Tuesday, February 27, 2018

A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies

ProPublica (Feb. 22, 2018): A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies, by Nina Martin:

The results of a five-year study, conducted by researchers in both the U.S. and Canada, on the effects of midwifery on maternal and infant health are in. The study was published in the peer-reviewed journal PLOS ONE; it analyzes hundreds of laws throughout the United States that dictate what a midwife can and cannot do when it comes to prenatal care and the birthing process. 

'We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,' said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.

The midwife model emphasizes community-based maternal and infant care along with avoiding any unnecessary, and potentially dangerous, interventions. Midwives have long been widely embraced in Europe as a positive component of maternal care. In the U.S., though, midwives often represent a "culture war that encompasses gender, race, class, economic competition, professional and personal autonomy, risk versus safety, and philosophical differences." 

The title "midwife" can have multiple meanings, ranging from "certified nurse-midwives," to "direct-entry midwives," to "lay midwives." Depending on the title and the state in which the midwife works, the midwife will have a different level of training and may or may not be licensed or regulated by the state. 

This new study indicates, though, that midwives may be part of the answer to the U.S.'s problematic infant and maternal mortality rates. Severe maternal complications have sharply risen over the past 20 years, and maternal care is seriously sparse in certain areas of the country. "Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist." 

While midwife regulations vary widely among states, the study shows that states that have more fully integrated midwifery systems within their health care have significantly better outcomes for mothers and babies. States with restrictive midwife regulations--like Alabama, Ohio, and Mississippi--regularly score much lower on tests of maternal and neonatal well-being.

Alabama, which has the worst infant mortality rate in the country, has long had strict midwife regulations, "reflecting attitudes that wiped out the state's once-rich tradition of black birth attendants." Alabama lawmakers, though, recently passed a bill legalizing certified professional midwives, taking one small step toward the process of greater midwife integration, and, hopefully, improved maternal and infant health care across racial and economic lines. 

Access to midwifery is often split among racial lines, as many of the states with the worst outcomes (and higher levels of opposition to midwives), including Alabama, have large black populations. The study suggests a correlation between improved access to midwifery and reduced racial disparities in the maternal health care field.

Jennie Joseph, a British-trained midwife who runs the Florida birthing center and nonprofit Commonsense Childbirth affirms this:

“It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”

The study, though, does not conclude that better midwife access will directly lead to better outcomes or vice versa. It acknowledges that many other factors also affect maternal and infant health among states, including access to preventative care, insurance, and rates of chronic disease.

Nonetheless, maternal health advocates have long recognized the benefits of midwifery and this is not the only study to highlight the positive effects of supporting midwives. A 2014 study found that integrating midwives into health care could prevent more than 80 percent of maternal and infant fatalities worldwide, in both low and high-resource communities. Even in the U.S., organizations such as the American Congress of Obstetricians and Gynecologists have begun embracing nurse-midwives despite lingering skepticism by many. 

February 27, 2018 in Culture, Current Affairs, Medical News, Pregnancy & Childbirth, Reproductive Health & Safety, Women, General | Permalink | Comments (0)

Tuesday, February 13, 2018

Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018

Cosmopolitan (Feb. 6, 2018): Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018, by Jennifer Gerson Uffalussy: 

A safe, early-pregnancy abortion option has been making waves across the United States since Planned Parenthood began its telemedicine abortion pilot program in Iowa in 2008. 

Telemedicine abortions enable those seeking a pregnancy termination to meet with a nurse in a local clinic where both patient and nurse loop in an abortion-providing doctor via video chat. The doctor consults with the patient to determine that they are a good candidate for early pregnancy termination and then authorizes the nurse to dispense two small pills to the patient. The patient takes the first pill in the office in the presence of the nurse and doctor and then later takes the second pill at home. The pregnancy is terminated within a day or two. 

These medications have become known at "the abortion pill" and include both mifepristone and misoprostol, which work together first to block the hormones a woman's body needs to sustain a pregnancy and then to empty her uterus. The FDA-approved abortion pills are for ending pregnancies less than 10 weeks along. A study of Planned Parenthood's telemedicine pilot program found that access to telemedicine abortions decreased second-trimester abortions throughout the state. Second-term abortions require surgical procedures and can carry increased risks.

Although abortion is legal in all 50 states, many states have tightened their restrictions on abortion access, making it very difficult for a person facing an unwanted pregnancy to safely terminate it. Restrictions such as mandatory waiting periods and insurance limitations are compounded in states with very few clinics that can perform abortions. In fact, about 90% of counties in the U.S. do not have an abortion provider. 

Telemedicine allows a patient to meet with an abortion provider even if she doesn’t live near one. Instead of driving long distances, women can go to a closer clinic or Planned Parenthood and video-chat a live, somewhere-in-state abortion provider who prescribes and (virtually, via on-site clinic staff) hands over the meds. “There is no increased risk of complications with a telemedicine visit,” says Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. He led a groundbreaking study published last fall that found telemedicine abortions are just as safe as those in which a woman swallows mifepristone in the same room as a physician.

While mifepristone has so far demonstrated a highly-safe success rate (its rates of complications are fewer than most common pain relievers), it cannot be obtained over-the-counter; instead a clinic, hospital, or doctor's office must dispense it.

Some states will allow a pregnant person to video chat with a doctor from her home and then receive both pills in the mail. Since 2008, though, 19 states have challenged the expansion of telemedicine abortions by passing laws that specifically require mifepristone to be dispensed "in the physical presence of the prescribing clinician."

Planned Parenthood continues to expand its telemedicine program despite the challenges. It has now established 24 telemedicine locations in the nation and plans to add at least 10 additional locations--some in new states--throughout this year. 

To find out if telemedicine abortion is available in your area, call the national Planned Parenthood hotline at 800-230-PLAN.

February 13, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Media, Medical News, Politics, Pregnancy & Childbirth, Pro-Choice Movement, Reproductive Health & Safety | Permalink | Comments (0)

Wednesday, February 7, 2018

For Nonbinary Parents, Giving Birth Can Be Especially Fraught

Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith

Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.

With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."

Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important.  When it is absent, patients report both physical and psychological trauma.

Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."

This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.

The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity. 

February 7, 2018 in Culture, Current Affairs, Fertility, Medical News, Men and Reproduction, Politics, Pregnancy & Childbirth, Reproductive Health & Safety | Permalink | Comments (0)

Friday, August 4, 2017

Study Finds States With More Abortion Restrictions Score Worse On Women's Health

WBUR 90.9 (Aug. 1, 2017): States With More Abortion Restrictions Score Worse On Women's Health, Study Finds, by Eojin Choi

A newly released report by Ibis Reproductive Health and the Center for Reproductive Rights found that the the twenty-six states with more than ten abortion restrictions had poorer health outcomes for women than the twenty-four states with fewer than ten restrictions.

Titled Evaluating Priorities: Measuring Women's and Children's Health and Well-being Against Abortion Restrictions in the States, the report's findings challenge anti-choice politicians' claims of passing abortion restrictions under the guise of protecting women's health and safety.

Some examples of positive, supportive policies include Medicaid expansion, expanded family and medical leave, mandated evidence-based sex education, maternal mortality review boards, and contraceptive parity laws. The study found that many states with more abortion restrictions lack these supportive policies.

The report was first published in 2014 and is updated for 2017. You can read the full report here.

August 4, 2017 in Abortion, Abortion Bans, Pregnancy & Childbirth | Permalink | Comments (0)

Thursday, July 13, 2017

California's maternal mortality rate is a third of the American average. Here's why.

Vox (Jun. 29, 2017): California decided it was tired of women bleeding to death in childbirth, by Julia Belluz:

At the same time the global maternal death rate fell by nearly 44 percent, between 2000 and 2014, the United States watched its maternal mortality rate skyrocket 27 percent. Maternal mortality refers to "the death of a mother from pregnancy-related complications while she's carrying or within 42 days after birth." Childbirth is more dangerous in the U.S. than any other wealthy nation. The reason? The U.S. does not value its women. 

The United States is in the company of only 12 other countries whose maternal mortality rates have actually increased in recent years, including North Korea and Zimbabwe.

Researchers and health care advocates argue that a high maternal death rate is a reflection of how that culture views its women.

[In the U.S.,] policies and funding dollars tend to focus on babies, not the women who bring them into the world. For example, Medicaid, the government health insurance program for low-income Americans, will only cover women during and shortly after pregnancy.

Texas, having rejected Medicaid expansion and closed the majority of its Planned Parenthood clinics, has the highest maternal mortality rate in the developed world. California, however, has proven to be an exception within the nation. The California maternal mortality rate has steadily decreased over the same time that the rest of the nation's has risen, thanks in large part to the California Maternal Quality Care Collaborative (CMQCC). 

60% of maternal deaths are preventable and the complications that cause them should be anticipated. The CMQCC finds that even within an imperfect health care system, death from childbirth need not be an inevitability. Maternal deaths in the U.S. often result from common complications like hemorrhaging and preeclampsia. The CMQCC has enacted simple, lifesaving procedures over the last decade to reduce the number of unnecessary maternal deaths. And, they're working.

First, they aimed to lower the number of unnecessary C-sections performed. Cesarian sections are often prematurely offered by obstetricians who are short on time. The procedure can leave mothers with internal scar tissue that ultimately makes future pregnancies more dangerous by increasing the mother's risk of hemorrhaging. 

As many maternal deaths are a result of hemorrhaging--a mother can bleed to death within five minutes--doctors set out to prepare every delivery room in hospitals participating in their program with a "hemorrhage cart," equipped with everything necessary to handle a bleeding problem the moment it begins. 

In a recent study, researchers found a 21 percent reduction in severe complications related to hemorrhages in the hospitals participating in CMQCC's program. Hospitals not participating in the program saw only a one percent reduction. 

California has demonstrated that even in our messy and imperfect health care system, progress is possible. They’ve shown the rest of the country what happens when people care about and organize around women’s health. Policymakers owe it to the 4 million babies born in the US each year, and their mothers, to figure out how to bring that success to families across the country. 

How the current health care debate and the resulting volatility of the insurance market will affect the United States' maternal mortality rate going forward remains to be seen.

July 13, 2017 in Medical News, Politics, Pregnancy & Childbirth, Reproductive Health & Safety, Women, General | Permalink | Comments (0)

Monday, May 15, 2017

Focus on Infants During Childbirth Leaves U.S. Moms in Danger

NPR (May 12, 2017): Focus on Infants During Childbirth Leaves Moms in Danger, by Nina Martin & Renee Montagne:

NPR and ProPublica profile Lauren Bloomstien, a 33 neonatal nurse who died in childbirth. Every year in the U.S., 700-900 women die from pregnancy or childbirth related causes.  The U.S. maternal mortality rate is three times that of Canada and six times that of Scandinavia.  In recent years, Great Britain has seen a dramatic decline in maternal mortality, but maternal deaths in the U.S. increased from 2000 to 2014, and according the CDC Foundation, almost 60% of those deaths are preventable. 

Maternal mortality rates are significantly higher among African-Americans, low-income women and women who live in rural areas, but according to NPR and ProPublica, maternal mortality affects women of all races, ethnicities and income levels.

[T]he worsening U.S. maternal mortality numbers contrast sharply with the impressive progress in saving babies' lives. Infant mortality has fallen to its lowest point in history, the CDC reports, reflecting 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth, and improve outcomes for very premature infants. The number of babies who die annually in the U.S. — about 23,000 in 2014 — still greatly exceeds the number of expectant and new mothers who die, but the ratio is narrowing.

The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica's and NPR's reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother's health and wellbeing.

In the U.K. maternal deaths are treated as system failures, and a committee of experts investigates every death from pregnancy or childbirth complications. In the U.S. maternal mortality reviews are left to the states. Thirty-one states have maternal mortality review process.  A federal bill Preventing Maternal Deaths Act of 2017 would authorize federal funding for states to establish or improve review processes. 


May 15, 2017 in Pregnancy & Childbirth | Permalink | Comments (0)

Monday, March 13, 2017

What to Think about the Decrease in Sperm Quality

New York Times (March 12, 2017), Are Your Sperm in Trouble?, by Nicholas Kristof: 

Sperm is decreasing in quality and testicular cancer is on the rise.  Studies show a rapid decrease in sperm quality from 2001 to 2015.  Some suggest that endocrine disruptors--chemicals found in plastics are to blame.  In one study of the effect of endocrine disruptors on fish, the males became intersex and incapable of reproducing.  

Human reproduction might be threatened by these developments, but scientists disagree about the scale of the problem.  Some believe we are are crossing the line where the question "can we sustain ourselves?" becomes relevant.  After all, endocrine disruptors mimic hormones; as such they possess the power to interfere with the biological process of becoming male in the womb.

Some have taken to avoiding plastics, including the ubiquitous sales receipts produced by thermal printers.  But individual action is probably not enough.  The endocrine disruptor lobby in Congress mirrors the power of Big Tobacco before the regulation of smoking became a foregone conclusion.    

March 13, 2017 in Pregnancy & Childbirth, Science | Permalink | Comments (0)

Thursday, February 9, 2017

Human Rights Experts Find That Detention of Pregnant Women Violates Human Rights

[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.



February 9, 2017 in Pregnancy & Childbirth | Permalink | Comments (0)

Tuesday, January 10, 2017

Pregnancy and the Brain

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.  


January 10, 2017 in Pregnancy & Childbirth | Permalink | Comments (0)

Friday, September 30, 2016

Likely Houston Zika Outbreak Complicated by Texas's Conservative Position on Reproductive Rights

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.”     

September 30, 2016 in Pregnancy & Childbirth, Reproductive Health & Safety, Sexually Transmitted Disease | Permalink | Comments (0)

Sunday, September 4, 2016

New York City Buildings Are Now Required to Have Lactation Rooms

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.”

September 4, 2016 in Medical News, Parenthood, Pregnancy & Childbirth | Permalink | Comments (0)

Thursday, August 25, 2016

Underage Abortion Does Not Destroy Adult Lives

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.:

A recent study conducted in Finland followed all women born in 1987 (n=29,041) and queried whether having an abortion at less than eighteen years of age is associated with adverse socioeconomic and health outcomes in early adulthood as compared with giving birth to a child at less than eighteen.  The researchers looked at socioeconomic, psychiatric and risk-taking-related health outcomes up to twenty-five years of age after underage (<18 years) abortion (n = 1041, 3.6%) and after childbirth (n = 394, 1.4%). Compared with the external control group consisting of a group with no pregnancies up to twenty years of age, both pregnancy groups were disadvantaged already prior to the pregnancy.  The study found that "underage abortion was not found to be associated with mental health problems in early adulthood, and socioeconomic outcomes were better among those who experienced abortion compared with those who gave birth."  The study confirmed that teenage motherhood is linked with numerous adverse outcomes in later life, including low educational levels and poor physical and mental health.  The results of the study can be generalized to settings of high-quality social and health-care services, where abortion is accessible and affordable to all citizens. 

August 25, 2016 in Abortion, Pregnancy & Childbirth, Teenagers and Children | Permalink | Comments (0)

Tuesday, August 23, 2016

"Set and Forget" in the Battle Against Teenage Pregnancy

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.

August 23, 2016 in Pregnancy & Childbirth, Teenagers and Children | Permalink | Comments (0)

Wednesday, July 6, 2016

What Can Be Done about Maternal Mortality in Uganda?

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. 



July 6, 2016 in In the Courts, International, Pregnancy & Childbirth | Permalink | Comments (0)

Thursday, June 23, 2016

Despite Legal Restrictions, Massachusetts Still Shackling Pregnant Inmates

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.


June 23, 2016 in Incarcerated Women, Pregnancy & Childbirth, Teenagers and Children | Permalink | Comments (0)

Friday, May 20, 2016

Macaulay Honors College, CUNY, hosts Policing Reproduction Symposium

74F9EB19-4E6D-4676-9E5D-D224B214545EToday we feature a blog by Prof. Elizabeth Reis

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.

May 20, 2016 in Pregnancy & Childbirth | Permalink | Comments (1)

Tuesday, May 3, 2016

Woman Locked in Ward after Giving Birth

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.

May 3, 2016 in International, Pregnancy & Childbirth | Permalink | Comments (0)

Monday, May 2, 2016

Kate Butler on Wrongs to Brain-Dead Pregnant Women

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.

May 2, 2016 in International, Pregnancy & Childbirth | Permalink | Comments (0)

Tuesday, March 15, 2016

Anti-Choice Laws Drive up Google Searches for Self-Induced Abortions

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.

March 15, 2016 in Abortion, Abortion Bans, Pregnancy & Childbirth | Permalink | Comments (0)

Monday, March 14, 2016

Unintended Pregnancy Rate Falls to 30-Year Low

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.

March 14, 2016 in Pregnancy & Childbirth | Permalink | Comments (0)