Reproductive Rights Prof Blog

Uganda Bans Female Genital Mutilation

Time Magazine: Uganda Outlaws Female Circumcision:

(KAMPALA, Uganda) — Uganda's parliament has approved a bill banning female genital mutilation.

Minister of Ethics and Integrity James Nsaba Buturo said that the new law, passed without opposition late Thursday, could give offenders a life sentence. (Read "Uganda's Anti-Gay Bill: Inspired by the U.S.")

Female genital mutilation, also known as female circumcision, is prevalent in portions of West and East Africa to limit women's sexual activity. More than 3,000 girls are affected each December in northeastern Uganda.

The girl's clitoris and sometimes other genital parts are removed. Doctors say it eliminates any pleasure for women during sex and can lead to complications during childbirth. . . .

Reseearch Suggests Folic Acid May Help Prevent Fetal Heart Defects

ABC News/Reuters Health: Folic Acid May Help Prevent Fetal Heart Defects:

 NEW YORK (Reuters Health) - Here's another reason for pregnant women to take folic acid supplements: they help prevent fetal heart malformations, new research from the Netherlands suggests.

"Given the relatively high prevalence of congenital heart defects worldwide, our findings are important for public health," Dr. Ingrid M. van Beynum of Radboud University in Nijmegen and her colleagues write.

Folic acid supplements are now recommended for all pregnant women, and women planning on becoming pregnant, in order to prevent birth defects involving the neural tube such as spina bifida. Many countries, including the US, now require bread and other wheat products to be fortified with folic acid for this reason, but this practice hasn't been adopted in The Netherlands.

Study Finds Casual Sex Does not Cause Emotional Damage

StarTribune.com: Casual sex – and no emotional wreckage?, by Josephine Marcotty:

Results of a study on casual sex among young adults surprise U researchers. But they note the physical risks.

As most every parent knows, hooking up for casual sex is bad for young people because it causes emotional or psychological damage.

Right?

Well, actually, no. At least not for young adults between the ages of 18 and 24, according to a new study by University of Minnesota researchers.

Even they found the results startling.

Democrats Seek Additional Preventive Care for Women in Health Care Bill

NY Times: Senators Pitch to Women and Elderly on Health Bill, by Robert Pear & David M. Herszenhorn:

WASHINGTON — In a day of desultory debate on sweeping health care legislation, senators appealed to two potent political constituencies on Tuesday, with Democrats seeking additional medical benefits for women and Republicans vowing to preserve and protect Medicare for older Americans.

The Democrats’ first amendment, offered by Senator Barbara A. Mikulski of Maryland, would require insurers to cover more screenings and preventive care for women, with no co-payments.

“Women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won’t pay for it unless it is mandated by state law,” Ms. Mikulski said. . . .

A vote on Ms. Mikulski’s amendment has not been scheduled but could come Wednesday. . . .

Ms. Mikulski’s proposal was prompted, in part, by the recent furor over new recommendations from a federal task force that breast cancer screenings begin later for many women. . . .

United States Ranks Poorly on Preterm Birth Rates

Time Magazine: Why the U.S. Gets a D on Preterm Birth Rates, by Alice Park:

For the second straight year, the U.S. earned dismal marks in its effort to reduce the national rate of premature births. The March of Dimes, which issues an annual state-by-state report card on the problem, gave the U.S. an overall D on Monday.

That grade was based on figures from 2007, which show that 12.7% of U.S. births were preterm. Those figures, which have remained constant in recent years, also earned the U.S. a D last year, when the March of Dimes began compiling its report card. The objective, set by federal health experts in the Healthy People 2010 program, is a preterm birth rate of 7.6%. Worldwide, the preterm birth rate is estimated at 9.6%, accounting for 12.9 million babies per year. "Preterm birth remains a very intractable problem," says Dr. Jennifer Howse, president of the March of Dimes Foundation. "It does not surprise me that we are not seeing any change [in the U.S.] — yet."

The rate of preterm births, which measures the proportion of babies born before 37 weeks' gestation, is a reflection of a number of factors, both biological and cultural. Starting in 2008, the March of Dimes began tracking three of the major contributors to the high preterm birth rate — lack of insurance among women of childbearing age, rates of cigarette smoking and the rate of babies born preterm, but at the tail end of pregnancy, between 34 and 36 weeks. . . .

New Guidelines Recommend Delaying First Cervical Cancer Screening Until Age 21

NY Times: Guidelines Push Back Age for Cervical Cancer Tests, by Denise Grady:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

See also: NY Times: Screening Debate Reveals Culture Clash in Medicine, by Kevin Sack:

This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright.

Two new recommendations, calling for delaying the start and reducing the frequency of screening for breast and cervical cancer, have been met with anger and confusion from some corners, not to mention a measure of political posturing.

New Report on Clandestine and Unsafe Abortions in Pakistan

Guttmacher Institute news release: Clandestine and Unsafe Abortions are Common in Pakistan and Threaten Women's Health and Lives:

Poor Women Most Affected by Unsafe Procedures

Induced abortion is legal under very limited circumstances in Pakistan, yet it is commonly performed, according to a new literature review, Abortion in Pakistan, released today in Karachi by the National Committee for Maternal and Neonatal Health (NCMNH) and the Guttmacher Institute. Researchers estimate that 890,000 abortions were performed in Pakistan in 2002, a rate of 29 abortions per 1,000 women of reproductive age (15–49) annually. Because access to abortion is highly restricted, the majority of these procedures take place under clandestine—and often unsafe—conditions. As a result, many Pakistani women suffer from serious health complications that sometimes result in long-term disabilities and death.

A major factor contributing to Pakistan's level of unsafe abortion is the country's low level of contraceptive use, which results in high levels of unintended pregnancy. Only 30% of married women of reproductive age use any contraceptive method and more than a quarter of these women use traditional methods, which are less effective than modern contraceptives. . . . 

Premature Births Are Main Reason for High Infant Death Rates in U.S.

NY Times: Premature Births Are Behind Infant Death Rates in U.S., Report Says, by Denise Grady:

High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

In Sweden, for instance, only 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005 — the latest year for which international rankings are available.

Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with only 2.4 in Sweden. Twenty-nine other countries also had lower rates.

Uganda has Highest Unmet Need for Contraceptives in East Africa

Guardian News: Huge unmet need for contraceptives in Uganda, by Joseph Malinga and Liz Ford:

Uganda has the highest unmet need for contraception in east Africa, but lacks the resources to address the problem

Sarah Arawo is aware of the problems of having more children. The mother of seven is HIV-positive and knows there is a risk of passing on the virus to a child (one of her children already has the virus), and because of the recent drought she and her husband, Francis Esweu, would struggle to feed any extra mouths.

Arawo, from Obiol village in Katine, north-east Uganda, wants to stop having children altogether, but she does not know how. She wants to find out more about family planning, but fears it could lead to conflict with her husband, whom she says is reluctant to use a condom when they have sex. At the same time, because of her condition, she fears she might experience complications if she takes another form of contraceptive.

Arawo is not alone. Limited access to family planning services, fears about side effects, opposition from partners and religious beliefs have led to Uganda having the highest unmet need for contraception in east Africa. . . . 

Philippine Congress Considers Measure to Expand Access to Birth Control

NY Times: Birth Control Bill Has Enemies in Philippines, by Carlos H. Conde:

Abortion is illegal in the Philippines, though birth control and related health services have long been available to those who can afford to pay for them through the private medical system. But 70 percent of the population is too poor and depends on heavily subsidized care through the public health system. In 1991, prime responsibility for delivering public health services shifted from the central government to the local authorities, who have broad discretion over which services are dispensed. Many communities responded by making birth control unavailable.

More recently, however, family planning advocates have been making headway in their campaign to change this. Legislation before the Philippine Congress, called the Reproductive Health and Population Development Act, would require governments down to the local level to provide free or low-cost reproductive health services — from condoms and birth control pills to tubal ligation and vasectomy. It would also mandate sex education in all schools, public and private, from fifth grade through high school.

Women of Color Advocate for Health Care Reform

National Latina Institute: National Latina Institute and Women of Color United Demand Demand Health Care Reform Now, by Samantha Harper:

Concerned women of color from around the country are sounding off on health care reform this Tuesday, October 27 in a national Congressional call-in day organized by the National Latina Institute for Reproductive Health (NLIRH) and other members of the Women of Color United for Health Reform. Activists are urged to call Congress and demand passage of a health care bill that ensures access to high-quality, affordable and easily accessible comprehensive health care for all.

“Latinas are the fastest growing segment of small-business owners, yet nearly 40% of us are uninsured. Women, particularly Latinas, and immigrants are being treated as negotiating chips in health care debates,” said Silvia Henriquez, executive director of NLIRH. “The health of women is vital to the health of our families and this nation.”

Working in coalition with social justice groups and communities of color, NLIRH has put forward a policy agenda that advocates for the inclusion of comprehensive coverage for reproductive health care services, including cervical cancer screenings, breast exams, contraception, and abortion access, for all residents in the United States.

American Cancer Society Rethinks Breast Cancer Screenings

NY Times: Cancer Society, in Shift, Has Concerns on Screenings, by Gina Kolata:

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated....”

Pregnant Women Especially Threatened By Swine Flu

NY Times: Flu Story: A Pregnant Woman's Ordeal, by Donald G. McNeil Jr.:

WEST PALM BEACH, Fla. — The group most threatened by swine flu and most in need of the new vaccine, world health authorities agree, is that of pregnant women. . . .

On Oct. 1, the Centers for Disease Control and Prevention said 100 pregnant women had been in intensive care with swine flu and 28 had died. That is a tiny fraction of what are believed to have been millions of cases in the country. But it is the best argument, federal officials say, for the drawn-out, expensive effort to make a swine flu vaccine.

Pregnant women are particularly susceptible because they are in the younger age group most likely to catch this new virus, while those over 50 who have had more flus rarely catch it. Moreover, pregnancy suppresses the immune system to protect the fetus, and the growing baby makes it harder for a mother to clear her lungs.

All but a few of the pregnant women who have died or been near death from swine flu are unknown. Privacy laws prevent health departments from releasing their names, and few families come forward. . . .

Unsafe Abortions Kill 70,000 Women Every Year

Reuters: Unsafe abortions kill 70,000 a year, harm millions, by Kate Kelland:

LONDON, Oct 13 (Reuters) - Increased use of contraceptives has pushed global abortion rates down, but unsafe abortions kill 70,000 women each year and seriously harm or maim millions more, a global report said on Tuesday.

Despite easier access to abortion with restrictions being relaxed in many countries, the number of abortions fell from an estimated 45.5 million in 1995 to 41.6 million in 2003, the report by the U.S.-based Guttmacher Institute said.

But the study found a stubbornly high number -- almost 20 million -- of unsafe abortions, mostly in poorer countries and often carried out by the women themselves using inappropriate drugs or herbal potions, or by untrained traditional healers.

Guttmacher Institute Study Shows Costs of Treating Complications from Unsafe Abortions

Guttmacher Institute news release: Unsafe Abortion Costs the Developing World Hundreds of Millions of Dollars Each Year:

New Study from the Guttmacher Institute Quantifies Burden on Health Care Systems

Treating the complications that result from unsafe abortion costs Africa and Latin America $227–280 million each year, according to a new study from the Guttmacher Institute. These costs (reported in 2006 US$) place a considerable added strain on struggling national health systems in Africa and Latin America, which spend an estimated $490 million annually treating complications from pregnancies and births. Moreover, unsafe abortion costs the developing world at least $341 million when the Asian and Pacific regions are taken into account.

Using two approaches—a World Health Organization model and a comparison of 20 empirical studies—the authors calculated that on average, treating postabortion complications costs an estimated $83 per patient in Africa and $94 in Latin America. When overhead and capital costs are included, these averages jump to $114 for Africa and $130 for Latin America, which are significant burdens for developing country clinics and hospitals.

“Because virtually all unsafe abortions are a direct consequence of unwanted pregnancies, the costs calculated in this study result from the failure to prevent those pregnancies through family planning or, where legal, to terminate them safely,” said lead author Michael Vlassoff, a senior research associate at the Guttmacher Institute. “Unsafe abortions are a significant cause of maternal mortality and threaten women’s health in these regions and around the world.” . . .

The study, “Estimates of Health Care System Costs of Unsafe Abortion in Africa and Latin America” appears in the September 2009 issue of International Perspectives on Sexual and Reproductive Health.

Second-Generation Female Condoms Now Available in United States

Female Health Company Press Release: 

Second-Generation Female Condom Is Now Available in the United States:
FC2 Female Condom Will Cost 30 Percent Less than Predecessor

Company Makes Announcement at a Meeting of Southeastern Reproductive Health Organizations: FHC Makes Special Commitment to Expand Access in U.S. Regions with Highest AIDS Case Rates

CHICAGO, IL--October 1, 2009--The Female Health Company (FHC) (NASDAQ: FHCO) announced today that its second-generation FC2 Female Condom®, which received regulatory approval from the Food and Drug Administration in March as an HIV prevention method, is now available for purchase in the United States. 

The company made the announcement in Atlanta at a meeting of the Southeastern Urban Initiative for Reproductive Health, a coalition of reproductive health advocates from Southern states that is advocating for increased federal funding for HIV prevention.

"America's HIV epidemic isn't going away. In fact, it's getting worse, and African American and Latino women are disproportionately impacted," said Dazon Dixon Diallo, Founder and President of SisterLove, a grassroots service organization that supports HIV/AIDS prevention and reproductive health programs for women in the Atlanta, Georgia region.  "It's time to provide women in heavily impacted communities with expanded access to affordable women-controlled options, and the female condom becomes that choice. Women will use it if they have it." . . .

FC2 may be purchased from the Company's two public sector distributors: 

Total Access Group, Inc.  www.totalaccessgroup.com 

Global Protection Corporation, www.globalprotection.com/store

In addition, FHC has launched a website, www.fc2femalecondom.com, which includes tiered pricing information for ordering a minimum quantity of 25,000 units directly from the Company. 

NOW Weighs in on Health Care Reform and Reproductive Health

National Organization for Women: NOW Urges Single-Payer as Best for Women:

Says Reproductive Health Care Must Be Covered

President Barack Obama's address to Congress and the people of the United States resonates at a time when people are fed up with the health care status quo because it is not working. The National Organization for Women is pleased President Obama mentioned the need for a public option to provide health care to those not currently served by the profit-driven private insurance industry.

As activists, we also acknowledge that the steps he outlined fall short of a guarantee of comprehensive health care for all, including the full range of reproductive health services required to ensure equality for women. We must assert our human rights as the debates continue.

Women do need consumer protection against abuses by health insurers, particularly against so-called pre-existing conditions, which so often and outrageously have been applied to exclude pregnancy and maternal care. . . . 

"Revista Argentina de Teoría Jurídica" Publishes Special Issue on Reproductive & Sexual Health Law

Via Martín Hevia (School of Law, Universidad Torcuato Di Tella; Global Fellow, International Reproductive & Sexual Health Law Programme, University of Toronto):

Revista Argentina de Teoría Jurídica of the Universidad Torcuato Di Tella is the law journal of the School of Law of the Universidad Torcuato Di Tella at Buenos Aires, Argentina. Its Vol. 13 is a special issue on reproductive and sexual health law.  It includes dossiers on sexual and reproductive health, conscientious objection, and medical confidentiality.

The special issue on Reproductive Rights includes Spanish translations of papers on conscientious objection by established scholars in the field:

Professor Bernard Dickens from the University of Toronto and Professor Rebecca Dresser from Washington University in St. Louis: "Servicios de Salud Reproductiva y el Derecho y Ética de la Objeción de Conciencia" and "Profesionales, Adecuacíón y Conciencia" respectively.

"Secreto Profesional Médico y Servicios de Salud Sexual y Reproductiva en la Jurisprudencia de la Corte Interamericana de Derechos Humanos" is a case comment on the leading case of the Inter American American Court of Human Rights on medical confidentiality, "De la Cruz Flores v. Perú" (2004), by Martín Hevia (School of Law, Universidad Torcuato Di Tella; Global Fellow, International Reproductive & Sexual Health Law Programme, University of Toronto) and Oscar Cabrera (O'Neill Institute for National and Global Health Law, Georgetown University Law Center).  The paper discusses the legal implications of De la Cruz Flores on the scope of medical disclosure of confidential information in the provision of post-abortion health care in Latin America.

"Derecho y Deber de Confidencialidad" by María Mercedes Cavallo (Graduate Scholar in Reproductive and Sexual Health Law, Faculty of Law, University of Toronto), is a detailed discussion on the fact that many Latin American legal systems that penalize abortion require medical professionals who assist a woman who has had an abortion to report the crime to official authorities, and how this is a barrier to women and adolescent girls' access to reproductive health services in Latin America.

In "Responsabilidades en los Servicios de Salud y Objeción de Conciencia," originally published in English as column by the IJGO, Professors Rebecca J. Cook and Bernard Dickens (Faculty of Law, University of Toronto) and Mónica Arango (Center for Reproductive Rights) comment on a recent decision by the Colombian Constitutional Court on conscientious objection,Sentencia T-209 (2008). The Court held that objecting providers have duties to refer patients to non-objecting providers, and that hospitals, clinics and other institutions have no rights of conscientious objection. The authors explain why the Court's decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients' legal rights.

In "Secreto Profesional y Obligación de Denunciar en la Jurisprudencia Argentina," Emiliano Villa (law student at the School of Law, Universidad Torcuato Di Tella) reviews the Argentine case law on whether the State can start criminal prosecutions against a woman who has had an abortion based on a report by the medical professionals in charge of her post-abortion health care.

The dossier also includes a transcript of a debate on conscientious objection organized by the students that took place at the Auditorium of the Universidad Torcuato Di Tella on June 8, 2009. The panelists were professors from several local universities with different viewpoints on conscientious objection. Faculty, students, members of the bar and doctors attended the session. Panelists and audience remarked upon the students' extraordinary achievement in organizing a debate on this complex topic.

The final paper is an interview to the President of the Argentine Society of Anthropological Medicine. The aim of the interview is to hear about the viewpoints of an Argentine doctor on human rights, conscientious objection and medical confidentiality. The doctor notes that medicine students should receive more formal ongoing education on human rights and the role of Bioethics Committees to educate doctors on the importance of medical confidentiality.

Revista Argentina de Teoría Jurídica is devoted to legal research. The journal is published in July and November of each year and accepts submissions both in English and Spanish. It is a theoretically-oriented journal of law. General jurisprudence, moral and political philosophy, economic analysis of law and doctrinal analysis are among its main concerns. The journal also accepts case law commentaries (provided they include theoretical content), notes and surveys of literature.

Students of the Law School are in charge of the publication and have the possibility of contributing notes and other works. An Editorial Board made up of Law Students and an Academic Committee of Law School professors controls the direction of the journal.

The entire symposium issue is available online, free of charge, here.

Guttmacher Institute Examines Benefits of Home Visiting Programs

Guttmacher Institute news release: Home Visiting Programs Touted by Obama Administration Improve Health and Well-Being of Both Women and Children:

Programs Have Attracted Attention as Part of Health Care Reform and President’s “Common Ground” Initiative Around Abortion

Home visiting programs that would be significantly expanded under a new initiative proposed by the Obama administration have demonstrated modest but important benefits for children and significant benefits for women, according to a new policy analysis published in the Summer 2009 issue of the Guttmacher Policy Review. Home visiting programs pair new families—particularly low-income, single-parent ones—with trained professionals who provide parenting information, resources and support throughout a child’s first few years.

“Home visiting programs have gained some real and well-deserved traction, especially with the Obama administration’s request for $8.6 billion over the next 10 years,” says Heather Boonstra, author of the policy analysis. “The current health care reform effort could well be the vehicle to secure funding for the program, as home visiting provisions have a good chance of being included if and when reform legislation is enacted.”

The administration’s initiative would support programs that have undergone rigorous evaluation, as well as those that have demonstrated promise in improving the lives of children, women and families. A variety of home visiting programs are operating across the United States, and various models have been shown to improve both the health and well-being of children, particularly by reducing child abuse and neglect, and the sexual and reproductive health of women by promoting pregnancy planning. . . . 

Uganda's Plan to Distribute Female Condoms Encounters Resistance from Funders Including PEPFAR

Time Magazine (8/30): The Battle in Uganda Over Female Condoms, by Nick Wadhams:

On the surface, it seems like a fine idea; reproductive rights groups certainly think so. In July, the Ugandan government announced that, using cash from the U.N. Population Fund, it would distribute 100,000 female condoms in a bid to stop a resurgence of HIV/AIDS. Advocates cheered the initiative, saying it would give women more control over their own bodies. But in the weeks since, major funders of anti-HIV/AIDS programs have shown far less enthusiasm, with many deciding not to back the plan. Instead of serving as a surefire weapon against the spread of HIV, Uganda's female condoms initiative has become the latest example of the limitations faced by governments, advocacy groups and donors in the fight against the virus....