Tuesday, November 12, 2019

UN Human Rights Expert Recognizes Obstetric Violence as a Human Rights Violation

Reproductive Rights Prof Blog (Nov. 12, 2019): UN Human Rights Expert Recognizes Obstetric Violence as a Human Rights Violation by Lara Russo:

On October 5th, 2019, the United Nations Special Rapporteur on violence against women, its causes and consequences presented a report to the UN General Assembly that looked at obstetric violence globally. The report entitled, “A Human Rights-Based Approach to Mistreatment and Violence Against Women in Reproductive Health Services with Focus on Childbirth and Obstetric Violence,” marks the first time an international human rights body has identified obstetric violence as a violation of human rights.

The term "obstetric violence" is widely used in South America, though is not commonly used in the international human rights community as of yet. The term broadly refers to mistreatment and violence experienced by pregnant people during facility-based childbirth. Internationally, violence against women is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” 

The report details the numerous ways that women’s human rights can be violated in the birth context including: forced or non-consensual procedures, torture or cruel and inhuman or degrading treatment from use of restraints or lack of anesthesia during painful procedures, use of medically unjustified procedures, and violations of privacy, confidentiality, humiliation and harassment by health care providers.

Informed consent is highlighted in the report as a fundamental human right that can act as a safeguard against obstetric violence. Pregnant people are frequently denied their right to make informed decisions about their care during childbirth, which the report identifies as a human rights violation. Examples of violation of informed consent include presentation of consent forms to a pregnant person while in labor when it is difficult or impossible to understand the forms or formulate questions about treatment and when a doctor makes decisions on behalf of a pregnant person because the doctor’s medical knowledge is deemed superior to a woman’s entitlement to information and autonomous decision-making. 

The United States was explicitly criticized in the report for the common usage of non-consensual procedures and restraints of pregnant people during birth. In the U.S. it is legal in many states for doctors and medical students to perform pelvic exams on unconscious women who are under anesthesia for another procedure, who do not require a pelvic exam, and who have not explicitly consented to one. Despite recent reforms, pregnant people who are incarcerated in prison, jail, and immigration detention continue to be shackled and restrained during labor, delivery, and the post-delivery recovery period. The Committee Against Torture also has expressed concern about the shackling of incarcerated pregnant people in the U.S.

In addition to the obstetric mistreatment in the United States highlighted in the report, other forms of violence and mistreatment also occur. A recent study found that 1 in 6 pregnant, laboring, and postpartum women in the United States experienced mistreatment by medical providers.  This number rose to 1 in 3 when narrowed to deliveries in hospitals rather than freestanding birth centers or at home and disparately impacts black women and people of color. This mistreatment includes being yelled at or scolded, ignored or refused assistance when asking for help, being coerced into interventions, such as induction or epidural, and threatened with having treatment withheld.

Among the recommended actions to address the issue of obstetric violence, the Special Rapporteur includes increased budgetary resources devoted to quality reproductive health care, ensuring professional accountability and sanctions by professional associations in cases of mistreatment. The report recommended addressing intersectional discrimination or compound stereotypes stating that

Some women experience intersecting forms of discrimination, which have an aggravating negative impact, and gender-based violence may affect some women to different degrees, or in different ways; appropriate legal and policy responses are needed in this regard.

One’s experience of intersectional discrimination or compound stereotypes can increase the likelihood of experiencing obstetric violence. The United States could do better in all of these realms.  

The position of Special Rapporteur on violence against women, its causes and consequences was created in 1994 as a means of integrating the rights of women into the human rights mechanisms of the United Nations. The mandate of the special rapporteur is to seek and receive information on violence against women, recommend ways in which to eliminate such violence, and work collaboratively with the other United Nations humans rights mechanisms.

November 12, 2019 | Permalink | Comments (0)

Thursday, October 31, 2019

Alabama abortion law temporarily blocked by federal judge

The Washington Post (Oct. 29, 2019): Alabama abortion law temporarily blocked by federal judge by, Ariana Eunjung Cha and Emily Wax-Thibodeaux:

A federal district court in Alabama blocked the state's extremist abortion ban, passed in May, earlier this week. The law would almost entirely proscribe the termination of a pregnancy in Alabama, including in cases of pregnancy resulting from rape or incest. The single exception to to the ban would be in the case of serious risk to the life of the pregnant person.

Alabama state representative Terri Collins--the author of the bill--has framed the law as a direct challenge to Roe v. Wade, and stated in response to the preliminary injunction that this decision "'is merely the first of many steps'" in the anti-abortion movement's "effort to preserve unborn life." Rep. Collins aims for challenges to the law to make it to the Supreme Court and called this week's ruling "both expected and welcomed" on the journey to SCOTUS.

Judge Myron H. Thompson, who penned the decision out of the U.S. District Court for the Middle District of Alabama, "wrote that it violates Supreme Court precedent and 'defies' the Constitution."

The Alabama law joins eight other states' blocked attempts at restricting abortion access unconstitutionally. 

October 31, 2019 in Abortion, Abortion Bans, Current Affairs, In the Courts, Politics, State and Local News, State Legislatures, Supreme Court | Permalink | Comments (0)

Tuesday, October 29, 2019

California Governor Signs SB 464 into Law, Requiring Perinatal Health Providers To Receive Implicit Bias Training

Essence (Oct. 10, 2019): California Now Requires Perinatal Health Providers To Receive Implicit Bias Training, by Tanya A. Christian: 

California Governor Gavin Newsom signed the "California Dignity in Pregnancy and Childbirth Act" (SB 464) earlier this month, which mandates implicit bias training for health care providers serving pregnant persons. State Senator Holly Mitchell authored the bill. Reproductive justice-oriented groups, including Black Women for Wellness, NARAL Pro-Choice America, Act for Women and Girls, as well as California Nurses Association all backed the law, which earned unanimous support in the state legislature. 

The law is aimed at reducing maternal mortality among Black women--who face a disproportionately high rate--in the United States. It will require all care providers to both engage with bias training and improve their data collection processes in order to better understand the causes behind pregnancy-related deaths.

"As it stands, the U.S. leads the developed world in the number of pregnancy-related deaths. Black women compromise a large portion of those casualties, presenting a risk of mortality that is three to four times that of White women."

California currently has the lowest maternal mortality rate in the country and hopes to improve it further through SB 464.

October 29, 2019 in Medical News, Pregnancy & Childbirth, Race & Reproduction, Reproductive Health & Safety, State and Local News, State Legislatures, Women, General | Permalink | Comments (0)

Monday, October 7, 2019

U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’

The Washington Post (Sept. 24, 2019): U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’, by Ariana Eunjung Cha: 

The United States, in a statement delivered to the United Nations General Assembly (UNGA) on September 23 this year, rejected the use of the term "sexual and reproductive health and rights" throughout U.N. documents and in particular within the international Sustainable Development Goals. Health and Human Services Secretary Alex Azar delivered the statement and emphasized that international instruments should not promote "abortion as a means of family planning." He disputed that there is an international right to an abortion.

The U.S., one among 19 nations who joined in the statement, further emphasized that "[they] only support sex education that appreciates the protective role of the family in this education and does not condone harmful sexual risks for young people."

The Netherlands delivered a responsive joint statement on behalf of 58 countries rejecting the U.S. position and stressing "the need to uphold the full range of sexual and reproductive rights." Country representatives also took to Twitter to object to the U.S. statement, using the hashtag #SRHR (sexual and reproductive health and rights), explicitly embracing the language the United States aims to erase. 

Many country representatives, along with civil society advocacy groups, underscore that on this issue of abortion the U.S. "align[s] with countries like Saudi Arabia and Sudan with poor human rights records."  They also emphasize the problematic nature of the United States' campaign to persuade other countries to form a new coalition in support of these regressive policies, calling attention to the fact that these efforts put "unfair pressure on poor countries" dependent on U.S. aid.

The Trump administration worked hard leading up the General Assembly to recruit conservative governments to support its efforts to roll back sexual and reproductive health and rights across the board. This campaign could have devastating effects on adults and children who rely on international programs for basic health care, particularly prenatal and postpartum health care. 

The United States-led campaign at the UNGA last week follows a similar effort directed at the World Health Organization (WHO) in which the U.S., Brazil, Egypt, Saudi Arabia, and several other states campaigned to reject the term "sexual and reproductive rights" from WHO policy, as Colum Lynch for Foreign Policy reports

October 7, 2019 in Abortion, Anti-Choice Movement, Current Affairs, International, Politics, President/Executive Branch, Reproductive Health & Safety, Women, General | Permalink | Comments (0)

Dutch Doctor Provides Abortion Pills to U.S. Women, Sues FDA

Fortune (Sept. 19, 2019): "A Doctor Who Prescribes Abortion Pills to U.S. Women Online is Suing the FDA. Is She Breaking the Law?", by Erin Corbett:

Dr. Rebecca Gomperts, a physician licensed to practice medicine in Europe, launched the website Aid Access in 2018 in order to meet the growing need for accessible abortion care in the U.S.

Patients seeking to end a pregnancy in its early stages through the use of the medications misoprostol and mifepristone can complete an online consultation form on Aid Access about their pregnancy and general health. Dr. Gomperts prescribes the medication to patients so long as they are "healthy, less than 10 weeks pregnant, and live within an hour's distance of a hospital in case of emergency."

Medical abortion is an FDA-approved method to end a pregnancy, and studies have found that independently managing an abortion using misoprostol and mifepristone pills is both safe and effective.

"There is no evidence that home-based medical abortion is less effective, safe or acceptable than clinic-based medical abortion,” reads one study from the World Health Organization (WHO).

The two pills work in combination to terminate a pregnancy in the first 12 weeks. Together, they are over 96% effective, and using misoprostol on its own is more than 80% effective in the first trimester. 

Dr. Gomperts emphasizes that the science supports the safety of medication abortions, including those done entirely by the women seeking the abortion themselves (in some cases, women may go to a clinic to physically receive the medication; in others, like here, women are prescribed the medications remotely, which are then mailed to them). "All medical abortions are self-managed," though, Dr. Gomperts says. "Women that go to a clinic and get the pill and have their miscarriage at home—it’s exactly the same procedure if they get the pills online.”

In the wake of the confirmation of right-wing, anti-choice Supreme Court Justice Brett Kavanaugh, along with the slew of extreme state-level restrictions on abortion access in recent years, Dr. Gomperts found that patients reaching out to her were seeking her help not only because they wanted an abortion but because they didn't know where else to get help or even information on any local health services available to them.

Dr. Gomperts received inquiries from over 40,000 women between March 2018 and August 2019. She prescribed the two abortion medications to just over 7,000 of those persons. The majority of the requests came from women living in abortion-hostile states with strict laws, like Alabama, Georgia, and Mississippi. Dr. Gomperts has consulted with women in all 50 states.

While several states have laws that criminalize any self-managed abortions, all of these statutes "pre-date Roe, likely making them unconstitutional," Erin Corbett, author of the Fortune article, says. They've been applied against pregnant persons nonetheless. 

On September 9th, Dr. Gomperts and her attorneys filed a lawsuit in federal court in Idaho against the FDA and other federal officials, claiming that they illegally confiscated "between three and 10 'individual doses of misoprostol and mifepristone' that Dr. Gomperts had prescribed to patients since March." 

The FDA claims that her practice "'poses an inherent risk to consumers who purchase'" these medications.

Dr. Gomperts asserts several claims for relief under both the Constitution and the Administrative Procedure Act. Prosecuting Dr. Gomperts or her patients would violate their rights to liberty, privacy, and equal protection under the Fifth Amendment, the lawsuit claims.

October 7, 2019 in Abortion, Abortion Bans, In the Courts, International, Medical News, Politics, Women, General | Permalink | Comments (0)

Friday, September 20, 2019

‘We Are Headed Toward a Public Health Crisis’: Title X Clinics Grapple With Trump’s ‘Gag Rule’

Sept. 11, 2019 (Rewire.News):‘We Are Headed Toward a Public Health Crisis’: Title X Clinics Grapple With Trump’s ‘Gag Rule’, by Erin Heger:

The Trump administration recently introduced a 'gag rule' on recipients of Title X funding, which provides federal money for family planning services to low income individuals hroughout the country. The new rule prohibits clinics receiving Title X funding from referring their patients for abortion care. Clinics that provide abortion services will also have to physically separate abortion and Title X-approved services.

HHS Office of Population Affairs operates Title X by funding “grantees” (health care organizations, state health departments, or non-profits) that oversee the distribution of Title X funds to safety-net clinics and other sites to provide family planning services to low-income, uninsured, and underserved clients.

Because of the recently introduced restrictions, health care organizations and some states are choosing to opt out of receiving Title X funding altogether rather than attempt to comply. The most notable of rejections may be from Planned Parenthood, which announced last month that it was rejecting funding under the new guidelines. The organization's clinics serve 40 percent of the country's Title X patients, and there are concerns that other providers will struggle to take on the resulting predicted increase in patients. According to Guttmacher Institute, there will need to be an estimated 70 percent expansion in clinics' caseloads in order to make up for Planned Parenthood's absence.

Seven states have also opted out, but other states and health care organizations have decided to stay, for fear that clinics they fund will not be able to afford to stay open without the Title X money. Providers in Missouri, for example, are in large part continuing to accept funding.  With previous restrictions on abortions leaving the state with only one abortion clinic, access to reproductive health care is extremely limited as is. "For the majority of Title X patients, their Title X provider is their only source of health care, particularly in small and rural communities," Audrey Sandusky of the National Family Planning and Reproductive Health Association told Rewire.News.

The second part of the gag rule requires that clinics somehow separate out their abortion services from their other functions. This is set to go into effect this coming March, but it's yet to be determined what hoops clinics will have to jump through to remain safely in compliance under these new standards. Many of the providers' plans submitted to the U.S. Department of Health and Human Services have not been approved as of yet. The largest of the Title X administrators, Essential Access Health, has had their plan approved, but its details have not been released.

Sandusky pointed out how low-income individuals already face serious barriers in their lives, and this new restriction makes it even more likely that they will go without care if they cannot go to a Title X provider. "That means they go without cancer screenings, STD testing and treatment, and HIV services. Given the uncertainty that exists across the country, we are headed toward a public health crisis." This certainly seems to be the case.

September 20, 2019 in Abortion, Anti-Choice Movement, Current Affairs, Poverty, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)

Thursday, September 19, 2019

Nearly seven percent of U.S. women say first sexual experience was forced

Sept. 16, 2019 (AP News): Many U.S. women say first sexual experience was forced in teens, by Lindsey Tanner: 

A new study published in JAMA Internal Medicine reports that "the first sexual experience for 1 in 16 U.S. women was forced or coerced intercourse in their early teens"--and often perpetrated by persons nearly a decade senior to the survivors.

The national survey conducted for the study did not use the term rape when asking participants about forced sexual experiences but identified a first sexual intercourse experience as "involuntary." Almost half of the participants who reported involuntary intercourse were physically held down during the experience, while just over half of the same respondents described being "verbally pressured to have sex against their will." 

The lead author of the study, Dr. Laura Hawks, affirms that “any sexual encounter (with penetration) that occurs against somebody’s will is rape. If somebody is verbally pressured into having sex, it’s just as much rape."

The study goes on to show that persons whose first sexual intercourse experiences amounted to rape reported "fair or poor health" twice as often as other women. The same women also "had more sex partners, unwanted pregnancies and abortions, and more reproductive health problems including pelvic pain and menstrual irregularities than women whose first sexual experience wasn’t forced."

The new study adds to the findings of prior research that identified a range of long-term effects of sexual assault, including "social isolation, feelings of powerlessness, stigmatization, poor self-image and risky behavior, which all may increase risks for depression and other mental health problems"

An editorial in this issue of the Journal "notes that the study lacks information on women’s health and any abuse before their first sexual encounter." It also doesn't include data on sexual violence after the women's first encounters, which, the editorial notes, may further "contribute to health problems."

The Journal calls for further research to fully understand and address the "range and consequences," particularly as related to long-term health outcomes, of sexual assault on survivors. 

Sex education specialists have responded emphasizing the need for inclusive education in U.S. schools that teaches children about consent among other healthy sexual practices. 

September 19, 2019 in Culture, Medical News, Reproductive Health & Safety, Scholarship and Research, Sexual Assault, Sexuality Education, Teenagers and Children, Women, General | Permalink | Comments (0)

Tuesday, September 17, 2019

Austin City Budget Includes Funding for Women to Overcome Barriers to Abortion Access

September 10, 2019 (NBC News): It just got a Little Easier for Low-Income Women in Texas City to Access Abortion Care, by Adam Edelman:

Last week, City Counsel members in Austin, Texas voted to include funding for low-income women to access abortion. This creative measure supports abortion access through funding services like travel to and from abortion clinics, lodging, and child care for women who need abortion procedures.

A Texas state bill enacted earlier this year, SB22, bans any Texas municipality from allocating public funding to groups that provide abortion care. However, the City Counsel's funding does not actually fund the procedure, sidestepping the restrictive legislation. 

'Advocates of the funding told NBC News it would not violate any of Texas’ restrictive abortion laws. Rather, they explained, the bill would merely help low-income women who need abortion care navigate a complicated landscape.'

Current Texas law imposes a number of barriers that make obtaining an abortion more time consuming and costly. Texas law bans abortion after 20 weeks post fertilization and requires pregnant women in Texas to visit an abortion clinic twice, first to undergo a sonogram and then, after a 24 hour wait,  to actually have the procedure. Additionally, all such costs must be paid out of pocket, as Texas law also prohibits private insurance from covering abortion care. The Austin law helps women pay some of the additional costs imposed on them by Texas law.

New York City Council recently approved a similar funding measure that allocated $250,000 to fund abortions for poor women who live in, or have traveled to New York City from the procedure. 

Advocates of the Austin measure hope that this action can provide an example for blue cities in red states to creatively advance abortion rights in their own cities. 

September 17, 2019 in Abortion, Current Affairs, Poverty, Pro-Choice Movement, State and Local News, Women, General | Permalink | Comments (0)

Thursday, September 12, 2019

Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota

Sept. 10, 2019 (CBS News): Medication abortion reversal is "devoid of scientific support," judge rules in North Dakota, by Kate Smith: 

Legislators in North Dakota recently mandated physicians tell patients who are receiving medication abortions that the procedure may be reversed. North Dakota House Bill 1336 bases its text "on a pair of studies that have been contested by The American Medical Association and the American College of Obstetrics and Gynecology." 

Judge Daniel Hovland, on Tuesday, September 10, issued a 24-page decision granting an injunction against the bill, which he said is "devoid of scientific support, misleading, and untrue." Further elaborating that:

'State legislatures should not be mandating unproven medical treatments, or requiring physicians to provide patients with misleading and inaccurate information...The provisions of [Bill 1336] violate a physician's right not to speak and go far beyond any informed consent laws addressed by the United States Supreme Court, the Eighth Circuit Court of Appeals, or other courts to date.'

The lawsuit against the Bill was filed by the American Medical Association and Red River Women's Clinic. Red River is North Dakota's only legal abortion provider. According to research conducted by the Guttmacher Institute, people seeking abortions in the state must, in addition to very likely traveling long distances to reach the clinic, "undergo a state-mandated 24-hour waiting period." Minors may not receive an abortion in North Dakota without notifying their parents, and the state limits the ways a private insurance provider may cover the procedure. 

A separate North Dakota state law "requires physicians to tell patients that abortion terminates 'the life of a whole, separate, unique, living human being.'" The AMA and Red River suit also challenges this law, but the court has not yet addressed this claim, thus far only issuing the preliminary injunction against House Bill 1336.

September 12, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Fetal Rights, In the Courts, Mandatory Delay/Biased Information Laws, Medical News, Politics, State and Local News, State Legislatures, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)

Thursday, September 5, 2019

A woman gave birth alone in a jail cell after her cries for help were ignored

Aug. 29, 2019 (The Washington Post): 'Nobody cared': A woman gave birth alone in a jail cell after her cries for help were ignored, lawsuit says, by Allyson Chiu: 

Diana Sanchez was booked into Denver County Jail just three weeks ahead of her due date in July 2018. Early in the morning on July 31, Sanchez's contractions began. Her water broke and labor progressed without any help from prison or medical personnel. Sanchez gave birth to a baby boy alone in her jail cell, on top of a single absorbent pad--the only item provided to her despite her persistent cries for help. Immediately after the birth of Sanchez's son, a man wearing surgical gloves entered her cell to apparently examine the baby; however it wasn't until over 30 minutes post-birth that Sanchez and her new baby were transferred to the hospital.

Sanchez's birth experience was captured in full on surveillance footage of her cell. In the footage, Sanchez is seen unfolding the square pad deputies provided her and placing it on her bed. The video also shows her labor in full, including her water breaking, her shouts for help, her frantic efforts to remove her pants and underwear as the baby was coming. In August, Sanchez told KDVR: "They put my son's life at risk. When I got to the hospital, they said I could have bled to death." 

The U.S. has the worst maternal mortality rates in the developed world across the board, but for women of color and incarcerated women, the rates rise significantly.

Sanchez has filed a lawsuit against the city and county of Denver, Denver Health Medical Center, and six individuals after the internal investigation found no wrongdoing. Mari Newman, Sanchez's attorney, says she hopes to "achieve some measure of accountability and to force wrongdoers to change their behavior.”

The suit mentions several past incidents in which inmates under the supervision of the city and county of Denver and Denver Health Medical Center personnel allegedly did not receive adequate care. One case, which was settled about 10 years ago, resulted in an agreement that jail staff are required to report medical emergencies up the chain of command and if no action is taken, to call 911 themselves, Newman said. Had that commitment been followed, Sanchez’s experience might have been avoided, she said.

A spokesperson with the Denver Sheriff Department asserted that deputies took appropriate action and "followed the relevant policies and procedures," adding that the Department has updated its policies to "ensure that pregnant inmates who are in any stage of labor are now transported immediately to the hospital." 

September 5, 2019 in Incarcerated Women, Pregnancy & Childbirth | Permalink | Comments (0)

Wednesday, September 4, 2019

How many steps it takes to get an abortion in each state

August 24, 2019 (Axios): How many steps it takes to get an abortion in each state, Orion Rummler, Aida Amer:

Each year states devise and pass more and more restrictions on access to abortion -- from mandatory waiting periods to required viewing of an ultra sound.  While legislatures consider each new restriction on its own, people who need abortion care experience the collective impacts of multiple restrictions. And, collectively these restrictions can create an undue burden to abortion access, as delay, travel time and cost, days off from work, childcare all add up.

To illustrate the barriers placed in the path of a person seeking abortion care, Axios has published piece showing how many steps it takes to get an abortion in each state.

Women and transgender men must take 5-8 steps to get an abortion in the most heavily regulated states. They often have to wait at least 24 hours after seeking an abortion, attend counseling against the decision and take at least 2 trips to a facility — and in 6 states, only 1 such facility is available.

Based on statistics from Guttmacher Institute, Axion charts restrictions in each state to conclude that

 

  • Virginia is the most restrictive state in the U.S. for minors under 18, who must take 8 steps to have an abortion by obtaining parental notification and parental consent.
  • Arizona, Indiana, Louisiana, Mississippi, Ohio, Wisconsin and Virginia are the most restrictive states for adults over 18.

In addition,

  • Utah, South Dakota, Oklahoma, North Carolina and Missouri have the longest wait times before one can undergo the procedure, clocking in at 72 hours.

 

 

September 4, 2019 | Permalink | Comments (0)

Tuesday, September 3, 2019

HHS Threatens to Defund UVM Medical Center for Allegedly Failing to Protect Conscience Rights of Nurse Who Opposes Abortions

August 29, 2019 (Rewire News): HHS Launches Another Attach on Abortion Providers Under Guise of 'Conscience Rights," by Dennis Carter:

Rewire News reports that the Office of Civil Rights in the Department of Health and Human Services has accused the University of Vermont Medical Center of “intentionally, unnecessarily, and knowingly” scheduling nurses to assist with abortions “against their religious or moral objections." HHS Head Roger Severino claims that these alleged actions violate the Church Amendments, laws from the 1970s that protect the conscience rights of individuals to object to performing or assisting in abortion or sterilization procedures if it is contrary to their religious or moral beliefs.  HHS has given the center 30 days to change its religious freedom policies or lose federal funding. 

 
According to Severino, the nurse who filed the claim feared she would lose her job if she opted out of assisting with the abortion. A medical center spokesperson stated that UVM has “robust, formal protections that safeguard both our employees’ religious, ethical and cultural beliefs, and our patients’ right to access safe and legal abortion” and that “employees are protected from discrimination based on any decision they make to opt out of procedures for treatments.”  She also stated that UVM promptly investigated the allegations when they were first made and determined that they were unsupported. 
 
Despite UVM’s ongoing discussions with HHS, Severino opted to issue the public statement. This action appears reflective of the direction of the Civil Rights Office, which has prioritized discrimination and religious claims of health care providers rather than discrimination faced by people who seek to access health care services.  According to Rewire: 
 
Since Trump entered the White House, OCR officials have transformed the office into a powerful political entity centered on so-called religious freedom. In 2018 Severino launched a health-care discrimination wing of OCR, known as the Conscience and Religious Freedom Division, to defend health-care providers who oppose abortion and do not want to treat LGBTQ people. This case marks the third enforcement action the division has taken to protect “conscience rights,” and it’s first action in defense of an individual health-care worker who objects to participating in abortion care.

September 3, 2019 in Abortion, Abortion Bans, Religion and Reproductive Rights | Permalink | Comments (0)

Monday, September 2, 2019

Racial Disparities Persist for Breastfeeding Moms

August 24, 2019 (PBS News Hour): Racial Disparities Persist for Breastfeeding Moms, by Laura Santhanam:

A recent study released by the CDC indicates that while 83 percent of mothers report breastfeeding babies at birth, substantial racial disparities exist with 85% of white mothers and 69% of black mothers reporting that they breastfed.  Several factors appear to contribute to the difference, including lack of support for breastfeeding in maternity wards and lack of community support including maternity leave.  PBS News Hour explains:

Previous research shows hospital maternity wards that serve larger black populations are less likely to help black women initiate breastfeeding after giving birth or offer lactation support following delivery, according to the CDC study. Often, staff in these facilities instead offer black babies formula.

Another serious barrier against breastfeeding for some black mothers is the need to return to work shortly after giving birth, according to previous studies the CDC cited. Black women are more likely than others to need to return to work earlier than 12 weeks, and tend to be confronted with “inflexible work hours” that make consistently nursing and expressing milk difficult, the study authors wrote.

Differences in breastfeeding rates are significant because breastfeeding can improve the health of mothers and their babies.  In the United States, the maternal mortality rate of black women is 3-4 times that of white women and the infant mortality rate of black babies is more than twice that of white babies.

The U.S. has one of the lowest breast-feeding initiation rates in the industrialized world and is the only developed nation that does not mandate paid maternity leave.  "In July 2018, the Trump administration drew criticism when they rejected a policy that supported breastfeeding at the World Health Organization, under pressure from the infant formula industry."  In 2010, Congress required that large employers provide reasonable break times for nursing mothers for up to one year as part of the Affordable Care Act.  However, despite the law, breastfeeding remains difficult for women in low wage jobs and jobs that lack flexibility.

September 2, 2019 | Permalink | Comments (0)

Friday, August 30, 2019

What’s Become of All the Extreme Abortion Bans From This Year?

Aug. 30 2019 (The Cut): What’s Become of All the Extreme Abortion Bans From This Year?, by Amanda Arnold:

This legislative season, a number of states passed extreme abortion restrictions.  The Cut's Amanda Arnold provides a rundown on the fate of these laws. Alabama passed a law that prohibits abortion in all cases except where the fetus is not viable or the pregnancy creates a serious danger to a woman's health. Kentucky, Ohio, Mississippi, Louisiana and Georgia passed 6 week bans and Missouri passed an 8 week ban.  In addition to banning abortion way before fetal viability, these laws have been criticized for banning abortion before a woman may even be aware she is pregnant.

None of the laws have gone into effect thanks to litigation.  TROs or preliminary injunctions have been issued in most states.  In Alabama it appears that the state will consent to a TRO pending the outcome of the underlying legal challenge, and a TRO hearing in Georgia is scheduled for late September. 

All these laws are clearly unconstitutional so the result is not surprising. However, states are expected to appeal the decisions with the hopes that Trump appointees to federal Courts of Appeal will be willing to ignore Supreme Court precedent.

“Trump has appointed over 100 judges to the federal bench, and we’re seeing circuit courts become more and more anti-abortion,” [Planned Parenthood director of state advocacy media Bonyen Lee-Gilmore] told the Cut. “This is no coincidence. Trump is remaking the judicial branch in order to push these unconstitutional laws forward, and we’re seeing these judges stare Supreme Court precedent in the face and create new rules.”

Even if Appellate Courts uphold lower court decisions blocking these laws from taking effect, it is likely that states will try to get the Supreme Court to hear the cases and reconsider Roe v. Wade.

August 30, 2019 | Permalink | Comments (0)

Tuesday, August 20, 2019

Planned Parenthood Just Lost $60M in Funding. What Does That Mean for Women?

August 20, 2019 (The Cut): Planned Parenthood Just Lost $60M in Funding.  What Does That Mean for Women?, by Erica Schwiegerhausen: 

Earlier this week Planned Parenthood announced that it would forgo approximately $60 million in federal funding under the Title X program rather than comply with new regulations issued by the Trump Administration.  Title X is a federal program that funds contraception and other reproductive care for low income women.  Under federal law, Title X funds cannot be used to pay for abortions.  However, the new rule would prohibit the provision of Title X services at the same facilities in which abortion care is provided and also limit Title X health care providers from providing referrals for abortion.

Planned Parenthood's acting president has stated that “We will not be bullied into withholding abortion information from our patients.”  Instead Planned Parenthood will withdraw from Title X while legal battles over the rule continue.  Last month, a federal appeals court refused to stay enforcement of the rule while the case is pending.

Planned Parenthood serves about 40% of Title X recipients.  In the short-term. Planned Parenthood will make "emergency funds" available and fundraise to make up for the loss of funds.  Other small, independent clinics are also affected.  For instance as many as 15 clinics in Maine may close rather than continue to receive Title X funding and comply with the rule.

August 20, 2019 | Permalink | Comments (0)

Monday, July 29, 2019

India's Transgender Bill Raises Rights Concerns

July 23, 2019 (Human Rights Watch): India's Transgender Bill Raises Rights Concerns:

India's parliament introduced a new bill meant to protect the rights of transgender people on July 19 this year. Human Rights Watch ("HRW"), though, says that the Transgender Persons (Protection of Rights) Bill does not protect certain important rights upheld by India's Supreme Court in 2014--namely, the right of transgender persons to self-identify. 

The human rights organization warns that "even though the bill says that a transgender person 'shall have a right to self-perceived gender identity,' its language could be interpreted to mean transgender people are required to have certain surgeries before legally changing their gender."

Meenakshi Ganguly, the South Asia director at HRW, emphasized that "it's crucial the the law be in line with the Supreme Court's historic ruling on transgender rights." The proposed law, instead, "appears to mandate a two-step process for legal gender recognition," requiring a trans person first to apply for an initial certificate and then to apply for a "change in gender certificate," which many perceive as requiring gender-affirmation surgery along with medical confirmation.

The bill also gives discretion to the district magistrate to determine the "correctness" of the person's application for the certificates yet is silent as to how the decision of "correctness" should be made. 

In 2014, the country's highest court ruled in NALSA v. India that transgender people are a recognized third gender, enjoy all fundamental rights, and are entitled to specific benefits in education and employment. The bill introduced this month does not address whether a trans person holding a male or female gender certificate, though, will have access to the government welfare meant for transgender persons. 

Human Rights Watch further calls out the bill for not only seemingly violating India's Supreme Court holding, but also for violating international standards for gender recognition, which require separation of legal and medical processes of gender reassignment. "Self-declared identity should form the basis for access to all social security measures, benefits, and entitlements."

Notably, the bill also includes intersex persons; HRW calls for the parliament to rename the  bill to make it clear that it includes intersex persons and establish additional explicit protections for intersex persons along with transgender persons.

Other changes parliament should make, HRW says, include: prohibiting medically unnecessary procedures on children, requiring the issuing of legal identity documents to interested persons that identify their preferred gender, and emphasizing training of teachers to "adopt inclusive methods" to ensure transgender or intersex children are not harassed, bullied, or discriminated against. 

Says Ganguly: “To enact a law that meets international standards, it’s critical that parliament fully bring transgender people into the conversation."

July 29, 2019 in International, Politics, Reproductive Health & Safety, Sexuality | Permalink | Comments (0)

Friday, July 26, 2019

Another State Could Soon Insert Anti-Abortion Propaganda Into Public Schools

July 19, 2019 (Rewire.News): Another State Could Soon Insert Anti-Abortion Propaganda Into Public Schools, by Erin Heger: 

Ohio--the only U.S. state without standardized health education--may soon require public schools to focus on the “humanity of the unborn child” in health education curriculum. 

House Bill 90, introduced by the state's GOP legislature, infuses anti-abortion language into health and science materials for students and would restrict schools from providing any abortion-related information or referrals to students facing pregnancy. The legislature aims for school programs to thoroughly detail information about fetuses and gestation, promoting carrying any pregnancy to term.

In 2016, Oklahoma also introduced similar legislation (calling it the "Humanity of the Unborn Child Act"), however it has not yet been implemented in the state due to "budget constraints."

Both HB 90 in Ohio and Oklahoma’s Humanity of the Unborn Child Act state their intended purpose is an “abortion-free society.” However, not informing young people of all their options does little to prevent abortion and instead leaves people not knowing what to do or where to turn when they do face an unintended pregnancy, said Cameron Brewer, an educator with Planned Parenthood Great Plains.

“If we are restricting the information students have access, to then we are doing them a disservice as educators,” Brewer told Rewire.News. “My goal as an educator is to make sure my students have all the information they need to make the best decisions for them.” 

July 26, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Culture, Fetal Rights, Politics, Reproductive Health & Safety, State and Local News, State Legislatures | Permalink | Comments (0)

Thursday, July 25, 2019

Telemedicine Abortion is Safe

July 23, 2019 (Rewire.News): Telemedicine Abortion is Safe, No Matter What Anti-Choice Lawmakers Claim, by Auditi Guha: 

A study released July 9 finds that outcomes for medication-driven abortion through telemedicine are comparable in-person medication abortion.

The results support the importance of telemedicine for reproductive health and safety particularly for those who cannot easily reach abortion clinics due to oppressively-restrictive anti-choice legislation. 

Medication abortion has been legal in the United States for nearly twenty years and is supported by the American College of Obstetrics and Gynecologists, National Abortion Federation, and Planned Parenthood. The procedure uses a combination of mifepristone and misoprostol pills and the telemedicine aspect helps clinicians have a wider reach in authorizing and supervising the process through remote video conferencing.

Telemedicine medication abortions have often been provided in clinics where the licensed clinicians video conference in while the patient is in clinic with nurses or other professionals, but direct-to-patient telemedicine abortion services are growing. Most patients requesting these services live in abortion-hostile states where they cannot easily reach a clinic at all.

The anti-choice movement has responded by working to restrict access to telemedicine abortion as well as in-clinic abortion services. Legal bans or restrictions currently exist in Arkansas, Idaho, Mississippi, and Utah. 

The recent study, though, "indicates that telemedicine abortion is 'a safe and effective way of ending an early pregnancy, with very rare complications' and can provide the same quality of health care patients receive at a health center," according to Dr. Julia Kohn, national director of research at Planned Parenthood Federation of America and the lead author of the study.

Kohn further says: "In many ways, this study does reaffirm what we already know: Medication abortion via telemedicine is safe and effective at ending an early pregnancy."

July 25, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, Medical News, Pregnancy & Childbirth, Pro-Choice Movement, Reproductive Health & Safety, Scholarship and Research, Science, State and Local News, State Legislatures, Women, General | Permalink | Comments (0)

Tuesday, July 9, 2019

Vaginal exams on unconscious, non-consenting patients are legal in 42 states

Jun. 26, 2019 (Vice): Med Students Are Doing Vaginal Exams on Unconscious, Non-Consenting Patients, by Hannah Harris Green: 

For decades, medical students around the country have been expected to perform pelvic exams on unconscious women--not for the patient's benefit but solely for the student's experience. Sometimes these exams are performed multiple times by different students on the same patient. The exams involve a student inserting "two gloved fingers into the patient’s vagina and [placing] one hand on her pelvis in order to feel the uterus and ovaries." This patient is never asked for consent prior to the procedure nor is she informed of the exam afterward.

One former student--now a pediatrician in Baltimore, Maryland--learned of these procedures during his OB/GYN rotation while studying at the University of Pennsylvania Medical School in the 1990s. He refused to participate, joining in a movement to ban the practice. Ari Silver-Isenstadt took a year out of his medical studies to study the ethical implications of this practice at Penn's School of Education. He subsequently published a study in 2003 in the American Journal of Obstetrics and Gynecology that found that over 90 percent of students at the five Pennsylvania medical schools he had focused on had performed vaginal exams on non-consenting, unconscious patients. He noted that students' initial discomfort with the procedure quickly dissipated as it became a regular part of their rotations. 

California became the first state to ban these invasive exams in 2003, the same year of Silver-Isenstadt's study. Since then, Illinois, Virginia, Oregon, Hawaii, Iowa, Utah, and Maryland have followed suit. Additional states that have introduced similar legislation this year include Connecticut, Minnesota, Missouri, Nebraska, New Hampshire, New York, Oklahoma, Washington, and Texas. No federal legislation yet addresses the issue. 

Some medical schools have also banned the practice institutionally as well--like Harvard--but others, including Duke University, consistently ask their medical students to perform pelvic exams sans consent throughout their education. 

While the procedure invades the privacy of any patient, consequences can be particularly severe for patients with a history of sexual trauma who either find out a pelvic exam was performed on them while unconscious or else wake up during the produce, as did Ashely Weitz in 2007.

Weitz said testifying about her experience in support of Utah's law in February was nerve-racking, especially because she expected there to be other women at the hearing at the state house with similar experiences, but she was the only one. Given the nature of these exams, people don’t know if it's happened to them. She said it was “a very healing practice to say 'this shouldn't happen to me, it shouldn't be happening in the way that it is happening in an institution.'” But there are still parts of the incident that she hasn’t recovered from. “It changed the way that I sought and received medical care,” she said. “I was, you know, thereafter very certain that I was never going to be sedated or unconscious in a manner that would have allowed that situation to happen again. So it was in itself very traumatizing.”

Utah's ban on unconscious pelvic exams was signed into law in March of this year. It requires both medical students and doctors to get explicit consent to perform such exams on anesthetized women. A law professor at the University of Illinois, Robin Fretwell Wilson, credited Weitz's testimony as the primary driving force behind the state legislation. 

Wilson herself advocates for requiring specific consent for any pelvic exams. While opponents to legislation requiring consent argue that general consent forms signed upon entering a teaching hospital already cover these exams, Wilson and other advocates for patient protections assert that it is ethically wrong to practice procedures that are of no benefit to the patient without direct consent.

Many advocates, including Weitz, connect the growing opposition to these vaginal exams to the rising tide of the #MeToo movement in recent years. "The #MeToo movement has helped people like Weitz better understand that the violations they endure are part of a wider cultural problem."

Wilson acknowledges that even 10 or 15 years ago, the attitude toward this practice was completely different. "At the time, medical school faculty 'were more than willing to stand their ground and say, "not only do we do it, but the patients in our hospitals have a duty to participate."' . . .  15 years ago, many schools 'did not see it as an issue.'"

Advocates of legal regulations requiring patient consent, though, still fear that enforcement of the new laws will be difficult. "In order for authorities to find out, students would need to both be aware of the law and willing to report wrongdoing by their supervisors, so [Silver-Isenstadt is] hoping the culture is what will ultimately change."

July 9, 2019 in Culture, Medical News, Miscellaneous, Scholarship and Research, State Legislatures, Women, General | Permalink | Comments (0)

Wednesday, June 26, 2019

UK Appeal court overturns forced abortion ruling

Jun. 24, 2019 (The Guardian): Appeal court overturns forced abortion ruling, by Harriet Sherwood: 

An appeals court in the UK overturned a recent decision by the court of protection in London, which had ordered a young pregnant woman to have an abortion against her wishes. 

The pregnant woman is in her twenties and suffers from learning and mood disorders, such that her mental capacity is akin to that of a "six to nine-year-old child."

There is no public information as to how the woman got pregnant and a police investigation is ongoing. In the meantime, the woman--now 22-weeks pregnant--and her mother  both wish for the pregnancy to continue and her mother intends to care for the child once born. A social worker agrees that the pregnancy should be allowed to continue. 

Three medical professionals, including one obstetrician and two psychiatrists, with England's National Health Service initiated the legal challenges when they sought permission from the court to terminate the pregnancy.

The court that ordered the termination originally stated that its decision was in the best interests of the woman. The woman's mother, a former midwife, appealed the decision. The appeals court is expected to provide their rationale at a later date. 

Abortions may be performed up to 24 weeks in a pregnancy under Britain’s 1967 Abortion Act.

June 26, 2019 in Abortion, In the Courts, International | Permalink | Comments (0)