? On pensions mis-selling, this place has separated by law the people who provide and sell pensions from the people who advise on pensions.[4] 

‘Independent’ or ‘crisis’ pregnancy agencies are notorious in other jurisdictions where they have been opened by pro-life organisations in order to dissuade women from having an abortion. Subsequent to this there was a ‘sting’ investigation by The Telegraph into the provision of abortion for reasons of social sex selection. This is something that was widely condemned and presumed to be illegal (it is not!). Further stories detailed allegations that doctors were ‘pre-signing’ HSA1 forms; these are the forms where a doctor verifies that the requirements of the Abortion Act have been met and a woman is entitled to an abortion. This led to then Secretary of State for Health Andrew Lansley calling on the Care Quality Commission to carry out emergency inspections on abortion clinics across the UK. 

All of these attacks are aimed at undermining the trust that the public have in clinician ability to regulate reproductive services. Given the current framing of abortion regulation in the UK this is a strategy that could provide successful in restricting access to abortion services overall. I will pick up at this point tomorrow when I discuss so-called TRAP (Targeted Regulation of Abortion Providers) laws.

[1] Rebecca J. Cook, Bernard M. Dickens ‘From reproductive choice to reproductive justice’ (2009) 106 International Journal of Gynecology and Obstetrics 106–109

[2] Loretta Ross ‘Understanding Reproductive Justice: Transforming the Pro-Choice Movement’ (2006) 14-19

[3] Polly Curtis and Ben Quinn ‘Abortion debate: Dorries campaign urged to reveal how it is funded’ The Guardian http://www.theguardian.com/politics/2011/sep/02/abortion-debate-dorries-campaign

[4] (Hansard; 7 Sep 2011 : Column 377)

Dr Sheelagh McGuinness is a Birmingham Fellow at the Birmingham Law School, University of Birmingham.

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