Charity must not stop at home

The International Development Secretary, Andrew Mitchell, defends the decision to ring-fence oversea

Andrew Mitchell may seem an unlikely Secretary of State for International Development. A supporter of William Hague for the Conservative Party leadership in 1997 and a friend of the maverick MP David Davis, Mitchell has long been seen as firmly on the right of his party. But look closely at this well-groomed Tory and you will see that he is wearing two coloured wristbands, one for Darfur and one for Rwanda, the latter marked: "Genocide: never again". The bands hint at the passions of a politician who is emerging as one of the most thoughtful members of the coalition.

Speaking to the New Statesman in his new office at the Department for International Development (DfID), Mitchell is impatient to make progress. "There's nothing to be said for opposition," he says. "You can only talk about things and you can lay your plans. You can't ­actually achieve very much; you have to be in government for that."

Now finally in office, Mitchell finds himself in the eye of a political storm, thanks to the decision of Tory high command to ring-fence ­development spending - a move aimed at aiding the "modernisation" of the once-toxic Tory brand. Despite the deficit, DfID's budget is set to rise by 63 per cent by 2013, and some commentators on the right have objected, citing the "age of austerity" and arguing that "charity starts at home".

Mitchell defends the funding pledge. "My ­argument is that charity does indeed start at home, but it doesn't stop there," he says. As well as reducing adminstration costs by a third, the new UK Aid Transparency Guarantee, he points out, will ensure independent assessment of development spending: "The ring-fencing imposes on all of us a double duty to make sure that for every pound that is spent on the development budget from hard-pressed taxpayers, we really get 100 pence of value."

But, surprisingly, he also concedes that the promise has not made his life easy: "It is quite a testing pledge - it's the sort of thing you make in opposition, then rather regret in government. But we've made it absolutely clear that that is what we are going to do." Given the obligation, he points to the "moral" case for increased aid, mentioning the 4,000 people who die from malaria each day, of whom 75 per cent are children under five.

Miracle worker

Mitchell also argues that development "is in our national interest". He cites Paul Collier, the Oxford University economist and author of The Bottom Billion, as he describes how the world's poorest people are "often trapped in conflict-ridden, insecure, badly governed states". Here he is at his most animated: "These are countries that export people . . . who put themselves into the hands of the modern-day equivalent of the slave trader, into a leaky boat, and cross hundreds of miles of ocean in the hope of tipping up on a European shore - these are not feckless benefit seekers . . . They are often the brightest and the best in those societies, who are seeking a better life for themselves and their families. How much better to persuade them, with international ­development and international support [for] their own country, that there's a future for them there?"

In addition, "the fact is that aid, where it is spent well, achieves miracles," says Mitchell. For him, there is one key statistic that demonstrates the aid budget's efficiency: "Britain, today, educates 4.8 million primary school children in Britain. And we educate five million primary school children around the developing world, at a cost of 2.5 per cent of what we spend on British children."

However, there are further controversies, including the coalition's decision to increase aid to Afghanistan by up to 40 per cent despite the well-documented corruption of Hamid Karzai's regime. Mitchell recalls a recent visit to a village near Kabul where he witnessed DfID accountability projects, and emphasises that "much of our money goes through the World Bank Trust Funds, which means it is only paid out on the basis of reimbursable receipts", giving the British taxpayer "some confidence that the money is being properly spent".

Then, there is the question of why the government is giving the tiny South Atlantic island of St Helena, populated by 4,000 people, a new airport - a project championed by Michael Ashcroft, the Tory donor. "We are doing it, first, because we have an obligation to the people of St Helena and, second, because it is in the interests of the British taxpayer," Mitchell says. Asked about Labour whispers that he was leant on by Ashcroft, he says: "Lord Ashcroft is a sort of Lord Voldemort [from Harry Potter] figure for the Labour Party - they think he is ­behind everything. He's got nothing to do with the decision on St Helena."

Compared to some of his colleagues, Mitchell - who describes himself as not "a particularly tribal beast" - is generous to his predecessors. He pays tribute to two former secretaries of state, Clare Short and Hilary Benn, while mysteriously omitting the most recent, Douglas Alexander. Short was a "brilliant development minister [who] advanced the cause of development", while Benn "was an absolute nightmare to shadow because he was extremely good at the job and a very nice guy".

He even adds, unprompted, that what Gordon Brown said at the AU summit in Kampala recently, about smart aid and IT investment, "was extremely sensible". However, he notes that the UN-endorsed pledge to spend 0.7 per cent of GDP enjoys cross-party support, which "takes development out of party politics".

Break with China

Under Mitchell, DfID is going back to the drawing board and considering the necessity of its presence in every country. The government has already announced that it will stop aid to China and to Russia. Aside from this, he presents two priorities. The first is the pledge to spend £500m a year on tackling malaria, though critics argue this is disproportionate in an overall health aid budget of less than £1bn. The second is improving access to contraception, which Mitchell has spoken about at the UN: "We will embed greater choice for women over whether and when they have children."

Overall, Mitchell appears at home at DfID, a department he forcefully defends, and where civil servants seem to have unusually high morale. Some senior Tories, including John Major and Douglas Hurd, have argued that it should be merged with the Foreign Office. Mitchell says the two departments should work closely together but adds: "It is sensible that development should be done by the development specialists and there is a very, very powerful argument for keeping the two departments separate - it's part of the reason why DfID has an excellent reputation around the world."

Mitchell slogged round 38 countries, working out a plan for government. Now, he is eager to get on with the job: "We've hit the ground running . . . and the lights have been burning late here as we implement our agenda."

Read an extended transcript of the Andrew Mitchell interview here.

Relations with Rwanda

It is telling that Andrew Mitchell was wearing a Rwanda wristband. The UK is Rwanda's largest bilateral donor, giving around £380m since the genocide in 1994. In the two countries' "memorandum of understanding", support is concentrated on three areas: public financial management, human rights and international obligations, and poverty reduction.

For DfID, Rwanda has become a key success story. The country has achieved the second-highest growth rates in Africa, averaging 10 per cent from 1994 to 2000, and 6 per cent since then. In tandem, poverty has decreased, from 70 per cent in 1994 to 57 per cent
in 2007.

But despite this progress, there are serious and growing concerns about the nature of the Rwandan government - led by the soldier-president Paul Kagame, an ethnic Tutsi.

Kagame has become increasingly autocratic, closing down newspapers and preventing the registration of opposition parties. Journalists and political activists have been murdered.

Rwanda will go to the polls on 9 August and Kagame will win, remaining in power for another seven years. The question, then, is whether he will change the rules that limit Rwandan presidents to two terms in order to hold on to power beyond 2017.

Sophie Elmhirst.

James Macintyre is political correspondent for the New Statesman.

This article first appeared in the 02 August 2010 issue of the New Statesman, Politics and comedy

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“There’s no equality in healthcare”: Working under the shadow of Ireland’s 8th

As the referendum on Ireland's anti-abortion law nears, the New Statesman talks to those working on the frontline of pregnancy about how the amendment affects their work. 

On 25 May, Ireland will hold a referendum that has been 35 years in the making. And it’s one of particular significance to women, whichever side they’re on.

The question is whether the 8th Amendment, which recognises the equal right to life of the unborn, should be removed from the constitution. While it is still in place, abortion cannot be legislated for or regulated in Ireland.

The only scenario in which abortion is currently legal in the Republic is where there is a “real and substantial” risk to the life, as distinct from the health, of a woman. In all other circumstances, including rape, incest and fatal foetal abnormalities, it is a criminal act to obtain one, with a maximum sentence of up to 14 years in prison.

This puts Ireland’s abortion laws well behind all other EU countries aside from Malta and Northern Ireland (as part of the UK). And it’s a human rights debate that has been raging in this historically Catholic country ever since conservative campaigners pushed for the amendment to be added back in 1983.

The impact of the current situation on Irish women and their health is clear, with thousands travelling abroad every year – mainly to England – to terminate unwanted or non-viable pregnancies. But what is it like to be the pro-choice medical professional who cannot support them? And what impact does the 8th have on Ireland’s maternity services as a whole?

“I was one of those people who grew up ‘pro-life’ and became pro-choice,” says midwife Jeannine Webster. “As I understood it then, you were not really a good person if you had an abortion. And then you learn, you know?”

Webster, who is 52, became a midwife in her early forties. She currently works at one of Ireland’s largest maternity hospitals, and has three adult children. In 2016 she became part of the campaign group Midwives for Choice.

For her, the issue with the 8th Amendment is the disparity in the level of care she can provide to women who make different choices: “There’s no equality in healthcare. Because as much as I can 100 per cent support a couple that want to continue with their pregnancy, I can’t do that for those who feel emotionally that would be too much.”

Webster tells me a story about a couple who came into her clinic a few months ago. During this visit, they learned their baby had a fatal foetal abnormality and would not survive outside the womb. The mother was in her second trimester of pregnancy with their third child.

 “The woman said, ‘Can we not just have the baby now?’ And I said, ‘No, because the baby still has a heartbeat.’ And she turned around to me, ‘But what’ll happen? What can I do?’ And I felt I couldn’t tell her what she could do. I can’t.”

“It absolutely makes a traumatic situation massively more difficult for them.”

In Ireland, as a medical professional, giving out information on abortion services abroad is subject to strict guidelines. It must not be accompanied by any advocacy or promotion of abortion and all options must be fully outlined. It is also against the law to make a referral to an abortion service on behalf of the pregnant woman. This makes difficult conversations tricky to navigate.

Despite this, 3,265 women travelled from Ireland to the UK in 2016 to have an abortion. That figure accounts for nearly 70 per cent of all non-resident abortions carried out in the UK that year.

Dr Jennifer Donnelly is a consultant obstetrician at Dublin’s Rotunda Hospital who deals with foetal abnormalities and complex maternal problems. She says that being unable to refer patients for termination services either at home or abroad creates health risks and unwelcome gaps in care.

“If somebody has got a devastating diagnosis and then has to try and negotiate a whole other health system with minimal support, it absolutely makes a traumatic situation massively more difficult for them,” she says. “We want to provide care for women. Part of that care is looking after women who are bereaved under those circumstances.”

Not all medical professionals agree.

“The Eighth Amendment has one medical effect only: it prevents Irish doctors from deliberately, as an elective matter, causing the death of an unborn child,” wrote Professor Eamon McGuinness, a consultant obstetrician and pro-life campaigner, in The Irish Times earlier this month.

“That right does not restrict doctors from acting to save the life of a woman where a serious complication arises,” McGuinness continued, in reference to recent reports of women being denied life-saving cancer treatment due to an unplanned pregnancy.

Dr Maeve Eogan, a fellow consultant obstetrician, was quick to point out on social media that although abortion is lawful where there is “a real and substantial risk” to a woman’s life, McGuinness had failed to address a number of important areas. For example, sexual violence and life-limiting foetal conditions, “or the fact that women travel and take unregulated medications every day”.

Eogan is Medical Director of Ireland’s National SATU (Sexual Assault Treatment Unit) Services. She has witnessed the trauma caused to women by both sexual violence and fatal foetal abnormalities first hand. One of her primary concerns is women’s fragmented experience of care.

“At the moment, Irish women who travel to the UK for termination of pregnancy – or access unregulated medications online – are not getting the full range of termination of pregnancy care,” she says.

“So they’re not getting the post termination follow-up, and they’re not getting the appropriate contraception. There isn’t the holistic care package. They’re accessing one piece of the jigsaw, but they’re not accessing the other things which promote their health in the long-term.”

“It in essence means that women have no guaranteed role in decisions about their care.”

When it comes to continued pregnancies in Ireland, pro-choice health professionals have differing views on whether the 8th Amendment plays any role.

Philomena Canning, a 57-year-old independent home birth midwife and founder of Midwives for Choice, believes the 8th Amendment undermines the rights of all pregnant women; not just those seeking an abortion.

 “The 8th Amendment strikes at the core of midwifery,” Canning says. “And at the core of midwifery is respect for the human rights and personal decision-making of the woman. It in essence means that women have no guaranteed role in decisions about their care and treatment from the time they get pregnant until the baby is actively born.”

She cites the 2016 case of Geraldine Williams, from Ballyjamesduff, Co Cavan, who had three children delivered by caesarean section and wanted to have her fourth child naturally.

In September of that year, when Williams was 40 weeks pregnant, the Health Service Executive applied to the High Court for an order allowing it to carry out a caesarean section against her wishes. This was to assert her baby’s right to life under article 40.3.3 of the constitution. Williams had already been hospitalised and would not agree to a c-section.

The judge ultimately refused to grant the order, saying the increased risks associated with a natural birth did not justify “effectively authorising to have her uterus opened against her will, something which would constitute a grievous assault if done on a woman who was not pregnant”.

But Eogan and Donnelly, both specialist consultants in their fields, insist that the impact of the 8th is generally restricted to women seeking terminations.

“That kind of situation is extremely rare,” says Donnelly. “A woman’s wishes should not be overwritten and a procedure should not be done to her without her consent.

“I think rather than it being the 8th Amendment, there certainly can be old fashioned attitudes from doctors and midwives to core ways of approaching things,” she concedes. “The woman’s views should not be disregarded and I think that would be a traditional patriarchal model, which is definitely changing, but I’m sure it may still be present in certain places.”

“We don’t have to have the 8th Amendment to be able to value women.”

Though their views might differ on this subject, all agree that Ireland’s maternity services still have a way to go to compete with the UK’s progressive, midwifery-led model for low risk births.

“We have pockets of excellent community midwifery in a whole range of areas in Ireland,” says Eogan. “But it is not universal. And some women who may wish to attend a community midwifery service, proximate to their home and their hospital, may not be able to do so.”

"While I may not agree personally that the amendment affects care in the labour ward, I don’t think it should be used as an excuse for poor professional behaviour either,” says Donnelly. “Our aim is to provide an excellent standard of care for women and we shouldn’t be using that as a barrier to consent, to exploring women’s concerns and choices in labour. From a cultural perspective, listening and communication is totally crucial, and if getting rid of the 8th helped to improve that culture, then I’m all in favour of that too."

And how might that culture change in Ireland, if the 8th Amendment is removed? “I hope that because that provision won’t be there that undermines women’s rights and choices that their voices will be a little more heard,” says 32-year old Dublin midwife Róisín Smith.

“And the things that women want – whether it be midwife-led care, midwife-led units, homebirths, being allowed more flexibility in terms of time in labour – all of that will be much more possible.

“We don’t have to have the 8th Amendment in our constitution for us to be able to value women and unborn babies as a society. Those kind of moralistic arguments that people make for the 8th, those morals don’t have to disappear because we also want to value women as mothers and decision-makers.”

This article first appeared in the 02 August 2010 issue of the New Statesman, Politics and comedy