Friday, November 2, 2018
Rewire.News (Nov. 1, 2018): Abortion Is on the Ballot in These States Next Week, by Lauren Holter:
Midterm voting is already well underway throughout the country with election day officially falling on Tuesday, November 6. While the citizenry waits to see whether Republicans or Democrats will next control their state legislatures, next week's elections will also implicate specific issues in addition to deciding our leaders. Abortion rights are on the ballot in Alabama, Oregon, and West Virginia.
Alabama's ballot measure proposes "personhood" rights for fetuses, which could criminalize access to certain contraceptives or in vitro fertilization. The measure, if passed, would act as a "trigger ban"and would completely outlaw abortion under the circumstances of a post-Roe world. Similar ballot measures have previously been proposed--and failed--in Colorado, Mississippi, and North Dakota. Republican legislators in Alabama want the state Constitution to explicitly elevate the rights of unborn fetuses over any right to an abortion. The Amendment does not include any exceptions to a prohibition on abortion--not even in the cases of threat to the mother's life.
In West Virginia, the No Constitutional Right to Abortion Amendment also aims to update their state Constitution. Lawmakers wish for the text to explicitly assert that nothing in the instrument protects the right to or funding for an abortion. The state already has a pre-Roe abortion ban that remains on the books, which would enter into force should Roe v. Wade be overturned, criminalizing abortion and punishing providers with imprisonment. The new Amendment proposal focuses on eliminating Medicaid funding for abortions. Medicaid currently covers "medically-necessary" abortions in West Virginia. While the Amendment does include exceptions for cases of rape, incest, fetal anomaly, or threats to life, opponents are particularly concerned that the new restriction would disproportionately harm low-income patients who do not qualify for exemptions.
Finally, the proposal in Oregon, called Measure 106, "would prohibit public funds from paying for abortions in Oregon except in cases of rape, incest, ectopic pregnancies, or a threat to the pregnant person’s health." Public employees and people on Medicaid would lose access to abortion as well. This measure would specifically override the Reproductive Health Equity Act, which Oregon passed last year to guarantee cost-free access to abortion and reproductive health services.
In the era of a Kavanaugh Supreme Court, advocates are particularly zealous about preemptively protecting abortion access on the state level, and those involved in these three states' campaigns are no exception.
Friday, October 19, 2018
FIGO.org (Oct. 16, 2018): International Federation of Gynecology and Obstetrics (FIGO) Speaks Out on Violence Against Women:
The International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique - FIGO) is a global organization that represents national societies of obstetricians and gynecologists. FIGO is meeting for their XXII World Congress in Rio de Janeiro this week. Early in the week FIGO announced, in partnership with the World Health Organization (WHO), a Global Declaration on Violence Against Women, citing stark statistics of the violence women suffer and the wide-reaching effects of such harm, including on reproductive health and safety.
The organizations found that 35% of women worldwide have experienced physical and/or sexual violence in their lifetimes. Most of this violence is committed by intimate partners. Circumstances of unrest, armed conflict, and displacement exacerbate the statistics. Women in South Sudan, for example, experience intimate partner violence at a rate double the global average.
WHO estimated that women who have been physically or sexually abused by a partner are 16% more likely to have a low-birth-weight baby.They are more than twice as likely to have an abortion, almost twice as likely to experience depression, and, 1.5 times more likely to acquire an STI, and in some regions, HIV, as compared to women who have not experienced partner violence.Health services are critical for supporting survivors to heal, recover and thrive. If accessed in time, health services can prevent unwanted pregnancies and the transmission of HIV, STIs, following rape. Unfortunately, these services are often not available and survivors lack access to basic, lifesaving care.
The Declaration on Violence Against Women announces members' dedication to, among other things, promoting women's health and rights, including sexual and reproductive rights. It announces concern over the "global public health problem" of violence against women and how it affects women physically, mentally, and sexually as well as how the violence affects the children of surviving women.
The Declaration concludes with several calls to action, urging delegates' governments to ratify CEDAW (the Convention on the Elimination of all Forms of Discrimination Against Women) and ensure the treaty's thorough implementation. It also calls for strengthened health systems, better allocation of budgets and resources to prevent and respond to violence, and the promotion of widely-available health services. The Declaration further advises obstetricians and gynecologists to "advocate for strategies to address violence against women in their communities, towns, cities or countries and [to] collaborate with civil society and voluntary organizations, particularly women’s health and rights organizations, which advocate for women affected by violence"
The World Congress continues to meet through the end of this week.
Thursday, October 4, 2018
Rewire.News (Oct. 1, 2018): Abortion Rights Got Two Important Legal Wins Last Week, by Jessica Mason Pieklo:
A Federal court in Kentucky ruled a 1998 state law aimed at limiting abortion clinics unconstitutional.
The law requires abortion clinics to have written transfer agreements with ambulance services and hospitals, often referred to as "transfer and transport" requirements. Even though the state's last abortion clinic (and a plaintiff in the lawsuit) has been able to maintain the licensure required by the law--and so stay open--the court agreed with the clinic's argument that Kentucky Gov. Matt Bevin (R) has used the law as a tool to try to cut off abortion access.
Judge Greg Stivers ruled:
The court has carefully reviewed the evidence presented in this case and concludes that the record is devoid of any credible proof that the challenged regulations have any tangible benefit to women’s health. The regulations effectively eliminate women’s right to abortions in the state. Therefore, the challenged regulations are unconstitutional.
The judge affirmed that “the challenged regulations are not medically necessary and do absolutely nothing to further the health and safety of women seeking abortions in the Commonwealth of Kentucky." The decision is expected to be appealed in the 6th Circuit.
October 4, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, In the Courts, Medical News, Politics, Pro-Choice Movement, Reproductive Health & Safety, State and Local News, State Legislatures, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)
Tuesday, October 2, 2018
Rewire.News (Sept. 25, 2018): Alaskan Survivors of Sexual Assault Urge Murkowski to Vote ‘No’ on Kavanaugh, by Katelyn Burns:
Even before last week's hearing for Dr. Blasey Ford's allegations against SCOTUS nominee Brett Kavanaugh, indigenous groups in Alaska have been voicing their opposition to the Judge's confirmation.
Alaskan sexual assault survivors--many of whom are Natives--are calling on Senator Lisa Murkowski (R-AK) to vote "no" on Brett Kavanaugh's nomination this week. Activists have also been protesting at Senator Dan Sullivan's office (R-AK), however, unlike Senator Murkowski, he announced his support for Kavanaugh shortly after the nomination in July.
Sexual assault is a pervasive problem in Native American communities. Natives, including Alaskan women, suffer from rape and sexual assault in staggeringly disproportionate numbers with little access to justice.
"According to the 2015 Alaska Victimization Survey, 50 percent of Alaskan women have been victims of sexual assault, intimate partner violence, or both." Furthermore, 97 percent of Native Alaskan sexual assault survivors suffered the violence at the hands of non-Native perpetrators. Notably, tribal justice systems cannot prosecute non-Natives for sexual assault.
Survivors are also speaking out in defense of Dr. Ford's delay in coming out publicly with her allegations. “Most of the time we would be blamed for being provocative in some way. So I can understand why someone would wait years to bring up a sexual assault," said one Alaskan Native survivor.
Native communities also oppose Kavanaugh's nomination on his views of Native rights generally and his misunderstanding of tribal history and government systems.
October 2, 2018 in Culture, Current Affairs, In the Media, Medical News, Politics, Public Opinion, Reproductive Health & Safety, Sexual Assault, Supreme Court, Women, General | Permalink | Comments (0)
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)
Saturday, August 25, 2018
Bustle (Aug. 22, 2018): A California Abortion Pill Law Would Require Colleges To Offer Them, Thanks to These Activists, by Lani Seelinger:
California could require medication abortion pills to be available across all of the state's public college campuses if a bill that originated through student activism passes by the end of the month. Activists at the University of California-Berkeley were already focusing on promoting reproductive health care when they realized that expanding that care to include access to medication abortions on campus in particular would improve many student lives.
"Medication abortion is the process by which a woman can terminate her pregnancy by taking a series of pills within the first 10 weeks of her pregnancy." These procedures are considered very safe and efficient, and activists recognize that campus access could alleviate the logistical issues of accessing the medication. Often the stress of accessing a medication abortion can harm a student's emotional, academic, and financial well-being. Over 500 students a month on University of California (UC) and California State University (CSU) campuses seek medication abortions.
The Women's Foundation of California--which fights for racial, economic, and gender justice--partnered with the students and alumni promoting the cause, and from there the effort spread from Berkeley throughout the state. California Senator Connie Leyva introduced the bill in the Senate earlier this year. It passed. Next, the bill must pass in the Assembly before August 31 in order to land on Governor Jerry Brown's desk.
The activists spearheading the campaign for the bill (SB320) are driven by the greater mission of de-stigmatizing abortion.
August 25, 2018 in Abortion, Contraception, Culture, Current Affairs, Politics, Pro-Choice Movement, Public Opinion, Reproductive Health & Safety, State and Local News, State Legislatures, Women, General | Permalink | Comments (0)
Wednesday, August 8, 2018
Aug. 7, 2018 (WIRED): Telemedicine Could Help Fill the Gaps in America's Abortion Care, by Garnet Henderson:
If a woman in Lubbock, Texas wants an abortion, the nearest clinic is 308 miles away in Fort Worth, forcing her to take time off from work, pay for travel, and likely arrange childcare to get there. If that same woman is less than ten weeks along, she’s a candidate for medication abortion—which could, theoretically, be completed in the privacy of her home. Texas, however, requires that the outdated FDA protocol for medication abortion be followed to the letter, and so the woman will have to return to the clinic within one to two weeks for a follow-up visit, despite evidence that an in-person follow-up is unnecessary.
So what if she could video chat with a doctor, pick up a prescription from her regular pharmacy, and manage her own abortion with on-call medical support— otherwise known as a telemedicine abortion?
As it turns out, similar services are already available in a handful of states, though they still involve physical visits to an office. A growing body of research suggests that medication abortion could be offered without any in-person interaction at all. It’s a possibility that is already the subject of an intense political debate that is likely to intensify with a Supreme Court more hostile toward abortion rights.
The first U.S. telemedicine abortion program began in Iowa ten years ago. Between 2008 and 2015, four Planned Parenthood clinics in Iowa performed 8,765 abortions via telemedicine. Each clinic followed the same basic protocol: a patient would come into the clinic for an intake appointment, including an ultrasound, and a doctor would review her images and medical history remotely. After talking to the patient via videoconference, the doctor would enter a password to unlock a drawer in front of the patient. Inside, there were two pills. The first pill, mifepristone, the patient took with the doctor still watching. The second pill, misoprostol, she took at home. Within two weeks, the patient returned to the clinic for a follow-up to ensure the abortion was complete.
A study of the Iowa program, which included the records of about 20,000 patients, showed that telemedicine abortion is just as safe and effective as meeting with a doctor face to face. Patients in Iowa were also more likely to have their abortions earlier in their pregnancies after telehealth was introduced.
Planned Parenthood affiliates in ten states currently offer telemedicine abortion. Telehealth services are also offered at a Whole Woman’s Health clinic in Illinois and in Maine at Maine Family Planning. The Iowa program was interrupted after the state passed a law banning telemedicine abortion in 2013, but was reinstated in 2015 when the Iowa Supreme Court ruled that law unconstitutional. Idaho was forced to repeal two laws banning the telemedicine abortion in order to settle a lawsuit with Planned Parenthood in 2017.
Despite these successful legal challenges, nineteen states currently ban telemedicine abortion. Both Oklahoma and Arkansas have tried to ban medication abortion altogether, including remote practices, but Oklahoma’s law was overturned, and a federal judge placed the Arkansas law on hold pending trial.
The Lilith Fund is one of numerous plaintiffs, led by Whole Woman’s Health Alliance, that recently announced a challenge to dozens of abortion restrictions in Texas, including the state’s telehealth abortion ban. Whole Woman’s Health Alliance is leading similar lawsuits in Virginia and Indiana.
Access to telemedicine abortions would be especially beneficial to patients in rural and other underserved areas. That doesn’t mean it will fix all problems of abortion access, of course. Medication abortion is only FDA-approved up to ten weeks of gestation, and some candidates for the procedure still prefer an in-clinic abortion. Medication abortion is a slightly longer process that still requires a follow-up visit.
The procedure—especially with some changes that make it more fully remote—has the potential to dramatically improve access. With special permission from the FDA, Gynuity Health Projects is conducting a study in Hawaii, Oregon, Washington, New York, and Maine that allows patients to receive pills by mail, eliminating the need for doctors to stock them. Mifepristone, pill number one, is regulated under the FDA’s Risk Evaluation and Mitigation Strategies, which means the medication has to be dispensed by a certified prescriber, not a regular pharmacist. While patients in that study still have to get an ultrasound and medical exam, scientific evidence suggests the process could be even simpler, foregoing the ultrasound altogether. Doing so would make the process even more self-determined.
Saturday, July 28, 2018
July 23, 2018 (TIME): Massachusetts Passes Repeal of 173-Year-Old Abortion Ban Amid Fears for Future of Roe v. Wade, by Samantha Cooney:
Earlier this month, Massachusetts became the first state to formally respond to the possibility of Roe v. Wade being overturned in the world of a two-Trump-nominee Supreme Court. Although abortion is already legal in the state, Massachusetts still has a 173-year-old law on the books banning the procurement of a miscarriage.
The bill is called the NASTY Women Act (Negating Archaic Statutes Targeting Young Women) and passed in a landslide. While abortion has technically been legal in the state since 1981, state legislators were driven to quick action to further protect these rights after Justice Kennedy announced his retirement.
A Masschusetts State Democrat said:
I think people are beginning to realize these are strange times we live in. Nothing is impossible, and we’ve got to have a ‘plan B.’ If these laws are enforced, what do we do? We’re not willing to sit back and say, ‘Well, it’s not going to happen here.’ The word for that is denial.
New Mexico and New York each have efforts underway to protect abortion rights as well.
While some critics accuse the NASTY Women Act and other similar bills of unnecessary political posturing, supporters cite that the rights we may take for granted are not always guaranteed. Rebecca Hart Holder, the president of NARAL Pro-Choice Massachusetts, says "the reality is any state can have a threat to abortion care.”
Thursday, July 26, 2018
The Department of Health and Human Services (HHS) announced the opening of a new division in January of this year: The Office of Civil Rights (OCR). The OCR's primary mandate is to enforce refusal of care laws.
Refusal of care laws essentially empower medical providers to deny care to patients if they disagree with the ethics of a particular procedure based on their religious grounds. The purported goal of these laws is to protect a healthcare provider from being forced into providing care that "violates their conscience."
This is an Executive-ordered decision that does not require legislative or judicial approval to go into effect or to implement its new rules and regulations.
Critics of refusal of care laws express concern that these requirements do not simply "protect" health care providers consciences, but can instead seriously harm patients. These laws may lead to a pharmacist refusing to fill a birth control prescription, a doctor refusing hormone therapy to a transgender patient, limitations placed on services to LGBTQ persons and partners, and of course abortion services may also become more limited.
HHS does not require providers who refuse treatment to refer patients to other providers or provide any information at all on other providers.
The OCR further has authority to initiate compliance reviews of any organization receiving federal funding to ensure conformity to the new rules.
Earlier this month, the Center for Reproductive Rights (CRR) and the National Women's Law Center (NWLC) filed a lawsuit against HHS for refusing to release records pertaining to the creation of the OCR. The organizations initially requested these records via a FOIA request in January 2018. The CRR and NWLC seek knowledge of why the new division was needed, how the OCR operates, allocates funding, and may be influenced by outside groups.
"We’re filing this lawsuit to force the Trump-Pence administration to justify why it’s using resources to fund discrimination, rather than to protect patients," said Gretchen Borchelt, NWLC Vice President for Reproductive Rights and Health.
HHS's new Office of Civil Rights follows additional moves by the Trump administration to limit equitable access to reproductive health care, including promoting the "Global Gag Rule," its domestic counterpart, and establishing regulations aimed at severely limiting funding to Title X programs.
July 26, 2018 in Abortion, Anti-Choice Movement, Contraception, Culture, Current Affairs, In the Media, Mandatory Delay/Biased Information Laws, Medical News, Politics, President/Executive Branch, Religion, Religion and Reproductive Rights, Reproductive Health & Safety, Sexuality | Permalink | Comments (0)
Sunday, July 8, 2018
AllAfrica (Jul. 6, 2018): South Africa: Social Development Co-Hosts Abortion and Reproductive Justice Conference, Press Release:
The Critical Studies in Sexualities and Reproduction, Rhodes University, the Sexual and Reproductive Justice Coalition (South Africa), and the International Campaign for Women’s Right to Safe Abortion, in partnership with South Africa's Department of Social Development will co-host the Abortion & Reproductive Justice: The Unfinished Revolution III conference at Rhodes University, Grahamstown, South Africa from July 8 - 12, 2018.
The conference is the third in a series that began in Canada in 2014 and continued in Northern Ireland in 2016. This year's conference aims to focus the conversation and scholarship on jurisdictions where abortion access is highly restricted. It will provide a platform "for delegates to explore, identify, share and pursue learning and research opportunities on a range of issues relating to abortion and reproductive justice in context, including access to abortion, activism and abortion politics."
The conference aims to contribute to the vision of universal access to reproductive justice and will be broken down into three parts: workshops, knowledge sharing, and action discussions. It will include the voices of a Youth Committee to speak to issues particularly relevant to young people.
The conference's presence in South Africa is notable, as, despite abortion being legal in the country, experts estimate that half the abortions that take place in South Africa are illegal due to lack of access to abortion providers.
The South African Government's position on abortion and reproductive justice is predicated on the understanding that the decision to have children is fundamental to women's physical, psychological and social health and that universal access to reproductive health care services includes family planning and contraception, termination of pregnancy, as well as sexuality education and counselling programmes and services.
Friday, June 29, 2018
Washington Post (Jun. 27, 2018): Students sue University of Notre Dame for restricting access to some birth control, by Erin B. Logan:
A Notre Dame alumna and three current student sued the university on Tuesday in the wake of Notre Dame's February 2018 announcement that it would deny access to "abortion-inducing" contraceptives. The lawsuit alleges violations of federal law and the First and Fifth Amendments. In addition to the university, the suit names the departments of Health and Human Services, Labor, and Treasury.
These health-care policy changes to Notre Dame's plan will affect undergraduate and graduate students as well as university employees and their dependents. The policy will go into effect on July 1 for employees and in August for students.
The roll-back of coverage by the university is a response to the U.S. Department of Health and Human Services' fall 2017 announcement that it would rescind the Obama-era rule mandating free contraceptive coverage in health plans. This requirement currently remains in effect, though, due to judicial injunctions. Notre Dame, however, carved out an exception for itself with the federal government after a 2013 suit against the mandate claimed a violation of its moral and religious convictions.
Thursday, June 28, 2018
New York Magazine (Jun. 27, 2018): Steps the Next Supreme Court Might Take to Roll Back Abortion Rights, by Ed Kilgore:
With the announcement of Justice Kennedy's imminent retirement comes the prospect of a much more conservative Supreme Court, particularly in relation to reproductive rights. Justice Kennedy stood in the majority of the 2016 Whole Women's Health v. Hellerstedt decision, which reaffirmed basic abortion access rights. Trump has promised to pursue the reversal of Roe v. Wade, though, and has stated his intentions to nominate a similarly-minded next justice.
Many states have recently enacted stricter abortion access requirements--like Louisiana's legislation banning abortions after 15 weeks of pregnancy or Iowa's fetal heartbeat ban. "Such laws are aimed at setting up a challenge to Roe if the Supreme Court lurches to the right — which is now an imminent possibility."
While it's unlikely that, even under a more conservative court, Roe would be immediately overturned, a shift to the right on the Supreme Court will likely lead to affirmation of new, state-level abortion restrictions. For example, rather than overturn Roe, which is backed by additional, subsequent precedent in 1992's Casey and 2016's Hellerstedt, the court might instead find an opportunity to reverse Hellerstedt, as the more recent decision. Such a move might reinvigorate efforts to enact Targeted Regulation of Abortion Providers, likely forcing abortion providers out of business with burdensome requirements and eliminating much abortion access, especially in already-conservative states.
Either way, if Trump nominates an anti-Roe Supreme Court candidate this year, and the Senate approves them, we can expect many more legal battles on the availability of abortion. "With one SCOTUS appointment and one decision, that could all change, and we could enter a period of abortion-policy activism unlike anything America has seen in decades."
June 28, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Media, Politics, President/Executive Branch, Public Opinion, Reproductive Health & Safety, Supreme Court, Targeted Regulation of Abortion Providers (TRAP) | Permalink | Comments (0)
Thursday, June 14, 2018
Rewire.News (Jun. 8, 2018): New York GOP Lawmakers Quash Contraception, Abortion Protections—For Now, by Auditi Guha:
The Reproductive Health Act (RHA), or S 2796, was drafted four years ago and recently passed by the Democratic-majority New York Assembly. The RHA is intended to rectify some of the shortcomings of local abortion law. The bill "repeals criminal abortion statutes, permits abortion after 24 weeks when the pregnant person’s health is at risk or when the fetus is not viable, and expands current law so that nurse practitioners and physicians’ assistants can provide abortion services."
The Comprehensive Contraception Coverage Act (S 3668), also passed by the Assembly, "would expand contraceptive coverage to include all forms of FDA-approved contraception (including vasectomies), authorize pharmacists to dispense emergency contraception, and add coverage for contraceptive education and counseling."
Gov. Andrew Cuomo (D) supported incorporating the RHA’s changes into state law in his budget proposal this year, but it’s been a hard push in a state where Republicans decide what bills get to be voted on. Procedural glitches made the fight tougher this week for both the RHA and the Comprehensive Contraception Coverage Act as the senate ground to a halt, the New York Daily News reported.
Senate Democrats last week again tried to bring both the RHA and the CCCA to the floor for a vote, but Republican leadership ended the session without action.
“Both these bills are supported by the governor and have passed the Assembly," Sen. Krueger said in a statement. "The Senate Republicans should stop using procedural maneuvers to block these bills which would ensure that individuals would have control of their own reproductive health decisions.”
The president and CEO of Planned Parenthood Empire State Acts, Robin Chappelle Golston, told Rewire.News: “Obviously legislation as simple as making access to contraception widely available was too much for the majority of the Senate...And I think the best answer for that is that people need to go out and vote this fall.”
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.
Monday, October 23, 2017
New York Daily News (Oct. 16, 2107): Councilman to introduce bill to protect employees from discrimination when it comes to reproductive health, by Jillian Jorgensen:
New York City Councilman Jumaane Williams plans to introduce a bill to prohibit workplace discrimination based on reproductive decisions in the wake of Trump's recent health care initiatives.
This proposal follows the "Boss Bill," currently before the state legislature, which aims to guarantee women access to medical procedures and medicine such as fertility treatments, contraceptives, and abortion.
The bill is co-sponsored by several women council members, including the chair of the Committee on Women's Issues, Laurie Cumbo (D-Brooklyn) and co-chair of the Women's Caucus Helen Rosenthal (D-Manhattan).
The bill would modify the city’s Human Rights Law to protect against employment discrimination based on “sexual and reproductive health decisions.”
That would include fertility treatments, family planning services and counseling, birth control drugs and supplies, emergency contraception, sterilization, pregnancy tests, abortions and HIV testing and counseling.
Thursday, July 13, 2017
Human Rights Watch (July 10, 2017): Contraception is Lifesaving but Often Out of Reach, by Nisha Varia
This week, the Family Planning Summit met in London. The goal of this annual meeting is to bring governments, donors, and civil society together to discuss progress and future goals in expanding access to modern contraception for millions of women globally.
Family planning and effective contraception saves lives.
Complications from pregnancy and childbirth are the second leading cause of death for adolescents ages 15 to 19 globally and cause 800 women and girls to die each day. The World Health Organization estimates that at least 22,000 women die from abortion-related complications each year.
This year, many lobbied for the Summit to include conversations on the effects of the Trump administration's reimplementation of the "Global Gag Rule." The controversial policy prohibits foreign nongovernmental organizations from receiving any U.S. health funding if they use funds from any source to provide information about abortions, advocate for or provide abortions.
The policy affects $8.8 billion of foreign assistance. The anticipated consequences of the Gag Rule include increases in unplanned pregnancies and dangerous abortions as well as a higher maternal death rate.
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.