Sex, lies and Lithuania: a misinformation campaign by antichoice advocates threatens common sense health reforms.

LITHUANIA IS IN THE MIDDLE OF a debate over sexual education and the availability of legal abortion. Conservative groups, some funded by the US-based ultraconservative Catholic group Human Life International, have misrepresented every common-sense initiative to reform sexual and reproductive health services, to the possible detriment of Lithuanians' health.

The Family Planning and Sexual Health Association of Lithuania (FPSHA) is a nongovernmental organization promoting the health benefits of access to safe reproductive health and rights for Lithuanian families. It was founded in 1995, just after the Cairo Conference on Population and Development, and has more than 300 members: physicians, parents, teachers, educators, journalists, social workers nurses, midwives and students. In late 2004, FPSHA released survey results showing that three-quarters of Lithuanian women support legal abortion and that almost two-thirds support the availability of medical abortion (which is not available in Lithuania), to terminate a pregnancy. However, the government and the Ministry of Health appear to have been more swayed by the concerted campaign by conservative voices than by the views and needs of Lithuanians, and much-needed reforms have not been introduced.

SEXUALITY EDUCATION

At the moment, sexuality and life skills education are not part of the curriculum in Lithuanian schools. Parents are expected to provide sex education. As not all parents want to provide this information, it is vital that civil society find a way to equip sexually active young people with the knowledge and tools to protect themselves from unwanted pregnancy and sexually transmitted infections.

Studies have shown that young people who receive sex education that focuses on abstinence and denies information on contraception are less likely to use contraception and protection when they do have sex than young people who have been educated about their options. The FPSHA has been working with parents, experts, parliamentarians and other advocates to introduce a comprehensive, voluntary sex education plan.

However, the broadly supported sex education proposals that initially came before parliament in 2002 have been delayed by the activities of some conservative groups seeking to deny Lithuanian society the rights and freedoms to even discuss these issues. This is a serious setback for Lithuanian youth and for those parents who need support and help educating their children. A recent international project launched with Swedish support in Estonia, Latvia and Lithuania, which set out to train some 20 teachers in each country on methods of teaching HIV prevention in schools, was not granted state funding in Lithuania. After some initial support, conservatives pressured Lithuania's Ministry of Education and Science to withdraw by utilizing tactics and a media campaign unprecedented in Lithuania. Both Estonia and Latvia continue to support the initiative.

The attacks against the Swedish-supported project were extreme, presenting blatant untruths as fact. "Swedish attacks against the strategists of sexuality education of students" was the title of an article in the newspaper Respublika, (March 30, 2004) that went on to say: "The core of Swedish recommendations and methodology is that the school should take a neutral position and respect any choice of the child, including teaching boys group masturbation, how to masturbate and inviting homosexual couples to the sessions." A Lithuanian doctor then adds that the program is "unacceptable."

The biased, unbalanced article focused on a Swedish sexuality education book that was not, in fact, proposed for or used in Lithuania and quotes, out of context, the line "Masturbation, sexual fantasies and dreams are just one way to perceive one's individuality," in an attempt to paint the Swedish-funded project as immoral. It further suggested that the training materials denied the benefits for children of being in two-parent families.

The article also incorrectly stated that Sweden has the highest number of abortions in the EU, in an attempt to link abortion statistics directly to sexuality education. In doing so, it ignored basic methodological issues such as likely under-reporting in Lithuania and the greater access to services in Sweden.

While the FPSHA and the Ministry of Education denied the substance of the allegations, the sensationalist approach of the article had much more of an impact than measured rebuttals from advocates, the government and health officials.

This article was part of a widespread campaign to distort the real facts about this project and manipulate the public and politicians against sexuality education initiatives. The campaign involved the denunciation of prominent doctors and advocates through the media, with potentially serious consequences for their reputations; letter writing campaigns; direct approaches to government officials; and the use of senior members of the Catholic hierarchy to oppose the reforms. It was perhaps not surprising when the government announced that it would no longer support the project in March 2004.

The government's withdrawal from this project comes on the heels of controversies related to two other sexual and reproductive health and rights initiatives. In 2002, a reproductive health law that would have implemented the 2001 WHO regional strategy on sexual and reproductive health was rejected by the parliament. There has also been opposition to a newly launched United Nations pilot project, "Youth friendly services in Lithuania," aimed at strengthening or expanding youth-friendly services in six municipalities. It sought to improve general health, focusing on HIV testing, managing domestic violence, sexual and reproductive health, mental health services, substance abuse and counselling on a range of issues (e.g. nutrition and hygiene).

ABORTION

In late 2004, the FPSHA released survey results showing that almost three-quarters of Lithuanians (72%) support legal abortion and almost two-thirds (63%) support the availability of medical abortion. However, at this time, the government has announced no plans to allow women to choose medical methods of abortion, perhaps not surprising in the face of the vitriolic protests and misinformation campaign waged by conservative opponents of safe abortion and family planning.

While a ministerial decree in 1994 made abortion legal on request for all those seeking it aged 16 and older, the Lithuanian parliament has not protected this right as 16- and 17-year-olds are often denied the right to a legal abortion. In fact, a proposed liberalization of the law was defeated following debate on the Reproductive Health Bill of 2002. (Ministry of Health of Lithuania, "Reproductive Health Law of the Republic of Lithuania," Draft II, June 4, 2002)

It is often assumed that where legal, abortion is safe. But, as in other former Soviet countries such as Moldova and Russia, abortion in Lithuania, especially for adolescent girls, is not safe, mainly because young girls often fear going to medically-certified providers in a hospital setting. They fear the stigma and they fear their parents finding out. Also, many doctors refuse to provide abortions for adolescents between the ages of 16 and 18, in spite of the ministerial decree allowing them. Therefore, young girls turn to other sources, medical or not, who will provide the service clandestinely. Unfortunately, these sources are not always safe. As a result, unofficial estimates in Lithuania put abortion rates among young people at double to four-fold official rates.

The overriding concern of prochoice advocates in Lithuania about the nonavailability of safe, legal abortion is the negative impact it has on the health and wellbeing of women and their children when abortion is not legal and accessible. Studies from the former Czechoslovakia and some Scandinavian countries of what happened to children who were born after their mothers were denied abortion show that these children have a significantly higher rate of crime, mental illness and problems in school. (Born Unwanted: Developmental Effects of Denied Abortion, Henry P. David et al., eds. Springer Publishing Company, 1988)

This situation should never be allowed to develop in Lithuania. However, opposition groups, led by Human Life International (HLI), are doing their utmost to reduce access to legal abortion to the Lithuanian women who need it by proposing waiting periods, encouraging doctors and entire hospitals to refuse to provide abortion or referrals for it, misinforming the public and government officials about medical abortion and proposing a shortening of the legal period in which a woman may have an abortion.

HLI is known for its extreme positions--even in comparison with other anti-reproductive rights organizations. While its stated focus is opposition to abortion, the group has historically promoted a much broader agenda. Taking an extreme, conservative Catholic position, the group has even declared itself to be against contraception. HLI preaches that the only way to prevent unwanted pregnancy is abstinence until marriage and natural family planning within marriage.

HLI's president, Father Thomas Euteneuer, visited Lithuania in May 2003 during which he spoke with five of the country's seven bishops. In his post-report trip, Euteneuer claimed to be crusading against a "new totalitarianism" called "choice" or "reproductive rights." This distortion is not unusual for HLI, OF Euteneuer, who joins the small, but vocal group of conservative organizations opposed to sexuality education and legal abortion which has distorted facts, confused and twisted scientific evidence beyond recognition and launched strident personal attacks on the people involved in advancing choices for women in Lithuania.

The studies cited above from the former Czechoslovakia and some Scandinavian countries about what happened to children who were born after their mothers were denied abortion are a salutary lesson about Lithuania's future unless visionary policymakers are encouraged to develop and implement policies that allow Lithuanian women to make autonomous choices about when and whether to have children. The availability of safe, legal abortion and voluntary sexuality education will help to reduce the abortion rate and reduce the incidence of sexually transmitted infections including HIV. The misinformation campaign we are witnessing is a barrier to developing health policies that make sense for the wellbeing of all Lithuanian society.

JEFFREY LAZARUS is a researcher at the Department of Community Medicine, Lund University and is on the board of Sex & Samfund, the Danish member association of IPPF.