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International reproductive Rights, May 24 edition: China, El Salvador, and Contraceptive Progress

24 May

China’s “one child policy” in the spotlight

China enacted its so-called “one child policy” over 30 years ago.  Facing a population boom, the government decreed that no couple could have more than one child (with a few exceptions) and strictly enforced this policy with prohibitive fines and, for those who were pregnant and could not pay, forced abortions.  Although in some cases these forced abortions have been documented and received international attention, it seems likely that every year millions of women in China are forced to undergo abortions they do not want or need.

Just as in most of the world, however, the policy is unequally applied, and exposes deeper injustices.  A recent op-ed in the New York Times highlighted the case of Zhang Yimou, a well-known film director who has 7 children (with 4 women).  According to the article:

The truth is: for the rich, the law is a paper tiger, easily circumvented by paying a “social compensation fee” — a fine of 3 to 10 times a household’s annual income, set by each province’s family planning bureau, or by traveling to Hong Kong, Singapore or even America to give birth.  For the poor, however, the policy is a flesh-and-blood tiger with claws and fangs.

Just as the option to choose when, whether, and how to have children in the United States is increasingly dictated by a family’s ability to pay for contraceptive and abortion services, Chinese women’s opportunities to have the number of children they want is dictated by their ability to pay a fine or travel for the privilege to give birth.  Either way, the end result is the same: reproductive injustice.

Beatriz continues to suffer due to “absolute” abortion ban in El Salvador

Beatriz is the pseudonym of a young woman who has been in a hospital in El Salvador for weeks.  She needs an abortion.  Those of you who are fans of the “Gang” know we don’t believe in exceptionalism; we think when a person says they need an abortion, for whatever reason, they need an abortion.  Unfortunately, most of the world does not agree with us and insists on defining which reasons for abortion are legitimate as a means of restricting access.

Even by the standards of exceptionalism Beatriz seems a likely candidate for access to an altogether too difficult commodity: a safe, legal abortion.  Beatriz has lupus, a disease that can worsen during pregnancy and puts her at increased risk of potentially lethal pregnancy-related complications compared with women who do not have lupus.  She also is suffering from kidney failure, a complication of her lupus that may be aggravated by her pregnancy.  Finally, the fetus she is carrying is anencephalic; it is missing parts of its brain and if it survives birth is unlikely to live more than a few hours.

Unfortunately for Beatriz, she lives in one of the most restrictive countries in the world when it comes to abortion.  While in almost all countries in the world the threat to her life would guarantee her right to an abortion to save her, El Salvador has no exceptions to its abortion ban, and no explicit exception to the ban to save a woman’s life.  Beatriz’s doctors have appealed to the country’s supreme court on her behalf, but it has deliberated for weeks without issuing a ruling.  Meanwhile, Beatriz is suffering.  Click here to sign a petition to the Salvadoran government asking them to uphold their obligation to protect her human rights and her life.

Uneven progress on improving access to contraceptives

A recent study that compared contraceptive use in low- and middle-income countries between 2003 and 2012 found a sharp increase in the number of women wanting to use family planning methods, from 716 million to 867 million.  There was a modest increase in the percentage of women who did not want to be pregnant who were using modern contraceptive methods, but population growth overpowered this effect.  While some progress has been made in some regions, mid and western African countries saw no increase in contraceptive use over the decade.  Another article in the same journal called for sustained efforts to provide contraceptive services to all women and couples who wish to delay or limit future childbearing.

International news roundup: Updates on Brazil, Circumcision, and UN Commission on the Status of Women

25 Mar

Brazilian doctors’ group urges decriminalization of abortion

As in many countries in Latin America, abortion is extremely restricted in Brazil. Currently, women can only legally have an abortion if the pregnancy results from rape, if their lives are threatened by the pregnancy, or if the fetus has a brain anomaly. Despite these restrictions, abortion is widespread, with an estimated 1 million Brazilian women undergoing abortions yearly. As in many countries where abortion is restricted, women with money can still get safe abortion care, while poor women must resort to unsafe abortions. The end result is an estimated 200,000 women per year hospitalized due to complications of unsafe abortions, making unsafe abortion the third most common reason for obstetrical hospital admissions and one of the top causes of maternal mortality in the country.

A group representing Brazilian doctors, the Federal Council of Medicine, is now urging federal lawmakers to allow abortions on demand in the first 12 weeks of pregnancy. The group has noted the strong impact unsafe abortion has had on public health in Brazil and also pointed out that current abortion laws in the country “are inconsistent with humanitarian commitments” and act paradoxically against “social responsibility and international treaties signed by the Brazilian government.” The Council represents 400,000 physicians; let’s hope they get more attention than the National Conference of Brazilian Bishops, which has already registered its distaste for this development.

No surgeon needed with new circumcision device

What do circumcisions have to do with abortion? Not a whole lot. But you may or may not know that circumcision does have a lot to do with reproductive justice for men and women living in countries with high HIV prevalence. Male circumcision, when performed by a skilled provider, reduces a man’s risk of acquiring HIV from an HIV-positive woman by about 60%. Unfortunately, it doesn’t appear to work the other way; that is, circumcision of HIV-positive men does not protect their female partners. However, by protecting men from acquiring HIV, their partners are likewise protected. Because many women do not have control over condom use in their relationships, and because try as we might we are still nowhere near 100% condom use, offering voluntary circumcision to men is one of the most promising interventions available to decrease the spread of HIV.

Despite this, scale up of voluntary male circumcision has been slow. Although there are many reasons for this, the skilled health worker shortage in low-income countries is a major barrier to increased implementation of male circumcision. The New York Times reported this month on the PrePex device, an inexpensive tool that, after being left on for about one week, causes the foreskin to drop off. Best of all, applying it takes less time than surgery and no surgeon is needed; nurses and medical officers can learn to use the device quickly.

UN Commission on the Status of Women makes important strides

Although some activists feared that, as happened last year, no outcome document would be agreed upon after this year’s Commission due to attempts from conservative actors (such as the Holy See, Iran and Syria) to derail negotiations, in the end a document was produced (see a draft here).

In addition to reaffirming important previous international agreements made in Beijing and Cairo, the document condemns violence against women, calls upon states to protect women and girls from violence, promotes education for all as a human right, and recognizes the need for women to be fully integrated into economic and social life. It also states that women who have been raped have the right to emergency contraception and safe abortion where permitted by local laws.

I of course would have liked to see more about the right to contraception (which is a right for all women, not exclusively those who have been raped) and safe abortion regardless of context or local laws, but with conservative forces working for months behind the scenes to prevent any progress, I consider this a small step forward.

New Pope in Rome But Same Anti-Contraception, Anti-LGBT Policies Will Endure

14 Mar

There had been black smoke for days, a signal from the conclave of cardinals that they had yet to decide the new leader of the Catholic Church. Yesterday morning as those of us on the west coast were heading to work, reports came in that white smoke now billowed from the Sistine chapel, a new pope had been chosen.

Meet Jorge Bergogolio, the archbishop of Buenos Aires, now known as Pope Francis I . As the Bishop of Argentina, he opposed Argentina’s leadership on birth control access, he is anti-abortion, anti-condom, and anti-LGBT* rights. A new pope, but no new policies. As he enters the papacy, he has a host of scandals and abuse issues to address.

those problems included reforming the Roman Curia, handling the pedophilia crisis and cleaning up the Vatican bank, which has been working to meet international transparency standards.

Pope Francis is the first Pope from the Americas, and it is said that his election indicates the Catholic Church’s focus on the global south. He grew up in Argentina as the son of Italian immigrants and studied to be a chemist. He has been known for his love and constant study of philosophy. On first look, he may appear a fresh choice for the Church. Upon closer inspection it is clear that the new Pope is more of the same.

For women and families in the global south, new efforts from a conservative Pope Francis’ church could spell disaster. The Catholic Church has previously denounced spreading information about wearing condoms, and have resisted calls to widen access to contraception in poor countries. With the election of this new, more conservative, Pope, all hope that the Church may change their ideology is lost.

While he is known for modernizing an Argentinian church considered to be among the most conservative in Latin America, he is also known for his strict views on morality — having staunchly opposed same-sex marriage, contraception and abortion.

He has called adoption by gay parents a form of discrimination against children — a stance that was publicly criticized by Argentinian President Cristina Fernández de Kirchner.

There you have it, more of the same. And while the new Pope is renowned for his HIV /AIDS work and his outward showing of compassion for the poor, his policies are no less hateful.

Savita Halappanavar, Ireland, and the false divisions in abortion laws

15 Nov

As most of you reading this probably already know, Savita Halappanavar, a young woman living in Ireland, died last month at a Galway hospital.  The details are not yet fully available, but it appears very likely that she would still be alive had she lived in a country with less restrictive abortion laws.  Savita apparently went into labor at 17 weeks of pregnancy (far too early for the fetus to survive on its own). According to her husband, she requested a termination, but was told that as Ireland was a Catholic country her request could be fulfilled only after fetal heart activity had stopped.  3 days later, the Savita finally got the abortion she requested; however, it was too late to prevent the fatal infection that developed while she was waiting.  She went into septic shock shortly thereafter and died a few days later.

Although I can only speculate, my best guess is that although Ms. Halappanavar’s treating physicians were aware that her condition was serious, they did not consider it life-threatening.  (Abortion is legal in Ireland according to its constitution when a woman’s life is at risk).  Although we doctors are often asked to determine a prognosis and to make pronouncements as to the likelihood that a disease will get worse or even become life-threatening, the fact is that we often lack the data to do so, and in the end it is a matter of opinion.  Highly-educated, highly-experienced opinion, but opinion nonetheless.  There are simply too many factors to take into account, and too few studies upon which to rely, to make any accurate predictions.  (As an example, I am sure all of you know somebody who was told he or she had 6 months to live and survived several years… or vice versa).

It is bad enough that doctors in Ireland are supposed to somehow determine whether a pregnancy is life-threatening or “only” health-threatening, a task which quite frankly is impossible.  To make matters worse, although they face criminal prosecution (and potentially lifetime imprisonment) if they perform a procedure that is not considered justified, no legal framework exists to help them determine in which situations they can legally perform an abortion.  How sick does a woman need to be for the situation to be considered life-threatening?  What conditions must be present?  What laboratory values must be exceeded?  There are no answers to these questions.

This problem is not new.  In fact, two years ago the European Court of Human Rights determined that Ireland had violated the rights of a woman (pseudonym “C”) who required an abortion on medical grounds for precisely this reason and cited “the lack of effective and accessible procedures to establish a right to an abortion” which “has resulted in a striking discordance between the theoretical right to a lawful abortion in Ireland on grounds of a relevant risk to a woman’s life and the reality of its practical implementation.” (Read more here in this excellent fact sheet from the Center for Reproductive Rights)

Unfortunately, even as the Court held that this woman’s rights had been violated, it found that the rights of two other applicants (pseudonyms “A” and “B”) who sought abortion on the grounds of their personal health and wellbeing were not violated. This judgment unfortunately solidifies a false division between types of abortions; those that are required for a woman’s life to be saved, and those that are required for her health to be maintained.  Whose health is most jeopardized by her pregnancy?

1) The woman with 4 children already in foster care, who suffered debilitating depression during each of her prior pregnancies, who might become suicidal in this pregnancy (applicant “A”); 2) the woman who could not afford to be pregnant or raise a child, who might not seek medical attention after complications from her abortion for fear of legal repercussions (applicant “B”); 3) the woman with cancer in remission, whose disease might get worse during pregnancy (applicant “C”); or 4) the woman who went into labor at 17 weeks (Savita Halappanavar)?

Anybody who claims they can answer this question objectively and precisely is fooling herself.  There is no way to objectively determine ahead of time which pregnancies are life-threatening and which pose a serious health threat.  Of course some are more likely to be problematic than others, but very dire-appearing situations often end up fine, and routine pregnancies can turn tragic in the blink of an eye.  In the end, the seemingly logical and ordered way countries go about restricting access to abortion (some allow abortion only to save a woman’s life, others to preserve her health, others for socioeconomic grounds, and still others without restriction as to reason)  no longer make sense, and the only reasonable thing to do is to leave the decision to the woman whose life is affected.

In response to the European Court of Human Rights’ judgment, the Irish government formed a committee  that was tasked to report back to the Committee of Ministers by the end of October of this year.  Clearly this was too late for Savita.  Let’s hope they have gotten some work done and it’s not too late for the next woman who needs an abortion in Ireland.

International reproductive rights roundup: August Edition

27 Aug

Court victory for victims of coercive sterilization in Namibia

Namibia’s highest court has ruled that the rights of three women were violated when they were sterilized without their consent while receiving care at public hospitals.   Sterilization without informed consent is only one of many violations of women’s rights that has been documented against women living with HIV in Namibia.  While this verdict occurred in Namibia, it may have profound implications for women around the word, as coercive sterilizations have been documented not only for women living with HIV in other countries but also among certain ethnic groups. Of note, many US women are still suffering from our country’s legacy of coerced sterilizations.

Review of the impact of US policy towards abortion on women victimized by rape as a weapon of war

In conflict-affected regions, rape is often used as a weapon of war.  This was true in Bosnia and Rwanda in the recent past, and is ongoing today in areas of the Democratic Republic of the Congo.  The Atlantic published a great review of how thousands of women in conflict-affected countries are being denied appropriate medical care after being raped during conflicts due to the US government applying conditions to aid money as stipulated in the Helms amendment (no exceptions to the rule against funding abortion services) as opposed to the Hyde amendment (exceptions granted for rape, incest, life endangerment).  Those of you who are fans of Abortion Gang know very well that we don’t agree with the “exceptions” mentality and believe that the reason doesn’t matter- but this is an interesting read nonetheless.

The Philippines ratifies the Domestic Workers Convention

Women and girls make up the vast majority of domestic workers worldwide, yet often have few or no rights.  Migrant workers are especially likely to be forced to work with no breaks, for little pay, or to even be confined forcibly.   The Philippine Senate ratified the treaty earlier this month, making the Philippines the second country (after Uruguay) to take an important step to guarantee rights to some of its most vulnerable workers.

How can we meet “unmet need”?

International family planning advocates often talk about the “unmet need for family planning.”  The way it’s calculated is complicated (if you’re interested, look here) but essentially it measures the percentage of women who are at risk of pregnancy (in other words, sexually active and not using a contraceptive method) who actually do not want to become pregnant in the next year. This group of women is considered a key population to target for family planning services because most of them probably will be happy to use contraceptives if they are available, affordable, and provided in an environment that offers respectful, high-quality care.  Over 200 million women worldwide are estimated to have an unmet need for contraception, and it will take a lot of work (not to mention money) to reach all of them. Stephen Goldstein at the K4Health blog does the math to show us which commitments would need to be kept in order to get contraceptives to everybody who has this “unmet need.”

The World-Wide Challenges to Reproductive Health Care Are No Joke

25 Jul

It can be really challenging to engage with the overwhelming international need for reproductive health care services, especially right now, when we face so many challenges of our own in North America. Just trying to help Mississippi or Kansas alone fight the good fight can be, and is, for some, a full-time job. But when we put the need for reproductive health care in a world-wide context I find that actually, it can help make the problems we face seem less overwhelming and more manageable, by making it one big problem that everyone in the world is impacted by and therefor should join the fight on behalf of: access.

We need access.

Access is beyond choice. We – and by that I mean, literally, everyone on the planet – need to know what our reproductive health care options are, and then we need to have access to education regarding which of those options best meet our individual needs, and then, when we make a choice, we need to have access to that care. That’s all. That’s it. We must have these things. We must make a world in which we all have these things. The end! There, we solved it. We can all go home now.

Breasts and Abortion

9 Aug

I remember the kerfuffle caused when Gwen Jacobs walked down the street topless in Ontario. I was 11 at the time of the court case in 1996 and I remember thinking, good for her. I also remember thinking how terribly unfair it was that men were allowed to walk around topless but women couldn’t. I can’t imagine actually walking around topless but I am glad that I have the right to do so since the Federal law criminalizing it was struck down. This case could be said to be a precursor to the now famous Slut Walks taking place around the world after a Toronto cop ‘confided’ to a group of York University students that the way to prevent sexual assault was to just not dress like sluts. The story became international news and feminists around the world responded with one simple message: women never ask to be raped.

Turns out women in New Delhi, India participated in their own Slut Walk. Unfortunately the author of that article, titled “Do Indian Women Need the Right to Dress like a Tart,” [YES!] asked,

In a country where 10 million babies have been killed in the womb because they were girls, where women are burned for dowry, murdered in honour killings, face domestic violence so frequent it’s as common as a power cut, where Dalit women fear sexual humiliation by upper caste men and where young girls are forced into prostitution, who needs the right to dress like a slut?

Really, I shouldn’t be shocked; it’s just another person who completely misses the point. Somehow, this author thinks all those problems are entirely separate from a woman’s ability to dress however she wants.

When a woman cannot dress however she wants without be subjected to constant sexual harassment, I will show you a woman who may be forced to have a sex-selective abortion or be murdered for the want of honour. I will show you a woman who is not respected, and is in fact disrespected because she is a woman. Women in the U.S. and Canada are certainly subjected to sexual harassment but the situation in India is extreme. Women in India are raped wearing traditional saris just like women here are raped wearing track pants, but the extreme violence against women in India is captured well by the Indian expression for sexual harassment: eve-teasing. As if sexual harassment is just school-yard teasing.

The point that this author misses entirely is that if these women could feel safe walking around dressed like ‘sluts’ then they would have infinitely more power than they do now. When men are punished for harassing women then women are empowered. When women are empowered they are able to free themselves from the shackles of oppression and violence and they are able to demand equality, which would reduce or eliminate sex selective abortions, which would see honour killings go the way of the dodo, which would see a reduction or extinguishment of domestic violence.

On the whole, women in North America have greater reproductive freedom due to a range of factors from financial resources to the law, but to trivialize Indian women’s attempts to empower themselves by declaring their right to dress however they please is to continue to oppress them. The author is correct: Indian women do have bigger fish to fry, but it’s a good idea to gut the fish before you fry it.

The author closes off with this gem,

Yet, the so-called younger generation of Indian feminists now want to dress in clothes that reveal their breasts and buttocks and demand this “self-objectification” as a right? And again focusing attention on their body parts as though it’s liberating? This is either false consciousness gone mad or I’ve got something wrong.

Slut walks have nothing to do with “self-objectification.” Women are objectified by society. There are native cultures where women walk around naked and that’s just the way it is. Objectification comes from outside, not from the individual woman. To suggest that women dressing so as to “reveal their breasts” is focusing attention on their body parts is the same as suggesting men who walk around shirtless are showing off their “breasts.”

As a man said in the article about Gwen Jacobs, we got over ankles so why can’t we get over breasts?

We Are Not Afraid to Speak Out About The A Word – Will You Join Us?

12 Oct

A guest post from Education for Choice.

Many pro-choice Americans think we in the UK have it all: free abortion on the National Health Service (NHS), providers who don’t have to wear bulletproof vests to work, and the general acceptance amongst society that abortion is a medical procedure that women should be able to access whenever they need it.  Growing up in the Midwestern U.S., I thought these same things. Because women have free access to abortion on the NHS, even a heck of a lot of Brits think that there is no work to be done here, but I’ve been working at EFC since January 2010 and I’ve learned that there’s no room for complacency. People here are always surprised to hear that anti-choice organisations are using American-style tactics to spread lies and misinformation in schools and at crisis pregnancy centres across the UK every day.

In the U.S. there are numerous inspiring and active pro-choice activist organisations, groups and advocates, but in the UK Education For Choice (EFC) is the only educational charity dedicated to enabling young people to make and act on informed choices about pregnancy and abortion. We at EFC are here to say out loud that abortion is not a dirty word and that our abortion rights should not be taken for granted.

This month, the new Government is having a Spending Review which promises drastic public sector cuts and the strong chance that some key public health strategies will not be renewed. EFC will no longer be able to rely on funding from the Government so we are looking at alternative sources of support. We met with a professional fundraiser recently. Her first suggestion was that we should leave the word abortion out of our organisational description. She described it as ‘the A word’ and explained that ‘it puts people off’.

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HIV and Pregnancy: A Death Sentence?

24 Jun

By now, I think everyone knows that HIV/AIDS is a major problem, especially in Africa. Poor medical care and lack of knowledge on the disease (even here in the U.S.) have caused fear, misconceptions, dread, and depression for those who contract it. For years, becoming pregnant after contracting HIV was a death sentence for the resulting child.

A few years ago, scientists discovered a “miracle” treatment for pregnant women with HIV–a way for her to deliver the baby without the child contracting HIV. Doctors and humanitarians alike cheered this wonderful treatment. Finally, a solution to the problem of mother-to-baby transmission.

I’m kicking myself at the moment for not being able to find the interview I heard on the radio, on NPR I believe, in which a doctor discussed this procedure. However, I did find a study done in Africa on the treatment.

The woman is given a shot of nevirapine, one drug of a three drug “cocktail” used to help the immune system in AIDS treatment, during labor. The child is then given a shot of it after birth. The majority of the time, this treatment is effective in preventing the transmission, and the child is spared from the terrible life of an HIV patient.

However, what other scientists have just discovered is that the use of nevirapine during labor is actually detrimental to the mother’s treatment later. There is a chance that the mother will become resistant to nevirapine, which renders useless the three drug “cocktail” used for HIV/AIDS treatment for her later. She will die sooner because of this. Her child will be without a mother.
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Turning a Blind Eye to Human Rights Abuses And Femicide in the Democratic Republic of Congo.

4 Apr

I’m getting extremely tired of the situation affecting women and girls in the Democratic Republic of Congo. I am frustrated because I feel that the United States is not taking action on this issue—there are organizations working on this issue, but there is so much more work to be done.

Just a couple of days ago, the Lord’s Resistance Army killed 321 civilians in a massacre. Approximately 80 children were killed and 250 civilians were abducted. The Lord’s Resistance Army has been raising hell for Congolese civilians for 23 years! Where is the action? Where is the help? The army pillages communities throughout the Democratic Republic of Congo; in this massacre alone they killed many women and mutilated many women and young girls. The UN Peacekeeping Mission in Congo has sent 1,000 peacekeeping troops to areas affected by the LRA’s reign of terror. I believe we need more civic action.
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