포럼 자료집 : 3차 성과재생산포럼_생명권 vs 선택권

이 이슈페이퍼는 다음과 같이 인용해 주십시오.
김동식･김영택･이수연(2014). 피임과 낙태 정책에 대한 쟁점과 과제: 여성의 재생산권과 건강권을 중심으로. 서울: 한국여성정책연구원

김동식, 김영택, 이수연

한국여성정책연구원 2014 연구보고서

=========================

목   차
Ⅰ. 서 론
1. 연구의 배경과 목적
가. 연구배경 및 필요성
나. 연구목적
2. 연구내용 및 방법
가. 연구 내용
나. 연구 방
3. 연구의 의의와 한계

Ⅱ. OECD 회원국의 피임과 낙태 정책현황 및 사례
1. OECD 회원국의 피임과 낙태 정책 현황
가. 사전피임약
나. 응급피임약
다. 낙태
2. 주요 OECD 회원국의 낙태 정책사례
가. 네덜란드
나. 독일
다. 영국
라. 일본
3. 시사점

Ⅲ. 국내 피임과 낙태 관련 법,제도, 입법발의 및 판례
1. 피임 및 낙태 관련법 제,개정
가. 모자보건법
나. 약사법
다. 형법
2. 피임 및 낙태 관련 주요 입법 발의
가. 모자보건법
나. 약사법
다. 형법

Ⅳ. 피임과 낙태 정책 관련 주요 쟁점
1. 피임 및 낙태 관련 논쟁 발단과 정부대책
가. 피임
나. 낙태
2. 피임 및 낙태 관련 주요 쟁점
가. 사전피임약
나. 응급피임약
다. 낙태
3. 피임 및 낙태 관련 주요 판례
가. 피임
나. 낙태

Ⅴ. 피임과 낙태 정책 관련 일반인 조사 결과
1. 조사 개요
2. 성 태도와 성적 자기결정권
가. 성과 성관계 관련 태도
나. 임신과 피임 관련 인식 및 태도
다. 성적 자기결정권
라. 산부인과 관련 인식
3. 피임약 및 낙태 관련 인식과 태도
가. 사전피임약
나. 응급피임약
다. 낙태
4. 피임약 복용 및 낙태 실태
가. 사전피임약
나. 응급피임약
다. 낙태
5. 피임약 복용 및 낙태 의향과 정책 수요
가. 사전피임약
나. 응급피임약
다. 낙태
6. 소결

Ⅵ. 피임과 낙태 정책 관련 전문가 델파이 조사 결과
1. 조사 개요
2. 1차 델파이조사 결과
가. 피임약 전체
나. 사전피임약
다. 응급피임약
라. 낙태
3. 2차 델파이조사 결과
가. 사전피임약
나. 응급피임약
다. 낙태
라. 여성의 재생산 건강권 보장 방안
4. 소결

Ⅶ. 정책과제
1. 기본적 정책과제
가. 여성의 권리로서 재생산건강권에 대한 인식 전환
나. 건강권으로서의 재생산권 보장을 위한 여성정책방향 설정
다. 피임에서부터 낙태에 이르기까지 여성에 대한 통합적 사고 필요
라. 피임과 낙태의 또 다른 주체로서 남성의 참여와 관심 제고
2. 세부적 정책과제
가. 여성의 재생산건강권 향상을 위한 안전성 제고
나. 여성의 재생산건강권 관련 법？제도 개선 및 기반 구축
다. 건강한 피임문화 정착을 위한 실질적 노력 필요

참고문헌

부    록

Abstract

“낙태권은 보편적 인권으로, 성관계, 임신, 출산, 낙태를 개인이 자유롭고 책임있게 결정할 수 있으며, 낙태와 관련한 정보와 시술 수단에의 접근권, 그 과정에 있어서의 건강과 안전을 보장받는 것을 골자로 한다.”

“우리 아이 낙태해줘” 친부모vs대리모…왜?

동아일보 입력 2013-03-11 03:00:00 기사수정 2013-03-11 09:34:08
http://news.donga.com/East/3/all/20130311/53600926/1

친부모의 낙태 요청에도 기형아 출산한 대리모 “구세주냐 악마냐” 美전역 논란

그녀는 구세주인가 악마인가.’

선천성 기형을 가진 아이를 친부모의 낙태 요청에 응하지 않고 출산한 대리모를 둘러싼 논란이 미국 전역에서 일고 있다.

최근 CNN방송에 따르면 코네티컷 주에 살던 크리스털 켈리 씨(31)는 2011년 8월 불임 부부를 돕는 것도 괜찮다고 생각해 2만2000달러를 받고 대리모가 되기로 결심했다. 두 딸을 둔 이혼녀였던 켈리 씨는 경제적으로 곤궁한 상태였다.

켈리 씨는 대리모 주선 회사를 통해 같은 주에 사는 한 부부와 연결됐다. 이미 3명의 자녀를 두고 있었던 의뢰인 부부는 4번째 아이를 원했지만 더이상 임신이 불가능하다는 판정을 받은 상태였다. 냉동보관 중이던 의뢰인 부부의 수정란은 2011년 10월 8일 켈리 씨의 자궁에 착상돼 임신은 순조롭게 진행됐다. 부부는 켈리 씨의 사정을 고려해 비용을 앞당겨 매월 나눠서 지급하고 매일 전화해 안부를 물을 정도로 친하게 지냈다.

문제는 임신 4개월인 2012년 2월에 불거졌다. 태아 사전검사 결과 심장기형과 구순구개열(언청이) 등이 있는 것으로 나타났다. 병원 의료진은 아이가 태어나면 수차례 심장수술을 받아야 하고 출생 후 정상 생활을 할 확률은 25% 정도라는 진단을 내렸다.

이후 대리모와 친부모의 ‘전쟁 아닌 전쟁’은 시작됐다. 친부모는 태어날 아이의 고통을 생각해 낙태를 요청했다. “이들은 이미 낳은 3명의 자식 중 2명이 미숙아로 태어나 오랫동안 병원 신세를 졌고 지금도 여러 질환에 시달리고 있다”고 설명했다. 그러나 대리모는 “부모라도 아이의 생명을 멋대로 빼앗을 수 없다. 아이에게 기회를 주기 위해 모든 것을 다 시도해 봐야 한다”며 낙태를 거부했다.

3월 초 임신 24주가 가까워지면서 대립은 더 극에 달했다. 임신 24주를 넘기면 법적으로 미국에서는 낙태가 불가능하기 때문이다. 친부모는 변호사를 고용해 켈리 씨에게 낙태를 종용했다. 불응하면 병원비용도 내지 않겠지만 낙태에 응해주면 1만 달러를 추가로 지급하겠다는 제안도 했다.

그러나 켈리 씨는 종교와 양심의 이유까지 들며 거절했다. 켈리 씨는 “나만큼 아이와 교감을 한 사람은 없다. 아이가 발로 배를 차고 배 속에서 놀면서 느끼는 감정을 누가 알겠느냐”며 아이의 생명줄을 놓을 수 없음을 호소했다.

켈리 씨는 궁리 끝에 아이를 출산할 수 있는 방안을 찾았다. 코네티컷 주와 달리 미시간 주에서는 대리모에게도 부모 자격을 준다는 것을 알았다. 켈리 씨는 4월 초 두 아이를 데리고 미시간 주로 이사를 했다. 태아 심장 전문의가 있는 미시간대 병원이 있다는 것도 이사의 중요한 이유였다.

문제는 직장이 없는 켈리 씨가 새로 낳을 아이를 돌볼 경제적 여유가 없다는 점이었다. 그는 고심 끝에 입양을 생각해냈다. 주변의 도움으로 어렵사리 아픈 아이를 입양할 양부모를 아이를 낳기도 전에 찾아냈다.

6월 25일 아이는 세상에 태어났다. 아이는 출생 당시 숨을 쉬지 못해 응급처치를 받았다. 출생 후 초음파 검사 결과는 더 심각했다. 뇌의 양반구가 완전히 분리되지 않은 ‘완전전뇌증(完全前腦症)’과 간이나 위가 제 위치에 있지 않은 ‘내장 변위(變位)’도 발견됐다.

생후 8개월째인 올해 2월 현재 ‘S’로 불리는 이 아이는 이미 몇 차례의 심장 수술을 받았고 구순구개열 수술 등을 앞두고 있다. 좀 더 자란 뒤 심장 수술을 몇 차례 더 받아야 한다. 의사들은 아이가 생존해도 걷거나 말하지 못할 확률이 50%쯤 될 것으로 예상하고 있다.

그럼에도 불구하고 켈리 씨와 아이의 양부모는 아이로부터 매일 경이로운 장면을 보고 있다고 CNN에 전했다. “아이는 매일 전염성 강한 미소를 보이며 깨어나고, 의사와 눈을 맞춤으로써 사람들을 놀라게 하고 있다”고 말했다.

현재 미국 사회는 켈리 씨의 결정이 새 생명을 구한 구세주라는 의견과 함께 아이가 평생 안고 살아야 할 고통을 고려하지 않은 무책임한 행동이라는 견해가 팽팽하게 맞선 상태다.

허진석 기자 jameshuh@donga.com

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Surrogate mom refuses to abort fetus with birth defects

http://blog.sfgate.com/sfmoms/2013/03/05/surrogate-mom-refuses-to-abort-fetus-with-birth-defects/

Crystal Kelley was offered $10,000 to abort the child who she’s holding in this photo. (CNN)

When a Connecticut couple learned their surrogate mother was carrying a fetus with developmental disabilities, they offered her $10,000 to have an abortion, reported CNN.

Crystal Kelley, 29, demanded $15,000 to undergo a procedure that she claimed went against her religious beliefs.

The unnamed couple refused and a legal battle over the surrogacy contract and the child’s fate followed.

In August 2011, Kelley had signed an official contract with a surrogacy agency saying that she’d agree to abort if the fetus had a severe abnormality. Now she was carrying a disabled child, but she didn’t want to honor the agreement.

Determined to give the fetus a chance at life, Kelley fled Connecticut for Michigan, where under state law the surrogacy contract would be disregarded and she would be recognized as the legal guardian.

In Ann Arbor, she gave birth to a child with severe medical conditions.

As more people turn to a third party to carry their babies, complicated situations like this are challenging the ethics of surrogacy. When all three people involved in a surrogacy aren’t on the same page, what should happen?

***

This isn’t the first time a surrogacy situation has gone bad and caught the attention of national media. In 2010, when a Canadian couple learned their surrogate mother was carrying a fetus that was likely to be born with Down syndrome, they demanded an abortion.

The surrogate didn’t want to abort the child, according to the National Post, and the child’s fate became about the surrogacy contract.

According to the couple’s agreement with the surrogate, if the surrogate birthed the child, the biological parents wouldn’t have any legal responsibility for the child.

But many legal experts are saying that if this situation had been brought to court the surrogacy contract would have been disregarded. Instead the court would draw from family law requiring the biological parents to support the child.

It’s hard to know what would have happened because a surrogacy contract had never been contested in a Canadian court, according to the National Post, and the surrogate in this case never filed a lawsuit and decided to have an abortion in the end.

But the story got the entire world talking about surrogacy and whether contracts should be followed in all situations. What happens when prospective parents don’t want the child being carried by a surrogate? Should they be forced to care for a child they don’t want or can they demand that the surrogate abort the child?

***

Crystal Kelley revealed all the details of her complciated surrogacy to CNN. (CNN)

Crystal Kelley decided to become a surrogate mom because as a single mother of two daughters she desperately needed the $22,000 fee. Also, she struggled with fertility issues herself and liked the idea of helping out others in a similar situation.

The unnamed pair already had three children and wanted a fourth but the mother could no longer have children. For help, they turned to a surrogacy agency.

Kelley and the couple immediately bonded at their first meeting, and in October 2011 an embryo the couple had left over from a previous round of in-vitro fertilization was inserted into Kelley’s uterus.

Ten days later, Kelley was pregnant. The would-be parents were supportive through the beginning of the pregnancy, often checking in on Kelley during her first trimester when she suffered from morning sickness. The prospective parents gave Kelley and her two daughters holiday gifts.

The relationship started to sour in February when ultrasounds spotted signs of abnormalities. Things got worse when Kelley had a high-level ultrasound at five months and the doctor concluded that the baby would likely have a cleft lip and palate, a brain cyst and heart defects.

Because the doctors determined that the baby would need multiple heart surgeries after birth and would have only a 25 percent chance of leading a normal life, the couple decided that an abortion was the next best step. The couple’s three children were all premature and two of them struggled with ongoing health issues. They feared the child Crystal was carrying faced an even more challenging fate.

Kelley felt differently. She wanted to give the baby a chance at life.

A meeting at the hospital between the three was emotional.

Kelley told CNN:

They were both visibly upset. The mother was crying. They said they didn’t want to bring a baby into the world only for that child to suffer. … They said I should try to be God-like and have mercy on the child and let her go.

I told them that they had chosen me to carry and protect this child, and that was exactly what I was going to do,” Kelley said. “I told them it wasn’t their decision to play God.

Overwhelmed and frustrated, Kelley walked out of the meeting.

The couple hoped their surrogate would move forward with an abortion but when the intended mother realized Kelley failed to make the appointment with the hospital, she and her husband offered her $10,000 to move forward with the procedure.

Kelley was tempted but felt she should be compensated more to do something that went against her religious values. Kelley told CNN that in a weak moment she let the surrogacy agency know that she’d terminate the pregnancy for $15,000.

The couple declined the offer, but Kelley claims that before she even received that news she had decided to have the baby.

In a final attempt to push for an abortion, the parents hired a lawyer. Kelley had signed a contract agreeing to abort if the fetus had severe abnormalities but the contract didn’t indicate what constitutes a severe disability. The lawyer alerted Kelley that she’d need to pay back all fees if she didn’t have an abortion because she was breaking the contract.

Kelley hired her own lawyer, Michael DePrimo, an attorney in Hamden, Conn. DePrimo wrote back: “Ms. Kelley was more than willing to abort this fetus if the dollars were right.”

Then the couple changed their minds and decided that they would exercise their legal rights to keep the baby and after birth they’d put her in foster care.

The legal squabble continued. With the 24-week legal limit for abortion just around the corner, Kelley decided to leave Connecticut where state law says that the baby’s genetic parents—the ones who supplied the sperm—are the legal parents, according to CNN. In April 2011, she moved to Michigan, one of several states that disregards surrogacy contracts and views the woman who’s carrying the baby as the legal guardian. She also chose Michigan because C.S. Mott Children’s Hospital at the University of Michigan has an outstanding pediatric heart program.

In Ann Arbor, Kelley and her girls settled into a new life. As her pregnancy progressed, Kelley thought a lot about whether to keep the baby or give it up for adoption. She was already struggling financially and decided it would be best to give her up for adoption.

Through an online group, Kelley connected with a mother of a special needs child who would adopt her baby.

The situation too took a complicated turn a month before the baby was due last June. The Connecticut couple filed papers in Superior Court for parental rights, indicating that they wanted to be the legal parents.

By filing the papers, the couple was forced to reveal that the wife was not the baby’s genetic mother. The couple used an anonymous egg donor.

Baby S was born with a cleft lip and palate. (CNN)

In the midst of a legal battle, Kelley gave birth to a baby with medical problems that were far worse than ever expected.

CNN reports:

She has a birth defect called holoprosencephaly, where the brain fails to completely divide into distinct hemispheres. She has heterotaxy, which means many of her internal organs, such as her liver and stomach, are in the wrong places. She has at least two spleens, neither of which works properly. Her head is very small, her right ear is misshapen, she has a cleft lip and a cleft palate, and a long list of complex heart defects, among other problems.

Kelley’s name went on the birth certificate but the space for a father was left blank.

Two weeks later, Kelley finally struck a deal with the couple. The husband and wife agreed to give up their parental rights as long as they could maintain a relationship with the child.

Kelley handed over the child, who is identified as Baby S, to the chosen adoptive mother.

In the seven months since Baby S’s birth, the unnamed adoptive mother told CNN that the Connecticut couple visited and held the child.

“They do care about her well-being. They do care about how she’s doing,” she said.

Baby S is leading a life filled with medical complications. She gets food through a tube inserted into her stomach. Her head is small and she has facial abnormalities. If she lives, she has a 50 percent chance of ever walking.

Some might see her life as miserable but her adoptive mother sees a lot of hope and joy.

“S. wakes up every single morning with an infectious smile. She greets her world with a constant sense of enthusiasm,” her mother said in an e-mail to CNN. “Ultimately, we hold onto a faith that in providing S. with love, opportunity, encouragement, she will be the one to show us what is possible for her life and what she is capable of achieving.”

As for Kelley, she’s chronicling her experience on her blog where she receives both fan and hate mail. Some see her as a brave woman who saved a child’s life while others see her as a selfish person who recklessly brought an unhealthy child into the world when she had no right to make that decision.

I think both Kelley and the couple behaved badly in this terribly sad story. The lesson here seems to be that surrogate moms and prospective parents need to have open and honest discussions about possible pregnancy outcomes and how they would respond to different scenarios before a contract is ever signed. Most importantly, they need to make sure that they share similar views on abortion.

The hero in this story is undoubtedly the selfless adoptive mother who was happy to care for Baby S and love her like her own. I can only hope that the child’s upcoming surgeries are successful and her medical condition improves.

What do you think?

Posted By: Amy Graff ( Email , Twitter , Facebook ) | Mar 05 at 3:30 pm

By Harry Alsop

3:01PM GMT 05 Mar 2013

==================

Surrogate Mother Who Refused to Abort Child Flees State to Keep Couple From Taking Custody

http://christiannews.net/2013/03/05/surrogate-mother-who-refused-to-abort-child-flees-state-to-keep-couple-from-taking-custody/

CNN recently reported a story of a woman who defied the demands of a couple to abort the baby that she was carrying for them as a surrogate.

The woman’s name is Crystal Kelley, who at age 29, was seeking to be a surrogate for a couple that was struggling with infertility. In addition to wanting to help a desperate family, she was in need herself of finances, which her surrogate services would provide.

In 2011, she arranged to meet with a couple in a playground near her home of Vernon, Connecticut to discuss carrying a child for the family. The unidentified couple had three children, but could not have more, and had two frozen embryos in storage.

Kelley and the family came to an agreement, and in October, she had both embryos implanted into her uterus. She was informed days later that one had survived. The two parties were cordial and friendly with each other — that is, until approximately five months into the pregnancy.

During a routine ultrasound, doctors had difficulty seeing the baby’s heartbeat and requested that Kelley go to Hartford Hospital for further tests. Later, Kelley received a phone call notifying her that the child had severe abnormalities, including heart defects, a cyst on the brain and a cleft lip and palate. They could also not locate the spleen.

Doctors told Kelley that the baby would require several heart surgeries following birth, and would likely survive, but would only have a 25 percent chance at a normal life. When the waiting couple found out, they demanded that Kelley obtain an abortion.

“Given the ultrasound findings, [the parents] feel that the interventions required to manage [the baby's health issues] are overwhelming for an infant, and that it is a more humane option to consider pregnancy termination,” stated a letter from Hartford Hospital.

Kelley refused.

“Ms. Kelley feels that all efforts should be made to ‘give the baby a chance’ and seems adamantly opposed to termination,” the document continued.

Kelley’s decision made the couple very upset.

“They said I should try to be God-like and have mercy on the child and let her go,” she remembered. “I told them that they had chosen me to carry and protect this child, and that was exactly what I was going to do. I told them it wasn’t their decision to play God.”

The couple then called Hartford Hospital to inquire about abortion services, but was informed that only Kelley could request an abortion.

Days later, Kelley received an email from a surrogacy organization, notifying her that the parents had decided that they did not wish to have rights to the child if he or she was to be born.

“You will be the only person who will be making decisions about the child, should the child is born,” wrote Surrogacy Internation’s Rita Kron.

However, she told Kelley that the couple had offered to pay $10,000 to have the baby aborted. Later, Kron took Kelley out to lunch to convince her to move forward with the abortion.

“She painted a picture of a life of a person who had a child with special needs,” Kelley recalled. “She told me how it would be painful, it would be taxing, it would be strenuous and stressful. She told me it would financially drain me, that my children would suffer because of it.”

In a statement that she later regretted, Kelley said to ask the parents if they would move forward with an abortion for $15,000. However, she quickly recanted and again resolved to keep the baby safe — no matter what.

Soon after, Kelley received a strongly-worded letter in the mail. The couple had hired an attorney.

“You are obligated to terminate this pregnancy immediately,” wrote attorney Douglas Fishman. “You have squandered precious time.”

In just weeks, Kelley would be 24 weeks pregnant and would not be permitted under law to abort. The attorney pressured her to schedule the abortion quickly, stating that she had signed a contract that agreed to end the baby’s life should there be a severe abnormality. He also threatened that if she did not abort, the parents would sue to get their money back — plus legal fees.

Kelley again refused. Instead, she obtained her own attorney, Michael DePrimo, who contended that the woman should not be forced to have an abortion.

“[A]bortion is off the table and will not be considered under any circumstance,” he wrote to Fishman.

However, soon after, Fishman contacted DePrimo and said that the couple had changed their mind. The planned to take custody of the child and then surrender her as a ward of the state upon birth. Kelley wouldn’t have it.

DePrimo then presented Kelley’s options, one of which was to move to a state where only the woman carrying the child is recognized as the mother under the law. After contemplating the issue, Kelley decided to move to Michigan.

“Once I realized that I was going to be the only person really fighting for her, that Mama bear instinct kicked in, and there was no way I was giving up without a fight,” she said.

She said she chose the state because it provided the best pediatric heart care in the country.

Because Kelley did not feel that she could raise the child herself, she contacted one of the women that helped her move to Michigan and asked if she would be interested in adopting. She said yes.

In the meantime, the couple filed court documents fighting for their rights to the child. However, in the paperwork, it was admitted that the woman was not really the mother as she had used an anonymous egg donor during the invitro fertilization procedure.

Therefore, when the child was born, a girl, Kelley’s name went on the birth certificate and the father’s name was left blank. The two parties agreed to give up rights to the baby as long as the adoptive parents would allow the couple to visit the child.

The infant still deals with numerous health issues, including a mishapen ear and head, and faces a number of risky heart surgeries, but according to her adoptive parents, is in good spirits.

“[She] wakes up every single morning with an infectious smile. She greets her world with a constant sense of enthusiasm,” they wrote in an email to CNN. “Ultimately, we hold onto a faith that in providing [this child] with love, opportunity, encouragement, she will be the one to show us what is possible for her life and what she is capable of achieving.”

Kelley, who is thankful that she fought for the baby’s life, says that she has been demonized by many as she has shared her story online.

“I can’t tell you how many people told me that I was bad, that I was wrong, that I should go have an abortion, that I would be damned to Hell,” she explained.

But Kelley is adamant that what she did was right.

“No one else was feeling this pregnancy the way that I was. No one else could feel her kicking and moving around inside,” she said. “I knew from the beginning that this little girl had an amazing fighting spirit, and whatever challenges were thrown at her, she would go at them with every ounce of spirit that she could possibly have.”

“When I look into her pretty blue-ish eyes, I can see that sparkle that makes me know that I did the right thing by standing up for her,” she added in a recent blog post.

==============
http://edition.cnn.com/2013/03/06/opinion/oconnor-surrogate-abortion

http://edition.cnn.com/2013/03/04/health/surrogacy-kelley-legal-battle

3월 8일 여성의 날에 다시금 여성을 둘러싼 성 건강과 재생산 건강, 그리고 재생산 정의에 대해 성찰하는 기회를 제공할 것이다. 

 ==================================================

‘누구’의 생명을 이야기하고 있는가? 

-재생산 권리의 관점에서 바라보는 낙태 

문현아(건강과대안 연구위원, 젠더와건강팀)

<목차>

1. ‘둘만 낳아 잘 기르자’ 속에 담긴 비밀 아닌 비밀

2. 임신-낙태-출산은 연결되어 있다.  

3. 재생산 권리, 재생산 건강, 재생산 정의 

4. 낙태가 일어나지 않을 수 있는 세상을 바란다. 

npr의 기사

1) 응급피임약(72시간 이내)의 경우 그 작용기전이 수정란의 착상을 막는 것이 아니라, 난자의 배출을 막는 것으로 밝혀져 응급피임약이 ‘낙태’를 초래한다고 주장하던 가톨릭 등의 주장은 근거를 잃게 되었다는 것 

2) 5일까지 피임 효과가 있는 ella의 경우도 수정란 배출을 막는 것이 작용기전이라는 주장이 우세해지고 있어 가톨릭이 강력한 이탈리아에서도 ella가 시판되었고 독일의 주교회의에서도 지난 주 ella를 강간피해자의 피임목적으로 가톨릭병원에서 사용하도록 허용했다고.

Morning-After Pills Don’t Cause Abortion, Studies Say

Enlarge image

Plan B is one of two emergency contraceptives available in the U.S.

UPI/Landov

The most heated part of the fight between the Obama administration and religious groups over new rules that require most health plans to cover contraception actually has nothing to do with birth control. It has to do with abortion.

Specifically, do emergency contraceptives interfere with a fertilized egg and cause what some consider to be abortion?

“The Health and Human Services preventive services mandate forces businesses to provide the morning-after and the week-after pills in our health insurance plans,” said David Green, founder and CEO of the arts and crafts chain Hobby Lobby, one of the firmssuing over the requirements. “These abortion-causing drugs go against our faiths.”

The morning-after pill he’s referring to is sold under the brand name Plan B. The week-after pill, which actually only works for five days after unprotected sex, is called ella.

Both are classified by the Food and Drug Administration as contraceptives. Neither is the same as the abortion drug RU486, or Mifeprex. That pill isn’t considered a contraceptive and isn’t covered by the new insurance requirements.

The constant references to Plan B and ella as abortion-causing pills frustrates Susan Wood, a professor of health policy at George Washington University and a former assistant commissioner for women’s health at the FDA.

“It is not only factually incorrect, it is downright misleading. These products are not abortifacients,” she says. “And their only connection to abortion is that they can prevent the need for one.”

That’s not a universal medical opinion, however.

“It would be my preference that none of these products had any potential to cause abortion or post-fertilization effects — that would be my preference — but we don’t know that,” says Gene Rudd, senior vice president of the Christian Medical and Dental Associations and a practicing OB-GYN in Bristol, Tenn.

That’s not really the case anymore.

For years, scientists knew the pills, particularly Plan B, were highly effective in preventing pregnancy after unprotected sex but weren’t exactly sure how they managed that. “It wasn’t really clear whether it worked before ovulation or after ovulation,” says Wood.

Scientists did know the drug worked primarily by preventing ovulation. It stops an egg from being released from a woman’s ovary and thus prevents any chance of fertilization and pregnancy. But they also thought the drug might make it more difficult for a fertilized egg to implant in a woman’s uterus.

Technically, that’s not an abortion, says Wood.

“We know that about half of fertilized eggs never stick around. They just pass out of the woman’s body,” she says. “An abortifacient is something that interrupts an established pregnancy.”

But people like Rudd worry that even if what the drugs do is not technically abortion, it’s still objectionable if it happens after fertilization.

But it turns out, at least when it comes to Plan B, there is now fairly definitive research that shows the only way it works is by preventing ovulation, and therefore, fertilization.

“We’ve learned a lot about how these drugs work,” says Diana Blithe, a biochemist and contraceptive researcher at the National Institute of Child Health and Human Development. “I think it’s time to revise our speculations about how things might work in view of data that show how things do work.”

For example, says Blithe, a study published just last year led the International Federation of Gynecology and Obstetrics to declare that Plan B does not inhibit implantation. And some abortion opponents in the medical community are beginning to accept that conclusion.

“Up until recently I would not prescribe the Plan B product because we didn’t have enough science to say it doesn’t have a post-fertilization effect,” says Rudd. “Now, I’m becoming — sitting on the fence with that.”

Less, however, is known about ella, the other widely available emergency contraceptive. And that’s where the controversy continues to rage.

“It kills embryos. And it kills embryos before they implant, and it kills embryos after they implant,” says Donna Harrison, director of research and public policy for the American Association of Pro-Life Obstetricians and Gynecologists.

Harrison says the biggest problem with ella is that it’s a chemical cousin of the abortion pill RU-486. “So at an equal dose of ella and RU-486, they cause equal actions,” she says.

But NIH’s Blithe, who worked to bring ella to market, says that’s wrong. First of all, she says, a woman would never take ella and RU-486 in similar doses “unless they were trying to harm themselves.”

Shots – Health News

Doctors And Women’s Groups Urge Feds To Relax Plan B Restrictions

Shots – Health News

More Women Turn To Morning-After Pill

But more importantly, while the drugs may be related, ella works much differently. “It’s chemically similar [to RU-486], but it was designed to have stronger effects on the ovary and less effect on the endometrium,” she says. RU-486 works in part by changing the lining of the uterus — the endometrium — to make it impossible for an early pregnancy to be sustained.

Blithe says studies have also shown that ella, like Plan B, doesn’t prevent pregnancy if a woman has already ovulated. Women who took the drug after ovulation got pregnant at the same rate as those who took nothing at all. She says that strongly suggests it does not have any effect on blocking implantation.

Ella opponents aren’t convinced. “To be as successful as they say it is, it would have to have post-fertilization effects,” says Rudd.

But opposition seems to be waning in Europe.

Ella is now available in heavily Roman Catholic Italy, for example. And on Thursday, Germany’s conference of bishops said both drugs are acceptable to give to rape victims in Catholic hospitals.

<피임약과 여성건강, 어떻게 볼 것인가>

일시: 11월 21일(수) 저녁 7시30분

장소: 건강과대안 사무실

*사회: 문현아

*패널: 나영(지구지역행동네트워크 사무국장)

꼬깜(여성민우회 회원-건강팀장)

송미옥(건강세상을위한약사회 전 회장)

강나영, 이상윤(건강과대안 젠더와건강팀)

*참고자료 순서

참고자료1 : 미국의 피임약 일반의약품 전환- 2p.

참고자료2 : 각 단체 성명 및 논평자료-5p.

*최근 낙태 관련 신문기사 

여성의 몸은 국가의 통제 대상이 아니다!

여성의 자기결정권과 행복추구권을 무시하고

형법 270조 1항 합헌 결정을 내린 헌법재판소를 규탄한다!

23일 헌법재판소는 여성의 요청에 의한 낙태 시술자를 처벌하는 형법 제270조 1항에 대한 합헌 판결을 내렸다. 우리는 국민 모두가 지니는 인간으로서의 존엄과 가치, 행복추구권과 그 불가침의 권리를 국가가 보장해야 함을 명시하고 있는 헌법 제10조에도 불구하고, 결국 국가에 의한 낙태 통제가 여성의 자기결정권과 행복추구권에 우선한다는 판결을 내린 헌법재판소를 강력히 규탄하는 바이다. 

특히 이번 위헌 소송은 여성의 요청에 의한 낙태 시술에 대해 상대 남성이 고소를 한 것이 계기가 된 사건이라는 점에서 상징적인 의미가 더욱 크다. 이 사건은 지난 2010년부터 한국프로라이프의사회가 낙태 시술을 한 병원과 의사들을 고발하면서 수많은 여성들이 원치 않는 임신에도 불구하고 이 사례와 같이 상대 남성 등으로부터의 폭력과 협박, 고소에 시달려야 했던 시기에 발생한 일이기 때문이다. 임신과 출산은 여성의 몸과 삶에 직결된 문제임에도 결국 자신의 의지와 상관없이 국가와 타인의 통제에 의해 좌우될 수밖에 없는 현실을 헌법재판소가 이번 판결로서 명백하게 승인하고 있는 셈이다.

무엇보다 우리는 이번 합헌 판결에 대한 헌법재판소의 결정 이유에 더욱 참담한 심정을 금할 수 없다.‘사익인 임부의 자기결정권이 태아의 생명권 보호라는 공익에 비하여 결코 중하다고 볼 수 없다’는 것을 판결의 중요한 근거로서 제시하고 있기 때문이다. 그러나 합헌 결정 요지에서 헌법재판소가 언급하고 있듯이, ‘인간의 생명은 고귀하고 존엄’하며 ‘생명에 대한 권리는 기본권 중의 기본권’이라고 본다면 임신과 출산에 대한 여성의 결정권 역시 이에 배치되는 것으로 이해되어서는 안 된다. 생명은 태어나 숨을 쉬는 것뿐만 아니라 살아가는 모든 과정으로서 존중되어야 하기 때문이다. 

임신과 출산은 하나의 단절된 사건이 아니라 여성의 삶에 지속적으로 영향을 미치는 과정이며 동시에 매우 구체적인 사회적 상황들 속에 놓여 있다. 그럼에도 불구하고 여성의 삶을 무시한 채 출산이 강요될 수밖에 없다면 이 역시 생명으로서의 여성의 존엄성을 침해하는 것이 될 수밖에 없는 것이다. 따라서 임부의 자기결정권을 ‘사익’으로, 태아의 생명권은 ‘공익’으로 해석하는 헌법재판소의 태도는 ‘생명존중’이라는 윤리적 가치를 협소하게 해석하는 것에 불과하며, 결국 여성이 지니는 사회적 역할과 가치, 존엄성을 무시한 채 여성을 재생산을 위한 도구이자 통제의 대상로만 여기는 인식수준을 여실히 드러내고 있는 것이다.

결정적으로, ‘낙태를 처벌하지 않거나 가볍게 제재한다면 낙태가 만연하고 생명경시 풍조가 확산될 것’이라는 헌법재판소의 결정 이유는 완전히 잘못된 판단에 근거하고 있는 것이다.

낙태율은 우리나라를 비롯해 낙태를 불법화하고 있는 나라에서 더 높으며, 안전하지 못한 낙태로 인한 여성 사망률 또한 매우 높기 때문이다. 무엇보다 낙태에 대한 통제는 사회적 낙인과 규제를 통해 결국 여성의 행위규범과 사회적 위치, 권리 전반에 대한 통제로 이어지기 때문에 여성의 성적 자기결정권과 평등권, 건강권, 행복추구권을 심각하게 침해할 수밖에 없다. 최근 몇 년 동안 낙태 시술에 대한 신고와 단속이 강화되면서 낙태 처벌을 빌미로 여성들에게 폭력적인 관계 유지를 강요하거나 협박을 하는 사건들이 버젓이 일어나고 있는 것도 이러한 사실을 반영하고 있는 현실인 것이다.

이와 같은 이유들 때문에 현재 OECD 30개국 중 23개국이 낙태를 합법화하고 있으며, 이 중 다수의 국가들이 공공 의료체계를 통해 여성이 필요한 경우 안전하게 낙태를 할 수 있도록 지원하고 있다. 또한 같은 이유에서 제49차 유엔 여성차별철폐위원회 역시 ‘낙태와 관련된 법, 특히 형법을 검토할 것을 고려하고, 안전하지 않은 낙태로부터 발생할 수 있는 합병증 관리를 위해 양질의 서비스를 제공할 것’을 한국 정부에 촉구하고 있다.

그러나 헌법재판소는 이러한 사실들은 고려하지 않은 채, 근거 없는 판단으로 낙태 통제를 위해 낙태죄를 유지하는 것이 옳다는 판결을 내림으로써 결국 여성의 기본권을 국가의 통제 목적의 하위에 두고 만 것이다.

한편으로 우리는 이번 판결이 비록 합헌으로 결정되기는 했으나 합헌 의견을 제시한 네 명의 재판관과 동수의 재판관들이 위헌 의견을 제시했다는 점에 주목한다. 위헌 의견에서 초기 낙태의 경우 모성 건강을 고려하여 임부의 자기결정권을 존중할 필요가 있다는 점, 따라서 자기낙태죄가 침해의 최소성 원칙에 위배된다고 판단한 것과 임부의 요청에 의한 낙태 시술 역시 위헌이라는 의견을 제시한 것은 낙태죄에 대한 사회적 논의를 시작할 수 있는 중요한 출발점이 될 것이다. 그러나 판결문을 통해 판단해 볼 때, 결과적으로 이번 판결의 과정에서 임신․출산의 사회적 의미와 여성들의 삶에 대해 진지하고 충분한 논의가 이루어지지 않았다는 점에서 헌법재판소의 안이한 판결에 매우 깊은 실망을 표하지 않을 수가 없다.

낙태에 대한 처벌이 강화되고, 낙태가 음성화 될수록 여성들은 자신의 삶과 직결된 임신의 유지여부와 건강 문제 등에 대해 상담을 하거나 의료적 도움을 받기도 어려워지며, 의사들 또한 여성의 건강권을 전반적으로 고려할 수 없게 된다. 저소득층과 청소년들은 비용이 높아지고 의료 접근성이 낮아질수록 더욱 위험한 상황에 처할 수밖에 없다. 불법시술로 인한 피해와 낙인이나 편견으로 인한 사회적 폭력 역시 온전히 여성이 감당해야할 몫이다. 그 어떤 추상적인 명분들 보다 엄연히 존재하고 있는 이 모든 현실들이 낙태죄의 위헌성을 증명하고 있다. 우리는 여성의 삶과 기본권에 대한 아무런 고려 없이 이토록 무책임한 판결을 내린 헌법재판소를 강력히 규탄하며, 이번 판결을 계기로 더 많은 이들과 함께 여성의 임신출산 결정권이 온전히 보장되는 법적, 사회적 조건들을 만들어 나가기 위해 계속해서 싸워나갈 것이다.

2012년 8월 24일

여성의 임신출산 결정권을 위한 네트워크

건강과 대안 젠더와 건강팀, 노동자연대 다함께, 동성애자인권연대, 민주노총 여성위원회, 붉은몫소리, 사회진보연대, 사회주의노동자정당건설공동실천위원회, 전국여성연대, 전국학생행진, 지구지역행동네트워크, 진보신당 여성위원회/성정치위원회, 통합진보당 여성위원회/성소수자위원회, 한국성폭력상담소, 한국여성민우회, 한국여성의전화