Reproductive Rights Prof Blog

President Obama Chooses a New Surgeon General

Wash. Post: Obama Selects Alabama Doctor as Surgeon General, by Michael Shear:

President Obama has chosen Regina Benjamin, a family physician from Alabama, to be the next Surgeon General, filling a key public health post ahead of an expected surge in the H1N1 flu next fall, White House sources said.

Benjamin gained fame through her public efforts to rebuild her rural health clinic after Hurricane Katrina devastated it. She founded the Bayou La Batre Rural Health Clinic in 1990 and rebuilt it after the hurricane.

Benjamin has also served as the first black woman to head the State of Alabama Medical Association and was associate dean for rural health at the University of South Alabama's College of Medicine.

Questions For Judge Sotomayor

NY Times Op-Ed: Questions for Judge Sotomayor:

Judge Sonia Sotomayor, President Obama’s nominee for the Supreme Court, is scheduled to appear today at a confirmation hearing before the Senate Judiciary Committee. The Op-Ed editors asked seven legal experts to pose the questions they would like to hear the nominee answer.

The contributors are Kathleen M. Sullivan, Michael Chertoff, Stephen L. Carter, Alberto Gonzales, Ann Althouse, Ronald Dworkin, and James MacGregor Burns.

See also: NY Times: Live Blogging the Sotomayor Hearings, by Kate Phillips.

U.S. Organizations Speak Out on Women and HIV to Inform Health Policy and National AIDS Strategy

Center for Health and Gender Equity press release: U.S. Organizations Speak Out on Women and HIV to Inform Health Policy and National AIDS Strategy:

(Washington, D.C.)-Fourteen U.S. organizations working on issues related to human rights, women, and HIV/AIDS submitted a series of policy recommendations to guide the Office of National AIDS Policy (ONAP) and related agencies in their efforts to achieve better outcomes for women living with and affected by HIV.  The report, entitled "Critical Issues for Women and HIV: Health Policy and the Development of a National AIDS Strategy" calls attention to the factors contributing to disproportionate rates of HIV among low-income women and women of color, as well as poor health outcomes for women living with HIV - and proposes concrete solutions that integrate systems of prevention and delivery of care.

"The face of the HIV epidemic is increasingly that of a minority woman living in poverty," said Gina Brown, Medical Case Manager of the NO/AIDS Taskforce. "Health care systems have largely neglected the complex medical, economic, and social realities of HIV-positive women."

The working group identified six key areas of focus for better policy and practices: Meaningful involvement by HIV-positive women in development of policy and monitoring and evaluation of programs; greater consideration of HIV-positive people's civil and human rights; health disparities in the U.S. South and rural areas; health care access; integration of sexual and reproductive health services with HIV testing, prevention and care; and HIV prevention. The report articulates specific policy recommendations that seek to improve the outcomes of women living with or vulnerable to HIV.  

"Involving the expertise of HIV-positive people and those working on the frontlines of service delivery is critical to improve prevention and care outcomes for communities impacted by HIV. We must use a human rights framework as we reform health policy and develop a National AIDS Strategy that will truly reduce HIV incidence and increase access to care for women," said Naina Khanna, Coordinator of the U.S. Positive Women's Network and Director of Policy and Community Organizing at WORLD.

Representatives from these organizations plan to meet with Jeff Crowley, Director of ONAP, and other key White House officials in the upcoming months to discuss their recommendations and the development of a National AIDS strategy.

The organizations that authored the report are African Services Committee; AIDS Alabama; Alliance of AIDS Services-Carolina; Center for HIV Law & Policy; Community HIV/AIDS Mobilization Project (CHAMP); Center for Health and Gender Equity (CHANGE); HIV Law Project; International Community of Women Living with HIV/AIDS (ICW); National AIDS Fund; National Women and AIDS Collective (NWAC); Sisterlove, Inc.; The U.S. Positive Women's Network (PWN); The Women's Collective; and Women Organized to Respond to Life-threatening Disease (WORLD).

The full text of the report can be accessed at: http://www.genderhealth.org/pubs/onaprecommendations.pdf.

Spain's Proposed Abortion Reform Draws Opposition from Catholic Church

RH Reality Check: The Church Battles Reforms in Spain's Abortion Law, by Angela Castellanos:

A draft of Spain's reformed abortion bill has ignited the Catholic Church, which called its congregation as well as the Catholic politicians to vote against the bill even though it has not yet been submitted to Congress.

The bill reflects the recommendations of the Spanish parliamentary commission, which for six months examined the effect of Spain's restrictive abortion laws. Last February, the parliamentary commission proposed a reform decriminalizing abortion in Spain so abortion would be removed from the Penal Code and included under the sexual health regulations.

Congress Debates Increased Screening for Postpartum Depression

Time Magazine: Should All Mothers Be Screened for Postpartum Depression?, by Catherine Elton:

A month after Melanie Blocker-Stokes gave birth, she stopped eating and sleeping. She had convinced herself that she was a terrible mother, and she was paranoid that the neighbors thought so too. Over two months, Blocker-Stokes was repeatedly hospitalized for postpartum psychosis; prescribed a cocktail of antipsychotic, antianxiety and antidepressant drugs; and treated with electroconvulsive therapy. Despite her family's efforts to help, Blocker-Stokes leaped to her death from the 12th story of a Chicago hotel in 2001, when her daughter was 3½ months old.

Now the Melanie Blocker-Stokes Postpartum Depression Research and Care Act, familiarly known as the Mothers Act, has passed the House and is headed for the Senate. If it becomes law, it will mandate the funding of research, education and public-service announcements about postpartum depression (PPD) along with services for women who have it.

The legislation has sparked surprisingly heated debate, dividing psychologists and spurring a war of petition drives aimed at either bolstering the bill or blocking its passage. . . . 

Parents Struggle with Telling Children about Their Surrogate Births

NY Times: No Stork Involved, but Mom and Dad Had Help, by Sara Rimer:

...While there is no widely agreed upon number for surrogate births, the American Society for Reproductive Medicine estimates 400 to 600 births a year from 2003 to 2007 in which a surrogate was implanted with a fertilized egg. Advocacy groups put the count much higher.

So despite the substantial costs (at least $30,000), there is now a group of young children whose parents are wrestling with this modern twist on the eternal question: Where did I come from?

These parents have to take the often excruciating saga of all they went through to have a baby and turn it into a child-friendly, reassuring and true Your Birth Story....

NY Times Commentary on Obama, the Pope, and Abortion

Room for Debate (NY Times): Does Obama Have a Friend in the Vatican?:

President Obama received a warm welcome at the Vatican on Friday in his first meeting with Pope Benedict XVI. Indeed, the Vatican has generally seemed more eager to form a relationship with Mr. Obama than many American bishops, who have been cooler because he differs from the church on abortion and other reproductive issues. The invitation Mr. Obama received to deliver the commencement speech at the University of Notre Dame, for instance, triggered strong public condemnation from conservative bishops.

Why does the American Catholic leadership seem to be focused on abortion, while the Vatican appears willing to view that issue as merely one among many on which to judge a political leader?

• John L. Allen Jr. The National Catholic Reporter
• James Martin, Jesuit priest
• M. Cathleen Kaveny, professor of law and theology
• Colleen Carroll Campbell, Ethics and Public Policy Center

The Place of Women on the Supreme Court

NY Times: The Place of Women on the Court, by Emily Bazelon:

In late February, three weeks after she had an operation for a recurrence of cancer, Justice Ruth Bader Ginsburg went to Barack Obama’s first address to Congress. Given the circumstances, it wasn’t an event anyone expected her to attend. She went, she said, because she wanted the country to see that there was a woman on the Supreme Court.

Now another woman, Judge Sonia Sotomayor, is about to begin the confirmation hearings that stand between her and a seat near Ginsburg on the high bench. After 16 years on the court — the last three, since the retirement of Justice Sandra Day O’Connor, as the only woman working alongside eight men — Ginsburg has a unique perspective on what’s at stake in Sotomayor’s nomination. I sat down with the 76-year-old justice last week to talk about women on the bench and their effect on the dynamics and decisions of the court.

Catholics for Choice on the Pope and the President

Catholics for Choice Press Release: The Pope and the President: Many Similar Outlooks but Very Different Roles:

Washington DC - Jon O'Brien, president of Catholics for Choice, issued the following statement about the meeting today between President Barack Obama and Pope Benedict XVI in Rome.
"In the last few weeks, many have speculated about the first meeting between President Barack Obama and Pope Benedict XVI. We at Catholics for Choice have repeatedly been asked about our take on this meeting. Certainly, for US Catholics it is an exciting moment to see our pope and our president meet.

"It is worth noting, however, that earlier this week, in his social encyclical 'Caritas in Veritate,' Pope Benedict claimed that the church does not "interfere in any way in the politics of States." These words are especially pertinent for Friday's meeting.

"While both men are world leaders, the pope and the president maintain distinctly different roles as a religious leader and a political leader, respectively. We must be clear that the pope does not command the same type of global responsibility as a member of the Group of Eight, such as the United States, and to expect G8-type political outcomes from this meeting would be unrealistic and wrong.

Continue reading

Obama Meets with Pope

Reuters: Obama at Vatican for first meeting with pope, by Jeff Mason:

VATICAN CITY (Reuters) - U.S. President Barack Obama arrived at the Vatican on Friday for his first meeting with Pope Benedict and what the White House says will be frank discussions on issues they agree and disagree on....

Unlike his predecessor George Bush, Obama and the pope do not see eye-to-eye on abortion rights and embryonic stem cell research....

Less than two months after his inauguration, Obama lifted restrictions of federal funding for human embryonic stem cell research, which the Vatican opposes because it destroys embryos.

U.S. Catholic bishops criticized Obama for lifting the ban and later many of the bishops denounced Notre Dame University, a leading American Catholic institution, for giving Obama an honorary degree.

Scientists Report Creating Human Sperm from Stem Cells

Time Magazine: Scientists Create Human Sperm from Stem Cells, by Alice Park:

Researchers at Newcastle University in England report they have coaxed the first human sperm cells from embryonic stem cells, in a remarkable demonstration of how quickly the field of stem-cell science is moving.

The achievement, described in the journal Stem Cells and Development, comes just 11 years after the first human-embryonic-stem-cell line was created — an eyeblink in scientific terms — in the lab of James Thomson at the University of Wisconsin. (See the top 10 scientific discoveries of 2008.)

Although the development once again raises the specter of creating humans in a petri dish or custom-designing egg and sperm cells for reproduction, lead author Karim Nayernia says that was not his team's intention. Rather, the experiment was a proof of concept that stem cells can generate any cell in the body — not only the dozens of tissues that make up the human body but also those egg and sperm cells that may give rise to altogether new bodies.

Study Suggests Way to Reduce Limited Risk of Infection from Abortion Pill Use

NY Times: Abortion Pill Study Suggests Way to Limit Infection, by Denise Grady:

A large study of the pills used to induce abortion has found that infections are rare but can be made even less common if the pills are taken by mouth instead of vaginally, and with antibiotics.

But it is not clear whether the findings will change medical practice. Abortion providers and other experts had different reactions to the study. Most agreed that it was reasonable to change to the oral route, but some hesitated at routinely prescribing antibiotics, which can have side effects, for a procedure with a very low infection rate.

About 1.1 million women in the United States have used abortion pills since they were approved in 2000. Last year, 184,000 women took them, said a spokeswoman for Danco Laboratories, which markets the pills. They work only for early pregnancies, up to 63 days, and still account for a small proportion of the more than one million abortions performed every year in this country.

Abortion Coverage and Health Care Reform

Time Magazine: Could Abortion Coverage Sink Health-Care Reform?, by Karen Tumulty:

Should government-subsidized health coverage pay for abortion procedures? For more than three decades, that question has seemed pretty much settled. The Hyde Amendment, passed by the House on September, 30, 1976, forbade Medicaid — a program for poor people, jointly administered by Washington and the states, which had up to then paid for about 300,000 abortions a year — from using any federal money to pay for the procedure. All but 17 states followed suit, banning use of their own funds as well; with a few modifications, the ban has stood up ever since.

The prospect of sweeping health reform, however, has reopened the issue. While current versions of the legislation do not address the abortion issue at all, late last month 19 anti-abortion Democrats in the House sent a letter to Speaker Nancy Pelosi, warning "we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan."

Uganda Moves to Ban Female Genital Mutilation

Salon.com (Broadsheet): Uganda to outlaw female genital mutilation, by Lynn Harris:

Let's make sure this one doesn't get lost in this week's Palin/Jackson shuffle: Uganda has moved to outlaw female genital mutilation. 

"God knew what he was doing when he created us. Do you think you are more intelligent than God?" President Yoweri Museveni asked the crowd at a recent event launching a campaign against the practice, Uganda's New Vision reported. "There is no part of the human body that is useless."

The president also dismissed any defense of FGM as a "cultural" practice, calling it dangerous not only to women but also to the babies they may later have trouble bearing. According to the Guardian, he also "pledged to help provide an alternative source of income for women who earn a living circumcising girls." 

A Lack of Medicaid Funded Abortions Forces Many to Carry Pregnancies to Term

Guttmacher Institute news release: Restricting Medicaid Funding For Abortion Forces One in Four Poor Women to Carry Unwanted Pregnancies to Term:

Approximately one-fourth of women who would obtain a Medicaid-funded abortion if given the option are instead forced to carry their pregnancy to term when state laws restrict Medicaid funding for abortion, because they lack the money to pay for the procedure themselves. According to a new report, “Restrictions on Medicaid Funding for Abortions: A Literature Review,” by the Guttmacher Institute and Ibis Reproductive Health, Medicaid funding restrictions also delay some women’s abortion by 2–3 weeks, primarily because of difficulties women encounter in raising funds to pay for the procedure.

Currently, 32 states and the District of Columbia allow Medicaid funds to be used for an abortion only in cases of rape and incest, or if the woman’s life is endangered, in accordance with the federal Hyde Amendment; only 17 states have policies to use their own funds to pay for all or most medically necessary abortions. Lacking insurance coverage, some poor women need a considerable amount of time to come up with the money to pay for an abortion, and may have to pull resources from other family necessities, like food or rent, if they are able to find the funds at all. As the cost of the procedure increases with gestation, many poor women become trapped in a vicious cycle of scrambling to raise enough money before the cost—and risk—increase further, while others are left with no recourse but to carry an unwanted pregnancy to term.

House Committee To Vote On Lifting DC Abortion Funding Ban

ACLU press release: House Committee To Vote On Lifting DC Abortion Funding Ban:

WASHINGTON – The House Appropriations Committee is expected to vote this evening on a financial services appropriations bill that includes a provision lifting a 20-year-old ban on the use of local funds for abortions in the District of Columbia. The American Civil Liberties Union urges Committee members to lift the DC abortion funding ban and opposes any attempts to reinstate this restriction.

 

“The federal government should not be in the business of telling the District of Columbia how to spend its own money,” said Vania Leveille, ACLU Legislative Counsel. “The District of Columbia, like our 50 states, should be free to determine local health policy based on the needs of people living within its jurisdiction. The decision whether or not to become a parent should not depend on where you live or how much money you make.”

 

Since 1980, Congress has prohibited the use of federal funds appropriated for the District of Columbia to pay for abortion services except in cases where the woman’s life is endangered and when she is a victim of rape.  Beginning in 1988, Congress went one step further by also preventing the District of Columbia from using its own locally raised revenues to provide abortion care for low-income women.  Congress lifted the ban in 1993 and 1994, but reinstated the measure one year later.

 

The Obama administration set the stage for today’s vote in its 2010 budget proposal by giving the District of Columbia the same privileges as the states to use local funds to support abortion care for low-income women.

 

“For far too long, this ban has allowed non-resident members of Congress to impose their own ideology, morality or religious belief on the District’s residents,” said Leveille. “Lawmakers who seek to negate the will of the District’s residents or leaders are not even accountable to the people of the District.  It is well past time for Congress to do the right thing and end this abortion restriction.”

 

For more information, go to: http://www.aclu.org/reproductiverights/abortion/40235leg20090707.html.

The Silence on Stillbirths

Wash. Post: Even Doctors Avoid Talking About Stillbirth, by Alan Goldenbach:

About a month after our son died, my wife and I made our first visit back to her obstetrician's office hoping to get answers to some of the questions that haunted us.

We had already learned why he died a day before he was supposed to be born; an autopsy showed his umbilical cord had become knotted. What we were left with was a helpless feeling, exacerbated by the fact that our son's death blindsided us. Over the previous year, we had absorbed countless pieces of pregnancy literature and fiercely adhered to our obstetrician's guidelines for a healthy pregnancy. While we knew that stillbirth is possible in every pregnancy, no book nor our doctor ever mentioned the term....

There are about 26,000 stillbirths annually in the United States -- one in about every 160 pregnancies, according to the Centers for Disease Control and Prevention. That is 10 times the number of deaths attributed to sudden infant death syndrome, which has been identified as a key public health issue, and four times the incidence rate of Down syndrome, for which prenatal testing has become almost ritual. Domestically, there are 2 1/2 times more stillbirths annually than deaths from AIDS.

Risks of Pregnancy and Diabetes

USA Today: Expectant mothers with diabetes face risky challenge, by Mary Brophy Marcus:

Before she became pregnant, Molly Duerr never understood why expectant moms would say they didn't care if it were a boy or a girl, only that the baby be healthy.

"I thought, 'Of course you'd want to know what the baby's going to be,' " says Duerr, 30, who has type 1 diabetes. But after becoming pregnant last year and realizing all the health risks associated with diabetes, she says, "I got it."

A growing number of women, like Duerr, are either heading into pregnancy with diabetes — type 1 and type 2 — or developing gestational diabetes while pregnant, says endocrinologist Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. Kirkman says diabetes raises the risk of miscarriages, delivery complications, maternal health problems and birth defects, but she adds that the risks can be slashed with pre-conception counseling, tight control of blood sugar and maintaining a healthy weight before and during pregnancy.

Despite Court Order, Arizona Sheriff Continues to Block Prisoners' Access to Abortion

ACLU Press Release (7/2): "America's Toughest Sheriff" Agrees To Stop Requiring Court Orders For Abortions But Creates New Obstacle:

PHOENIX - The American Civil Liberties Union late yesterday asked an Arizona court to prevent Maricopa County Sheriff Joseph Arpaio from requiring inmates to prepay transportation costs before they can obtain an abortion.

As part of a partial settlement in an ACLU lawsuit involving the right of women prisoners to obtain timely, safe and legal abortions, Arpaio agreed to follow a 2005 court order prohibiting Maricopa County correctional facilities from requiring inmates to obtain a court order before an abortion. However, in the course of settlement negotiations, Arpaio decided inmates must prepay transportation and security costs associated with obtaining the procedure.

"After defying court rulings that prison officials cannot require women prisoners to obtain a court order before an abortion, Sherriff Arpaio finally agreed to abide by the courts; however, he put up yet another obstacle to care," said Brigitte Amiri, a senior staff attorney for the ACLU Reproductive Freedom Project. "Arpaio's new requirement that inmates must pay for transportation costs upfront amounts to a bait and switch. It's time for Sherriff Arpaio to stop playing games with women's health."

In May 2004, on behalf of a woman inmate seeking an abortion, the ACLU challenged an unwritten Maricopa County Jail policy that required inmates to obtain a court order before officials would transport for abortion care.  The Superior Court of Arizona, Maricopa County, struck down the unwritten policy in August 2005, holding that it violated women's reproductive rights and served "no legitimate penological purpose." The Arizona Court of Appeals upheld that decision; both the Arizona and the United States Supreme courts refused to hear the case.

Regardless of these rulings, Maricopa County Jail continued to require women to obtain a court order before an abortion, and in August 2008, the ACLU asked the court to hold Arpaio in contempt. In the course of settlement negotiations in that case, Arpaio shifted tactics and began insisting that inmates who seek abortions must pay upfront for transportation and security costs. Inmates requiring transportation for other medical care are not charged for transport either before or after receiving services.

"The courts have already confirmed our position that Arizona prison officials cannot put up roadblocks to abortion care simply because they do not agree with the decision to end a pregnancy," said Alessandra Soler Meetze, Executive Director of the ACLU of Arizona. "Sheriff Arpaio's latest move to require prepayment is just another way for him to take the law into his own hands."

In last week's partial settlement, Arpaio agreed to notify all employees and include information in the Rules and Regulations for Inmates that a court order is not required for a pregnant inmate to obtain abortion care.

The case is Doe v. Arpaio, CV2004-009286. Lawyers on the case include Amiri and Talcott Camp with the ACLU Reproductive Freedom Project, and Dan Pochoda of the ACLU of Arizona.

To read the brief: www.aclu.org/reproductiverights/abortion/40106lgl20090701.html

To read last week's partial settlement: www.aclu.org/reproductiverights/abortion/40091lgl20090619.html

Abrams & Brooks on Same-Sex Marriage and the "Accidental Procreation" Argument

Kerry Abrams (University of Virginia) & Peter Brooks have posted Marriage as a Message: Same-Sex Couples and the Rhetoric of Accidental Procreation on SSRN. Here is the abstract:

In his dissent in the 2003 case Goodridge v. Department of Health, Justice Robert Cordy of the Massachusetts Supreme Court introduced a novel argument in support of state bans on same-sex marriage: that marriage is an institution designed to create a safe social and legal space for accidental heterosexual reproduction, a space that is not necessary for same-sex couples who, by definition, cannot accidentally reproduce. Since 2003, every state appellate court considering a same-sex marriage case has adopted Justice Cordy's dissent until the recent California Supreme Court decision In Re Marriage Cases. In case after case, courts have held that marriage allows states to send a message to potentially irresponsible procreators that 'marriage is a (normatively) necessary part of their procreative endeavor' and that same-sex couples do not need marriage because they only procreate after considerable effort and forethought. This article examines the accidental procreation argument through the lenses of anthropological theory, history, literature, and constitutional law. We conclude that marriage has sometimes been used to channel male heterosexuality into reproduction, but to argue that this goal is the sine qua non of marriage is to vastly oversimplify its history in both law and culture. We then undertake a genealogy of the accidental procreation argument and speculate about its possible effects on the institution of marriage. We suggest that if courts continue to insist upon a definition of marriage that is so distinct from the actual practice of the institution, the law may actually be less and less influential in regulating intimate behavior.