Thursday, February 9, 2017
[Cross posted on Human Rights at Home Blog: Feb. 8, 2017] Human Rights Experts Find That Detention of Pregnant Women Violates Human Rights, by Megan Lynch:
In August 2014, a Wisconsin woman named Tammy Loerscher went to her local services agency because she believed that she was pregnant, but had serious medical conditions and could not afford health care. She was referred to the emergency room of a nearby hospital, where her urine was collected to test for pregnancy and for controlled substances. When the results returned “unconfirmed positive,” she was reported to child protective authorities. A temporary order of custody was issued to detain Tammy in the hospital. The next day a hearing was held over the phone. There was a lawyer representing the child protective agency, and a legal guardian to represent Tammy’s fetus, but Tammy herself was not given a lawyer, and the judge refused to delay the hearing to permit Tammy to find one. The judge ordered her to report to an inpatient treatment facility after being discharged from the hospital. No assessment was ever completed as to whether Tammy had a substance use disorder or needed inpatient treatment. When Tammy refused to enter inpatient treatment, she was ordered to serve 30 days in jail. While incarcerated she was denied medical care, held in solitary confinement, and threatened to be tased. Tammy was released after 18 days in jail subject to drug monitoring for the duration of her pregnancy. All subsequent drug tests were negative.
Last October, Tammy told her story to Seong-Phil Hong of the United Nations Working Group on Arbitrary Detention during the Working Group’s visit to the United States. An expert on arbitrary detention, Mr. Hong recognized that Wisconsin’s actions violated Tammy’s human rights and that there are better ways for the state to address concerns about fetal health. Late last year, the Working Group issued a statement emphasizing that confinement of pregnant women suspected of drug is inappropriate and that involuntary detention should be used only as a last resort, for the shortest period of time needed, and with appropriate due process protections. The group emphasized that “confinement should be replaced with alternative measures that protect women without jeopardizing their liberty.”
Despite the Working Group’s statement, every year, hundreds of pregnant women are involuntarily detained in the United States because they are suspected of drug use. Wisconsin is one of 5 states with laws that permit pregnant women to be detained for the supposed benefit of a fetus. These statutes were designed in the 1990s amid fears of the effects of in utero exposure to cocaine. Despite decades of research undercutting the belief that use of criminalized drugs is certainly and uniquely harmful to fetal health, these laws continue to be used to issue protective custody orders against pregnant women.
In addition to lacking scientific basis, laws that punish people who use drugs during pregnancy threaten the public health. As the American College of Obstetricians and Gynecologists has stated: “Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse.” Instead, threats of arrest and incarceration harm fetal and maternal health because they discourage women from seeking medical advice and prenatal care. The medical community in the United States and around the world universally condemn punitive approaches, recommending support and voluntary treatment where appropriate.
Not only do these laws harm the people they purport to protect, they also violate women’s fundamental human rights. Detaining pregnant women based on suspected drug use unfairly deprives them of liberty based on their pregnancy status. While civil commitment is permitted under U.S. law, the laws used to detain pregnant women lack the stringent standards required for civil commitment in other contexts, including a risk of imminent harm and due process protections. These statutes set no requirement that the state prove that a woman has a substance use disorder, or that the substance she is alleged to use is harmful to fetal development before detaining her. Nor do they require that the state consider alternative, less invasive measures before authorizing involuntary confinement. Rather, in most cases, simply testing positive for a drug is grounds for confinement in a treatment facility, regardless of whether it is medically appropriate.
Even if state intervention could be justified under extreme circumstances, these overbroad laws fail to provide adequate procedural protections. Indeed, in Wisconsin, a woman is not entitled to an attorney until appeal, even if she explicitly requests one. Further, the proceedings are sealed, closed proceedings, preventing public scrutiny of the process. This places the onus on women who have undergone this process to come forward to tell their stories.
The UN Working Group made clear that these laws run contrary one of the most fundamental rights under international law: the right to liberty and to be free from arbitrary detention. The right to liberty is deeply embedded in the American psyche, dating back to our nation’s birth and the Declaration of Independence’s promise of the right to life, liberty and the pursuit of happiness. The right to liberty would later be emphasized in the UN Declaration of Human Rights, and the US reaffirmed its commitment to liberty and freedom from arbitrary detention when it ratified the International Convention on Civil and Political Rights.
Because freedom from arbitrary detention is a fundamental right, international human rights standards require that individuals only be detained as a last resort, for the shortest period of time needed, and with appropriate due process protections. Any use of detention must be necessary and proportionate. According to the Working Group, Wisconsin’s law failed to meet these standards.
The Working Group’s recognition that detaining pregnant women suspected of drug use violates their human rights, and the widespread agreement that this practice actually threatens maternal and infant health, should be a call to reconsider our approach to substance use in pregnancy. Instead of spending money on counterproductive punishment and coercive treatment, we should ensure that women like Tammy are able to trust that the people they turn to will provide help, not handcuffs.
Tuesday, January 10, 2017
New York Times (Dec. 19, 2016): Pregnancy Changes the Brain in Ways That May Help Mothering, by Pam Belluck:
A recent study notes that pregnancy works changes in the brain, specifically in the part that perceives the feelings of others. Scientists query whether these changes have anything to do with mothers' emotional attachment to their offspring. The change actually involves the loss of gray matter in areas of the brain involved in social cognition, "that ability to register and consider how other people perceive things." The loss of gray matter sounds like a bad thing, but it may simply be a "neutral" offshoot of pregnancy-related stress or a beneficial sequella of pregnancy that prunes and trains the brain to be ready for the challenges of raising children, be they bonding, recognizing social threats, or recognizing the needs of an infant. The study seems to indicate that the more the brains of pregnant women changed, the better mothers they were (measured by emotional attachment, pleasure, and hostility toward the child). There is an analog to these changes in the brain in the brains of adolescents, whose brains sees a decrease of gray matter in several regions that scientists believe provide "fine tuning for the social, emotional and cognitive territory of being a teenager." The study detected no changes in the brains of new fathers.
Friday, September 30, 2016
HoustonPress (Sept. 19, 2016): Texas's Conservatism on Reproductive Rights May Make Fighting Zika Harder, by Carter Sherman:
As Houston braces for an outbreak of Zika (the city's mosquito season will extend well into October), activists are taking note of the likelihood that Texas's ultra-conservative stance on reproductive rights will make it harder for the state to fight the virus. The Population Institute, an international non-profit that aims to expand access to family planning resources, has reported that "Texas's especially dire track record on the issue makes the state 'particularly vulnerable." The state received an F-, the lowest possible grade, in the Institute's 2015 Report on Reproductive Health and Rights.
Despite the recent victory in Whole Woman's Health v. Hellerstedt, the fact that many abortion clinics in Texas remain closed means that "some women who contract Zika may have no choice but to carry a pregnancy to term." And with the number of people traveling to Texas from other regions of the world, Zika will remain a year-round concern.
Genevieve Cato of the Lilith Fund expressed her consternation: “I personally have found it almost maddening that we are seeing this potentially devastating possibility of a Zika outbreak at the same time that the state is doubling down on its willful inaction on expanding access to reproductive healthcare.”
Sunday, September 4, 2016
New York Magazine (August 12, 2016): New York City Buildings Are Now Required to Have Lactation Rooms, by Laura June
A bill requiring some New York City-run buildings to have rooms allocated specifically for lactation as of July 2017 was passed unanimously by the City Council and signed by Mayor de Blasio. There will be no restroom facilities in the rooms, but they will be equipped with electrical outlets for pumps. New York job center buildings, medical centers, and borough offices owned by the City are just some of the buildings protected by the new law.
Mayor de Blasio said in a statement, "This bill is about fairness, access, and health — no new mother should be unable to breast-feed because she can’t find a private space." He added that the "bill takes our city one step toward being a place where all women feel comfortable breast-feeding whenever they need to, wherever they need to.”
Thursday, August 25, 2016
Human Reproduction (July 7, 2016): Is Underage Abortion Associated with Adverse Outcomes in Early Adulthood? A Longitudinal Birth Cohort Study up to 25 Years of Age, by Suvi Leppälahti, et al.:
Tuesday, August 23, 2016
New York Times (Jul. 19, 2016): Winning the Campaign to Curb Teen Pregnancy, by Tina Rosenberg:
It is common knowledge that girls who get pregnant have a range of difficulties. They have trouble finishing school and often have babies at risk for health problems and who themselves will experience academic difficulty and incarceration. The birthrate for teenage mothers in the United States has hit a new low. It is now even lower than it was in the 1950s. No one knows the cause of the drop in the birthrate, but it appears not to have to do with an increase in abortions (that rate has also dropped) but with an increase in contraceptive use.
The drop in the birth rate may also have to do with the show “16 and Pregnant.” After it began airing on MTV in 2009, teen pregnancy rates dropped three times as fast as previously. Such declines were most remarkable in regions where more teenagers were watching MTV. Google searches for “how to get birth control” spiked on days following an episode’s airing.
Colorado appears to have embraced the data. The state offers long-acting reversible contraceptives cost-free to women and girls. These “set and forget” methods have become the most reliable forms of birth control. Some of the cost to the state is subsidized by Obamacare and Medicaid. The Medicaid program saves on the cost of unwanted births and the medical care of children in poverty. Colorado’s experiment has been a success. Now the challenge lies in convincing other states to follow suit.
Wednesday, July 6, 2016
AfricLaw (June 3, 2016): Uganda: Why the Constitutional Court Should Rule on the Right to Health, by Michael Addaney:
Responding to the shocking statistic that thirteen women giving birth in Uganda die each day due to circumstances that could be prevented (e.g., severe bleeding, infection, hypertensive disorders and obstructed labor), Michael Addaney notes that universal human rights could play a role in addressing the crisis. The current obstacle, he notes, is the political question doctrine, which forbids courts from deciding certain cases because the question lies in the province of elected officials.
In 2011, a non-governmental organization sued Uganda for violating the constitutional rights to health and life by not providing basic minimum maternal health care. The court ruled that the petitioners had presented a political question. Addaney notes, however, that the International Court of Justice has questioned judicial dodging of "political" questions "whenever the rights, interests or status of any person are infringed or threatened by executive action." The Supreme Court of Uganda appears to agree. In 2015, it reversed the ruling of the lower court, holding that "the petition has critical questions that need constitutional interpretation."
Addaney is hopeful that with the evolution of human rights and modern constitutionalism the political question doctrine will see its end.
Thursday, June 23, 2016
Jezebel (May 17, 2016): Report Finds Pregnant Massachusetts Inmates Are Still Being Illegally Shackled, by Anna Merlan:
In 2014, Massachusetts passed legislation prohibiting the shackling of pregnant inmates. The law prohibits shackling women when they are in labor, in their second or third trimester of pregnancy and immediately post-delivery. Despite the law a recent report found that many Massachusetts counties fail to enforce law and even have written policies that explicitly violate it.
The report published by Prisoners' Legal Services and the Prison Birth Project
charges that neither the state Department of Corrections nor a single county sheriff’s office is fully implementing the anti-shackling law, and that knowledge of what the law even entails “varies not just from one prison or jail to another, but among corrections personnel who work for the same prison or jail.”
The report documents instances of shackling during labor and in hospital beds post-delivery. The report also found violations of the law's requirement that pregnant women be transported in vehicles with seatbelts to prevent the danger caused by sliding around in van seats or benches while handcuffed.
Massachusetts is one of 22 states that have anti-shackling laws. Its experience illustrates the need for monitoring and implementation of these laws.
Friday, May 20, 2016
Macaulay Honors College, CUNY, hosts Policing Reproduction Symposium, by Elizabeth Reis, Professor Macaulay Honors College:
As readers of this blog are well aware, since 1973, the year of the historic Roe v. Wade decision legalizing abortion rights, hundreds of pregnant women, particularly women of color, have been arrested, detained, and jailed for matters relating to their pregnancies. Some have had miscarriages and yet have been suspected of feticide; others have admitted drug or alcohol use to their physicians and have been arrested for harming the fetus; yet others have faced legal scrutiny for refusing bed rest orders or requesting VBAC (vaginal deliveries) instead of cesarean sections. Authorities have prosecuted pregnant women based on the idea of “fetal personhood,” the notion that an unborn fetus has the same rights as a pregnant woman.
On May 15 and May 16 Macaulay Honors College at The City University of New York hosted a symposium called Policing Reproduction that brought together a diverse range of scholars, students, and the public to discuss these alarming trends in women’s reproductive health. On May 15, Johanna Schoen, Professor of History at Rutgers University read from her new book, Abortion After Roe. On May 16, symposium panelists included Lynn Paltrow, J.D., Founder and Executive Director of National Advocates for Pregnant Women; Jeanne Flavin, Professor of Sociology at Fordham University; Kimberly Mutcherson, Vice Dean and Professor of Law at Rutgers Law School, Miriam Zoila Perez, a journalist and activist based in Washington, D.C. and author of The Radical Doula Guide: A Political Primer for Full-Spectrum Pregnancy and Childbirth Support; Michele Goodwin, Chancellor’s Professor of Law at UC Irvine School of Law as well as Founder and Director of the Center for Biotechnology and Global Health Policy at Irvine and author of the forthcoming Policing the Womb; and Civia Tamarkin, award-winning journalist and filmmaker who is working on a film about these issues, Misconception: A War Story.
The range and depth of the symposium’s presentations and the lively discussions surrounding them can’t be easily summarized. But among the most important themes that emerged was that the systematic erosion of women’s access to abortion and other reproductive health services is part of a larger, under-acknowledged assault on women’s basic rights as citizens and persons.
Tuesday, May 3, 2016
Center for Reproductive Rights Press Release (Apr. 1, 2016): Case of Illegal Detention and Death of Woman at Hospital Heads to High Court of Nigeria:
With support from the Center for Reproductive Rights, an advocacy group has filed suit in the case of a woman illegally detained by a hospital to which she was admitted after suffering complications in the course of a cesarean section at another hospital. Folake Oduyoye was discharged after two months but was locked in a guarded ward that lacked toilet facilities and mosquito netting because she could not pay her bill in full. Oduyoye eventually died from post-partum sepsis and pneumonia.
The lawsuit seeks a declaration that the detainment was illegal, unconstitutional, and in breach of Oduyoye's rights, along with financial reparations and a public apology.
The Center has been working to end the mistreatment of women in maternity hospitals.
Monday, May 2, 2016
The Journal IE (Mar. 30, 2016): The Horrific Case Involving a Young Pregnant Brain-dead Woman May not Be a One-off, by Kate Butler:
Two years ago, the Eight Amendment to the Irish Constitution resulted in a judicial circus act as the court wrestled to define the rights of the 15-week-old unborn fetus carried by a brain-dead pregnant woman reposing in an Irish hospital. The fetus was highly unlikely to survive. The woman's family was forced to bring a petition to the High Court asking it to order that the woman's artificial life support be terminated.
The court held that it was in the best interests of the unborn child to authorise the withdrawal of life support, and said that maintenance of life support would deprive the mother of dignity in death and subject her father, her partner and her young children to “unimaginable distress in a futile exercise.”
Butler notes that this case is not a "one-off." Indeed, new legislation in Ireland grants individuals autonomy to employ advanced healthcare directives to choose the course of their end-of-life care, except if the individual is a pregnant woman. The legislation requires medical professionals to refuse the wish of a pregnant woman to refuse life-prolonging care. Those same professionals have no discretion in the matter. They must refer the case to the judiciary.
Butler is concerned about how the Irish Constitution's guarantee of the right to life of the unborn will apply in cases where the fetus has a greater chance of survival if the brain-dead woman is kept on life support.
The ambiguities . . . are not accidental or due to some governmental oversight. They are intentional. This new legislation makes that clear.
Butler is calling on the new government to launch a referendum to repeal the Eighth Amendment.
Tuesday, March 15, 2016
New York Times (Mar. 5, 2016): The Return of the D.I.Y. Abortion, by Seth Stephens-Davidowitz:
The recent surge in state-level anti-abortion legislation, such as the Texas TRAP law at issue in Whole Woman’s Health v. Hellerstedt, has led to the closure of many abortion providers across the country. While the impact of such laws on access to safe abortions is clear, the response of pregnant women is less so due to the silencing stigma surrounding the procedure.
Google searches can help us understand what’s really going on. They show a hidden demand for self-induced abortion reminiscent of the era before Roe v. Wade.
This demand is concentrated in areas where it is most difficult to get an abortion, and it has closely tracked the recent state-level crackdowns on abortion.
While only 34% of people involved in an abortion – that is, people who have had an abortion or their partners – tell anyone about the procedure, Google searches offer a window into the decision behind an abortion.
Search rates for self-induced abortion were fairly steady from 2004 through 2007. They began to rise in late 2008, coinciding with the financial crisis and the recession that followed. They took a big leap in 2011, jumping 40 percent. The Guttmacher Institute singles out 2011 as the beginning of the country’s recent crackdown on abortion; 92 provisions that restrict access to abortion were enacted. There was not a comparable increase in searches for self-induced abortions in Canada, which has not cracked down.
These statistics do not reveal the true trends in self-induced abortions across the country, but they certainly indicate a disturbing increase in demand in states where abortion services have become all-but impossible to obtain.
Monday, March 14, 2016
Guttmacher Institute (Mar. 2, 2016): U.S. Unintended Pregnancy Rate Falls to 30-Year Low; Declines Seen in Almost all Groups, but Disparities Remain, by Rebecca Wind:
A new analysis from the Guttmacher Institute, just published in the New England Journal of Medicine, shows that the U.S. unintended pregnancy rate declined substantially between 2008 and 2011. According to “Declines in Unintended Pregnancy in the United States, 2008–2011,” by Lawrence B. Finer and Mia R. Zolna, there were 45 unintended pregnancies for every 1,000 women aged 15–44 in 2011, down from 54 per 1,000 in 2008. The 2011 rate was the lowest observed in three decades. Although unintended pregnancy rates have declined among nearly all demographic groups examined, disparities still remain, particularly for poor women and women of color.
The study, released last week, can be found here.
Tuesday, March 1, 2016
ACLU Blog (Feb. 25, 2016): The Rising Threat of Religious Hospitals Denying Women Medical Care, by Alexa Kolbi-Molinas:
Catholic hospitals across the country follow the religious directives of the United States Conference of Catholic Bishops. This means that such hospitals will, for example, withhold medical services when a pregnant woman is hemorrhaging until her death is sufficiently imminent rather than induce labor to complete a miscarriage.
Currently, 10 of the 25 largest hospitals in the US are Catholic-affiliated. These hospitals receive federal funds, but they follow religious policies that deviate from the medical standard of care. These unlawful procedures have prompted the ACLU to file suit in cases such as Tamesha Means v. United States Conference of Catholic Bishops in order to force changes in policy.
Tuesday, February 23, 2016
RH Reality Check (Feb. 18, 2016): Pope Francis Suggests that Contraception May Be Acceptable for Catholics Fearing Zika Virus, by Jodi Jacobson:
The Zika virus, now found in 34 countries, may cause microcephaly in infants born to recently infected women. Some countries, including El Salvador, have responded to the recent increase in microcephaly by advising that women avoid pregnancy for up to two years. Last week, Pope Francis responded to questions about Zika virus, saying that it may be acceptable for Catholics to use contraception to avoid pregnancy when fearing possible infection.
Asked during a press conference whether abortion or birth control could be considered a “lesser evil” in response to the Zika virus, which appears to be linked to birth defects, the Pope replied that he believes abortion is a crime and is never acceptable, but that the use of modern birth control (“artificial contraception” in church parlance) may be permitted in exceptional circumstances.
Abortion “is an evil in and of itself” the Pope claimed. “On the other hand, avoiding pregnancy is not an absolute evil,” he said, referring to prior circumstances in which the church has sanctioned the use of birth control, such as in the 1960s, when nuns were subject to rape as a weapon of war in the Belgian Congo.
The Pope's statements may encourage Catholic countries to make contraceptives more readily available, thus avoiding increased birth defects due to Zka virus.
Friday, February 19, 2016
New York Times (Feb. 11, 2016): Pregnancy Clinics Fight for Right to Deny Abortion Information, by Erik Eckholm:
At more than 3,000 crisis pregnancy centers (CPCs) run by religious opponents of abortion, a woman cannot obtain information on where to obtain an abortion. To fight a California law requiring such centers to post a notice that free or low-cost abortion, contraception and prenatal care are available to low-income women through public programs, some CPCs are claiming a free-speech right to withhold such information. Attempts in other states to regulate CPCs in this fashion have been struck down by federal courts. But courts in California have so far refused to enjoin the regulations, the theory being that they do not force the CPCs to declare their religious beliefs but merely require them to provide factual information about public programs. There are lingering concerns that CPCs are misleading pregnant women with false information about the complications of abortion and its longer-term effects.
Wednesday, February 17, 2016
New York Times (Feb. 9, 2016): Chinese Who Violated One-Child Policy Remain Wary of Relaxed Rules, by Kiki Zhao:
Before China dismantled its one-child policy, couples who violated it often could not surmount the hurdle of obtaining the registration document (hukou) necessary for their second child to attend state schools, receive health care, marry, open a bank account or even buy train tickets. Now that hukous have been declared a right of all citizens and the one-child policy has been lifted, parents are still worried that they will be required to pay a fine for violating the one-child policy when it was the law. Municipal governments throughout China have not been clear or uniform in their messages about whether fines will be imposed retroactively.
Thursday, November 5, 2015
RH Reality Check (Nov. 4, 2015): Coerced C-Sections: The Latest Reach of Fetus First Laws, by Jessica Mason Pieklo:
Michelle Mitchell is suing her doctor for assault and battery alleging that she was coerced into having a c-section. The case is scheduled to go to trial in Augusta Circuit Court Nov. 4. Jessica Mason Pieklo writes:
According to court documents, Mitchell claims that once she was admitted to the hospital, [her doctor] demanded she have a c-section based on an ultrasound image performed a week earlier . . . and concerns over the baby’s size. Mitchell says that her previous doctor had recommended an induction of labor or c-section, but gave her no indication that vaginal birth was medically not an option or that a c-section was required.
Mitchell says that she signed a document refusing consent for the c-section, and that over the next four hours, [the doctor] and other employees of the hospital threatened her in various ways, including calling Child Protective Services to take her expected child away should she fail to consent. According to the complaint, after hours of this treatment, Mitchell relented.
The doctor has argued that Mitchell changed her mind after signing the signed refusal and consented to the surgery. Pieklo notes that the number of c-section births have grown in this country making the question of patient autonomy increasingly important.
Friday, May 8, 2015
TIME: How a New Study on Premature Babies Could Influence the Abortion Debate, by Eliza Gray:
A new study showing that a tiny percentage of extremely premature babies born at 22 weeks can survive with extensive medical intervention could change the national conversation about abortion, though the research is unlikely to have a major effect on women’s access to abortions in the short term.
Pro-life advocates said the study—which was published by theNew England Journal of Medicine on Wednesday and found that 3.5% percent of 357 infants born at 22 weeks could survive without severe health problems if hospitals treated them—could benefit the pro-life movement by sparking discussion about the viability of premature babies. . . .
This article correctly points out that the study in no way contradicts or forces reconsideration of Supreme Court precedent governing pre- and post-viability abortions. Unlike what some articles suggest, the Supreme Court has never set viability at a specific point in pregnancy (even in Roe), but rather has left the determination of viability to the provider to determine based on the individual facts surrounding each pregnancy. Viability depends on many factors, including the type of medical facilities available.
Friday, April 3, 2015
Vox: An Indiana woman is facing 20 years in prison for "feticide", by Christophe Haubursin:
Indiana did something unprecedented this week: it sentenced a woman to a 20-year prison sentence for violating a decades-old feticide law.
Purvi Patel's conviction, announced on Monday, is the first American case in which a court has found a pregnant woman guilty of violating a fetal homicide law. . . .