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Six Supreme Court Cases to Watch This Term

12:08 pm in Uncategorized by RH Reality Check

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

The US Supreme Court

These Supreme Court cases could affect women’s rights in the near future.

The United States Supreme Court term begins in October, and while the entire docket has not yet been set, already it’s shaping up to be a historic term, with decisions on abortion protests, legislative prayer, and affirmative action, just to name a few. Here are the key cases we’re keeping an eye on as the term starts up.

1. Cline v. Oklahoma Coalition for Reproductive Justice

The Supreme Court looks poised to re-enter the abortion debate, and it could do so as early as this year if it takes up Cline, the first of the recent wave of state-level restrictions to reach the high court.

Cline involves a challenge to an Oklahoma statute that requires abortion-inducing drugs, including RU-486, to be administered strictly according to the specific Food and Drug Administration labeling despite the fact that new research and best practices make that labeling out of date. Such “off-label” use of drugs is both legal and widespread in the United States as science, standards of care, and clinical practice often supercede the original FDA label on a given drug. In the case of cancer drugs, for example, the American Cancer Society notes that “New uses for [many] drugs may have been found and there’s often medical evidence from research studies to support the new use [even though] the makers of the drugs have not put them through the formal, lengthy, and often costly process required by the FDA to officially approve the drug for new uses.” Off-label use of RU-486 is based on the most recent scientific findings that suggest lower dosages of the drug and higher rates of effectiveness when administered in conjunction with a follow-up drug (Misoprostol). According to trial court findings, the alternative protocols are safer for women and more effective. But, according to the state and defenders of the law, there is great uncertainty about these off-label uses and their safety.

When the issue reached the supreme court of Oklahoma, the court held in a very brief opinion that the Oklahoma statute was facially invalid under Planned Parenthood v. Casey. In Casey, a plurality of justices held that a state may legitimately regulate abortions from the moment of gestation as long as that regulation does not impose an undue burden on a woman’s right to choose an abortion. Later, in Gonzales v. Carhart, a majority of the Supreme Court, led by Justice Anthony Kennedy, interpreted Casey to allow state restrictions on specific abortion procedures when the government “reasonably concludes” that there is medical uncertainty about the safety of the procedure and an alternative procedure is available.

Cline, then, could present an important test on the limits of Casey and whether, under Gonzales, the Court will permit states to ban medical abortions. But it’s not entirely clear the Court will actually take up Cline. At the lower court proceedings, the challengers argued that the Oklahoma statute bars the use of RU-486’s follow-up drug (Misoprostol) as well as the use of Methotrexate to terminate an ectopic pregnancy. If so, the statute then bars both any drug-induced abortion and eliminates the preferred method for ending an ectopic pregnancy. Attorneys defending the restriction deny the law has those effects, and do not argue that if it did such restrictions would be constitutional. With this open question of state law—whether the statute prohibits the preferred treatment for ectopic pregnancies—the Supreme Court told the Oklahoma Supreme Court those disputed questions of state law.

So a lot depends on how the Oklahoma Supreme Court proceeds. Should the Oklahoma Supreme Court hold that the Oklahoma statute is unconstitutional because it prohibits the use of Misoprostol and Methotrexate, this case could be over without the Supreme Court weighing in. But if the Oklahoma Supreme Court invalidates the law insofar as it prohibits alternative methods for administering RU-486, the Supreme Court will almost certainly take a look.

2. Town of Greece v. Galloway

The Roberts Court is set to weigh in on the issue of when, and how, government prayer practices can exist without violating the Establishment Clause’s ban on the intermingling of church and state. In Marsh v. Chambers, the Supreme Court upheld Nebraska’s practice of opening each legislative session with a prayer, based largely on an unbroken tradition of that practice dating back to the framing of the Constitution. In Marsh, the Court adopted two apparent limits to a legislative prayer practice: The government may not select prayer-givers based on a discriminatory motive, and prayer opportunities may not be exploited to proselytize in favor of one religion or disparage another.

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Ensuring Access to Safe, Legal Abortion: A Global Movement Grows

12:19 pm in Uncategorized by RH Reality Check

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

Each year, 47,000 women throughout the world die from complications of unsafe abortion. That’s an estimated 13 percent of maternal deaths — more than 120 women every day whose deaths are entirely preventable. Approximately 220,000 children lose their mothers this way every year.

Maternal deaths caused by unsafe abortion are both devastating for the families involved and detrimental to their larger community. Guaranteeing access to safe, legal abortion — and removing barriers to access in countries where abortion is legal — is essential to saving women’s lives and reversing these tragic statistics.

On September 28th, national and international women’s health groups will come together to mark the Global Day of Action for Access to Safe, Legal Abortion. This Day of Action has its roots in a 20-year movement across Latin America to reverse restrictive laws that criminalize abortion and reduce stigma for women who have abortions. Unfortunately, after decades of struggle, we still have a lot of work ahead — internationally and even here in the United States.

In many countries, outright bans or stringent restrictions on abortion result in women turning to unregulated providers for unsafe, clandestine procedures. Persisting stigmas around abortion, lack of appropriate counseling and information, and inadequately trained health care providers lead to even more women turning to dangerous options for ending a pregnancy.

Sarah O., a young mother in Ghana, is one woman who faced an impossible decision about her body and health. Already struggling to support six children, Sarah learned she was pregnant with a seventh. She traveled to a local clinic where she sought the advice and counsel of one of the nurses on staff, in confidence. The nurse did not think Sarah should end the pregnancy. When she was unable to convince Sarah to raise another child, the nurse told Sarah to carry the pregnancy to term and then she or one of the other nurses would adopt the child. Sarah left the clinic and returned home. A few days later, the staff at the clinic learned that Sarah had died from sepsis after attempting to terminate the pregnancy herself. This sad loss might have been avoided if Sarah had received appropriate counseling, nonjudgmental care, and had genuine access to her full range of options.

Sarah’s situation is unfortunately not unique. Nearly 98 percent of all unsafe abortions occur in developing countries.

In the United States, legal abortion has led to a dramatic drop in the number of women put at risk by unsafe abortion after the 1973 Supreme Court decision in Roe v. Wade that de-criminalized the procedure. However, women in this country face many of the same barriers to access as women globally — stigma, lack of access to trained providers, misinformation, threatening political ideology, and government intrusion into women’s personal decision making.

More than one-third of women in the United States live in one of the 87 percent of counties that have no abortion provider. In 24 states, mandatory waiting periods make it even more difficult, and sometimes impossible, for women to access safe, legal abortion. Over the past two years, we have seen a drastic increase in threats to safe, legal abortion — with 1,100 bills to restrict access to reproductive health filed at the state level in 2011, and over 900 filed in just the first three months of 2012.

We know that access to safe, legal abortion saves women’s lives. Studies also show that in countries and states where policy ensures that abortion is safe, legal, and accessible, abortion rates are actually lower. In countries that place a premium on women’s health, access to safe, legal abortion goes hand-in-hand with access to contraception and pregnancy prevention strategies. In the end, women who have control over their health and are able to plan their pregnancies are also able to enjoy positive outcomes such as higher educational attainment and economic prosperity.

It’s up to us to ensure that restrictive laws and out-of-touch ideologies that put women’s lives at risk have no place here in the United States and around the world. We cannot allow politics to jeopardize women’s health, rights, or lives. We must continue to push forward. Join us today in the Global day of Action for Access to Safe, Legal Abortion and talk with friends and family, reach out to your elected officials, or get involved with organizations doing local and global advocacy to protect and expand abortion access.

Rep. Bruce Rendon’s Anti-Abortion “Super-Bill” On Fast Track in Michigan Legislature

11:23 am in Uncategorized by RH Reality Check

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

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In Michigan, Republican State House Representative Bruce Rendon has introduced an anti-abortion “super bill”—one piece of legislation that includes protocol for screening women for coercion prior to an abortion, along with several TRAP laws including new liability insurance requirements for abortion providers, the regulation of abortion clinics as surgical facilities, and new restrictions on the disposal of fetal remains. The bill would also require the presence of a physician for medication abortion — a particularly damaging regulation in a state where 82 percent of counties have no abortion provider, and many women in rural areas rely on the safe and effective tele-med prescription of medical abortion.

Each of these new restrictions has already been proposed in a separate bill in the Michigan House and Senate; the hypocritical “anti-coercion” legislation, for example, has already passed through the House and is now awaiting a Senate vote. And a bill that would create new regulations on the disposal of fetal remains has been criticized for the potential trauma it would cause for women experiencing miscarriage. But Rendon’s HB 5711 is the first bill in the state to roll so many abortion restrictions into one package, threatening to create in one fell swoop serious barriers for both women in need of abortion care and abortion providers. Packaged with the bill, HB 5713 sets forth sentencing guidelines for violations of the new regulations, and also includes a prohibition on all abortions after 20 weeks in all cases except when it is necessary to save a life.

Additionally troubling is the speed at which HB 5711 appears to be moving through the legislative process. Many of Michigan’s anti-choice bills have languished for months without being brought before a committee; the Senate bill regarding the disposal of fetal remains was assigned to the committee on health policy back in October of 2011, a bill prohibiting the tele-med prescription of medical abortion has been awaiting an appearance before the same committee since last June. But HB 5711 was introduced on May 31st – ironically, and perhaps not coincidentally, the anniversary of Dr. Tiller’s assassination — and is already scheduled to be discussed by the House committee on health policy on Thursday, June 7th. It is likely that the Republican-majority committee will recommend the bill favorably, and that it will be rapidly headed for a House vote.

Losing the Right to Abortion, Week by Week: Restrictions on Later-Term Abortions Harm Women

7:21 am in Uncategorized by RH Reality Check

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

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The landscape for access to abortion is shifting quickly, as state after state passes restrictive laws. Particularly affected by these new laws are women who need abortions later in their pregnancies.

In April 2010, Nebraska became the first state in the country to pass a restriction on abortion after 20 weeks, based on an unscientific claim that fetuses feel pain after 20 weeks gestation. The Nebraska law banned abortions after 20 weeks for any reason except if the pregnant woman’s life is in danger. Prior to the passage of this law in Nebraska, there were 21 states (plus the District of Columbia) where abortion was available after 20 weeks. Although in most of these states these services were dependent on one site and one physician, nonetheless the services existed. Since April 2010, legislation limiting abortions to 20 weeks has been signed into law in Alabama, Georgia, Idaho, Indiana, Kansas, Oklahoma and North Carolina. Bills making access to later abortion more difficult were passed in Missouri and Ohio.

Arizona’s lawmakers have gone even further. Although the Roe v. Wade Supreme Court decision legalized abortion through the second trimester, generally understood as 24 to 26 weeks, Arizona has redefined biology and the right to abortion. Last week Arizona signed into law new restrictions on abortion after 18 weeks. By any calculation, 18 weeks is the middle of the second trimester, and mid-pregnancy. The trimester construction of Roe is becoming irrelevant in many states.

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Making Sense of Herman Cain and Abortion

8:48 am in Uncategorized by RH Reality Check

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

On this week’s episode of Reality Cast, I have a segment about the situation with Herman Cain’s incoherent and inconsistent approach to abortion rights. Cain has been on at least two TV shows where he said in the same breath both that he doesn’t think abortion should be legal and that the government shouldn’t make that decision for you, without acknowledging in the slightest that these two positions inherently contradict each other. There’s been multiple attempts to understand why Cain is so daft about this. Some folks believe he’s trying to have it both ways, but hasn’t figured out any political trickery to allow himself to speak out of both sides of his mouth without getting caught. I theorized at XX Factor that Cain’s incoherent position reflects the incoherent position of roughly half the people who claim to be “pro-life”, but also want abortion to be legal in some or all cases.

But now we have a little bit more of a clarification from Cain on his position.

“I do not think abortion should be legal in this country,” Cain said on Fox today. “Abortion should not be legal. That is clear. But if a family made the decision to break the law, that’s that family’s decision.”

Of course, this contradicts his previous statements about how the government should stay out of it. Now he thinks the government should ban abortion, and he seems to have not considered in the slightest that breaking the law isn’t just a matter of “choice”, but that it can have very real consequences if you’re caught. Read the rest of this entry →

Stop Entrapping Providers: What I Told the Kansas Department of Health and Environment

7:03 am in Uncategorized by RH Reality Check

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

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As Jodi Jacobson reported earlier today, public hearings were held in Kansas today for the abortion regulations created by the Kansas Department of Health and Environment.  I presented the following testimony on behalf of Kansas NOW.

I’m the State Coordinator for Kansas NOW, which means that I stand before you today as a grassroots women’s rights activist and equality advocate.   I stand before you today, as a voice for a whole lot of Kansas women who cannot be here to tell you how they feel about these regulations.  These women want me to express what they think about the possibility of losing their access to existing abortion clinics within their state.  These are good women who have either used these clinics personally, or simply take comfort in knowing that these facilities exist should they need them.

While I may not be a public health professional, my understanding as a graduate student of Public Administration is that government enacts regulations when a public need for protection presents itself, in the case of Kansas Department of Health and Environment, when some public health concern or externality needs to be addressed.  As employees of an agency that is supported by public tax dollars, deliberative, non-ideological processes are to be expected, especially with regard to the health and well being of the citizens they work for.  I do not believe that this regulatory process met those deliberative, non-ideological tenets. Read the rest of this entry →

What New Legal Obstacles to Safe Medication Abortion in Ohio Mean for Women

10:55 am in Uncategorized by RH Reality Check

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

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The legal landscape for abortion is changing rapidly in Ohio, as it is in many states. Our governor recently signed into law a measure requiring as-yet-unspecified “viability testing” on women seeking abortions past 20 weeks.  At least half a dozen other restrictive measures were recently passed or are on the horizon, including the “Heartbeat Bill,” which seeks to outlaw abortions as early as 6 weeks (before many women know they are pregnant). It’s unclear what this will all mean for clinics and for women.  At my clinic, Preterm, the largest independent abortion provider in the state, women are calling us daily asking if abortion is still legal.

At the same time, Ohio clinics and our patients are now dealing with the effects of a restrictive law passed several years ago. Caught up in court challenges until last spring, this law dictates the way medication abortions—induced by a combination of mifepristone (mife), also known as RU-486, and misoprostol (miso)—must be performed in Ohio. It requires doctors to use an outdated FDA regimen, established during trials in the 1990s, instead of a lower-dose evidence-based regimen that has been used safely and effectively all over the U.S. for more than a decade.

Essentially, the FDA regimen shortens the time a medication abortion can be used from 63 days to 48 (or from 9 weeks of pregnancy to just under 7), triples the amount of mife used (and at $90 a pill that adds up!), and increases the required number of clinic visits from three to four, so that a doctor can watch the patient swallow the miso at the clinic rather than allowing her to dissolve it inside her cheek at home.

Our First Case

The first medication abortion patient we saw at Preterm after the new regulations went into effect was exactly one day over the new legal limit for taking the combo of pills that is used to end an early pregnancy without surgical intervention.   Read the rest of this entry →

Va. Governor McDonnell Expected to Issue “Emergency” TRAP Regulations Today

11:49 am in Uncategorized by RH Reality Check

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

Using a highly unusual “emergency” process, Virginia Governor Bob McDonnell is expected on Friday, August 26th to issue guidelines under what is known as a Targeted Regulation of Abortion Providers (TRAP) law that will treat clinics providing first trimester abortions as a form of hospital. There are no medical or public health indications for such regulations.

In March, McDonnell, a virulently anti-choice Republican, signed SB 924, a law that requires clinics performing first trimester abortions to be regulated as hospitals. The bill gave the state’s Board of Health 280 days to create and to enact the new regulations. Because McDonnell has invoked “emergency” status for the process, it is expected that temporary regulations–which will first be issued tomorrow and voted on by the Board of Health in September–will be put in place for a period of up to 18 months while permanent rules are developed through a more established process.

The catch is this: the McDonnell Administration is bypassing virtually all democratic processes in place for the creation of such regulations. Under the emergency designation, the normal process for public review and comment on regulations, which usually involves several opportunities for expert testimony and public comment and an economic impact assessment among other considerations, has been completely thrown out. Instead, draft regulations will be released tomorrow, and then voted on at a meeting of the Board of Health on September 15th. Instead of any public hearings or comment periods, the Board meeting will be the only time for the public to speak out.  After the board votes on these temporary regulations, they will go to the governor for final approval. Moreover, the McDonnell administration has claimed it has the authority to rewrite without any further notice or input any temporary regulations presented to it for signature.

I’d say that is as close to government by fiat as it gets.

Analysts suggest that the temporary regulations will have an insidious effect of creating uncertainty among clinics as to what to do. Normally, such regulations would include a period of time–two years–during which clinics can make accommodations for any changes that might be necessary to comply with law, such as changes in physical structure, which can be expensive.  But by issuing temporary regulations, the McDonnell Administration puts existing clinics on an uncertain path: Do they take on the expense of adapting to regulations that might be thrown out or replaced in 18 to 24 months when more “permanent” regulations are published? Or do they take the risk of being found in violation of medically-unnecessary regulations that are costly and impede their ability to provide services to women in need?

Virginia has a lot of company in creating medically unnecessary TRAP laws and regulations seeking to diminish access to abortion care. “Nearly 30 states have some sort of TRAP law,” notes Elizabeth Nash, Senior Public Policy Associate at the Guttmacher Institute. “Regulations in some states essentially require clinics providing abortions to become miniature hospitals by mandating they meet ambulatory surgical standards.”

The Center for Reproductive Rights (CRR) notes that TRAP laws generally fall into one of three categories: health facility licensing schemes, ambulatory surgical center requirements, and hospitalization requirements.

Health facility licensing schemes vary widely in their breadth and scope, but generally require that abortion facilities (but no other comparable offices or clinics) become licensed by the state and meet a range of regulations governing such matters as physical construction, staffing, and procedures.

Ambulatory surgical center (“ASC”) requirements mandate that abortion providers – including, in at least one state, those that provide only first-trimester medical or surgical abortions – be licensed as ASCs, which are sophisticated facilities designed for the performance of a range of out-patient surgeries. “These requirements go far beyond the recommendations of the national health organizations in the field of abortion care, and converting a physician’s office or outpatient clinic into an ASC can be too expensive for many providers.” notes a CRR report.

Hospitalization requirements mandate that abortions beyond a certain gestational age (generally at some point in the second trimester) be performed in a hospital. Although many states have some type of hospitalization requirement on the books, the vast majority of those laws are unenforceable because they been declared unconstitutional by a court ruling or state official, or have been superseded by another law.

In the case of Virginia, the TRAP laws specifically target first trimester abortion, one of the safest medical procedures performed in the United States. As I wrote in July:

More than 90 percent of abortions occur in the first trimester of pregnancy.  Legal, early surgical termination of pregnancy performed by a trained provider is among the safest possible surgical procedures of any kind, anywhere.  Early medical abortion (using medications to end a pregnancy) has a similar safety profile. Less than 3 percent of women who undergo early termination of pregnancy report any complications whatsoever; the vast majority of those “complications” are issues so minor they can be handled in a medical office or clinic.  Fewer than 0.5 percent of women have serious complications from early termination that require hospitalization or surgery.

Does the “emergency push” by the McDonnell administration for abortion regulations come after a rash of problems found at clinics providing abortion care? No. There is no precipitating event other than the desire by Governor McDonnell and his Attorney General Bob Cuccinelli to turn back the clock on women’s health and rights.

Advocates are unable to say at this time what will be included in the temporary regulations expected out tomorrow, but suspect they may in some form reflect those adopted in states such as South Carolina or in Kansas.

In many states with anti-choice legislatures and governors, such as Kansas, TRAP laws can literally become a farce.  In July, Kansas Governor Sam Brownback and the Kansas Department of Health put in place regulations targeting abortion clinics that proscribed the size of the janitor’s closets, the temperature at which rooms should be kept, and the size of staff and patient lockers. They further required that clinics be prepared to deal with a “live birth,” a completely superfluous and misleading regulation given that there is no such thing as a “live birth” in the first trimester of any pregnancy. In South Carolina, regulations mandate similarly irrelevant aspects of a clinic’s physical plant, down to the types of faucets to be installed in sinks. The Kansas TRAP regulations were temporarily enjoined by a federal court in a suit brought by CRR and the American Civil Liberties Union.

These actions are separate from and go far beyond the normal regulation of health clinics–licensing of physical plant and providers, standards for cleanliness, operational standards for equipment used–under which abortion clinics and other clinics performing procedures with similarly low levels of risk must already comply.

While TRAP laws are ostensibly put in place to “protect women” or “protect patient safety,” these terms are simply the Orwellian equivalent of a bait and switch. Guttmacher Institute’s Nash notes that there is no credible research on the impact of these types of TRAP regulations on patient health or outcomes, and therefore no evidence that these improve either health or outcomes in any way. It is clear the vast majority of these laws are enacted simply to make create medically-unnecessary obstacles that anti-choice lawmakers hope will be prove too great for providers to overcome, and in turn make it more difficult for women to obtain early abortions by making clinics providing them more scarce.  It is a nakedly obvious strategy to reduce access through harassment using the excuse of protecting health. In fact, the risks to women’s health are far higher if they are forced by lack of access to seek abortions later in their pregnancies.

Contrast Virginia with the states of Delaware and Maryland, which in fact have or are considering laws regulating abortion clinics truly focused on patient safety, according to Nash. In these states, for example, laws actually do focus on protecting patient health and providing a safe and clean environment by writing regulations to ensure that the physical plant of a clinic is safe, functional, and sanitary without focusing on things like the size of patient lockers or the outcomes of operations not ever performed. In this way, Nash notes, states can focus on safety by allowing for each clinic to be configured differently as long as they meet basic standards.

Though legal organizations working to protect the rights and health of women can’t predict what the regulations will contain and therefore are unable to comment on any legal strategy, women’s groups from across Virginia have sprung into action to protest efforts by the McDonnell administration to strip women of their rights. The Virginia Coalition to Protect Women’s Health formed in 2011 as a response to the attack on women’s health and safety prompted by Senate Bill 924. The goal of the coalition is to “protect and ensure access for all women in all regions of Virginia to safe first-trimester abortion and comprehensive reproductive health care services,” and to oppose “excessive, burdensome or unneeded regulations that undermine patient access to medical care for political or ideological purposes.”  The Coalition is expecting to collect at least 10,000 signatures to deliver to the Board of Health before the September hearing, and is requesting support from women in the state in this effort.

 

Women’s Reproductive Rights Under Threat in Colombia

10:32 am in Uncategorized by RH Reality Check

Written by Hanna Hindstrom 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 The Women’s News Network (WNN).

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At 11 years of age, Nina was raped by her stepfather. Traumatized and pregnant, she sought an abortion. But every doctor she met claimed conscientious objection and refused. She was forced to travel 35 miles to another city, where she eventually tracked down an obstetrician willing to help.

She was one of the lucky ones.

Despite a landmark ruling five years ago – when Colombia’s Constitutional Court decriminalized abortion in cases of rape, fetal abnormality or to save the mother’s life – less than 0.5 percent of procedures are carried out legally each year. Many doctors simply turn girls like Nina away.

There is endemic confusion about the status of the law, especially the rules for conscientious objection, coupled with a widespread reluctance to obey it. Unsafe abortion remains the third leading cause of maternal deaths in a country where, according to government figures, over 300,000 take place each year.

Upon its inception the law has been the target of an aggressive anti-choice campaign, led by conservative political forces and supported by the Catholic Church. These forces are now threatening to unravel the little progress made.

Since coming into office in 2009, the Procurador-General, Alejandro Ordonez – the official appointed to protect the constitution and promote human rights – has led a vociferous campaign to dismantle the legislation. Read the rest of this entry →

International Human Rights Court Says Governments Must Ensure Timely Access to Maternal Health Services

9:22 am in Uncategorized by RH Reality Check

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

In 2002, Alyne da Silva Pimentel, a 28-year-old Afro-Brazilian woman, died after being denied basic medical care to address complications in her pregnancy. Her death might be like any one of the other hundreds of thousands of women who die of complications of pregnancy or unsafe abortion each year worldwide, but for one thing: It was taken to court.

Maternal mortality in Brazil is high, especially for a country of its relative wealth and level of development. It is even higher among women who, like Alyne, are of Afro-descent, indigenous, and/or low-income. Alyne died of complications resulting from pregnancy after her local health center mis-diagnosed her symptoms and delayed the emergency care she needed to live.

On November 30, 2007, the Center for Reproductive Rights, with Brazilian partner Advocaci, filed Alyne da Silva Pimentel v. Brazil, brought the first ever maternal mortality case before the UN’s Committee on the Elimination of Discrimination Against Women (CEDAW). The Center’s petition argued that Brazil’s government violated Alyne’s rights to life, health, and legal redress, all of which are guaranteed both by Brazil’s constitution and international human rights treaties, including CEDAW. 

“Alyne’s story epitomizes Brazil’s violation of women’s human rights and failure to prevent women from dying of causes that, by the government’s own admission, are avoidable,” said Lilian Sepúlveda, the Center’s Legal Adviser for Latin America and the Caribbean. “We filed this case to demand that Brazil make the necessary reforms to its public health system—and save thousands of women’s lives.”

In its brief, the Center asked the Committee to require Brazil to compensate Alyne da Silva Pimentel’s surviving family, including her 9-year-old daughter, and make the reduction of maternal mortality a high priority, including by training providers, establishing and enforcing protocols, and improving care in vulnerable communities.

This week, the case was decided in a historic decision by CEDAW, establishing that governments have a human rights obligation to guarantee that all women in their countries—regardless of income or racial background—have access to timely, non-discriminatory, and appropriate maternal health services.

“Sadly,” said a statement from CRR, “Alyne’s story is one of thousands in Brazil, and all around the world, in which women are denied, and in some cases refused, basic quality medical care to address common pregnancy complications. And the countless lives lost unnecessarily as a result mean that today’s victory can only be regarded as bittersweet.”

Nonetheless, continued the statement, “today marks the beginning of a new era. Governments can no longer disregard the fundamental rights of women like Alyne without strict accountability. And while nothing can reverse Alyne’s fate, today’s decision means that Alyne’s mother and daughter will finally see justice served—and women worldwide will benefit from the ruling issued in her name.”