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Muchisimas Gracias: Latinas Thank Abortion Providers

2:09 pm in Uncategorized by RH Reality Check

Written by Jessica Gonzalez-Rojas for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Every day, it seems there is a new article highlighting the growing number of restrictions on abortion and reproductive health care. We are only a few months into most states’ legislative sessions, yet in Alabama and Mississippi, we’re already seeing a revival of “personhood” and TRAP laws, which threaten to prevent medical professionals from providing care. In Texas, lawmakers continue to try to find more ways to block women from basic health services.

Like all women, Latinas need, and seek, reproductive health care, including abortion, contraception, sex education, and prenatal care. In spite of outdated stereotypes perpetuated in the media, our data shows that Latino/as are in favor of protecting women’s health, and have compassionate views on abortion. Eight in 10 Latinos say they would support a close friend or family member who had an abortion.

A Latina who decides to end a pregnancy should have our community’s support and respect. But even with the support of friends and family in place, structural barriers, including poverty, discrimination, immigration status, and language prevent many Latinas from accessing these health care services. It doesn’t help that 87 percent of U.S. counties have no identifiable abortion provider, according to the Guttmacher Institute.

Providing abortion can present significant challenges to doctors, nurses and clinic staff. Many of these providers face hostile, life-threatening environments, threats to their families, invasions of privacy, and endless legal assaults, creating tremendous obstacles to treating their patients. In spite of that, they go to work each day and provide the care that women urgently need. That’s why at the National Latina Institute for Reproductive Health (NLIRH), we are taking the time to thank and reflect on the invaluable service these providers give their patients.

Doctors like Nilda L. Moreno-Ruiz, MD, an ob-gyn on the NLIRH board of directors who has dedicated her life to providing the full range of pregnancy-related care for her patients. For Dr. Moreno-Ruiz, patient care must be holistic in order to be effective, and that means getting to know her patients and their families and the daily struggles they may face.

When Dr. Moreno-Ruiz talks about providing abortion services, she talks about sitting with her patients, many of whom she has known for years, she talks about comforting them, listening to them, and connecting with them. She cares deeply for her patients, and for women everywhere: that’s why she’s chosen to provide the full range of care a pregnant woman might need, including abortion.

Or providers like Dr. Pablo Rodriguez, a community advocate both here and abroad for Latina women living in some of the world’s most under-served and under-resourced communities. From his travels in the Andes, Dr. Rodriguez has seen the misery and suffering many Latinas endure to access birth control and safe abortions as reproductive health care becomes less and less available, a growing concern many providers share for communities in the U.S.

Dr. Moreno-Ruiz and Dr. Rodriguez, and others like them, provide bilingual, culturally competent, and compassionate care. They understand the need for a broader advocacy framework that addresses how these issues are connected and work daily to help women overcome the structural barriers Latinas face in accessing health services.

Today, we take the time to thank these heroes, and all abortion providers, for the role they place in ensuring that every woman is able to make her own decisions about her pregnancy, family and her future.

Through NLIRH’s Yo Te Apoyo (I Support You) campaign, we are sending messages of support for Latinas who are making critical decisions about whether and when to become a parent or have another child. On this day, we also say, “Yo te apoyo,” to abortion providers, as well as their staff, supporters and defenders. We support them as they have supported us.

Join the conversation on Twitter at: #Thx2ABProviders

Evidence-Based Advocacy: How Do Abortion Providers Experience Stigma?

1:59 pm in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

DC Anti-abortion protest banner reads: 3500 Americans Aborted Daily

In today's culture, abortion providers face considerable stigma. Researchers at the University of Michigan study ways to mitigate its effects.

Ask anyone to tell you who’s doing the most innovative research on abortion provider stigma and they’€™ll tell you it’€™s Dr. Lisa Harris and her interdisciplinary team at the University of Michigan. Together they pioneered the Provider Share Workshop, a pilot project testing the possibility that a support group for abortion providers could help reduce the negative impact of stigma. She writes about topics that others in even the most pro-choice communities shy away from €”the need to have open and honest conversations about second trimester abortion provision, how stigma affects abortion complications, and, recently, the need to recognize conscience as a motivating factor in abortion provision. Now, Dr. Harris and her team, which includes social worker Jane Hassinger, and public health PhDs Michelle Debbink and Lisa Martin, have gone a step further and actually mapped out how abortion providers experience abortion stigma, coining a new term: the legitimacy paradox.

Based on their interviews with abortion clinic staff who participated in the Provider Share Workshop, Dr. Harris and her team theorize that the combination of stigma and silence perpetuate a vicious cycle:

When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions. This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.

The marginalization of abortion providers within medicine and society at large is not a new issue. In fact, as Dr. Harris and others have written, negative portrayals of abortion providers go back at least two centuries in the United States. In the nineteenth century, the American Medical Association opposed abortion in part because non-physicians (such as midwives, osteopathic doctors, and others) were the majority of abortion providers at that time and took away valuable business from physicians. The AMA sought to criminalize abortion to push these competing practitioners out of business, and thus began the association of abortion provision with “deviance” from mainstream medicine.

As the women’€™s liberation movement made the case for safe and legal abortion in the mid-twentieth century, abortion providers were depicted as “back alley butchers.” This portrayal and the grotesque images associated with it communicated the very real dangers of illegal and unsafe abortion, but neglected that many thousands of safe illegal abortions that were provided by both clinicians and lay-people during this time. While the use of the “back alley butcher” imagery certainly helped to legalize abortion in the United States, Dr. Harris argues that it did so while further stigmatizing abortion providers.

To track how abortion providers experience stigma today, Dr. Harris’ team conducted a focus group with abortion clinic staff in a Midwestern abortion clinic. She documented that all abortion clinic staff, including clinicians, counselors, front desk workers, and others, feel the negative impacts of doing stigmatized work. Providers commented on encountering stigma in public discourse, such as in political rhetoric, from institutions, such as hospitals and churches, as well as in their every day relationships with family, friends, and even their patients. As a result of this stigma, providers often have to choose if and how to disclose their involvement in abortion provision, weighing the possibilities of relationship conflict and threats to their safety if they decide to disclose, or isolation and disconnection if they keep their work a secret.

What are the consequences of this stigma? One possibility is that it may contribute to violence and harassment of abortion providers. Dr. Harris and her team explain:

Read the rest of this entry →

“It was Worth the Sacrifice:” Kenya’s Dr. John Nyamu on Why He Spent a Year in Prison

1:59 pm in Uncategorized by RH Reality Check

Written by Mary Fjerstad for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted with permission from Ipas.

This article was also published in Medical Abortion Matters (November 2012).

Until 2011, abortion was illegal in Kenya except to save a woman’s life. For years the climate of fear and secrecy surrounding abortion hurt women, their families, and health-care providers. Unsafe abortion in Kenya still causes an estimated 30 percent of maternal deaths and countless other injuries.

Now, a newly ratified Kenyan constitution allows for legal abortion on much broader terms — and, when the new law is fully implemented, it stands to dramatically increase women’s ability to exercise their reproductive rights.

Ipas’s senior clinical advisor Mary Fjerstad recently sat down with Kenya’s much-respected Dr. John Nyamu to discuss the long and difficult path he and so many other Kenyans have traveled to get where they are today.

Mary Fjerstad: Doctor Nyamu, would you tell me what the situation was like in Kenya when abortion was considered a criminal act? [Editor's note: Before constitutional reform, abortion in Kenya was highly restricted with few legal indications for having the procedure.]

Dr. John Nyamu: Most health-care workers were afraid of talking about it openly. Abortion was never performed in government hospitals unless the life of the woman was in real danger. Even then it was very bureaucratic as one doctor could only do the procedure with permission in writing from two other doctors; one doctor had to be a psychiatrist and the other doctor had to be a senior doctor in the hospital. Abortions were performed by D&C or induction. In reality, these legal abortions were provided almost exclusively at Kenyatta National Hospital, provincial hospitals and very rarely in district hospitals. (Kenyatta National Hospital is the major teaching hospital in Nairobi).

There were wards in hospitals where women who had unsafe abortions were treated for uterine and bowel damage due to perforations and developed sepsis, brain damage and many women died.

There was tremendous secrecy about abortion, women were aborting late. The penalty for a doctor who performed an [illegal] abortion was 14 years [in prison]; pharmacists could be imprisoned for three years for giving abortifacient medicines and women themselves could be imprisoned for seven years for having an abortion.

Some private clinics were providing safe abortion. They were harassed regularly by local police, usually by extortion. They were used virtually as the personal ATMs of the police [ATM = Automatic Teller Machine, a banking machine from which you can withdraw cash using a bank card]. A policeman would say, “I’m short of cash, give me your cash or I’ll arrest you.” The entire staff, including nurses, doctors and women seeking abortion could be arrested. Due to the fear, the providers kept servicing [the police] to buy their freedom.

Your case was profiled by The Center for Reproductive Rights’ paper in 2010, “In Harm’s Way: the Impact of Kenya’s Restrictive Abortion Law.” Can you briefly describe what happened to you that led to this paper?

In 2004, [data were shared] which showed worrying trends and consequences of unsafe abortion in Kenya. This was followed by a major crackdown on clinics, hunts for women who had abortions, some clinics were closed and I was targeted. There were 15 fetuses found along a major road with some documents from a hospital I had worked at previously but had since closed. My clinic was raided and two nurses and I were arrested. This appeared to have been very well organized with all the media including print, radio and TV present to report on the matter.  When we were asked to pay bribes, we refused — because we knew the fetuses were not from our clinic and the documents were planted on the road — and we were locked up. [Editor's note: subsequent pathology examinations found that the fetuses were still-born fetuses, not aborted fetuses.]

The three of us were ultimately charged with two counts of murder, rather than an abortion-specific offense. Since murder is a non-bailable offense in Kenya, we had to stay in remand prison pending our trial. We all spent a year in prison. One of the nurses was six months pregnant and delivered while she was in prison. One of the nurses still works for me and the other got her green card and has since immigrated to the United States.

A senior doctor, a gynecologist, was instructed by the Director of Medical Services of the Ministry of Health to accompany the police and inspect the two clinics operated by Reproductive Health Services. The purpose of the inspection was to verify if there was any abortifacient equipment. He gave witness in court that the two facilities had legal equipment normally found in a gynecologist’s clinic and he would be surprised if he did not find it as he uses the same equipment for his work. The police forensic department was asked to look for DNA on the equipment from the clinic. DNA was taken from any instruments or equipment with blood on them — even the couches and lab coats were confiscated. The results from the government chemist found that there was no DNA linkage between the fetuses found on the road and any blood specimens from the clinic. The doctor also found that the clinic was duly registered and all staff had proper and up-to-date licenses.

The case was eventually ruled as improper [Editor's note: They were acquitted of all charges]. With that ruling, the attorney general decided not to pursue prosecution due to lack of evidence.

Was it horrible being in prison for a year?

Yes, it was horrible, but it was worth the sacrifice. I was held at the Kamiti Maximum Prison, which is where the hard-core criminals are remanded. I was confined in a small cell for a whole year. I really felt persecuted, but as I said, it was worth the sacrifice.

Why do you say it was worth the sacrifice?

My arrest and imprisonment was in the media virtually every day. The publicity was an opening for people to realize the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public. There are only about 250 OB/GYNs in Kenya; some districts have none. The media sensation from this case galvanized the Kenya Obstetrical and Gynaecological Society (KOGS), the National Nurses Association of Kenya, the Federation of Women Lawyers, human rights advocates, women’s rights organizations and many others to form an alliance of reproductive health rights advocates.

This alliance exists to date and is known as the Reproductive Health and Rights Alliance (RHRA). The RHRA is an advocacy platform to agitate for the reduction of maternal mortality and morbidity due to unsafe abortion. This alliance also offers technical support to abortion service providers through Reproductive Health Network (RHN). The public became aware of abortion and the toll of unsafe abortion. The window was open to the public to realize the terrible toll of unsafe abortion in Kenya.

This debate extended to the drafting of a new Constitution in 2010. The Constitution says that “every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.”

My arrest, imprisonment and [the resulting] publicity generated a public awareness that led to a transformation in the understanding that safe abortion is essential to preventing maternal morbidity and mortality.

Is there any further action in your own case?

Yes, I have since sued the government for malicious prosecution and subsequent confinement for one year in remand prison. The case has been in court for the last six years without yet being assigned a hearing.

What does the expansive definition of health in the new constitution mean in terms of when an abortion is considered legal?

Abortion is legal if the pregnancy endangers the life of the woman; as an emergency treatment; or when it endangers health, with health defined broadly: physical, social and mental. If in the opinion of a trained health professional an abortion is provided in good faith (in other words, where the pregnancy jeopardizes the woman’s physical, social or mental health), it is legal. [Editor's note: Under the new law, a woman can make her abortion decision with one health-care provider; others are not required to be involved or sign off on the decision.]

What categories of health-care providers can perform legal abortion?

Physicians, nurses, midwives and clinical officers [who have completed training to perform abortion services] can now perform legal abortions.

What are the next steps in transforming the policies to establish safe, legal abortion in Kenya?

Ipas and other organizations took the lead in writing a document called, “Standards and guidelines for reducing morbidity and mortality from unsafe abortion.” The title is taken from a similar document from Zimbabwe and is brilliant. Kenya, like other countries, wants to achieve the Millennium Development Goal of 75-percent reduction in maternal mortality; this can’t be achieved if safe abortion isn’t available.

The other milestone on transformation is the revision of codes of ethics and scope of practice for all the professional associations in Kenya. These have been done and are waiting to be launched.

This transformation to legal abortion access in Kenya is a testament to very brave, inspired people dedicated to the common good who have sacrificed a lot. How have all the changes we’ve discussed affected providers of safe abortion and women?

Providers are now aware of the enhanced protections that have been offered by the constitution. This in turn has increased access to safe abortion services and thereby enabled women to realize their reproductive health rights. In addition, incidences of provider harassment are now on the decrease.


A Doctor Testifies: Wisconsin SB 306 Will Endanger My Patients

3:25 pm in Uncategorized by RH Reality Check

State Capitol in Madison (photo: lori_greig/flickr)

State Capitol in Madison (photo: lori_greig/flickr)

Written by Fredrik Broekhuizen, MD for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Dear Chairwoman Vukmir and Senate Health Committee Members:

I provide abortion care to patients in hospital settings as well as in outpatient clinics.  A significant number of these patients undergo medically indicated abortions for lethal fetal anomalies or to preserve their life or health. Often, patients have significant medical problems (as cancer, diabetes, heart failure) which require expertise and care in addition to a safe abortion procedure.  Many of the patients I treat are referred to me by their primary care physician in Wisconsin, often from a significant distance. I have described examples of the care I provide in the attached article I wrote for the Capitol Times a few months ago.

I oppose SB 306 since it interferes with the ability of myself and other physicians to practice sound evidence-based medicine. This bill interferes with my ability to provide care to patients in need of my expertise and it limits patient choice and autonomy.

1) SB 306 creates an unacceptable barrier in the doctor patient relationship, harming the continuity of care providers strive for in Wisconsin.

Under current law, Wisconsin Statute Sec. 253.10, any qualified physician in the state of Wisconsin can provide informed consent counseling, make the voluntariness determination and obtain the state required 24-hour consent form from a patient.  Oftentimes these primary care physicians refer the patient to an abortion provider, who provides counseling and again obtains consent for the procedure.  This bill would require that the abortion provider obtains the initial consent. This new and additional requirement delays care and interferes in the patients existing relationship with her primary care physician.  In addition, the referring physicians know their patients and are often the best informed regarding the patients’ medical condition. Certainly any licensed physician is qualified to obtain the initial consent. The physician performing the abortion will verify that consent and provide counseling prior to a procedure.  This bill will greatly impede the continuity of care and put up obstacles between a woman and her primary care physician. Read the rest of this entry →

Not a Moment to Lose: We Must Protect Abortion Providers’ Rights

6:44 am in Uncategorized by RH Reality Check

Written by Dr. Suzanne Poppema for – News, commentary and community for reproductive health and justice.

When Physicians for Reproductive Choice and Health was founded in 1992, it was a dangerous time for abortion providers. Several of my colleagues had been shot by anti-choice extremists, some murdered, and many clinics were bombed or blockaded by protestors. I wore a bulletproof vest to work at my abortion clinic outside Seattle. It sometimes felt like providers were an endangered species.

Physical violence ebbed over the next decade, but that proved to be a temporary lull. In the past few years, I’ve seen one colleague’s clinic destroyed by arson, while my friend George Tiller was murdered last spring. It isn’t just violence that affects abortion providers today, though—we are also the targets of pointless state laws that limit women’s access to health care. The number of anti-abortion laws this year—about 370—may be a record high.

After LeRoy Carhart declared his intention to continue Dr. Tiller’s work and provide later abortions to women who need them, the state of Nebraska passed a law banning abortions after 20 weeks. Their ostensible reason—that the fetus can feel pain at that point—contradicts the best scientific evidence about fetal development. The real goal of this law was clear from the beginning: to make it impossible for Dr. Carhart to offer women abortions later in pregnancy.

Nebraska wasn’t the only state this spring to target abortion providers and the women they serve. Oklahoma stood out with a series of bills aimed at making abortion more difficult, including a mandatory ultrasound and a lengthy questionnaire doctors must complete before a woman can have an abortion. Meanwhile, Arizona, Mississippi, and Tennessee have blocked women from buying insurance policies that cover abortion, and more states are considering similar bans.

In light of the many restrictions and fears abortion providers must live with every day, Physicians for Reproductive Choice and Health has introduced an Abortion Provider’s Declaration of Rights. The aim of the declaration is simple: to state that abortion providers deserve the same treatment and protections that other physicians enjoy as a matter of course.

Among the rights spelled out in the declaration are: the right to practice medicine free from fears of violence, harassment, and intimidation; the right to give patients complete, medically accurate information about the procedure; and the right to continue their training and conduct research on abortion methods. All are basic rights taken for granted in any other field of medicine, but denied to abortion providers.

While a part of me is discouraged that we need to enumerate these rights, I also know that there is strength in numbers. Among the first signers of the petition were Jeanne Tiller, Dr. Tiller’s wife; his daughter, Rebecca Tiller-Bunting; Dr. Carhart; and other prominent abortion providers. More than 800 people have signed the petition to date, and I urge you to add your name. Together, we can show the extremists and anti-choice politicians that there is a strong community committed to protecting abortion providers and the women they serve.