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The Power of Pills: Putting Abortion Back in the Hands of Women Around the World

4:02 pm in Uncategorized by RH Reality Check

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

A collection of different pills

As governments force clinics out of business, pill-based abortions offer freedom of choice to women.

Unwanted pregnancies are a fact of life. Globally, nearly a fourth of all pregnancies are unplanned and 22 percent of pregnancies end in abortion. Women experience unwanted pregnancies because they have forced sex, (worldwide, one in three women are survivors of sexual violence), they don’t have access to contraceptives, or they simply didn’t plan on becoming pregnant.

Women who have unwanted pregnancies should be respected and their rights to choice upheld. However, in many countries, government policies, and societal practices do not uphold women’s right not to continue a pregnancy and women with unwanted pregnancies are forced into motherhood. Certainly this is evident in the United States; just before the new year, the governor of Virginia quietly signed legislation designed to close abortion clinics in the state. These laws are punitive, restricting women’s reproductive autonomy and freedom and creating categories of who can and can’t obtain abortions.

Fortunately for women, pills have changed the landscape of abortion. Abortion with pills, also known as medical abortion (MA), provides a safe, low-cost and easy to use method to terminate pregnancies. In addition to being safe and effective, medical abortion has changed the dynamics of who can provide abortions, where women get them, and who has control over the process. Evidence shows that those closest to women — community health workers and midwives — and women themselves can be trained to use abortion pills to safely terminate a pregnancy, thus giving women back the control of their own bodies. In fact, it was women in Brazil who first discovered the potential of misoprostol (cytotec) to safely end an unwanted pregnancy and who shared this knowledge through their social networks.

In order for women to benefit from the potential of medical abortion, however, they must be active participants in decisions related to where drugs are distributed and for what cost, what information is shared and by whom, and what social and medical support is needed.

Last month, Ipas hosted a meeting — “In Women’s Hands: Increasing Access to Medical Abortion Drugs and Information through Pharmacies and Drug Sellers” — in Nairobi, Kenya, that brought together 66 participants from 11 countries to discuss these important issues. Participants included a Kenyan hotline program manager, president of the Ugandan Midwives Association, several pharmacy managers from South Africa, and a Nepali senior public health officer in the Ministry of Health and Population, to name a few. The broad swath of countries and professionals represented illustrates commitment to a movement — to give women control of their reproductive lives, particularly through abortion with pills. In different countries, women, advocates and providers have developed innovative strategies to meet this goal.

In Tanzania, the Women’s Promotion Centre founded its own small pharmacy in a rural community as an alternative model for supporting women’s access to safe motherhood and abortion. This effort was born out of the “fire of anger about unnecessary deaths and suffering of women and… passion to save mothers’ lives in Kigoma,” said Martha Jerome of the Centre. Because no pharmacies were selling the lifesaving drug misoprostol, they founded a pharmacy to provide the drug themselves. They trained staff to provide counseling and support and they formed an alliance with like-minded doctors to help women with any complications. They also supply contraceptives as well as other medicines. The competition that resulted from their lower prices has driven down the cost from other private drug sellers, making these medicines more affordable for women who need them.

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Does She Really Support Reproductive Rights? Mixed Messages from Brazil’s First Female President

11:51 am in Uncategorized by RH Reality Check

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

At the recent Rio+20 summit, Brazilian President Dilma Rousseff  joined with other women heads of state in signing a “call to action” in support of the right of women to sexual and reproductive health. It was a true “photo-op” moment generating plenty of international headlines for Rousseff, Brazil’s first female president, and the other high-profile leaders.

But for those of us actively working for women’s reproductive health rights in Brazil, it was more of an “Oh, really?” moment.

Because we could see what probably was coming. Despite her backing of the call to action, Rousseff ended up signing onto the final document produced at Rio+20 — a compromise plan that made no mention at all of women’s reproductive rights and that has since been roundly criticized for selling out not only women but Mother Earth herself.

Only a few months ago, Rousseff used her presidential power to enact a controversial measure establishing a national pregnancy registry in Brazil. Far from increasing women’s reproductive rights, the registry posed a genuine threat to those rights.

Fortunately, in response to an intense campaign by feminist and reproductive rights advocates, Brazil’s national lawmakers decided to let the registry law die for lack of congressional approval, thereby showing a true commitment to women’s human rights.

The controversial law, Provisional Measure 557, had been enacted by Rousseff last December, when the country was focused more on the holidays than on politics. Provisionary measures such as PM 557 are a way for Brazilian presidents to enact laws without congressional authorization and are intended for urgent matters.

On the surface, PM 557 did seem to address an undeniably urgent matter, that of Brazil’s high maternal mortality rate. It required all pregnant women to register their pregnancies with the state, ostensibly to ensure better access to quality maternal care.

But the reality would have been far more complicated. A national registry of pregnant women — which one critic rightly termed “Kafkaesque” — would have allowed the government to monitor and control women’s reproductive choices. Even after a provision on the rights of the unborn had been withdrawn, the legislation continued to disregard women’s human rights, such as the right to privacy and confidentiality of health information. It still raised many concerns. Once a woman registered her pregnancy, would she have been legally obligated to have the child? What about pregnancies ending in miscarriage or an abortion? Would women have faced legal consequences? If the pregnancy endangered a woman’s life or was the result of rape, would women get information on where to get legally permitted abortions?

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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.”

Dirty Campaigning, Brazilian Style

6:49 am in Uncategorized by RH Reality Check

Written by Gillian Kane for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

“Murderer,” “anti-Christ,” “candidate of death.” No, this isn’t Sharron Angle talking about Harry Reid in advance of tomorrow’s election. This was the combative rhetoric framing the lead up to Sunday’s run-off election in Brazil. The 2010 presidential elections marked the first time abortion became a highly debated campaign issue and it followed a fairly American script, replete with allegations against front runner, Dilma Rousseff, that she was a lesbian, a child-killer, a socialist. The tactic didn’t pay off: Rousseff won a resounding victory last night with 56 percent of the vote to become Brazil’s first female president.

It is remarkable that the Catholic Church and its right wing allies succeeded to the extent they did in making abortion a wedge issue because both presidential candidates, Rousseff and her opponent, José Serra, the former governor of Sao Paulo state, are hardly pro-choice—at at least in the way we Americans define pro-choice. Neither advocates for legalizing abortion, neither campaigned on a pro-choice platform, and neither has aligned with the activist Brazilian pro-choice movement.

Abortion is illegal in Brazil, though permissible for two exceptions; rape and risk to life of the pregnant woman. The Brazilian feminist movement, active now for almost 30 years, has made significant progress in the face of unrelenting opposition to legal abortion reform. Gains, however, are measured not in legislative change—there are few political champions within the National Congress—but rather in creating broad awareness about unsafe abortion as a public health issue, ensuring that legal abortions are available, developing a grassroots movement to support legalizing abortion and preventing any regression on existing legislation.

The extraordinary visibility of abortion in this campaign season attests, in part, to the work of the anti-choice opposition. Read more