Monday, April 8, 2019
YES! Magazine (Apr. 2, 2019): For Black Women, Reproductive Justice Is About More Than High-Risk Pregnancies, by A. Rochaun Meadows-Fernandez:
Recently, journalists, medical professionals, and advocates have been emphasizing the discrepancy in medical care between White women and women of color. The maternal mortality rate is already abysmally low in the United States; this rate is even worse for Black women. These reports have largely focused on the medical risks of pregnancy and childbirth for women of color, but there is another, lesser-reported area of reproduction that also disproportionately burdens women of color: infertility.
"While infertility affects roughly 12 percent of the population, Black women are twice as likely to experience challenges achieving or sustaining a pregnancy—and less likely to seek assistance." Infertility can also severely harm the mental health of someone wishing to get pregnant.
Options to prevail against infertility often include the use of assisted reproductive technologies, including surrogacy.
Surrogacy has been met with controversy from many angles over the years. Those against the practice express concerns of stigma, exacerbated classism, commodification of women's bodies, and exploitation. "Some countries, including Mexico, have banned commercial surrogacy under the guise of protecting low-income women and children from exploitation."
Advocates, however, argue that surrogacy is a viable option for many people to pursue their dreams of parenthood they otherwise have trouble achieving.
Black women in particular are less likely to pursue surrogacy, among other reproductive technology, and are less likely to be surrogates as well.
According to the Centers for Disease Control and Prevention, from 1999 to 2016, gestational carriers resulted in 13,380 deliveries and the birth of 18,400 infants. Although the current figures are unknown, surrogacy is helping to counter infertility struggles.
Still, the number of Black surrogates and Black intended parents remain low.
This could possibly be because of the stigma from slavery that historically frames enslaved Black women as surrogates for their White female owners. But is most likely because of the high costs normally associated with surrogacy (about $100,000, which includes medical and health care expenses for the carrier and agency or finder fees)—although some may turn to family or friends where there is no compensation—called altruistic surrogacy.
Surrogacy can occur in two ways: the traditional way in which the surrogate is impregnated by either the intended father's sperm or that of a donor, while using her own eggs; or, gestational surrogacy in which the surrogate is impregnated using the eggs of either the intended mother or an egg donor. In the former, the surrogate is genetically related to the child and the in the latter, she is not. Gestational surrogacy requires a few additional interventions, like IVF, and is generally more expensive.
Many intending parents prefer gestational surrogacy, though, in order to lessen the likelihood that the surrogate will develop an emotional connection and assert a biological claim of custody over the resulting child. "This is an intended parent’s worst fear."
"Juli Fraga, a psychologist who specializes in women’s health, including pregnancy-related depression...suggests that it is especially important for all members of the surrogacy contract to be open to seeking mental health services."
In re Baby M is one of more famous cases illustrating potential legal battles that may arise over surrogacy. In this case, intended parents William and Elizabeth Stern fought for custody after their surrogate, Mary Beth Whitehead, invalidated their contract and attempted to claim custody over "Baby M." The court ultimately held that the surrogacy contract was entirely unenforceable, likening it to the "sale of a child." The court also held that William Stern, the child's biological father, retain custody according to the best interests of the child, but that Whitehead, the surrogate and also the child's biological mother, also retain visitation rights with the child.
Similar cases have continued to arise between surrogates and intended parents. Baby M influenced a shift in the legal protections and parameters for surrogacy, though. "It’s now suggested that intended parents prioritize entering contracts in states that support protective surrogacy legislation. But only 17 states and the District of Columbia have laws governing the conditions of surrogacy."
It is important to ensure that Black women are receiving the same medical care and equitable access to reproductive services, including reproductive technology and protections in cases of surrogacy (either as the intending parent or the surrogate), as White women. Equally as important is removing the stigma around infertility and opening conversations to all women about their reproductive options.
In once recent case, GloZell Green, a Black woman and YouTube star, was told by a fertility specialist that she'd waited too long to have children at age 39. Green began searching for the best way to enter motherhood and ultimately had a baby girl through gestational surrogacy. Green shared her surrogacy journey with her millions of subscribers, hoping to break the stigma and open conversations. She highlights that "above all else, she doesn’t want Black women to be embarrassed about infertility."
Tuesday, March 5, 2019
The New York Times (Mar. 1, 2019): An 11-Year-Old in Argentina Was Raped. A Hospital Denied Her an Abortion, by Daniel Politi:
Despite laws in Argentina saying that pregnant people may seek abortions in the case of rape (one of the only instances in which abortion is legal in the country), an 11-year-old rape survivor was denied the abortion she requested and instead forced into a C-section delivery.
The child was reportedly raped by her grandmother's boyfriend. She discovered her pregnancy at 19 weeks after going to the hospital complaining of severe stomachaches. Both the child and her mother pushed for her to receive the abortion, but doctors administered drugs without consent to hasten the development of the fetus so that she could deliver instead (the doctors told her that they were giving her "vitamins").
Fernanda Marchese is the executive director of Human Rights and Social Studies Lawyers of Northeastern Argentina, which is representing Lucía (a pseudonym) and her family. Marchese reports that the hospital permitted anti-abortion activists to enter Lucía’s hospital room, "where they urged her to have the baby, warning that she otherwise would never get to be a mother."
"Reproductive rights groups filed emergency lawsuits that led to a court order instructing the hospital to carry out an abortion at once." The doctors still refused, citing conscientious objections.
Private sector doctors Cecilia Ousset and José Gigena agreed to conduct the abortion, but because Lucía’s pregnancy was so far along, they decided they had no choice but perform a C-section. Dr. Ousset identified that Lucía’s life was at risk throughout the ordeal in a phone interview with the New York Times. Lucía is now healthy and should be discharged soon.
Genetic material from the umbilical cord will be studied and possibly used to prosecute the man who is alleged to have raped Lucía. He has already been arrested.
Although the case has gained notoriety, many say it reflects a reality in parts of Argentina. “In the north of Argentina,” Dr. Ousset said, “there are lots of Lucías and there are lots of professionals who turn their back on them.”
March 5, 2019 in Abortion, Abortion Bans, Anti-Choice Movement, In the Media, International, Medical News, Politics, Pregnancy & Childbirth, Reproductive Health & Safety, Sexual Assault, Women, General | Permalink | Comments (0)
Saturday, February 9, 2019
Devex (Feb. 5, 2019): In Nigeria, Trump administration policies bite hard, by Paul Adepoju:
Trump's policies limiting reproductive rights and funding for reproductive health and education services continue to wreak havoc on foreign initiatives aimed at promoting family planning, slowing population growth, and educating girls and women.
Nigerian hospitals and NGOs are facing severe shortages of reproductive health supplies since Trump both cut funding to the United Nations Population Fund (UNFPA) and implemented the "global gag rule," withdrawing funding from any agency that offers abortion-related education or services.
Nigeria, a middle-income country facing a population boom, lost over 60% of its funding for family planning supplies and services in the year after Trump pulled UNFPA funding. "In 2016, when UNFPA got its last support from the U.S. government, it was able to spend $15,444,880 on family planning in Nigeria. In 2017, it spent just $6,132,632."
Trump justified these funding cuts by promulgating theories that the UNFPA cooperated with coercive abortions and involuntary sterilization, which the UNFPA categorically denies and is readily backed up by multiple human rights organizations.
The rate of contraceptive usage in Nigeria is already very low, and the African country also faces one of the highest maternal mortality rates in the world.
Several organizations--including Generation Initiative for Women and Youth Network--are on-the-ground in Nigeria working to educate women and provide safe and reliable access to health care to shift these statistics. Their work, though, has been severely limited by the loss of funding as a result of U.S. policies under the Trump administration.
Erin Williams, program officer for grantmaking and international partnerships at the International Women's Health Coalition, told Devex:
As a result [of these policies], Nigerian health services will continue to fragment, deteriorate, and decrease, increasing the burden on vulnerable women and girls in search of comprehensive and quality health care. More women will look for contraceptive and pregnancy alternatives outside the medical and legal system.
While much of the justification for pulling U.S. funding relies on anti-abortion ideology, the implications of the policies are much farther-reaching than "just" abortion. Nigeria has slowed in its ability to address maternal health needs generally, including instances of gender-based violence, as well in its ability to address wide-reaching disease concerns like the spread of malaria and tuberculosis. Furthermore, the policy-shift has actually led to increased numbers of abortions throughout Sub-Saharan Africa in the countries hit hardest by the loss of funding.
Congress this week is set to introduce the Global Health, Empowerment and Rights Act, which would repeal the global gag rule permanently and help to ensure consistent reproductive health care around the world. It is unlikely to be passed by the Republican-controlled Senate, however, or to be signed by Trump.
February 9, 2019 in Abortion, Anti-Choice Movement, Contraception, Current Affairs, International, Medical News, Politics, Poverty, Pregnancy & Childbirth, President/Executive Branch, Reproductive Health & Safety, Women, General | Permalink | Comments (0)
Friday, February 8, 2019
NY’s Reproductive Health Act is Not Radical; It Simply Recognizes that the Lives and Dignity of Pregnant People Count Too
NY’s Reproductive Health Act is Not Radical; It Simply Recognizes that the Lives and Dignity of Pregnant People Count Too (Feb. 7, 2019), by Cynthia Soohoo:
Not surprisingly, President Trump’s attack on New York’s Reproductive Health Act during Tuesday night’s State of the Union address blatantly mischaracterized the RHA. But it also underscores a glaring gap in anti-abortion advocates’ pro-life views -- the right to life and dignity of people who are pregnant.
The RHA continues to recognize a state interest in fetal life and prohibits abortions after 24 weeks in almost all circumstances. However, the law also recognizes that in some situations, denying a pregnant person the ability to end a pregnancy imposes serious and irreparable harm on her, including situations where the pregnancy endangers her life and health. And in those situations, the state cannot force the pregnant woman to continue the pregnancy against her will. This is consistent with current Supreme Court jurisprudence and international human rights law. The UN Human Rights Committee made this explicit in a recent General Comment clarifying that while states can regulate abortions, they should not do so in a manner that violates the right to life of the pregnant person or her fundamental human rights.
The RHA does no more than protect the human rights of pregnant people. The law only allows abortions post-24 weeks in two situations. First, abortions are allowed where the fetus will not survive outside of the womb. The RHA recognizes that a woman should not be forced to continue what was often a wanted pregnancy -- knowing that the fetus will not survive -- against her will. In such cases, the state’s interest in protecting a viable fetus is not at issue, and human rights experts have held that denying a woman access to an abortion in these circumstances is cruel, inhuman and degrading treatment.
Second, the RHA allows a woman to have an abortion where continuing the pregnancy endangers her life or health. Some women may choose to continue pregnancies in these circumstances. But the RHA acknowledges that the pregnant person must be allowed to make her own choice taking into account the risk that she faces and the impact her death or disability would have on her family and community.
In both situations covered by the RHA, human rights experts have held that state denial of an abortion violates the human rights of the pregnant person. In fact, concern over state prohibition of abortions in those circumstances led UN human rights experts to write to the U.S. to encourage passage of laws like the Reproductive Health Act. This is not a radical position. It is merely the recognition of the value of the life and dignity of pregnant people. The failure of critics of the RHA to understand this is a glaring gap in their “pro-life” views.
February 8, 2019 in Abortion, Current Affairs, In the Media, International, Politics, Pregnancy & Childbirth, President/Executive Branch, Reproductive Health & Safety, State Legislatures, Women, General | Permalink | Comments (0)
Tuesday, November 13, 2018
The Guardian (Nov. 12, 2018): Woman who bore rapist’s baby faces 20 years in El Salvador jail, by Nina Lakhani:
In the wake of fetal personhood, or similar, ballot measures being proposed and passed throughout the U.S., it's important to look to other countries where abortion is criminalized to see the effects of living in a world where abortion and those who seek or perform them are punished.
A survivor of habitual sexual abuse by her grandfather has been imprisoned in El Salvador since April 2017 on charges of attempted murder. Last April, Imelda Cortez, then 20-years-old, gave birth to a child fathered by her rapist. She experienced intense pain and bleeding before the birth, which caused her mother to bring her to the hospital. The doctors there suspected an attempted abortion and called the police. The baby was born alive and well, but Imelda has never been able to hold her, as she's been in custody since her time in the hospital last year.
Authorities conducted a paternity test, which confirmed Imelda's claims of rape, yet her grandfather has not been charged with any crime. Imelda's criminal trial began this week and a decision from a three judge panel is expected next week.
Abortion is illegal in all circumstances--no exceptions--in El Salvador. The strict ban has led to severe persecution of pregnant people throughout the country, often most heavily affecting impoverished, rural-living people. Most people accused of abortion simply experienced a pregnancy complication, including miscarriage and stillbirth.
This pattern of prosecutions targeting a particular demographic suggests a discriminatory state policy which violates multiple human rights, according to Paula Avila-Guillen, director of Latin America Initiatives at the New York based Women’s Equality Centre. Cortez’s case is a stark illustration of how the law criminalises victims.
Abortion has been criminalized in El Salvador for 21 years. While a bill was drafted nearly two years ago--with public and medical support--aiming to reform the system and relax the ban to allow the option of abortion at least in certain cases (for example, rape, human trafficking, an unviable fetus, or threat to a pregnant person's life), it remains stuck in committee and is not expected to make it to vote.
November 13, 2018 in Abortion, Abortion Bans, Current Affairs, In the Courts, International, Politics, Poverty, Pregnancy & Childbirth, Reproductive Health & Safety, Sexual Assault, Women, General | Permalink | Comments (0)
Monday, October 8, 2018
Rewire.News (Oct. 1, 2018): House Republicans Jam ‘Personhood’ Language Into New Tax Bill, by Katelyn Burns:
The U.S. House of Representatives last week passed a bill that would extend "the ability to count 'unborn children' as beneficiaries under 529 education savings plans."
The bill, referred to as the Family Savings Act, is a part of a current push for updated tax legislation. Anti-choice activists have promoted the addition of personhood language--effectively defining zygotes, embryos, and fetuses as persons with all the rights that entails--to legislation for some time. The cause is now embraced by many Congressional Republicans as well.
"Personhood laws" have consistently been rejected in ballot measures across the country.
Representatives and activists alike warn lawmakers to be vigilant of the tactic of sneaking anti-choice provisions into larger bills. “This is how extremist views creep into the mainstream," said Rep. Diana DeGette (D-CO). "Provisions like this one should never become law—they can lead to limits on access to abortion and even birth control.”
Supporters of the legislation--personhood language and all--claim that it will "finally" allow expectant parents to begin saving for their future child's education through a 529 plan. Parents-to-be, however, "can already open a 529 plan listing themselves as the beneficiary before switching it over to the child once they are born."
The Family Savings Act is not expected to pass in the Senate ahead of the midterms, but this is not the first time--and surely not the last--lawmakers have tried to slip similar provisions into tax reform or other legislation.
Wednesday, September 19, 2018
Sierra (Sept. 18, 2018): Climate Activists Say Women Are Key to Solving the Climate Crisis, by Wendy Becktold:
Last week, San Francisco hosted the Global Climate Action Summit (GCAS). The three-day conference brought together heads of state, policy makers, scientists, and leaders from civil society to discuss clean energy and averting catastrophic climate change. One of the recurring topics focused on the necessity of investing in women's rights, including sexual and reproductive rights, in combating climate crises.
Decades of research indicate that investing in women's rights can dramatically contribute to addressing both development and climate challenges around the globe. In particular, access to education and robust reproductive rights strengthens opportunities for women worldwide. Supporting women is proven to translate to more sustainable development including the promotion of clean energy over fossil fuels.
"Access to reproductive health services is...key to reducing pressure on natural resources." A lack of access to contraception, for example, leads to many millions of unplanned pregnancies, which in turn can prevent women from creating the productive and sustainable systems they would otherwise be able to contribute to. Better education can also reduce birth rates and further improve the livelihood of women around the world.
In poorer parts of the world, women produce 60-80 percent of food crops. Providing women with better education and resources such as access to small business loans (like their male counterparts often have) could could reduce the number of people who go hungry around the world by 150 million.
Many summit conversations at the conference, in addition to countless side events, highlighted the shared frustrations of women around the world.
Some climate activists found the summit’s emphasis on high tech solutions exasperating. 'There’s often a focus on techno fixes,' said Burns [of the Women’s Environment and Development Organization], 'when for years, we’ve been saying that investing in women’s human rights is how we can address climate change. There is still this huge disconnect between the rhetoric and the solutions that are coming from feminists and frontline voices.'
"Women are also disproportionately affected by climate change," in part because global warming reaches the impoverished first and most people living in poverty are women.
The conversations at the GCAS highlighted how integral reproductive rights and support of women's opportunities are to innumerable issues. The ripple-effect of guaranteeing sexual and reproductive rights, the research shows, extends far past simply being able to plan a pregnancy; such support builds up communities around the globe, reduces poverty, and has the power to fight behemoth challenges like climate change as well.
September 19, 2018 in Conferences and Symposia, Contraception, International, Miscellaneous, Politics, Poverty, Pregnancy & Childbirth, Reproductive Health & Safety, Scholarship and Research, Women, General | Permalink | Comments (0)
Wednesday, June 27, 2018
New York Times (Jun. 26, 2018): Supreme Court Backs Anti-Abortion Pregnancy Centers in Free Speech Case, by Adam Liptak:
Justice Thomas wrote for the five-justice, conservative majority who decided Tuesday that California's "crisis pregnancy centers" cannot be forced to provide information on abortion services in the state.
The case, National Institute of Family and Life Advocates v. Becerra, No. 16-1140, centered on a California law that requires pregnancy centers whose aim is to dissuade pregnant people from abortions to provide information on the availability of abortions in California.
The state requires the centers to post notices that free or low-cost abortion, contraception and prenatal care are available to low-income women through public programs, and to provide the phone number for more information.
The centers argued that the law violated their right to free speech by forcing them to convey messages at odds with their beliefs. The law’s defenders said the notices combat incomplete or misleading information provided by the clinics.
The state legislature enacted the law after finding that hundreds of the pregnancy centers used "intentionally deceptive advertising and counseling" to confuse or intimidate women from making informed decisions about their health care. The law also required that unlicensed clinics disclose that they are unlicensed.
Justice Thomas wrote that the requirements for the notices regarding abortion availability were too burdensome and infringed on the clinics' rights under the First Amendment. The ruling reverses a unanimous decision from a three-judge panel of the United States Court of Appeals for the Ninth Circuit, which had upheld the law.
Justice Breyer penned a dissent, joined by Ginsburg, Sotomayor, and Kagan, citing the contradiction between the majority's decision here and a Court decision in 1992 that upheld a Pennsylvania law that required abortion-performing doctors to inform their patients about other options, like adoption.
June 27, 2018 in Abortion, Anti-Choice Movement, In the Courts, Politics, Pregnancy & Childbirth, Pro-Choice Movement, Religion, Religion and Reproductive Rights, State and Local News, State Legislatures, Supreme Court | Permalink | Comments (0)
Friday, June 8, 2018
Rewire.News (June 6, 2018): Is Your Hospital Catholic? Many Women Don’t Know, by Amy Littlefield:
About one in six women in the United States name a Catholic facility as their go-to hospital for reproductive health care.
However, more than a third of these women are unaware that their hospital is Catholic, according to a survey revealing an “information gap” about Catholic hospitals, where religious rules dictate access to contraception, sterilization, and abortion services.
Among women who listed a Catholic hospital as their primary facility for reproductive care, only 63 percent knew that the hospital was Catholic, researchers found. The study, published in the journal Contraception, did not address whether respondents knew how Catholic hospitals restrict care.
Women with annual incomes under $25,000 are less likely to realize their hospital is Catholic than women who make more than $100,000 a year, the researchers found, underscoring how these barriers disproportionately affect marginalized patients. A January report found women of color are more likely to give birth in Catholic hospitals and thus bear the brunt of these religious restrictions.
Patients seeking care in Catholic facilities have been turned away while bleeding and made to wait until they sicken to receive miscarriage treatment. Cesarean section patients in Catholic hospitals often can’t have their tubes tied at the same time they give birth, requiring a second surgery elsewhere. Transgender patients have had gender-affirming surgeries canceled on religious grounds.
The researchers called on hospitals to better advertise their Catholic affiliations. “Efforts are needed to increase hospital transparency and patient awareness of the implications that arise when health care is restricted by religion,” they wrote.
Women overwhelmingly want to be informed about religious restrictions: eighty-one percent say it’s important to know these barriers when they decide where to go for care.
Thursday, May 3, 2018
The Hill (May 2, 2018): Iowa lawmakers pass strictest abortion law in the US, by Julia Manchester:
On Wednesday, May 2, 2018, Iowa legislators passed "the heartbeat bill." The legislation bans abortions once a fetal heartbeat is detected. Essentially, the heartbeat distinction would ban abortions by the sixth week of pregnancy.
Opposition to the bill claims that it would ban abortions before some women even know they're pregnant.
The passage of the bill comes as the Trump administration has taken a hard-line stance on abortion, spurring a slew of abortion laws across the nation.
Nineteen states adopted a total of 63 restrictions to the procedure in 2017, which is the highest number of state laws on the issue since 2013, according to the Guttmacher Institute.
The bill now goes to Gov. Kim Reynolds's (R) desk, but, if signed, is expected to be challenged as a violation of Supreme Court precedent including Roe v. Wade.
Thursday, April 19, 2018
The New York Times Magazine (April 11, 2018): Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis, by Linda Villarosa:
Villarosa of The New York Times Magazine profiles several black mothers and their pregnancy, child birth, and health care stories while exploring the extraordinarily wide disparity in care that black women receive compared to white women.
The U.S. is one of only 12 countries whose maternal mortality rates have actually increased in recent years and now has a mortality rate worse than 25 years ago. Maternal mortality refers to "the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy." Women of color are three to four times more likely to die from pregnancy-related causes as white women.
Moms are not the only ones facing the consequences of underdeveloped care.
Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel.
In the past, many explanations for the disparity turned to poverty, assuming that it was poor and uneducated black women and their babies that suffered the most. But the crisis does not consider class lines, it turns out. "In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education."
In 2014, Monica Simpson--the executive director of SisterSong, an organization dedicated to reproductive justice for women of color, and a member of advocacy group Black Mamas Matter Alliance-- testified before the United Nations Committee on the Elimination of Racial Discrimination. She called on the United States to “eliminate racial disparities in the field of sexual and reproductive health and standardize the data-collection system on maternal and infant deaths in all states to effectively identify and address the causes of disparities in maternal- and infant-mortality rates.” That the United States has not done so is a violation of the international human rights treaty, she says.
This is important for many reasons, one of which is the dramatic effect that society and systemic racism have on a pregnant person's "toxic physiological stress levels." This stress increases the chances for hypertension, pre-eclampsia, and other dangerous pregnancy complications, and it is exacerbated by the pervasive, systemic racial bias embedded in the United States' health care system. Racial bias, discrimination, and the toll it takes on women of color throughout their lives and pregnancy contributes to increased maternal complications across all class and education levels.
Even when controlling for income and education, African-American women had the highest allostatic load scores — an algorithmic measurement of stress-associated body chemicals and their cumulative effect on the body’s systems — higher than white women and black men. ...Though it seemed radical 25 years ago, few in the field now dispute that the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country.
Community care systems that incorporate the medical and personal support of doulas and midwives have proven to increase black women's chances at a healthy pregnancy, delivery, and postpartum experience.
"One of the most important roles that doulas play is as an advocate in the medical system for their clients." A doula may sometimes be the only person consistently present with the mom-to-be during her birth experience, too. One study of 2,400 women found that "more than a quarter of black women meet their birth attendants for the first time during childbirth, compared with 18 percent of white women."
Doulas “are a critical piece of the puzzle in the crisis of premature birth, infant and maternal mortality in black women.”
Rachel Zaslow, a midwife and doula in Charlottesville, Virginia established Sisters Keeper--a collective of 45 black and Latina doulas in Charlottesville. They offer free birthing services to women of color.
'The doula model is very similar to the community health worker model that’s being used a lot, and successfully, throughout the global South,' Zaslow says. 'For me, when it comes to maternal health, the answer is almost always some form of community health worker.' Since 2015, the Sisters Keeper doulas have attended about 300 births — with no maternal deaths and only one infant death among them.
An analysis of a similar program in New York City showed that, over a five-year period, moms receiving the support of the doula program experience half as many preterm and low-weight babies compared to other community members.
Tuesday, February 27, 2018
ProPublica (Feb. 22, 2018): A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies, by Nina Martin:
The results of a five-year study, conducted by researchers in both the U.S. and Canada, on the effects of midwifery on maternal and infant health are in. The study was published in the peer-reviewed journal PLOS ONE; it analyzes hundreds of laws throughout the United States that dictate what a midwife can and cannot do when it comes to prenatal care and the birthing process.
'We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,' said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.
The midwife model emphasizes community-based maternal and infant care along with avoiding any unnecessary, and potentially dangerous, interventions. Midwives have long been widely embraced in Europe as a positive component of maternal care. In the U.S., though, midwives often represent a "culture war that encompasses gender, race, class, economic competition, professional and personal autonomy, risk versus safety, and philosophical differences."
The title "midwife" can have multiple meanings, ranging from "certified nurse-midwives," to "direct-entry midwives," to "lay midwives." Depending on the title and the state in which the midwife works, the midwife will have a different level of training and may or may not be licensed or regulated by the state.
This new study indicates, though, that midwives may be part of the answer to the U.S.'s problematic infant and maternal mortality rates. Severe maternal complications have sharply risen over the past 20 years, and maternal care is seriously sparse in certain areas of the country. "Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist."
While midwife regulations vary widely among states, the study shows that states that have more fully integrated midwifery systems within their health care have significantly better outcomes for mothers and babies. States with restrictive midwife regulations--like Alabama, Ohio, and Mississippi--regularly score much lower on tests of maternal and neonatal well-being.
Alabama, which has the worst infant mortality rate in the country, has long had strict midwife regulations, "reflecting attitudes that wiped out the state's once-rich tradition of black birth attendants." Alabama lawmakers, though, recently passed a bill legalizing certified professional midwives, taking one small step toward the process of greater midwife integration, and, hopefully, improved maternal and infant health care across racial and economic lines.
Access to midwifery is often split among racial lines, as many of the states with the worst outcomes (and higher levels of opposition to midwives), including Alabama, have large black populations. The study suggests a correlation between improved access to midwifery and reduced racial disparities in the maternal health care field.
Jennie Joseph, a British-trained midwife who runs the Florida birthing center and nonprofit Commonsense Childbirth affirms this:
“It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”
The study, though, does not conclude that better midwife access will directly lead to better outcomes or vice versa. It acknowledges that many other factors also affect maternal and infant health among states, including access to preventative care, insurance, and rates of chronic disease.
Nonetheless, maternal health advocates have long recognized the benefits of midwifery and this is not the only study to highlight the positive effects of supporting midwives. A 2014 study found that integrating midwives into health care could prevent more than 80 percent of maternal and infant fatalities worldwide, in both low and high-resource communities. Even in the U.S., organizations such as the American Congress of Obstetricians and Gynecologists have begun embracing nurse-midwives despite lingering skepticism by many.
Tuesday, February 13, 2018
Cosmopolitan (Feb. 6, 2018): Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018, by Jennifer Gerson Uffalussy:
A safe, early-pregnancy abortion option has been making waves across the United States since Planned Parenthood began its telemedicine abortion pilot program in Iowa in 2008.
Telemedicine abortions enable those seeking a pregnancy termination to meet with a nurse in a local clinic where both patient and nurse loop in an abortion-providing doctor via video chat. The doctor consults with the patient to determine that they are a good candidate for early pregnancy termination and then authorizes the nurse to dispense two small pills to the patient. The patient takes the first pill in the office in the presence of the nurse and doctor and then later takes the second pill at home. The pregnancy is terminated within a day or two.
These medications have become known at "the abortion pill" and include both mifepristone and misoprostol, which work together first to block the hormones a woman's body needs to sustain a pregnancy and then to empty her uterus. The FDA-approved abortion pills are for ending pregnancies less than 10 weeks along. A study of Planned Parenthood's telemedicine pilot program found that access to telemedicine abortions decreased second-trimester abortions throughout the state. Second-term abortions require surgical procedures and can carry increased risks.
Although abortion is legal in all 50 states, many states have tightened their restrictions on abortion access, making it very difficult for a person facing an unwanted pregnancy to safely terminate it. Restrictions such as mandatory waiting periods and insurance limitations are compounded in states with very few clinics that can perform abortions. In fact, about 90% of counties in the U.S. do not have an abortion provider.
Telemedicine allows a patient to meet with an abortion provider even if she doesn’t live near one. Instead of driving long distances, women can go to a closer clinic or Planned Parenthood and video-chat a live, somewhere-in-state abortion provider who prescribes and (virtually, via on-site clinic staff) hands over the meds. “There is no increased risk of complications with a telemedicine visit,” says Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. He led a groundbreaking study published last fall that found telemedicine abortions are just as safe as those in which a woman swallows mifepristone in the same room as a physician.
While mifepristone has so far demonstrated a highly-safe success rate (its rates of complications are fewer than most common pain relievers), it cannot be obtained over-the-counter; instead a clinic, hospital, or doctor's office must dispense it.
Some states will allow a pregnant person to video chat with a doctor from her home and then receive both pills in the mail. Since 2008, though, 19 states have challenged the expansion of telemedicine abortions by passing laws that specifically require mifepristone to be dispensed "in the physical presence of the prescribing clinician."
Planned Parenthood continues to expand its telemedicine program despite the challenges. It has now established 24 telemedicine locations in the nation and plans to add at least 10 additional locations--some in new states--throughout this year.
To find out if telemedicine abortion is available in your area, call the national Planned Parenthood hotline at 800-230-PLAN.
February 13, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Media, Medical News, Politics, Pregnancy & Childbirth, Pro-Choice Movement, Reproductive Health & Safety | Permalink | Comments (0)
Wednesday, February 7, 2018
Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith
Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.
With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."
Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important. When it is absent, patients report both physical and psychological trauma.
Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."
This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.
The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity.
Friday, August 4, 2017
WBUR 90.9 (Aug. 1, 2017): States With More Abortion Restrictions Score Worse On Women's Health, Study Finds, by Eojin Choi
A newly released report by Ibis Reproductive Health and the Center for Reproductive Rights found that the the twenty-six states with more than ten abortion restrictions had poorer health outcomes for women than the twenty-four states with fewer than ten restrictions.
Titled Evaluating Priorities: Measuring Women's and Children's Health and Well-being Against Abortion Restrictions in the States, the report's findings challenge anti-choice politicians' claims of passing abortion restrictions under the guise of protecting women's health and safety.
Some examples of positive, supportive policies include Medicaid expansion, expanded family and medical leave, mandated evidence-based sex education, maternal mortality review boards, and contraceptive parity laws. The study found that many states with more abortion restrictions lack these supportive policies.
The report was first published in 2014 and is updated for 2017. You can read the full report here.
Thursday, July 13, 2017
Vox (Jun. 29, 2017): California decided it was tired of women bleeding to death in childbirth, by Julia Belluz:
At the same time the global maternal death rate fell by nearly 44 percent, between 2000 and 2014, the United States watched its maternal mortality rate skyrocket 27 percent. Maternal mortality refers to "the death of a mother from pregnancy-related complications while she's carrying or within 42 days after birth." Childbirth is more dangerous in the U.S. than any other wealthy nation. The reason? The U.S. does not value its women.
The United States is in the company of only 12 other countries whose maternal mortality rates have actually increased in recent years, including North Korea and Zimbabwe.
Researchers and health care advocates argue that a high maternal death rate is a reflection of how that culture views its women.
[In the U.S.,] policies and funding dollars tend to focus on babies, not the women who bring them into the world. For example, Medicaid, the government health insurance program for low-income Americans, will only cover women during and shortly after pregnancy.
Texas, having rejected Medicaid expansion and closed the majority of its Planned Parenthood clinics, has the highest maternal mortality rate in the developed world. California, however, has proven to be an exception within the nation. The California maternal mortality rate has steadily decreased over the same time that the rest of the nation's has risen, thanks in large part to the California Maternal Quality Care Collaborative (CMQCC).
60% of maternal deaths are preventable and the complications that cause them should be anticipated. The CMQCC finds that even within an imperfect health care system, death from childbirth need not be an inevitability. Maternal deaths in the U.S. often result from common complications like hemorrhaging and preeclampsia. The CMQCC has enacted simple, lifesaving procedures over the last decade to reduce the number of unnecessary maternal deaths. And, they're working.
First, they aimed to lower the number of unnecessary C-sections performed. Cesarian sections are often prematurely offered by obstetricians who are short on time. The procedure can leave mothers with internal scar tissue that ultimately makes future pregnancies more dangerous by increasing the mother's risk of hemorrhaging.
As many maternal deaths are a result of hemorrhaging--a mother can bleed to death within five minutes--doctors set out to prepare every delivery room in hospitals participating in their program with a "hemorrhage cart," equipped with everything necessary to handle a bleeding problem the moment it begins.
In a recent study, researchers found a 21 percent reduction in severe complications related to hemorrhages in the hospitals participating in CMQCC's program. Hospitals not participating in the program saw only a one percent reduction.
California has demonstrated that even in our messy and imperfect health care system, progress is possible. They’ve shown the rest of the country what happens when people care about and organize around women’s health. Policymakers owe it to the 4 million babies born in the US each year, and their mothers, to figure out how to bring that success to families across the country.
How the current health care debate and the resulting volatility of the insurance market will affect the United States' maternal mortality rate going forward remains to be seen.
Monday, May 15, 2017
NPR (May 12, 2017): Focus on Infants During Childbirth Leaves Moms in Danger, by Nina Martin & Renee Montagne:
NPR and ProPublica profile Lauren Bloomstien, a 33 neonatal nurse who died in childbirth. Every year in the U.S., 700-900 women die from pregnancy or childbirth related causes. The U.S. maternal mortality rate is three times that of Canada and six times that of Scandinavia. In recent years, Great Britain has seen a dramatic decline in maternal mortality, but maternal deaths in the U.S. increased from 2000 to 2014, and according the CDC Foundation, almost 60% of those deaths are preventable.
Maternal mortality rates are significantly higher among African-Americans, low-income women and women who live in rural areas, but according to NPR and ProPublica, maternal mortality affects women of all races, ethnicities and income levels.
[T]he worsening U.S. maternal mortality numbers contrast sharply with the impressive progress in saving babies' lives. Infant mortality has fallen to its lowest point in history, the CDC reports, reflecting 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth, and improve outcomes for very premature infants. The number of babies who die annually in the U.S. — about 23,000 in 2014 — still greatly exceeds the number of expectant and new mothers who die, but the ratio is narrowing.
The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica's and NPR's reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother's health and wellbeing.
In the U.K. maternal deaths are treated as system failures, and a committee of experts investigates every death from pregnancy or childbirth complications. In the U.S. maternal mortality reviews are left to the states. Thirty-one states have maternal mortality review process. A federal bill Preventing Maternal Deaths Act of 2017 would authorize federal funding for states to establish or improve review processes.
Monday, March 13, 2017
New York Times (March 12, 2017), Are Your Sperm in Trouble?, by Nicholas Kristof:
Sperm is decreasing in quality and testicular cancer is on the rise. Studies show a rapid decrease in sperm quality from 2001 to 2015. Some suggest that endocrine disruptors--chemicals found in plastics are to blame. In one study of the effect of endocrine disruptors on fish, the males became intersex and incapable of reproducing.
Human reproduction might be threatened by these developments, but scientists disagree about the scale of the problem. Some believe we are are crossing the line where the question "can we sustain ourselves?" becomes relevant. After all, endocrine disruptors mimic hormones; as such they possess the power to interfere with the biological process of becoming male in the womb.
Some have taken to avoiding plastics, including the ubiquitous sales receipts produced by thermal printers. But individual action is probably not enough. The endocrine disruptor lobby in Congress mirrors the power of Big Tobacco before the regulation of smoking became a foregone conclusion.
Thursday, February 9, 2017
[Cross posted on Human Rights at Home Blog: Feb. 8, 2017] Human Rights Experts Find That Detention of Pregnant Women Violates Human Rights, by Megan Lynch:
In August 2014, a Wisconsin woman named Tammy Loerscher went to her local services agency because she believed that she was pregnant, but had serious medical conditions and could not afford health care. She was referred to the emergency room of a nearby hospital, where her urine was collected to test for pregnancy and for controlled substances. When the results returned “unconfirmed positive,” she was reported to child protective authorities. A temporary order of custody was issued to detain Tammy in the hospital. The next day a hearing was held over the phone. There was a lawyer representing the child protective agency, and a legal guardian to represent Tammy’s fetus, but Tammy herself was not given a lawyer, and the judge refused to delay the hearing to permit Tammy to find one. The judge ordered her to report to an inpatient treatment facility after being discharged from the hospital. No assessment was ever completed as to whether Tammy had a substance use disorder or needed inpatient treatment. When Tammy refused to enter inpatient treatment, she was ordered to serve 30 days in jail. While incarcerated she was denied medical care, held in solitary confinement, and threatened to be tased. Tammy was released after 18 days in jail subject to drug monitoring for the duration of her pregnancy. All subsequent drug tests were negative.
Last October, Tammy told her story to Seong-Phil Hong of the United Nations Working Group on Arbitrary Detention during the Working Group’s visit to the United States. An expert on arbitrary detention, Mr. Hong recognized that Wisconsin’s actions violated Tammy’s human rights and that there are better ways for the state to address concerns about fetal health. Late last year, the Working Group issued a statement emphasizing that confinement of pregnant women suspected of drug is inappropriate and that involuntary detention should be used only as a last resort, for the shortest period of time needed, and with appropriate due process protections. The group emphasized that “confinement should be replaced with alternative measures that protect women without jeopardizing their liberty.”
Despite the Working Group’s statement, every year, hundreds of pregnant women are involuntarily detained in the United States because they are suspected of drug use. Wisconsin is one of 5 states with laws that permit pregnant women to be detained for the supposed benefit of a fetus. These statutes were designed in the 1990s amid fears of the effects of in utero exposure to cocaine. Despite decades of research undercutting the belief that use of criminalized drugs is certainly and uniquely harmful to fetal health, these laws continue to be used to issue protective custody orders against pregnant women.
In addition to lacking scientific basis, laws that punish people who use drugs during pregnancy threaten the public health. As the American College of Obstetricians and Gynecologists has stated: “Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse.” Instead, threats of arrest and incarceration harm fetal and maternal health because they discourage women from seeking medical advice and prenatal care. The medical community in the United States and around the world universally condemn punitive approaches, recommending support and voluntary treatment where appropriate.
Not only do these laws harm the people they purport to protect, they also violate women’s fundamental human rights. Detaining pregnant women based on suspected drug use unfairly deprives them of liberty based on their pregnancy status. While civil commitment is permitted under U.S. law, the laws used to detain pregnant women lack the stringent standards required for civil commitment in other contexts, including a risk of imminent harm and due process protections. These statutes set no requirement that the state prove that a woman has a substance use disorder, or that the substance she is alleged to use is harmful to fetal development before detaining her. Nor do they require that the state consider alternative, less invasive measures before authorizing involuntary confinement. Rather, in most cases, simply testing positive for a drug is grounds for confinement in a treatment facility, regardless of whether it is medically appropriate.
Even if state intervention could be justified under extreme circumstances, these overbroad laws fail to provide adequate procedural protections. Indeed, in Wisconsin, a woman is not entitled to an attorney until appeal, even if she explicitly requests one. Further, the proceedings are sealed, closed proceedings, preventing public scrutiny of the process. This places the onus on women who have undergone this process to come forward to tell their stories.
The UN Working Group made clear that these laws run contrary one of the most fundamental rights under international law: the right to liberty and to be free from arbitrary detention. The right to liberty is deeply embedded in the American psyche, dating back to our nation’s birth and the Declaration of Independence’s promise of the right to life, liberty and the pursuit of happiness. The right to liberty would later be emphasized in the UN Declaration of Human Rights, and the US reaffirmed its commitment to liberty and freedom from arbitrary detention when it ratified the International Convention on Civil and Political Rights.
Because freedom from arbitrary detention is a fundamental right, international human rights standards require that individuals only be detained as a last resort, for the shortest period of time needed, and with appropriate due process protections. Any use of detention must be necessary and proportionate. According to the Working Group, Wisconsin’s law failed to meet these standards.
The Working Group’s recognition that detaining pregnant women suspected of drug use violates their human rights, and the widespread agreement that this practice actually threatens maternal and infant health, should be a call to reconsider our approach to substance use in pregnancy. Instead of spending money on counterproductive punishment and coercive treatment, we should ensure that women like Tammy are able to trust that the people they turn to will provide help, not handcuffs.
Tuesday, January 10, 2017
New York Times (Dec. 19, 2016): Pregnancy Changes the Brain in Ways That May Help Mothering, by Pam Belluck:
A recent study notes that pregnancy works changes in the brain, specifically in the part that perceives the feelings of others. Scientists query whether these changes have anything to do with mothers' emotional attachment to their offspring. The change actually involves the loss of gray matter in areas of the brain involved in social cognition, "that ability to register and consider how other people perceive things." The loss of gray matter sounds like a bad thing, but it may simply be a "neutral" offshoot of pregnancy-related stress or a beneficial sequella of pregnancy that prunes and trains the brain to be ready for the challenges of raising children, be they bonding, recognizing social threats, or recognizing the needs of an infant. The study seems to indicate that the more the brains of pregnant women changed, the better mothers they were (measured by emotional attachment, pleasure, and hostility toward the child). There is an analog to these changes in the brain in the brains of adolescents, whose brains sees a decrease of gray matter in several regions that scientists believe provide "fine tuning for the social, emotional and cognitive territory of being a teenager." The study detected no changes in the brains of new fathers.