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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.”

Ignore That Self-Affixed Halo: Anti-Choicers Know Just What They Are Doing to Incite Violence

11:46 am in Uncategorized by RH Reality Check

Immediately after the assassination of Dr. George Tiller in the vestibule of his church in Wichita, Kansas just over two years ago, anti-choice leaders who had long used stridently violent language to describe Dr. Tiller specifically and abortion care generally, fell all over themselves proclaiming innocence of any connection to the murder.  Among these was Troy Newman, current president of Operation Rescue, who stated:

“We are shocked at this morning’s disturbing news that Mr. Tiller was gunned down… Operation Rescue has worked for years through peaceful, legal means, and through the proper channels to see him brought to justice. We denounce vigilantism and the cowardly act that took place this morning.”

But the fact is that Newman and his cohorts regularly used imagery and language that depicted Dr. Tiller himself as a monster and in many ways indirectly if not directly suggested him as a target for someone willing to commit a violent act. That someone turned out to be Scott Roeder, who had, it turns out, several links to Operation Rescue.

And, as the saying goes, a picture is worth a thousand words. Any doubt of Newman’s own gruesome feelings of glee about Dr. Tiller’s murder can be summed up in a photo showing Newman standing at the site of Dr. Tiller’s assassination giving a thumbs up.

Operation Rescue and other anti-choicers have now turned their sights on Dr. LeRoy Carhart, who is providing late abortion care to women in need several times a month in Germantown, Maryland.  During the several hours I spent on three days in Germantown, to help with clinic defense, I saw suggestions of violent action everywhere, courtesy of the anti-choicers marshaled by Operation Rescue and its colleague organizations.

First, for example, there was the truck plastered with photos of what the anti-choicers claim are mangled fetuses.  These photos, whether real or not, are obviously distasteful, and meant to be so. But they are also misleading if not outright fake.  If, for example, a woman is carrying a fetus that has died in utero, and it is removed for her own mental and physical health, it may well look grisly. So would, for example, heart surgery. But the implication without context is that someone is killing near-born babies without reason. Using photos-and science for that matter–that is either created entirely for shock value or so grossly misrepresents reality as to have no relation is a primary strategy of the anti-choice movement.

But also plastered across this truck, amidst the “dead baby” photos were photos of Dr. Tiller and those of Dr. Carhart. Those of Dr. Tiller pronounced him “dead,” and tho

se of Dr. Carhart had large yellow arrows fixed around the perimeter with the word “Abortionist” in large black block letters, pointing to Dr. Carhart.  The message, if not explicit, is nonetheless clear: “One of these men is dead, the other is still working. Whaddya gonna do about it?”

Then there were the sidewalk chalk drawings, pictured here.

These drawings, which were one version of other drawings that appeared on a different day as well, were drawn out by teenagers “called in” by OR to help out with th protest.

Among these on Sunday were the sayings:

  • Would it bother us more if they used guns?
  • What would Jesus do? (with a gun)
  • Would it bother us if they used guns?

A drawing of an exploding gun as at the bottom of this row of chalk drawings.

Again, these images have two purposes. One is to suggest violence is an answer to something that anti-choicers don’t like, namely, women exercising self-determination in their lives by determining whether and when to have children, taking control over their own reproduction and sexual health, and safeguarding their own and their family’s health when a wanted pregnancy goes horribly awry.

The other is to intimidate those who are protecting women seeking care, and doctors who serve them. What would come to your mind if you walked the street toward your doctor’s office and there were exploding guns sketched on the sidewalk leading up to the office door?

Operation Rescue and other anti-choice groups such as those in Germantown use religion and piety to advance a patriarchal agenda cloaked in religious fervor.

But it is violence by any other name.

American Life League’s Questions on Facebook: They’re Not Asking “What Would Jesus Do”

11:27 am in Uncategorized by RH Reality Check

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

I can’t remember when or why I initially friended the American Life League on Facebook, but here they are, popping up in my newsfeed periodically to tell me about the many and varied ways the premarital sex-having-sluts of America are murdering their young en masse, guided predominantly by the heathen-begloved hand of Planned Parenthood, which gleefully holds secret abortion parties behind closed doors.

Perhaps it’s rude or callous of me to admit that part of the reason I haven’t un-friended the American Life League is because I find their posts somewhat funny. Or quaint? Even comforting? I can’t put my finger on it–all I know is that I used to be a pro-life Republican, myself, and there’s something about the ALL Facebook page that’s a little bit like going back and reading your diary from junior high, even the pages with the awful angsty poetry.

But mainly the reason I can’t un-friend the American Life League is because I don’t want to miss another opportunity to comment on their periodic What Would You Do?-style posts that ask followers what they might do, personally, if horrific things happened to them–horrific things like a doctor who performs abortions living in their neighborhood, or Planned Parenthood having a booth at the county fair. Truly, nightmares abound:

Read the rest of this entry →

!Si, se puede!? For Latinas and Other Uninsured Women, Gaps Remain in Access to Birth Control

9:46 am in Uncategorized by RH Reality Check

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

It’s about time we had some good news. It’s been a long, hot summer in DC and a rough year of partisan attacks on women’s health in Congress and around the country. Like a cool rain after a long drought, the Department of Health and Human Services (HHS) recommendations that birth control be covered without co-pay brought welcome relief to women around the country.

A refreshing example of sound policy informed by scientific and public health experts, this decision will have profound ramifications for many women and families, and may have special resonance for Latinas, immigrant women, and others who continue to face multiple barriers in accessing birth control. So, that’s the good news.

The not-so-good news? We’re going to need a lot more rain before this drought is over.

In honor of Latina Week of Action for Reproductive Justice 2011, I’m going to celebrate the HHS recommendations, while at the same time keeping in mind the unfinished work of ensuring access to contraception for all Latinas, including immigrant women.

It is not my intention to undersell the importance of the HHS decision. On the contrary, for too long, a woman’s ability to pay for birth control has determined whether and when she can prevent pregnancy, and including birth control as no-copay preventive care is a big step in the right direction.

And for Latino communities, economic relief of any kind cannot come soon enough. A new study by Pew shows Latino families have been hit hardest by the recession, accounting for the largest single decline in wealth of any ethnic and racial group in the country. These recent economic losses compound longstanding wealth and health disparities experienced by Latinas and their families. For Latinas who do have insurance or will be able to get it under the new exchanges, not having to pay out-of-pocket for their birth control could be transformative: leaving a little more money in the bank each month to help them with rent, tuition, buying groceries, and taking care of the children they already have.

But—and this is a big but—nearly four in ten Latinos is uninsured. And it probably comes as no surprise that lack of insurance is just one of many roadblocks Latinas encounter when they need to access health care, including contraception.

The Spanish phrase “!Si, se puede!” has long been used by Latinos the world over as a political rallying cry—and the two very different meanings of this iconic phrase may be instructive in examining the complex picture of Latinas’ access to reproductive health care. On the one hand, “Si se puede!” means “Yes we can!” an appropriate statement of celebration in the wake of this recent victory. (As in, “Thanks, Secretary Sebelius! Si se puede!!”) On the other hand, “Si se puede…” can also mean “IF she can…” and this conditional statement hints at the obstacles that remain. IF a Latina can get health insurance, IF she can make it to a provider’s office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

For some women, that’s a few too many “ifs.” In addition to being less likely to have insurance, some Latinas, particularly immigrant or Spanish-dominant women, do not know where or how to find safe and accessible reproductive health care in their communities. Immigrant Latinas may be particularly vulnerable to unscrupulous “providers” who offer substandard care or misinformation. Just last week, reports surfaced that a counterfeit emergency contraception (EC) pill had been targeted to Latinas in the US. Other women may be experiencing contraceptive coercion, a form of intimate partner violence where a partner restricts a woman’s access to her birth control pills or refuses to use condoms. So even in a world where birth control is covered and hundreds of Planned Parenthood and other health clinics do provide quality care, some women could still slip through the cracks.

How can we reach the women who may not reap the benefits of the no-copay birth control decision? We can start by giving them more highly-effective options that do not require a provider’s supervision. Removing the age restriction on Plan B® emergency contraception would be a great start, and bringing a daily birth control pill over-the-counter also shows promise. If a woman of any age (or her partner, for that matter!) can pick up her EC or monthly pill pack with the rest of the shopping, more women will have birth control when they need it. (Intrigued? To weigh in with your thoughts on an over-the-counter birth control pill, you can fill out this survey.)

Every woman also needs better education about the full range of birth control options available to her. When unplanned pregnancy does occur, women need access to a full range of services: abortion care, prenatal care, and adoption counseling. Finally, reproductive health care does not exist in a vacuum: women also need social, educational, and economic opportunities, freedom from violence and coercion, and resources to care for their children and loved ones.

For many Latinas, the world I’ve just envisioned is still a long way off.

Our vigilance is needed to make sure that we build on all our victories by continuing to fight for more and better options for women. Just as every woman has different life circumstances that help determine what kind of birth control is right for her, each woman faces different barriers to accessing that birth control—including the need for insurance coverage and many others as well. We need more policymakers to take a cue from HHS Secretary Sebelius, and help create a world where every Latina “se puede,” where every woman has the support, education, and options she needs to plan pregnancy, care for her family, and care for herself.

As Two Deadlines Near, Concern Rises About HHS Adoption of IOM Recommendations on Preventive Care for Women

7:18 am in Uncategorized by RH Reality Check


"Deadline" by betchaboy on flickr

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

See all of our coverage of the IOM report and HHS guidelines here.

Will women’s health insurance be held hostage to the debt ceiling fiasco?

On July 19th, an expert panel convened by the Institutes of Medicine (IOM) released a set of evidence-based recommendations on the range of basic preventive care services for women that should be covered by insurance plans without a co-pay under health reform.  The recommendations were requested by the Department of Health and Human Services (HHS) to guide its final decision-making on these issues, and to put the imprimatur of peer-reviewed public health and medical science as well as evidence from clinical practice behind the final guidelines.

Services recommended by IOM for coverage without a co-pay include an annual well-woman visit as well as contraception, sterilization, gestational diabetes screenings, cervical cancer screenings, HIV/STI annual testing, domestic violence counseling, and breastfeeding support.  The Administration could have included these same services–including those on family planning services and contraceptive supplies–as part of its initial guidelines based on existing evidence. But the IOM process was seen by some as necessary not because these findings were not already self-evident to clinicians and public health experts, but because it is widely known that fanatical anti-choice groups and legislators would object to and fight against anything that improves the reproductive and sexual health of women or enables them to exercise their right to self-determination. Read the rest of this entry →