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Disability, Prenatal Testing and the Case for a Moral, Compassionate Abortion

11:18 am in Uncategorized by RH Reality Check

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

by Sierra @No Longer Quivering

Note: If the headline didn’t already clue you in, this is controversial subject matter. If you come away from this article thinking that I advocate genocide of a disabled population or the coercion of women pregnant with disabled fetuses into abortion, that I hate disabled people or think that Down syndrome people don’t deserve to live, you have failed to understand my point. Please walk away from the computer, breathe deeply, and start again from the beginning.

I believe that it is possible and desirable to respect disabled people while still working to eliminate genetic disorders so that children who might have had Down syndrome or cystic fibrosis (or any other disease) have a chance to be born without them. I believe that abortion of a disabled fetus can be a compassionate choice made for morally sound reasons, and does not at all conflict with the respect due to disabled people. I am firmly pro-choice, and I believe strongly that the wellbeing of all born persons in a family is paramount before considering the needs of a fetus. My position is that fetuses are incapable of being self-aware and therefore cannot experience suffering the way born persons do. The prevention of suffering is central to my moral beliefs.

If you’re already angry, please stop reading and go get yourself a nice cappuccino. Have a beautiful day. And then, if you still really want to read this, take frequent breaks to punch a pillow with a "hello, my name is Sierra" badge stuck to it.

Her.meneutics, the "for women" arm of Christianity Today, recently ran an article by Sarah Eekhoff Zylstra on prenatal testing:

What You Need to Know About the Hidden Benefits (and Costs) of New Prenatal Tests

Apparently, science can do something awesome: tell you the genome of your fetus within the second trimester:

Using a blood sample from the mother and saliva from the father, scientists at the University of Washington mapped out the entire genome of a child while he was in the womb. The discovery, which was published June 6 in Science Translational Medicine, makes it possible to spot disorders from sickle cell disease to cystic fibrosis to Down syndrome in the second trimester of pregnancy.

Best of all, at least for those of us who shiver at the thought of an amniocentesis, is that it’s noninvasive.

About 10 percent of the free-floating in a mother’s blood belongs to her baby, and by comparing her blood with her own and the father’s DNA, scientists can pinpoint which DNA belongs to the baby. From there, they can sequence the child’s entire DNA code. Or at least, they can get pretty close. Their accuracy rate was about 98 percent in the infant boy they tested.

Zylstra says that, "at first blush," this information looks "incredible." Yes, it does. Because it is. This kind of technology gives us more control over our own reproduction, which means that we’re better able to make ethical decisions about our parenting. As Zylstra points out, parents who are expecting a special needs child can prepare in advance for what that means.

But there’s a catch, says Zylstra:

You can be emotionally prepared for his birth. You could choose a C-section if that was warranted, or line up services for him, or join a support group.Or abort him.That’s the rub, said Gene Rudd, president of the Christian Medical and Dental Associations.

It’s hard to imagine this test wouldn’t be the instigation of selective abortions, since many women with prenatal diagnoses of Down syndrome currently abort, he said. "It’s search and destroy that we do that now with Downs," he said. "And to what benefit do we do that? If we look at the statistics or surveys that come from families that have raised a Downs individual, 97 percent said it was rewarding."

It’s a life worth living, and many see that, says Amy Julia Becker, who has written extensively about her daughter with Down syndrome. Heart conditions and respiratory troubles often suffered by those with Down syndrome can be treated, life expectancy has risen from 25 to 60, and by all accounts, raising a son or daughter with Down syndrome can be a wonderful gift. The numbers are tricky, but Becker says that about 70 percent of babies prenatally diagnosed with Down syndrome are aborted.

"Ultimately, the problem is that we have a society that says it’s okay to kill unborn babies," Rudd told me. "If that weren’t permissible, this information wouldn’t be misused." Prenatal testing in a country with legal abortion lets parents decide if that child is "good enough" to live, he said. But as imperfect, capricious, sinful beings, how do we figure we’re smart enough, or good enough, to judge anybody else’s shot at life?

"Who are we to say that cystic fibrosis is such an overwhelmingly terrible disease that they shouldn’t be allowed to live?" Rudd said. "Do we say that about a one-year-old who is diagnosed? What’s different about a younger child?"

There are a lot of pieces to this pie, so I’m going to address them problem-by-problem. Ready? Here we go. This article:

  1. Fetishizes disability.
  2. Dehumanizes children.
  3. Downplays economic concerns and long-term viability.
  4. Minimizes the suffering of children and caregivers.
  5. Is logically inconsistent.
  6. Conflates fetuses with born children, and therefore
  7. Devalues labor, delivery and motherhood.
Before we go any farther, here is my main point:
 
Having an abortion to prevent a child from being born with Down syndrome or another disability can be a positive moral choice. Okay, now let’s go on (assuming you’re not already plotting my demise).
 
1. Fetishizing disability
 
The disability rights movement is hugely important and I support it. It’s especially vital for individuals with mental illnesses, who are often judged as "not really disabled" because there’s nothing visibly wrong with them. Disabled people have a long history of being medically abused, used as test subjects without consent, being abandoned or forced to live in squalor, and being generally reviled, disrespected and treated like freaks. We need a movement to rectify that and prevent it from ever happening again. I’m glad we have one.
 
Now. Here’s where I depart from Zylstra and other activists.
 

Respecting the rights of disabled people does not mean honoring or celebrating disability itself. Apart from the perspective and political activism that many disabled people have found via their experiences as a discriminated-against class, I’d wager most people who are disabled would rather not be. Just like poor people value their wisdom but would really rather not be poor. I’ve been a poor kid. I’m still pretty poor. I’ve learned a hell of a lot about empathy from being poor. But would I choose to be poor? No. Would I want others to be poor kids? No. Would I jump at the chance to end poverty once and for all? Yes! I want people to listen to what I’ve learned, but I don’t want them all to have to learn it the hard way, like I did. I would wager that at least some disabled people feel the same.

When you argue that children with Down syndrome are "special gifts" or that raising them is a "rewarding experience" for parents, you are appropriating their difficulties and fetishizing their difference. That is the opposite of respecting a disabled person. I get that who we are is shaped by experience and that many disabled people consider disability to be integral to their personalities — just as I see poverty as a formative experience for me — but I doubt they would have chosen to be disabled in the first place. Would they have voluntarily given up able bodies for the wisdom earned from being disabled? Would they refuse treatment, if it were available? Would they choose to suffer disabilities just so that their parents could have the "reward" and "special gift" of raising them?

Amy Julia Becker of Thin Places writes:

I hate the thought that there will be fewer people with Down syndrome in the world as a result of advances in prenatal testing. As I’ve written before, it impoverishes us all when we selectively abort babies based upon particular characteristics (gender, for instance, in China and India… disabilities here in America).

I understand this argument. I do. I get how parents of Downs children learn from their experiences and love their children fiercely and imagine how empty and cold the world would be without children like theirs. But this line of reasoning makes me profoundly uncomfortable. By all means, love your child! By all means, share your hard-earned wisdom! But to wish for Down syndrome to never go away? to never be cured? Why would you wish that?

I can’t help but think that it’s not about the children’s quality of life (wouldn’t you choose a life for your child that didn’t include Downs, if you could?) but about the parents’ inability to distinguish between their love for their kids and the condition from which their kids suffer. By all means, celebrate your child and his or her wonderful uniqueness! (I say this without irony.) But don’t reduce your child to the mere fact of having Downs, as though having Downs makes them a kind of endangered species and that Down syndrome must continue forever because kids like yours would never exist again without it. Your child would be special, you would have that bond, with or without Downs.

Wanting to eradicate a condition that causes suffering or dependence in a population is not the same as wanting that population to die. Imagine for a moment that we’re not talking about abortion. If it were possible to "cure" Down syndrome prenatally, preserving the same fetus, would you deny your child the treatment because you’d hate to see fewer Down syndrome children in the world?

Which brings me to #2.

2. Dehumanizing children

Focusing on the "rewards" to parents of raising a special needs child means privileging parents’ personal growth over the best interests of their potential child.  If parents choose to bring into this world a child that cannot be reasonably expected to care for himself as an adult, they are gambling with their child’s future. Who will care for him or her when the parents are gone? Do they have the resources to provide for their child’s medical needs? Do they have other children who would be neglected because of their parents’ intense focus on caring for the special needs child?

Now, I understand that many, many Downs people are able to function in the world without immediate care, but others can’t. I think it’s awfully brazen and selfish not to consider one’s potential child’s quality of life for the entire duration of that child’s life before deciding what to do. I think it’s necessary to ask tough questions of yourself, to honestly answer the question of whether or not you can provide that child with everything he or she will need for life.

Special needs children aren’t high-maintenance pets that exist to teach you lessons about fortitude and compassion. They are people. And it’s because a special needs fetus will become a person at birth that abortion should be on the table. Responsible, moral reproductive choices involve doing the hard math and yes, making decisions to either give your child the best possible long, independent life or to terminate the pregnancy early if you know you can’t.

Clinging to a soundbyte belief system that makes your decisions for you ("Abortion is murder!") or abdicating responsibility ("God will provide as long as I don’t get an abortion!") means shirking your fundamental duty as a parent: to make decisions with your child’s best interests at heart until your child can do so herself. That responsibility may lead you to give birth to and raise a disabled child — and more power to you! — as long as you’re doing it with your eyes open and taking every possible precaution to make sure you can deliver on the promise of care you are making your newborn child. But it may also mean having an abortion.

It intrigues me that religious people, the ones who are the first to point out the flaws and fallen nature of the world, are the last to acknowledge the result: that horrible things happen, and those situations require hard decisions. Birth defects and excruciating diseases happen. To refuse to act to minimize suffering (indeed, to prevent it) is at best selfish and at worst abusive. To pretend that there is always a perfect answer to a problem in this imperfect world is to effectively close your eyes and live in your own imagination.

3. Classism

Not every family can afford the medical care of a special needs child. Not every family can afford the time spent caring for a special needs child, especially if they already have multiple children. To demand that families that know they lack these resources nonetheless give up everything to bring a child into a world where it will be neglected, inadequately treated by doctors, and in all likelihood end up in foster care or, as an adult, homeless, is cruelly insane. To focus on mere "life" to the exclusion of the quality thereof is not just stupid, it’s evil. It is deliberately inflicting suffering on others to soothe your own conscience.

And in case you’re wondering, the cost of a lifetime of care for a Down syndrome child has been recently estimated at 2.9 million dollars.

(Though, given that the estimate was made in the context of a lawsuit, it’s probably a little on the high side.)

4. Minimizing the Needs of Others

Parents and caregivers are people, too. They do not forfeit their own needs when they have children; indeed, doing so is actually harmful to children. Recall the many times I’ve said that having a stay-at-home mother made me feel hopeless and guilty about becoming a woman. I was put in the impossible position of either following in her footsteps, thereby ensuring that every female in our line would do nothing but sacrifice for her children and never get to have her own dreams, or not following in her footsteps and feeling guilty that I was (a) rejecting her by rejecting her lifestyle and (b) doing my own potential children some kind of injustice, even though I didn’t want my children facing the quandary I was! I wished my mother had more of a life outside of raising me, because then I would be freer to have a life, too.

If parents choose to welcome a special needs child into their family, they must consider how it will affect not only that child, but also themselves and their other children. They must make room for breaks and self-care to preserve their own health, mental and physical. In my own church, there was a woman with two children who got pregnant and found out her child had a fatal defect. She decided against having an abortion, believing that God would honor her and heal her child (or at least provide for it). The child lived 13 years in unspeakable pain, without cognition, undergoing surgery after surgery until she died — and by this time the family had exhausted its resources, the other two children had been practically abandoned. The mother had worked herself to the bone, endured a failed promise from God, and had to mourn the child all over again at the end of it all. That child was not a "blessing." It was not a "rewarding" experience — though the mother might tell you so out of sheer love and the need to justify her situation. The child’s birth destroyed her family, and she was never even aware enough of her own existence to realize she was loved. How is that the hand of God?

5. Logical Inconsistency

First, we get the argument that raising a special needs child is a blessing:

[Says Rudd:] "If we look at the statistics or surveys that come from families that have raised a Downs individual, 97 percent said it was rewarding."

That is abhorrent abuse of statistics. First, your entire sample (people who have chosen not to abort) is already biased toward the belief that what they’re doing is rewarding. Where are the surveys for women who chose to abort Downs fetuses? You’re comparing this 97 percent to an empty page. They might say that their abortion was a blessing, but you can’t print that, can you? Not on a Christian blog.

Second, the parenting discourse in Western culture is so punitive that parents of "typical" children aren’t even free to express that they dislike the drudgery of parenting without being accused of being sociopaths and hating their kids. That’s why such statements as "I hate being a mom" show up anonymously on Secret Confessions and have been called the Greatest American Taboo. How much more pressure is there on parents of special needs kids never to admit that they wish they weren’t?

Then, we get this:

"Who are we to say that cystic fibrosis is such an overwhelmingly terrible disease that they shouldn’t be allowed to live?" Rudd said. "Do we say that about a one-year-old who is diagnosed? What’s different about a younger child?"

Little is different about a younger child. Everything is different about a fetus. A fetus does not have cognition. A fetus lives inside a woman’s body. A fetus has never drawn a breath. A fetus has not lived a life to miss. Those are significant differences.

Also, when did we go from talking about the relative independence of some Downs individuals to the horrible suffering inflicted by cystic fibrosis? Read this description and see if you think it’s an apt comparison: 

Cystic fibrosis is a disease passed down through families that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of the most common chronic lung diseases in children and young adults. It is a life-threatening disorder. Lung disease eventually worsens to the point where the person is disabled. Today, the average life span for people with CF who live to adulthood is approximately 37 years, a dramatic increase over the last three decades. Death is usually caused by lung complications.

Would you utter a sentence like this?: I hate the thought that there will be fewer people with cystic fibrosis in the world as a result of advances in prenatal testing. Would you tell parents how "rewarding" it is to raise a child with cystic fibrosis? Who are we to say that the disease is overwhelmingly terrible? Rudd asks. Well, here’s who we are: Caring parents. Compassionate, educated doctors. People who don’t want to inflict unnecessary suffering by bringing a not-yet-conscious fetus into the world to experience a waking nightmare and die, choking or suffocating, at half the normal life expectancy. That’s who.

There’s also the little problem that the article jumps back and forth between arguing about the intrinsic worth of life and the rewards of being a caregiver. These two competing perspectives make the argument hard to follow.

6 + 7. Erasing Motherhood

It’s a common trope of the pro-life movement that "a moment before birth" a fetus is a baby, and therefore abortion is the same as infanticide. This is not only scientifically inaccurate, it’s misogynistic. It erases the woman, her wellbeing, and her labor from the entire equation. Childbirth is momentous. It matters. It is not just a legal flagpole where personhood is arbitrarily assigned. It is the moment at which a child begins to occupy the world as an independent being.

It is also a moment made possible by the bodily work (pain, sweat, blood and tears) of a woman. If we grew children in plastic incubators with green fluid and Classical music playing gently in the background, then the "moment before birth" comparison might be apt. But it isn’t, because children live in their own bodies, and fetuses live in their mothers’. While that fetus is in its mother’s body, she does have sovereignty over the decision whether or not to bring the child into the world. That is her sacred right as a mother. It is her sacred right as a woman not to have her body violated against her will — be it by another adult, a child or a fetus. Alone, a fetus cannot be brought into the world to become a baby. Therefore, you can’t talk about a fetus as though it exists without regard for the woman upon whom its existence depends. To alienate the pregnant woman from a discussion about pregnancy is like having a conversation about the weather on an asteroid.

Zylstra concludes her article:

It’s not that the test is bad. To be able to map a child’s DNA while they’re still in the womb is fascinating. But so is the fact that many mothers believe that it would be worse to live in an imperfect body than not to live at all.

There’s a huge problem here. Cystic fibrosis is a serious disease. Downs syndrome can be serious. Genetic diseases can leave children’s independence stalled, their mobility hampered, their bodies aching, their minds wracked with torturous bouts of depression and anger, their futures uncertain and their families stressed to the breaking point. This isn’t about perfect and imperfect bodies. This is not the difference between passing on genes correlated with overweight and comparing your potential child to fitness models. The perfect/imperfect body dichotomy is a red herring. No body is perfect. It’s disingenuous and manipulative to assert that having a serious genetic disorder is equivalent to having a few pimples and a crooked nose.

If I somehow (metaphysics be damned!) had a choice to be born in a body that would slowly disintegrate on me, like that of Stephen Hawking, or not to be born at all, I’d pick the latter. This does not mean that I think Stephen Hawking shouldn’t be alive. He is a great scientist. He has done marvelous things with his life. But that does not make the pain and horror of his situation any less. If I could prevent my own child from being born into a life like that, I would. I consider it my moral imperative. And if Stephen Hawking and I were hanging out in the metaphysical waiting room before descending to earth, and he told me he didn’t want to be born into all that suffering, it would be unfathomably selfish of me to demand that he endure what he has endured just so that I (and other healthful people) could benefit from his mind.

My Points:

If you made it this far, congratulations. Here’s the rundown:

  1. Respect disabled people for their personhood, but don’t promote the continued existence of disabilities. That doesn’t do anyone any favors.
  2. Don’t treat disabled children as special projects to improve their parents’ character.
  3. Don’t act like everybody can afford to live by your conscience.
  4. Don’t prioritize the wellbeing of a fetus over the entire family.
  5. Don’t force special needs children into families that don’t want them, and will abuse, neglect or abandon them. They have it hard enough in families that want them and have the resources to care for them.
  6. Don’t conflate serious disorders with minor imperfections to guilt parents into a choice to raise a child they don’t want to have.
  7. Don’t abuse statistics to lie about the satisfaction rate of parents with special needs children.
  8. Don’t minimize the labor of mothers or pretend that you can talk about fetuses without women.
It is possible to choose abortion based on a positive screening for genetic disorders because you are morally opposed to inflicting suffering on others. It is possible that women who abort fetuses with Down syndrome or more series disorders do it not because they hate Downs people or like genocide or are Selfish Career Bitches(TM), but because they honestly believe it’s what’s best for their families. The anti-abortion crowd is not the only one with a flagpole stuck in the moral high ground.
 
Now, finally, a thought experiment.


Why is it a "blessing" and a "rewarding" experience to raise a child with Down syndrome, but not one with Fetal Alcohol Syndrome? If there’s something inherently valuable about disabilities themselves that improves the lives of people who have them and whose loved ones have them, why does the origin of the disability make such a difference? Why is taking every precaution to avoid FAS, to the point of making pregnant women neurotic, a worthwhile societal goal? Why does no one hate to imagine a world in which there are no children with FAS?

I suspect the answer has something to do with control. Because if you can control an outcome (or at least think you can), people will be justified in blaming you for an adverse outcome. But if you can’t prevent suffering (or think you can’t), your reputation remains untarnished. If you see suffering in your future and evade it, those who are suffering will attack you for your selfishness and arrogance. ("How dare you have it so easy?") But is that feeling of moral superiority actually moral superiority? I don’t think so. It sounds more like a cry of pain at the unfairness of the world — which is something we should be trying to fix, not perpetuate.

Sierra is a PhD student living in the Midwest. She was raised in a "Message of the Hour" congregation that followed the ministry of William Branham. She left the Message in 2006 and is the author of the blog The Phoenix and the Olive Branch.

Michele vs. Michelle: Breastfeeding Wars Rise to the Top

8:14 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

You may have taken a break from the news about Wisconsin, Egypt and the budget battles to read about the fabricated “debate” over breastfeeding supplies. I write “fabricated” because Rep. Michele Bachmann has created an argument over First Lady Michelle Obama’s decision to support tax breaks for breast pumps for mothers. From Politico:

Minnesota Rep. Michele Bachmann ripped Michelle Obama on Tuesday, speculating that the first lady might one day run for office, and accusing her of trying to implement a “nanny state” based on her newest push to get mothers to breastfeed their children in order to help combat childhood obesity.

Bachmann wrongly states, on last Tuesday’s Laura Ingraham radio program, that the federal government would be paying for breast pumps and related supplies for mothers who need to pump, either because they are working (and, by the way, pay their own taxes) or because they are home with their babies, maybe on maternity leave (if they are lucky enough to get family leave), and have decided that breastfeeding is the best option for them and their babies. But Bachmann continues to spew misinformation and rhetoric in place of truth,

Bachmann continued, “…To think that government has to go out and buy my breast pump for my babies. You wanna talk about the nanny state? I think we just got the new definition of a nanny.”

After all, tax deductions for acne cream and denture adhesive are allowable but since those aren’t politically expedient, I suppose Bachmann is less concerned. Read more

Addressing Obstetric Fistula: Towards a Just and Healthy Life for All

8:56 am in Uncategorized by RH Reality Check

Written by Kelly Castagnaro for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

This article is part of a series by RH Reality Check in collaboration with EngenderHealth, Guttmacher Institute, the International Women’s Health Coalition, the Fistula Foundation, the United Nations Population Fund (UNFPA), and the Campaign to End Fistula.  All articles in this series can be found at this link.

The series is being published during a time of renewed efforts by advocates and the public health community to increase U.S. international support for efforts to address obstetric fistula, a wholly preventable but debilitating and sometimes deadly condition caused most immediately by prolonged labor and too early or too frequent childbearing, but generally rooted in lack of access to health care and discrimination against women.  Fistula affects the lives of individual women, their children and families, and also grossly undermines women’s economic productivity and participation in society. The global public health community has called for comprehensive strategies both to prevent new cases and treat existing cases of fistula.  Congresswoman Carolyn Maloney (D-NY) will soon introduce legislation intended to support a comprehensive U.S. approach to fistula as part of a broader commitment to reducing maternal mortality and morbidity worldwide.

It has been said that in an unequal world, women are the most unequal among equals.  Obstetric fistula—a condition driven by a range of inequities in access to basic health services, nutrition, education and other basic elements— is a living example of this statement.

Obstetric fistula is a tear or hole in the birth canal through to the urinary tract and/or rectum and caused by obstructed labor; left untreated, women become incontinent and may uncontrollably leak urine and feces.  With more than two million women living with obstetric fistula and between 50,000 to 100,000 new cases each year, we must do more collectively to prevent and treat this condition.

This requires a focus on the human rights dimensions of public health problems. 

Whether by choice, persuasion or coercion, many girls in the developing world have had sex before their 15th birthdays, often without adequate information or protection from unintended pregnancy or sexually transmitted infections (STIs), including HIV. For example, an estimated 60 million women between the ages of 20 and 24 in developing countries were married before 18.  The Population Council estimates that this number will increase by 100 million over the next decade if current trends continue.

For girls, sexual initiation is more likely to occur in the context of sexual violence and forced marriage, both of which place them at high risk of pregnancy, and STIs, including  HIV.  In Ethiopia, for example, nearly 70 percent of young married girls are forced to have sex before they have begun to menstruate. Because their bodies are not fully developed and ready to bear children, these young girls are at high risk for injury and death during pregnancy and childbirth. In fact, complications from pregnancy and childbirth are the leading causes of death among girls between the ages of 15 and19 in the developing world.

Read more

Home Birth “Common Ground”?

8:59 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

It may be less well-known than the effort to find common ground between the pro-choice and anti-choice movements but it’s no less controversial, it seems.

The growing childbirth advocacy movement has highlighted the divide between those who would like to see expanded access to safe, state-regulated out-of-hospital birth and midwifery for women and those who oppose access to these options.

However, a new effort, nearly three years in the making, to bridge the divide is underway. According to the American College of Nurse-Midwives, a Home Birth Consensus Summit is being convened in 2011 and will bring both camps to the table in an effort to find areas of agreement with the ultimate goal of improving maternity care for pregnant, birthing and postpartum women and their babies.

In a statement about the summit, ACNM notes that the meeting will be facilitated by “the Future Search Network, a nonprofit organization that is internationally known for brokering lasting agreements and shared initiatives in highly volatile and polarized settings, around issues related to poverty, health care access, regional and ethnic conflict, and education. Future Search meetings produce a “Common Ground Agenda,” which articulates a shared vision and direction.”

It’s likely not shocking that this issue is considered “highly volatile,”  if you’re a regular reader of RH Reality Check or have ever been a part of the maternity care system as patient or provider in this country. Despite a steady stream of peer-reviewed, published, scientific studies on the safety of planned home birth and the widespread use of midwives in other countries as credible maternity care providers, mainstream medical associations like the American Medical Association (AMA) and the American College of Obstetrics and Gynecologists (ACOG) are fiercely opposed to any home birth options – licensed and regulated or not. Whereas a host of public health associations, nurses groups, nurse-midwifery organizations, certified professional midwifery advocates and even many individual MDs are working hard, daily, to pass state laws legalizing home birth and certified professional midwifery.

Progress is happening, though. Read more

New Mother’s (False) Positive Drug Test Leads to Baby’s Removal…Poppy-Seed Bagel the Culprit

7:28 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

We all have nightmares from which we awaken, in the middle of the night, wiping our brows and silently thanking a deity of one sort or another that it was all just a dream.

But for some, as absurd as the events may seem, the nightmare is real. 

The ACLU of Pennsylvania filed a federal lawsuit today on behalf of a couple, Elizabeth Mort and Alex Rodriguez, who experienced such a nightmare.

In April of this year, Elizabeth Mort gave birth to a beautiful baby girl; her first child. The baby’s name is Isabella. The threesome (Mort, Rodriguez and Isabella) returned home on April 29th, 2010, from Jameson Hospital where Isabella was born, ready to settle into life as a family. One day later baby Isabella was taken from her parents by Lawrence County Child and Youth Services (LCCYS) and held for five days at an undisclosed location, because Mort had failed a drug test given to her while in the hospital.

Only, she wasn’t on drugs. Not even close.

Mort had eaten a poppy-seed bagel from Dunkin’ Donuts two hours prior to checking into the hospital before giving birth. The drug test picked up on the poppy seeds and came out positive. The agency, with two police officers present, acting on the information from the hospital-administered drug test, took Isabella from her parents. Read more

Advocates Push ACOG to Remove Barriers to VBACs

7:05 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Birth activists including providers have waged a long fight against barriers to VBACs (Vaginal Birth After Cesarean). For too long, they say, women who have had a prior c-sections and would like to attempt a vaginal birth for subsequent pregnancies, have had inadequate access to at least attempting a trial-of-labor. The reasons for the lack of access? Well, it depends upon who you ask.

Ask many hospital adminstrators and ob-gyns and they’d say there’s a risk of uterine rupture (which is true), and that recommended hospital policy, via organizations like the American College of Obstetricians and Gyneocologists (ACOG), has made allowing for women’s access to VBACs extremely challenging. Many hospitals have enacted bans on VBACs. State legislators have even jumped into the fold, attempting to ban VBACs in birth centers and elsewhere.

On the other hand, the recently held National Institue of Health consensus conference on VBACs, led by a panel of maternity care experts concluded that,

“…a trial of labor is a reasonable option for many women with a prior cesarean delivery. They [the panel] also urged that current VBAC guidelines be revisited, malpractice concerns be addressed, and additional research undertaken to better understand the medical and non-medical factors that influence decision making for women with previous cesarean deliveries.”

As well, the panel chair, Dr. F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwester Medical Center said, of the findings, “The use or employment of VBAC is certainly a safe alternative for the majority of women who have had one prior c-section.”

Then, this summer, ACOG responded. Read more

The ‘State’ of Midwifery: Pushing for Legalization

6:36 am in Uncategorized by RH Reality Check

Written by Rebecca A. Spence for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

This post is one in a series of pieces RH Reality Check is publishing to highlight National Midwifery Week 2010 (Oct 3- 9).

Women want out-of-hospital maternity care, and they deserve legal access to midwives trained to provide it. In 23 states, Washington D.C., Puerto Rico, and Guam, Certified Professional Midwives (CPMs) face prosecution for serving women who have decided not to give birth in a hospital. Families in these states are forced into an underground economy of providers whose training and credentials could be difficult to ascertain, and are left without any means to report a practitioner who lacks adequate skills. If they do opt to hire a midwife who is practicing illegally, smooth and efficient transfer to a higher level of care can be compromised in the event that it becomes necessary, putting mothers and babies at risk. That’s why more and more states, pushed by consumers and their allies who are part of The Big Push for Midwives Campaign, are passing legislation to license CPMs.

No federal law, Supreme Court decision, or Constitutional amendment can ensure that we have access to the maternity provider of our choice, because licensing and regulation of health professionals occurs at the state level. The Big Push for Midwives engages with consumers in state-by-state efforts to secure a path to legalization and integration of Certified Professional Midwives. Advocates have been on the ground doing this work for years, and are gradually achieving success. Groups like the Alabama Birth Coalition, Ohio Families for Safe Birth, North Carolina Friends of Midwives, the Coalition for Illinois Midwifery, and Massachusetts Friends of Midwives, and others, are tireless grassroots organizers for women and families who chose to give birth outside of the hospital.

Like other movements for social and reproductive justice, securing safe access to choice in childbirth demands solidarity from individuals and organizations not traditionally thought of as allies of midwives and out-of-hospital birth. The mainstream reproductive justice and women’s rights movements must actively stand by women who are demanding our rights as citizens and as mothers.  Aggressive, well funded forces of organized medicine are determined to keep Certified Professional Midwives  underground, threatening women’s autonomy and the public’s health.  This includes the American Congress of Obstetricians and Gynecologists (ACOG), a self-proclaimed “advocate for quality health care for women,” and the American Medical Association (AMA), organizations that wield their reputations and considerable financial influence over state legislators to keep birth in the hospital and make women outlaws.

The medical journal The Lancet recently published an editorial that concluded “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” This is a familiar message to reproductive health activists: women don’t have the right to value our own lives when babies are involved. And, if the opinion of some doctor or judge about the wisdom of a particular woman’s choice for maternity care differs from her own, she may be forced to accept medical treatment that she doesn’t want or need.

Punitive attacks on women’s rights in birth are not the sole province of the medical establishment. Predictably, and tragically, paternalistic enforcement comes from many sources.  Child protective services in Illinois and Ohio have seized custody of the newborn babies of women who exercised their right to choose home birth with midwifery care — even though the babies born at home were perfectly healthy.  Families have lost custody of their children or faced CPS investigations simply because the mother gave birth at home with a midwife in a state where her legislators have failed to regulate and license Certified Professional Midwives.

Whether or not state legislatures respect the wishes of their constituents and vote to legalize CPMs, women will continue to choose home birth. So long as midwifery remains illegal in so many states, and even in our nation’s capital, these assaults on our rights will continue.  This is  why licensing and integrating CPMs, trained and experienced experts in out-of-hospital birth, makes sense for American women. Happy Midwifery Week, everyone. Won’t you join us?

Does Refusing a C-Section = Child Abuse?

7:06 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Is it willful ignorance? A lack of education? Or some sort of untouchable mysticism that surrounds that which we all share and though rarely speak of?

I’m talking about childbirth and the endless misunderstandings and misinformation that go along with birth – especially in this culture. From what women experience emotionally and physiologically during labor to what women’s legal and ethical rights look like during the same period, the impact of not only our ignorance about birth but our desire to control what we don’t know or don’t understand, serves no one.

Case in point.

The National Association for Pregnant Women (NAPW) recently acknowledged a victory in which they played a part related to a woman who had given birth three years ago and had her newborn swiftly whisked away by a child protective authority claiming child endangerment for refusing to "pre-authorize" a cesarean section. The victory came in the form of a court decision last week reversing a lower court’s decision to terminate the mother’s parental rights (Ms.M aka V.M.) and remove the baby from her custody at birth, because she didn’t consent to a c-section, even though it was never medically necessary. According to NAPW staff attorney Farah Diaz-Tello, the issue of whether refusal of a cesarean section can be fashioned as medical neglect of a child was essentially "put to bed" in an opinion by the Appellate Division last year. However, Judge Carchman, writing in this recent decision confirms that the refusal to consent to a c-section has "no place" in the proceedings, stating that the term "child/ren" does not extend to fetuses for the purposes of the abuse/neglect statute under which Ms. M’s parental rights were terminated.

According to NAPW,

Even though Ms. M delivered a healthy baby vaginally, and would have consented to a cesarean if it ever became necessary [emphasis added], this resulted in a child welfare investigation, the state’s decision to remove the child from her parent’s custody at birth, and termination of parental rights. In the decision published today (PDF), the Appellate Division reversed the lower court’s termination of Ms. M’s parental rights and ruled that the child protective authority had failed to meet its burden of showing that Ms. M was “unwilling or unable to eliminate the harm facing the child” and that “termination of parental rights will not do more harm than good.”

Ms. M entered St. Barnabas Hospital in New Jersey, in 2006, after experiencing contractions. She was immediately asked to sign consent forms for "the administration of intravenous fluids, antibiotics, oxygen, fetal heart rate monitoring, an episiotomy and an epidural anesthetic" but she refused to essentially pre-consent to "any other invasive treatment." Kathrine Jack, staff attorney with NAPW involved in the case from the beginning, told RH Reality Check,

"This occurred in a New Jersey hospital that has a 50 percent c-section rate. The hospital policy is that whenever a maternity patient comes in the door, they immediately are asked to pre-authorize any intervention. It’s standard practice and it’s not uncommon."

Jack’s colleague, Farah Diaz-Tello, a fellow NAPW attorney continued,

"A lot of hospitals have these. From a legal perspective, however, they are questionable. Can you have informed consent, pro-forma?"

It’s an excellent question and it’s precisely in a case like this where that idea gets tested. Can a woman exercise informed consent to a medical intervention during labor if the situation under which she may consent to the intervention hasn’t happened yet? This hospital has a c-section rate that is well above what the World Health Organization deems a safe c-section rate; if women are consenting to a c-section right off the bat (not to mention fetal heart-rate monitoring, antibiotics, episiotomies, and epidurals!) regardless of whether one is actually medically indicated, it’s certainly blurring the lines between what’s medically necessary and the power of suggestion from a medical "authority." Where does an individual’s right to make an informed choice begin and hospital legal policy end?

Ms. M had a history of psychiatric issues, having been on a range of medication including Zoloft and Prozac and in psychotherapy prior to her pregnancy. Not unlike millions of Americans, she suffered from what was characterized at different times in the court decision as depression, a panic disorder, post traumatic stress disorder and bipolar disorder. She went off her medication during her pregnancy for fear of its effect on her fetus. Prior to coming to the hospital to give birth, there was no indication that she was a danger to herself or to others. V.M. sought prenatal care, according to the records, from Dr. Ted Stevens, an ob-gyn.

This all changed, according to the lower court ruling, during her labor. Ms. M suddenly became a danger to her as-of-yet unborn child when she a) refused to consent, before it was necessary, to a c-section and b) became, what was referred to in the court decision as "combative."

According to the decision,

"In the hospital records, V.M. is described as "combative," "uncooperative," "erratic," "non-compliant," "irrational" and "inappropriate." She ordered the attending obstetrician, Dr. Shetal Mansuria, to leave the room and told her if she did not do what V.M. said, she would be off the case. V.M. then threatened to report the doctor to the police. In fact, at one point V.M. did call the Livingston Police to report that she was being abused and denied treatment. She told a nurse that "no one is going to touch my baby."

As Diaz-Tello told RH Reality Check, when asked about what kind of "combative behavior" Ms. M/V.M. displayed during and immediately after birth,

"The ‘combative behavior’ was in relation to things that happened after the delivery…you have to see them in the context of when they told her they were taking her baby away."

Her "combative" and "non-compliant" actions, then, were in response to being told by the hospital that the baby she had just given birth to would be taken from her. The decision states:

She would not allow Dr. Mansuria to touch the baby or perform an ultrasound examination. . . . V.M. "was very boisterous and yelling and screaming at the top of her lungs."

Is this potentially what the in the first court, ruling against Ms. M, also meant by "uncooperative", "erratic" and "irrational"? Well, that pretty well describes many women’s behavior during birth but most especially for women who may not abide by what a doctor’s and others’ vision is for her labor and delivery. In fact, notes NAPW,

"…the court itself cites a clinician’s opinion that “it is not surprising that she panicked at the time of delivery . . . [after] being approached about the possibility of a Cesarean section” given her particular emotional vulnerability."

Ms. M had been evaluated by a psychiatrist because of her refusal to consent to a c-section ("She thrashed about to the extent that it was unsafe…to administer an epidural"); and because, from the record, she was "very boisterous…yelling and screaming at the top of her lungs." The psychiatrist spoke with her for an hour to make sure she understood the risks and complications of having a c-section or refusing one; Ms. M was honest about her psychiatric history, according to the notes, and was clear about her choice. The psychiatrist concluded that:

"…V.M. (Ms. M) was not psychotic and had the capacity for informed consent with regard to the c-section."

Not only did the psychiatrist find she had the capacity for informed consent and therefore was capable of saying no to the surgery but mental health, says Diaz-Tello, is not a reason in and of itself for taking a child away from her or his parents.

Despite the psychiatrist’s finding, however, and despite having no apparent legal basis, the initial decision to remove the newborn from Ms. M’s and her husband’s care was specifically related to her decision not to pre-authorize a cesarean section. An amicus brief, filed on behalf of more than 20 organizations and experts including many individual physicians called the lower court’s decision an "injustice and misuse of the child welfare laws" and notes:

"The record is clear that hospital staff referred V.M.’s case to the Division of Youth and Family Services (“the Division” or “DY FS”) at least in part because of concerns regarding V.M.’s decisions during labor, including her decision not to preauthorize consent to cesarean surgery."

Unfortunately, the lower court also relied entirely on hearsay evidence to keep Ms. M, her husband, and their baby apart for three years. The series of events were recounted in court, seemingly, to highlight her "combative" and "erratic" behavior without giving rise to the real reasons behind her actions. Jack explains:

"None of the people who were present during her labor and delivery actually testified to anything. The only evidence was the testimony of the child welfare case worker testifying about what the people in the hospital told her after the fact. For example, the evidence of combative behavior is pretty subjective and it was the care providers giving information to a case worker who gave it to the lower court judge…it was a hearsay problem. They may have conflated her adamant refusal [to consent to a c-section] at the time with her anger afterwards and wanting to call the police [after they said they were taking her baby from her]."

It’s not just the fact that the plaintiff (the New Jersey Division of Youth and Family Services) relied on hearsay evidence to prop up its position and ultimately ensure a newborn was separated from her parents but that there seemed to be no legal basis for the decision. According to the amicus brief, not only is the right to refuse consent of a c-section constitutionally protected but the New Jersey statute (N.J.S.A. 30:4C-15.1(a)) used by the court to terminate Ms. M’s parental rights does not pertain to pregnant women. From the amicus brief,

"…family court judges may not consider pregnant women’s medical decisions in terminating parental rights" because, says the amicus brief, "that law does not apply to pregnant women or their fetuses."

What would the fall-out have been, therefore, had the Superior Court of NJ not ruled in the mother’s favor, last week?

"Our thought in taking this case was to prevent a precedent that would allow for the consideration of a woman’s decision-making process during labor or about labor to have any place at all in neglect or termination of parental rights," says Jack of NAPW.

Diaz-Tello goes on,

"…the concern that this would be used as precedent to force women to have c-sections was taken care of at the Appellate level last year. What made this case a continuing problem was the "other factors" were all either precipitated by or discovered as a result of the refusal. The current case doesn’t resolve that problem, but at least it directly states in the majority opinion that the refusal of the cesarean had "no place" in the termination proceeding.The reason we stayed with the case, is that her refusal [to consent to a c-section] opened up a fishing expedition because of the nature of the child welfare proceeding. Once the door is open you can have field day with every aspect of a woman’s life – that even though they can’t technically use that as the finding, they can use it in some capacity…"

It’s certainly a valid concern given how women’s choices are judged and then used as reasons to deny us our rights. From the cases of women who have given birth to stillborn babies being convicted of homicide because of a history of drug-use while pregnant, to women who are raped only to see their own sexual history used against them in court, courts have used personal biases and pre-conceived notions of how society believes women should behave to justify legal decisions with profound and very real consequences.

For Ms. M, her husband and their now three-year old child, however, the story isn’t over.

With this recent victory, the case has hit a happier note but there is a possibility that the NJ Department of Youth and Family Services will repeal the Appellate court decision; they have thirty days to do so. If they don’t appeal, says Jack, the case goes back to the lower court which will hopefully take steps towards reuniting the family. But because they have been separated so long, says Diaz-Tello, this is certain to be a long process.

ACOG Says Yes to VBACs

7:18 am in Uncategorized by RH Reality Check

Written by Amie Newman for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Good news from the American College of Obstetricians and Gynecologists (ACOG), on VBACs (Vaginal Birth After Cesearean). New guidelines were released by the organization yesterday marking a significant change in their recommendations regarding VBACs:

"Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans," note the guidelines released today by the American College of Obstetricians and Gynecologists.

VBACs have been treated controversially over the years by hospitals and organizations like ACOG, with guidelines and hospital policies designed to bar women from choosing a "trial of labor" for a birth, even after they’ve had one or more prior c-sections. The thought process behind these bans seemed to be most often connected to the fear, by hospital administrators and doctors, of uterine rupture and other complications. Unfortunately, the fear is more perception and suggestion than rooted in fact. The risk of uterine rupture, according to ACOG themselves, is extremely low, occurring in one-half of one percent of all cases (though serious, requiring emergency surgery). It is unquestionably a serious risk to take into consideration when planning for the type of birth one wants to have – but it has been "over-emphasized" by ACOG, according to Lamaze, International, making it more difficult for women to authentically assess the risks vs. complications of a VBAC. Cesarean sections are major surgery though and come with risk and potential complications as well. In addition, the c-section rate in the United States has climbed to dangerous levels, according to the World Health Organization, with one out of every three women birthing via cesarean section.

Just last year Joy Szabo of Page, Arizona was told she’d essentially be forced into have a c-section because her local hospital refused to allow VBACs. She decided, instead, to drive the 350 miles into Phoenix to a hospital that "allowed" her to birth vaginally.

In fact, the hospital in Page, AZ adopted their guidelines banning VBACs because of the way administrators interpreted the original ACOG guidelines suggesting hospitals have a surgeon and anesthesiologist on call during a VBAC. The Page hospital understood these guidelines to mean they needed coverage of both a surgeon and anesthesiologist at the hospital "24/7" as well as two physicians present at any VBAC. Unfortunately, other hospitals followed suit after ACOG released their original guidelines (which did recommend the "immediate availability" of surgical and anesthesia personnel before allowing a trial of labor for a woman who has had a previous c-section) and VBACs became less and less available over the years.

Birth activists and birth-bloggers who advocates for increased access to VBACs shared their thoughts on the updated guidelines calling them a "breath of fresh air" but also "long overdue."

ICAN, the International Cesarean Awareness Network, issued its own press release yesterday stating:

“VBAC bans place women in the untenable situation of being forced to undergo unnecessary major surgery if they are unable to find a VBAC supportive alternative. This is a first step in
returning to women an appropriate respect for patient autonomy.”

ACOG acknowledged that these guidelines imposed an undue onus on hospitals:

"Given the onerous medical liability climate for ob-gyns, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women’s access to VBAC."

ACOG likely took into consideration the recent NIH Consensus Development Conference on VBACs in March of this year, from which a statement was developed by a panel of medical experts on the safety of VBACs. The statement included an agreement that VBACs are a "reasonable option" and "safe alternative" for women who have had a prior c-section.

In fact, the chair of the panel of NIH Consensus Conference experts, Dr. F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center, noted in reference to the panels’ findings on the safety of VBACs:

"The VBAC rate has gone from 30% to 10% over the last fifteen years… [which] would seem to indicate that planned repeat cesarean delivery is preferable to a trial of labor. But the currently available evidence suggests a very different picture: a trial of labor is worth considering and may be preferable for many women…The use or employment of VBAC is certainly a safe alternative for the majority of women who have had one prior c-section."

ACOG clearly took note and focused squarely on the rising cesarean section rate in the United States as a key element of their decision to update their guidelines:

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

But The Feminist Breeder, a birth activist and blogger, gave credit where she feels credit is due:

And I don’t think they get the credit here.  I think we do. That’s right – you and me.  So thank you to the the women like Joy Szabo, and Jill from Unnecesarean.  To the women like Desirre Andrews, and Jennifer Block.  To Nicette Jukelevics and Jen from VBACFacts.com.  To the women of ICAN, and the midwives who risk prosecution to attend a home birth after cesarean where the state doesn’t support it.  To all the women who Tweeted, and Facebooked, and Blogged this issue until government health experts couldn’t help but take notice.

We did this.  We made this change happen because we spoke up and insisted on being treated better. But the work is not done yet. Now, we must take this statement to our providers and hospitals and challenge those VBAC “Bans.”  Send the statement to your sisters, coworkers, and friends who may be considering a VBAC.  Write about it, talk about it, and keep spreading the message until VBAC is no longer a four letter word.

These updated guidelines encourage physicians to discuss VBAC "early in the prenatal period" to develop a plan. The group also strongly recommends that hospitals put in place policies that ensure any and all personnel needed for an emergency c-section can be gathered quickly. Unfortunately, it’s this language that still "troubles" Lamaze, International. While the organization was pleased to see updated guidelines, they did take issue with some of the language and what they perceive to be an over-emphasis on the extremely low risk of uterine rupture:

The revised guidelines acknowledge that requiring “immediately available” resources for an emergency cesarean have resulted in hospitals, insurers and the obstetric community issuing formal or informal bans of VBAC, effectively denying women access to care and choice in birth.  While this was not the intention, the “immediately available” language remains in the new guidelines, which may continue to unfairly limit women’s access to VBAC.

Additionally, the guidelines continue to emphasize risks of uterine rupture, a rare, but potentially dangerous complication, for women who choose a VBAC.  Unfortunately, this does not help women contextualize the benefits and risks of VBAC versus elective repeat cesarean delivery (ERCD). 

Women still experience high rates of particular medical interventions which not are always necessary, when birthing at hospitals in this country – from electronic fetal monitoring to labor-inducing drugs – and therefore, even with a trial of labor allowed, it’s important that pregnant women understand how best to reduce their chances for an unnecessary c-section.

A Complicated Delivery: G8 Commits $5 billion to Maternal and Child Health But Big Questions Remain

7:22 am in Uncategorized by RH Reality Check

Written by Amy Boldosser for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Amy Boldosser is reporting for RH Reality Check from the G8 meetings, in partnership with Family Care International.  See other coverage of the G8 by Amy here and here, and a piece by Stephen Lewis of AIDS-Free World.

The first day of the G8 Summit answered some of the questions that maternal, newborn and child health advocates had about Canada’s signature G8 initiative, The Muskoka Initiative for maternal and child health. Speculation had been rampant all day following Canadian Prime Minister Harper’s midday announcement that Canada is committing $1.1 billion Canadian dollars in new spending over five years for maternal and child health programs in poor countries, bringing Canada’s total maternal and child health spending to almost $3 billion Canadian.  Harper made the announcement in his brief comments before the beginning of the G8’s afternoon session with invited leaders from Africa and the Americas. As the G8 leaders headed in to closed door meetings, advocates were left to wonder whether Canada could pull off the heavy lift of gaining similar concrete, new financial commitments from the G8 member states for saving the lives of women and children.

So did they deliver for the world’s women and children? Well, sort of. When the doors were opened and Prime Minister Harper addressed advocates and press again, he announced that the, “G-8 leaders made a historic commitment to the Muskoka initiative to maternal, newborn and child health. Together, G-8 members have committed US $5 billion over the next 5 years.” In addition, Harper revealed that, “G-8 leadership has also attracted the donations and contributions from other countries and foundations of more than US $2.3 billion for a total of US $7.3 billion.  In addition to our G-8 partners, we would also like to thank the Netherlands, Norway, New Zealand, South Korea, Spain, Switzerland, the Gates Foundation and the United Nations Foundation.”

Canadian officials refused to release specifics on what each country pledged. Harper indicated that each of the G8 countries did make a contribution, although he admitted some contributed more than others relative to the size of their economies. He chalked up the differences in pledges to differences in priorities among countries and differences in country financial situations and said that since Canada’s economy is in the strongest financial position, it had made the largest country contribution to this flagship initiative.  Press sources provided some rough figures on country commitments:

  • The US committed $1.346 billion over two years (the US didn’t commit to the requested five years of funding) pending “Congressional appropriations”
  • Germany committed more than $500 million over five years
  • Japan committed about $500 million over five years
  • France committed to about $400 million over five years
  • Britain committed $300 million per year over two years (like the US, Britain didn’t commit to five years of funding)
  •  and Italy, to no one’s surprise, apparently pledged the least of all.

Canada’s leadership in putting maternal and child health on the agenda was generally praised by advocacy groups, and Canada’s $1.1 billion pledge, the largest among G8 members although still short of what advocates had been asking for, was regarded as a “respectable” amount. Reaction to the total Muskoka Initiative pledge, however, was one of disappointment that G-8 leaders had failed to heed calls to double their collective aid on maternal and child health to $4 billion a year, for a total of $20 billion over five years. According to Save the Children, that investment could have saved an additional 1 million children a year and more than 200,000mothers a year. 

So now we know what money is on the table but some very important questions remain if we are truly to make progress in reducing the numbers of maternal deaths (more than 350,000 women die every year in pregnancy and childbirth) and newborn and child deaths (more than 8 million children die before their fifth birthday every year). 

How will these funds be distributed and used? There is a global consensus on the package of high quality, low cost interventions that are needed to prevent maternal, newborn and child deaths including comprehensive family planning programs; skilled care before, during and after pregnancy and childbirth, including emergency obstetric care, for mothers and newborns; safe abortion, when and where legal; and improved child nutrition and prevention and treatment of major childhood diseases.  But some governments, including Canada, have given into political pressures to announce that this money won’t be used to fund provision of safe abortions or potentially even family planning.  Advocates will be watching to see how the G8 spends its money and to hold governments accountable for meeting these commitments.  As the G20 Summit starts today, we are also hopeful that G20 governments will take up the G8 commitment to maternal and child health.  South Korea, host of the next G20, and some other G20 governments are pushing for a bigger role on development and we are hopeful that the pledges made to the Muskoka Initiative by non G8 member countries may hint at a broader commitment of non G8 countries to save the lives of women and children.