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The Global Sexual and Reproductive Health Act of 2010: An Investment in Everyone’s Future

8:30 am in Uncategorized by RH Reality Check

Written by Rep. Yvette Clarke for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Right now, the largest gathering of world leaders in at least a decade is assembling at the United Nations in New York to assess what progress has been made in reducing poverty, improving health and ensuring access to education in developing countries.  One issue on the agenda that is especially dear to me is how to combat pregnancy-related deaths and injuries and improve women’s health in developing countries.

No woman should die giving life—and the good news is that most pregnancy-related deaths, as well as sexually transmitted infections (STIs) and HIV, are preventable with a package of basic, proven health interventions. But despite recent progress, far too many women in poor countries still face terrible risks.

We as Americans should make it a priority to save women’s lives. It’s not only the right thing to do, but these investments also reduce poverty, spur the global economy and protect U.S. national interests. To that end, there are three crucial contributions the United States can make—sound policies, sufficient funding, and true leadership.

To help promote sound policies, I introduced legislation in April that would revise existing U.S. laws to meet—and even exceed—current international standards. My legislation, H.R. 5121, The Global Sexual and Reproductive Health Act of 2010, outlines a progressive model for delivering sexual and reproductive health services by supporting voluntary family planning, education and outreach. H.R.5121 also recognizes that half the world’s population is under the age of 25 and promotes sexual and reproductive health care for young people, for instance through comprehensive sex education. It further addresses assistance during humanitarian disasters and conflicts, reduction of unsafe abortion, prevention of STIs and HIV, contraceptive development, training of healthcare professionals, and various other initiatives.

In short, H.R. 5121 is a roadmap that would ensure the maximum impact for the generous financial contributions America is making to global health.

Another top priority is to ensure sufficient funding. The United States is already the world’s biggest donor of international family planning assistance, a proud achievement that we should build on by increasing our current spending on these programs to $1 billion. We should likewise boost our support for other maternal, newborn and child health programs, to at least $2 billion.

The total spending involved is modest given the tremendous impact it will have around the world, and it should be a priority even in the face of our own budgetary restraints. If other countries, including developing countries themselves, do their part, the impact could be truly staggering. Fully meeting the need for both family planning and maternal and newborn health services could cut pregnancy related deaths by 70 percent, and newborn deaths by almost half. The key is to make these investments simultaneously to maximize their impact and, ultimately, save money.

Lastly, the United States should take the lead and become a passionate advocate for women’s health, at the UN meeting  and beyond. Secretary of State (and former New York Senator) Hillary Clinton in particular, has been an outspoken champion, and the Obama administration has made up a lot of ground—both on policy and on funding—that was lost during the previous administration. But there’s much more to be done, and we must sustain and accelerate our current efforts to save the lives of women, newborns and children around the world.

In the words of Dr. Martin Luther King Jr., “Cowardice asks the question – is it safe?  Expediency asks the question – is it politic?  Vanity asks the question — is it popular?  But conscience asks the question – is it right?  And there comes a time when one must take a position … because it is right.”  These health services are vital building blocks of stable societies and healthy economies.   Only healthy women whose human rights are protected can be fully productive workers and effective participants in their country’s political processes.  Only when women are healthy and empowered can they raise and educate healthy children.

All of us need to do our part to hold ourselves, our government and world leaders accountable. The time is now to make women’s health an international priority. The international advocacy community demands it; the women of the world require it; and the families of the world depend on it. One love.

Assisted Reproductive Technology: Let’s Focus on One Healthy Baby at a Time

7:13 am in Uncategorized by RH Reality Check

Written by Jennifer Rogers for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

The hubbub of Kate Plus 8 and Nadya Suleman is largely over. One year ago, articles covering multiple births and stories of in vitro fertilization were front-page news, but today I’m hard-pressed to name even a celebrity who has had a high-order multiple in the last few months. While I take this as good news, the data on assisted reproductive technologies (ART) tells a slightly different story.

Assisted reproductive technology includes fertility treatments in which both eggs and sperm are handled in the laboratory—this includes in vitro fertilization (IVF). It is well-documented that women who undergo IVF are more likely to deliver multiple-birth infants than women who conceive without assistance.  In fact, almost half of all IVF pregnancies result in multiple-birth deliveries.[i] Pregnancy with multiples is usually a direct result of multiple embryo transfer. This means that two or more embryos are transferred to a woman’s uterus at one time. And although the percentage of triplet-or-more births has declined from 6 percent to 2 percent from 1998 to 2007, the percentage of twin births remained stable at about 30 percent.

Because the use of ART has doubled since 1998, many of us now know a friend, family member, colleague, or, at the very least, know of a celebrity who has undergone the procedure. We have become accustomed to the idea of twins, a remarkable conceptual change given the relative rarity of natural twin births in humans. But the problem is that, in comparison to singletons, pregnancy with multiples, including twins, raises health risks—for both a woman and her infant. For women, these risks include higher rates of cesarean section, maternal hypertension, preeclampsia, hemorrhage, and death. Infants are more likely to require neonatal intensive care, and experience higher rates of low birth weight, preterm birth, and cognitive and physical impairments.

Single embryo transfer (SET), however, nearly eliminates pregnancy with multiples because only one embryo is transferred and, thus, decreases the health risks for a woman and her child as well.

Compounding these health risks is an economic consideration, something made more pressing in the midst of health care reform and our economic crisis. Policymakers, health care providers, and insurance companies are paying more attention than ever to the bottom line, and we know that—at least in the short term–multiple versus single embryo transfer is less expensive. In fact, if we kept our current insurance policies and, at the same time, created a universal SET policy, it would cost patients an extra $100 million to achieve the same pregnancy rates.

But this would be a short-sighted and eventually hugely expensive misunderstanding of the issues. Because of the long term health risks associated with multiple births, moving to SET-alone would save in overall healthcare costs.[ii] For instance, in the United States alone, maternal and newborn hospital charges per family were $9,845, $37,945, and $109,765, respectively for singleton, twin, and triplet births.[iii] Thus, creating policies that promote single embryo transfer (SET) are becoming the talk of the ART town. These estimates indicate an elective SET policy could improve the overall health of women and infants while at the same time save million of dollars in health care costs.

So, why hasn’t SET become the standard of care?

This question raises several issues.  The first problem lies with current federal policy. The Fertility Clinic Success Rate and Certification Act of 1992 requires fertility clinics to only report their pregnancy and birth success rates. This regulation creates incentives for physicians to transfer multiple embryos to ensure better success rates. Although the American Society for Reproductive Medicine (ASRM) has released voluntary guidelines that recommend physicians transfer only one embryo and no more than two to women 35 and younger,[iv] the emphasis on better numbers versus better health means that providers are still willing to transfer more embryos despite the potential risks to a woman and her newborn. This practice also assumes that multiple embryo transfer leads to higher pregnancy rates. Although, in the past, this has been the case, more recent research suggests single embryo transfer does not compromise the pregnancy rate, especially for younger women with high quality embryos.[v],[vi],[vii][viii]

Second, many insurance companies do not cover IVF treatment in the United States. In fact, two states—California and New York—have laws that specifically exclude coverage for IVF. For instance, California’s law requires health care plans that cover expenses on a group basis must “offer coverage for the treatment of infertility, except in vitro fertilization.” And even in states where infertility is covered, coverage may be limited to a one-time only benefit for expenses arising from the procedure. This means that many patients bear the full cost of IVF and, thus, feel pressure to transfer multiple embryos in order to achieve a pregnancy on their first try. And having twins is less costly initially than having successive singletons. Older women may even feel more pressure to have twins because they may not be able to become pregnant a second time.

Third, the health risks arising from pregnancy with multiples, even twins, is not widely known. As a culture, whether through shows like Jon & Kate Plus 8 or the popularity of celebrity twins, we celebrate and even glamorize multiple births. However, studies show that when IVF patients receive information about the health risks, they are more interested in pursuing SET.[ix],[x]

Thankfully, instead of working reactively to propose regulations or new policies based on outlier cases (i.e. Ms. Suleman and her octuplets), there are proactive steps women’s health advocates can promote built on support and honesty to help improve the health and well-being of women and their children. Forward thinking policies—like encouraging SET—are concrete solutions to these issues.

As we implement health care reform, we have a unique opportunity to require insurance coverage of infertility diagnosis and treatment, including STI screening and treatment (a leading cause of infertility) and multiple IVF cycles. Studies have found that if insurance covers multiple embryo transfers, patients are more willing to choose SET. This coverage must also be coupled with patient education on the health risks associated with multiple births. Research has found time and again that accurate information about the risks associated with multiple embryo transfer can lead both women and men to choose SET.

We also need better and more robust data collection. We can change our policies to define “success” in terms of healthy pregnancies, safe births, and healthy babies, rather than the superficial live birth count currently used in federal law. Clinics should be rewarded for responsible medical practices such as the quality of the counseling they provide women and men before they begin down the ART path. This also means providing individualized care—because, for some women, especially women of advanced age or those who have previously gone through IVF with no success, SET may not be the answer.

Last, but not least, as reproductive health advocates, we must look closely at the benefits ART provides in alleviating the burden of infertility as well as the challenges it presents in exacerbating poor health outcomes and high health care costs. We must provide women and men the tools—education, support & respect—to make the best decisions for themselves and their families. An open and honest conversation about ART can lead to policies that support the health of women and children, help bring down our long-term medical costs, and better speak to the personal crisis of infertility. Free from sensationalism, we can do all three.

[i] http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5805a1.htm?s_cid=ss5805a1_x

[ii] Petok, W. D. (N.D.). Single Embryo Transfer: Why Not Put All Your Eggs In One Basket? American Fertility Association. Retrieved from http://www.theafa.org/library/article/single_embryo_transfer_why_not_put_all_your_eggs_in_one_basket/

[iii] Collins, J. (2007). Cost efficiency of reducing multiple births. Reproductive BioMedicine Online, 15, 35-39.

[iv] American Society for Reproductive Medicine [ASRM] (2009). Guidelines on number of embryos transferred. Fertility and Sterility, 92, 1518-9.

[v] Stillman, R. J., Richter, K. S., Banks, N., & Graham, J. R. (2009). Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertility and Sterility, 92(6), 1895-1906.

[vi] Saldeen, P., & Sundtrom, P. (2006). Maintained pregnancy rate after introduction of elective single embryo transfer in women 36-39 years. Fertility and Sterility, 86, S76.

[vii] Anderson, A. R., Graff, K. J., Distefano, J., Seegers, J., Whelan III, J., & Crain, J. L. (2006). When is a single embryo transfer appropriate? Fertility and Sterility, 86, S191.

[viii] Komaba, R., Maeda, M., Sugawara, N., & Araki, Y. (2007). The effective prevention of multiple pregnancies by elective single embryo transfer. Fertility and Sterility, 88, S154.

[ix] Newton, C., & McBride, J. (2005). Single embryo transfer (SET): Factors affecting patient attitudes and decision-making. Fertility and Sterility, 84, S3.

[x] Hope, N. J., Phillips, S. J., & Rombauts, L. (2010). Can an educational DVD improve the acceptability of elective single embryo transfer: A randomized controlled study. Fertility and Sterility, 90, S67.

Breaking the Bank for Bed Rest

12:48 pm in Uncategorized by RH Reality Check

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

Bed rest.

It sounds vaguely Victorian, doesn’t it? Confined to one’s bed, suffering from an incurable physical ailment of days long gone. Bed rest is the catch-all term we still use to describe the order given to pregnant women, by physicians or midwives, who are in some danger of a preterm birth and so must spend their pregnancy off their feet.

"I think of it as house arrest," Mary Murry, CNM, RN with the Mayo Clinic tells RH Reality Check. "You don’t have to be in bed all of the time but you can’t be going out and about either."

If this sounds like a woefully incomplete medical description, it is. There is no universally agreed-upon “definition” of bed rest even while 1 in 5 women in the United States will be placed on bed rest at some point, and for various lengths of time, during pregnancy. Some women are prescribed bed rest for only a few days while others spend significant periods of time supine, at home, or in a hospital, literally confined to home for weeks or months. For most working families, especially those in the lowest income levels, living paycheck to paycheck, taking even a day away from work seems impossible – but a week, a month, several months? Why is it, then, that the U.S. offers the most threadbare of safety nets for pregnant and new mothers who, by medical necessity, must frequently refrain from working to care for themselves and, after childbirth, a baby who may be in need of extensive medical care? In the richest country in the world, it’s shocking how limited our support is for pregnant and new mothers and their families. For mothers who have been on bed rest and become leaders in the fight to secure more and better resources, this is not only a health care issue it’s a women’s rights issue.

“From the perspective that nearly 1 in 4 women will be limited by bed rest, I see it as a women’s rights issue that women of all ages should stand behind. Pregnancy is a normal human function. Procreation shouldn’t have such a high risk of job loss, career suicide or financial ruin for a woman,” says Angela Davids founder of the international organization KeepEmCookin.com. The organization provides support and education to women on bed rest.

The reality is, says Darline Turner-Lee, advocate and mother of two young children:

“This happens to women from every walk of life and every culture. It happens to older moms and younger moms, both. Some women sail through and other women who are vegan and exercise have a preterm birth. This is why we have to galvanize all women and get them to see that it’s a women’s rights issue.”

Turner Lee was put on bed rest with both of her children and started an organization, Mamas on Bedrest & Beyond, that provides services, support, resources and information to high-risk pregnant women and new mothers. 

Bed rest may be prescribed for a variety of reasons and depending upon what those reasons are, a pregnant woman may be able to plan for the time or be immediately swept off her feet, almost literally, into bed to spend weeks or even months.  The chance that something might go wrong during pregnancy isn’t something people want to talk about though, let alone plan for.

“A lot of women are caught unexpected [by a complication during pregnancy and prescription for bed rest]. Nobody talks about it, so when it happens you’re smacked upside the head. You’re not prepared,” Turner-Lee says. “Many women can’t plan for it. If you can, maybe you can save up vacation time so you have some paid leave. But many don’t, or can’t, plan for bed rest.”

Babs Haller Garrett is Resource Director for Hand to Hold, a Texas-based not-for-profit organization providing ongoing support, resources and education to parents of premature babies. She reveals a stark yet unifying reality:

Anyone can have complications. Anyone can be prescribed bed rest. And anyone can lose their job because of a complicated pregnancy.”

Murry tells me that the most common reasons for bed rest are premature labor, premature rupture of membranes and elevated blood pressure.

And for each woman, symptoms may be more or less threatening, requiring more or less rest.

That doesn’t mean, however, that bed rest isn’t a shared experience.

Most women ordered on bed rest become at the least, reticent partners in discomfort, frustration, sadness and sometimes physical pain over the days, weeks or months they are confined as they attempt to bring their pregnancy to full-term and birth a healthy baby.

“Most women think they would love nothing more than being told they have to stay in bed all of the time. That lasts about 24 hours and then boredom sets in and we find it isn’t much fun.  Most women stand it because it is the best thing for the baby,” says Murry.

To be clear, however, Murry tells me that bed rest isn’t without its risks: “It doesn’t take long in bed for muscle wasting to occur.  It also puts the woman at a greater risk for developing a blood clot.”

“Bed rest with my son was one of the loneliest times of my life. And I felt so useless, not being able to fully care for my 2-year-old daughter during that time,” Davids says.

Holly Blume was placed on bed rest for more than five months when pregnant with her son, Austen. “It was the most challenging experience in my life. I was on medication that had uncomfortable side effects. My body literally ached from head to toe  – even my ears hurt from lying on my side so much. Anytime I rolled over I contracted, therefore, there was constant anxiety.”

Unfortunately, a pregnant woman’s worry over the health of her growing baby, how to care for other children at home and her own health is often overshadowed by anxiety over finances.

“At 22 weeks I was informed I needed to be on bed rest. I remember that day – I was at work. I came in after having been to the doctor and my immediate first thought was, ‘Oh my god, what am I going to do about money?’ I was worried about the baby but after that my first thought was about money,” Aviva (who asked that only her first name be used) told RH Reality Check, on her first day back at work after having her baby.

How do pregnant women ordered on bed rest pay their bills if they can no longer work? For low-wage workers, living paycheck to paycheck, is bed rest even possible? Does family leave cover bed rest? If a woman has saved up vacation or sick days but uses them up during her period of bed rest, does she have any way to take leave post-birth and still have the guarantee of a comparable job to which to return afterwards? Are there other coverage options available?

The federal Family and Medical Leave Act (FMLA), passed in 1993, allows pregnant women and parenting women (and men) time away from work and a guarantee of a comparable job to which to return. And eleven states – including Washington, California and New York have their own versions of the FMLA. California even offers paid leave. In addition, pregnant women who suffer from diagnosed complications may be eligible for short-term disability insurance. Health care reform has brought improvements to programs for some pregnant women offering the potential to reduce the number of women who need to be on bed rest in the first place. According to Pew Center for the States, a $1.5 billion federal grant program for evidence-based state home visitation for pregnant women and new mothers will be established through the Affordable Care Act. Insurance companies will no longer be able to deny coverage to pregnant women seeking preventive care, based on classifying pregnancy as a “pre-existing condition,” and Medicare will cover low-income adults, expanding access to coverage for women immediately prior and after pregnancy.

However, these initiatives are not enough.

The truth is that for lower income women in low-wage jobs, there are essentially no options. For some, it makes more sense to simply quit a job that offers no reason to stay. The Program on Gender, Work & Family, notes that while “some low-income workers may qualify for unpaid leave under the Family and Medical Leave Act, most cannot afford to take it. Without workplace flexibility or paid leave, low-income workers are forced to choose between caring for their families and their economic security.” That’s not really a choice, is it?

The United States is one of only four developed countries that do not offer paid leave to all new mothers. FMLA is available to employees of businesses with more than fifty employees, with other restrictions in place as well. Because it simply provides for unpaid leave, it leaves 51 percent of new mothers (and pregnant women) without any assured way to support themselves and their families; while 49 percent of women “cobble together paid leave…using sick days, vacation days, disability leave and maternity leave.”

Short-term disability insurance is helpful – if your employer or state offers it or you think to purchase it on your own. However short-term disability usually covers only six weeks of leave – and at approximately 60 percent of your salary.  And because there is no uniform “bed rest” diagnosis, some insurance companies decide that the a doctor’s “prescription” for bed rest isn’t enough to qualify a woman for coverage.

Davids says:

“I’d like to see doctors put the prescription of bed rest in writing, with specific guidelines. I think this would help employers and insurance companies acknowledge that bed rest is a treatment, just like a medication or a surgical procedure. It is a method of keeping pressure off of the cervix, of keeping blood pressure down, of increasing blood flow to the baby, and of encouraging healthy growth. Bed rest is a medical treatment, not a vacation.”

That said, the American College of Obstetricians and Gynecologists (ACOG), in a pamphlet on high blood pressure in pregnancy, only says, “bed rest at home or in the hospital may help reduce the pressure…and may be prescribed.” It is not a cure and some studies have suggested that bed rest does not do much to stem preterm labor. However, given that physicians and other care providers do frequently prescribe bed rest – in some form and for some length of time – it’s critical that we acknowledge its role in a family’s financial world.

Aviva worked for a small business. Short-term disability insurance was not available to her. Plus, since the business had fewer than fifty employees, says Aviva, “right off the bat, I couldn’t get family leave.” She continues, “My plan, with my husband, was that I was going to work until the week before the due date so I could be out of work for three months after the baby was born. But immediately that went out the window.”

A prescription of unexpected bed rest meant a frightening financial reality.

“My doctor told me I needed to be on bed rest at 22 weeks. At thirty weeks my water broke so I needed to go to the hospital, where I stayed until my baby was born at 32 weeks. That time spent not at work – I couldn’t get any official help. I had three weeks of accrued vacation time and a week of sick leave. I had to get loans from my family.”

Aviva says she doesn’t know what she would have done if she didn’t have family near by to help her.

Babs Garrett Haller says she and her husband have been “financially ruined” by their experience.

When Babs became pregnant in 2007 she and her husband Joe were thrilled. But a month after finding out she was pregnant with twins Jack and Kate, devastation rained down. When she was 22 weeks pregnant, Jack died in-utero and Babs wound up on bed rest, in the hospital. Kate was born just weeks later, at 25 weeks, and months in the NICU (neo-natal intensive care unit) followed.

“Being on bed rest, unexpectedly, exhausted nearly all of my FMLA (family leave),” Garrett Haller told RH Reality Check. But FMLA provided Babs with time only. To cover expenses while dealing with the loss of one baby, her own fragile health and the health of her daughter before birth and then in NICU afterwards, Garrett Haller used a combination of accrued sick and vacation time as well as a brief period paid for by short-term disability insurance.

“Guidelines for short-term disability insurance are strict so it wasn’t in effect long. We appealed to my OB and Kate’s perinatologist/neonatologist to write letters requesting more time away from work.”

Still, after four weeks of bed rest, and two more months afterwards dealing with intensive care for her daughter, her employment was terminated.

Her husband was employed but not able to cover all expenses plus the immense burden of the new medical expenses they were now carrying. They were out of money – and time.

“After my FMLA ran out, I actually went back to work — leaving Kate alone in the NICU — in an effort to show good faith to my employer that I planned to return once things were more stable. Even with this effort and income, we still couldn’t avoid the financial strife that followed. When my daughter finally came home from NICU, she was mine to hold, feed, have at home, free of wires and tubes but I had to choose between returning to work (keeping my job) or spending time with my new baby (getting fired).”

Babs “chose” to stay home – a decision she says she would absolutely make again – but it cost them everything:

“We just recently admitted to ourselves that we cannot recover from the financial trauma of being unemployed for a year, with medical expenses, having cashed out our retirement and maxed out our credit cards.”

Becoming pregnant and birthing a baby, should not throw families into poverty, frantically trying to find a way to piece together a puzzle only to find key pieces missing. Yet it does. Momsrising.org notes that:

“having a baby is currently a leading cause of “poverty spells” in this country—a time when income dips below what’s needed for basic necessities like food and rent. And, a full quarter of families with children under six live in poverty.”

Says Turner-Lee, “This country has no safety net for pregnant and parenting women – we make no provision for women having a normal birth let alone women who must go on bed rest, or who experience preterm birth.”

It’s enough to make you stand up and make change. It is exactly what Turner-Lee’s web site, Mamas on Bedrest & Beyond in partnership with organizations like David’s KeepEmCookin.com and Better BedRest are doing. They offer support for and resources to women and their families, but they are also banding together to support paid family leave efforts in Congress. Calling the financial struggle women experience when on bed rest an “invisible crisis,” the founder of Better Bedrest, Inc., Joanie Reisfeld, says she and her organizational partners have met with Senator Barbara Mikulski (D-MD) to discuss the critical importance of paid family and medical leave, as well as increased funding for research into high-risk pregnancy. Mikulski was instrumental in the passage, in 2009, of the Federal Employees Paid Parental Leave Act which gives federal employees four paid weeks of leave, of the twelve weeks total leave allowable.

Momsrising.org and their one million plus members continue to advocate for paid leave as a priority. Paid family leave, the organization notes, is a “key way to stop the downward economic spiral that happens to many women when children are born.” I’d add that the downward economic spiral often happens before children are born, when pregnant women struggling with a medical condition and to maintain a modicum of health and wellness for themselves and their babies must stop working temporarily without the financial support necessary to do so. To that end, the organization is pushing an expanded federal FMLA to include businesses with at least 15 employees, to cover more family members and to provide paid leave. They are also proposing the creation of a $1.5 billion fund for states that are passing paid family leave bills, to offset the costs. 

For mothers who have been on bed rest, there is no shortage of creative suggestions for how this country can best assist pregnant women on bed rest: from supplemental coverage for all mothers who end up on bed rest for at least thirty days to extended leave options for mothers and fathers who have premature infants to emergency grants for families who find themselves in financial crises from an unexpected bed rest stint.

Unpaid leave is simply of no use to many working families who live paycheck to paycheck and cannot afford even one day without paid work. It’s a right for a privileged few Americans and even then it seems to be one without many benefits.

When it comes down to it, Turner-Lee says that most people are “summarily disgusted” about not having paid leave in this country:

“So many laws [governing the workplace] are antiquated – we have to make provisions for parents with children. Women now make up 52% of the workforce. If we stand up together and say this is absurd, then something will get done. We have to stand up and demand what we deserve.”

If you have a story to share, please check in with Mamas on Bedrest & Beyond. They will soon launch a campaign to raise awareness of the financial strain bed rest puts on pregnant women and their families. Please share your story by emailing info@mamasonbedrest.com. These stories will also be used to raise awareness among lawmakers and to encourage them to pass paid maternity/family leave.

Nebraska and the Falsehood of Fetal Pain

10:21 am in Uncategorized by RH Reality Check

Written by Susan Yanow for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

In August I cheered the injunction against Nebraska’s so called “Women’s Health Protection Act.”  This misleadingly named law would have required physicians to present all research about possible health risks related to abortion, even if the information is outdated, false or misleading, to every woman seeking an abortion.  Stopping that law was a victory. But Nebraska is not done with its attacks on women’s rights.

On October 15, Nebraska will enact another law that will have a chilling impact on women’s abortion access.  This law will ban abortions 20 weeks after conception or later, with exceptions only in cases of medical emergency, the pregnant woman’s imminent death, or a serious risk of “substantial and irreversible physical impairment of a major bodily function.”  The bill is based on unsubstantiated and misleading “science” that claims that a fetus can feel pain at 20 weeks.  It is also the first law in the country to exclude a woman’s mental health as a reason for an abortion.  Before this law is replicated in other states, advocates have to prepare us to fight this blatant attack on our right to abortion.

As advocates, we need to be able to talk about the reliable science of fetal pain and the connection between physical and mental health. We need to educate others, and ourselves and combat the use of pseudoscience and unsubstantiated “facts” as tools in the war to limit access to abortion.

The question of whether or not a fetus feels pain during an abortion can be a troubling one to some women and clinicians. The science of what a fetus experiences is complicated – without verbal reports and direct access to the mind of a fetus, scientists can only make inferences about what fetuses are able to experience. What is known is that to experience pain, the brain and nervous system must be developed enough to both react to a noxious stimulus and to have the enough neurological development and organization to experience the stimulus as “pain.” Authorities in both the U.S and Great Britain have conducted thorough reviews of all available studies of fetal pain. Both groups of experts have found that there is no evidence that fetuses develop the neural pathways necessary to feel pain until well into the third trimester. In fact, there is increasing evidence that the fetus never experiences the state of true wakefulness that is necessary for the experience of pain.  Instead, new research shows that the fetus is kept in a continuous sleep-like unconsciousness by the presence of specific chemicals in the uterine environment.  This makes sense; if a fetus inside the uterus could experience pain in the way that a baby can outside of the uterus, the sensation of having its head squeezed through the vaginal canal during birth would be excruciating!  These facts should be very reassuring to women who seek abortions and are concerned about fetal pain.  Advocates need to use these facts to counter those who would use claims of fetal pain to limit our rights. (For more information on Fetal Pain, see this fact sheet and these articles).

While the question of fetal pain is complicated, the concept that preserving a woman’s mental and emotional health is not a “good enough” reason for an abortion is infuriating.  Mental health is as important to women’s well-being as is physical health. Our brains and bodies are connected, and this interconnectedness is well recognized in medicine and in health care legislation. Roe v. Wade recognized the threat to a woman’s mental health as a legitimate reason for ending an unwanted pregnancy.  The Nebraska ban, however, will disallow mental health as a reason for abortion after 20 weeks.  The Nebraska legislature has decided that avoiding theoretical fetal pain (based on discredited scientific theories) outweighs the emotional well-being of a pregnant woman.  Nebraska’s law limits a woman’s right to abortion through the second trimester as codified in Roe v. Wade and presents a clear challenge to Roe.  Once in place, this law will limit the practice of Dr. Leroy Carhart, who currently is the only provider in Nebraska and most surrounding states who provides abortions to 24 weeks (and later for fetal anomalies).  The Nebraska ban will mean more delays, travel, expense and barriers for women in the heartland of our country who need later abortion care.

This is yet another attempt to erode our right to abortion, law by law, week by week. What happens in Nebraska unfortunately won’t stay in Nebraska.  Get the facts and be prepared for similar controversies over fetal pain and mental health in your state. 

Working with Jailed Pregnant Women Changes a Physician’s Career

6:25 am in Health care by RH Reality Check

Written by Dr. Carolyn Suffrin for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Late one night during my first months as a physician, I was helping a woman deliver her baby. I was a first year resident in obstetrics and gynecology, training at a hospital in Pennsylvania. It was already a familiar scene to me: the mix of excited anticipation for the beautiful and messy arrival of new life, and of nervous anticipation for the possible complications which any doctor-in-training fears. It was, by all accounts, a typical delivery room scene. Except by one account: the mother-to-be was shackled to the bed.

She was incarcerated at a nearby prison, and though I had no idea what alleged offense got her there, I had some idea that the pangs of labor and the numbing effects of her epidural seemed to override the need for any kind of restraints; how could she possibly flee in between painful contractions? I watched the baby’s heart rate on the monitor dip with each contraction, hoping desperately the mother would push her little one out soon. What if we needed to do an emergency cesarean section, I thought? How would we quickly transfer her from the labor room into the operating room with metal chains attaching her to the bed? As it turns out, she did push her baby out, and we welcomed new life into the world. I handed mom her baby, which she cradled in her one unshackled arm.

That moment in the delivery room troubled me so deeply that it has started me on a path to caring for incarcerated women in California. I now practice as an OB-Gyn at the San Francisco County Jail and at San Francisco General Hospital, the county hospital where jailed pregnant women deliver their babies. . . .

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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.

Unmasking Fake Clinics: The California Edition of 12th and Delaware

6:48 am in Uncategorized by RH Reality Check

Written by Alexa Cole for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

The premiere of HBO’s documentary 12th and Delaware marked the first time a mass audience got an inside look at a so-called “crisis pregnancy center” (CPC). Like many of you, I watched as the “counselor” at the CPC featured in the film manipulated and misled women in crisis situations. I still can’t get some of the scenes out of my mind, such as the one in which the CPC director tells a woman that going forward with her pregnancy could make her verbally abusive boyfriend change his behavior.

The film gave vivid examples of threats CPCs pose to women’s freedom and privacy, and I am glad it’s starting a conversation in the blogosphere and beyond—but, one thing bothers me. The documentary takes place in Fort Pierce, Florida, across the country from my state of California.

I work as a pro-choice advocate in California, so I often hear from friends that bad things going on in Florida or other parts of the country wouldn’t happen here. I mean, how could a CPC operate in California? It’s the most pro-choice state in the country, right? And if CPCs are here, they must be few and far between.

Well, CPCs are here, and I can relate to the manipulation that many women in the film were subjected to because I experienced it myself right here in my backyard.

During the summer months of 2009, NARAL Pro-Choice California Foundation staff sent volunteers to CPCs around the state.  These volunteers posed as women who might be facing an unplanned pregnancy and who needed both a pregnancy test and knowledge of their options.  As volunteers on the project, they were trained to be unbiased and neutral throughout the investigation in order to ensure accuracy and after each visit filled out a lengthy debriefing form on everything they saw, spoke of, and read in the center.  

Their stories are troubling. One volunteer was told that “women who have abortions have strong reactions when they hear vacuums because they use vacuums to remove the fetus.” Another volunteer was asked if she “wanted to be branded as a loose woman…to have [her] name written on bathroom walls.”  Others’ questions about abortion and contraception were ignored or met with hostility and judgment. If and when abortion was brought into the conversation, CPC employees used delay tactics and graphic images to deter women from seeing abortion as an option. 

The results of this investigation, published by NARAL Pro-Choice California Foundation in its report Unmasking Fake Clinics, demonstrate that the pro-choice state of California is under attack from the “fake clinic” arm of the anti-choice movement.  While only 59 percent of California counties have an abortion provider, 91 percent of California counties have at least one CPC. For women who are young, live in rural areas, or have low incomes, the “counseling” these centers provide may be the only resource available when they are faced with a decision that could affect the rest of their lives.  More than half of centers in this study specifically offer “free” counseling.  More than two-thirds of CPCs represent their counseling as unbiased, when in fact, our report documents that CPCs provided false information to women seeking assistance or information about abortion and birth control.  No matter how a person feels about the question of legal abortion, everyone can agree that women should never be misled when seeking information about pregnancy, birth control, abortion, or sexually transmitted diseases.  

NARAL Pro-Choice California Foundation found that CPCs in California often use propaganda and delay tactics to dissuade women from considering birth-control or legal abortion.  These include misstating statistics about the effectiveness of condoms (60 percent of CPCs in the study advised that condoms are ineffective in reducing pregnancy and the transmission of certain STDs) or providing misinformation about the consequences of undergoing an abortion (85 percent of CPCs in the study advised that abortion increases the risk of infertility and that abortion leads to mental health problems).  Most troubling is that eschewing medical integrity seriously endangers women’s reproductive health, as it ultimately may delay women from seeking appropriate comprehensive medical care. 

NARAL Pro-Choice California Foundation seeks to change this.  Many lawmakers at all levels of government have expressed interest in working on this issue.  Nationally, Rep. Carolyn Maloney (D-NY) and Sen. Robert Menendez (D-NJ) have introduced the Stop Deceptive Advertising in Women’s Services Act, which aims to prescribe rules prohibiting deceptive advertising of abortion services.  Locally, the organization is sharing these findings with community leaders around the state and hopes to work with city-level officials at passing ordinances similar to those in Baltimore and Austin.  Enacting more ordinances like these will help to offset another common deceptive strategy CPCs employ: just like the CPC in 12th & Delaware, many position themselves near or even next to legitimate clinics to confuse women intending to go to the reproductive-health care provider located on the same street.

While CPCs in California are currently not being held accountable for their deception, continuing to expose their practices through reports like Unmasking Fake Clinics provides women with the ability to make healthy decisions and lays the ground work for advocacy that will ensure these centers can no longer use misinformation and delay tactics to discourage women from pursuing safe, comprehensive, and legal options.

What’s happening in Florida, as seen in 12th and Delaware, is not only happening here in California but all over the country. NARAL Pro-Choice California Foundation’s investigation highlights that though California has long been considered the top state for respecting women’s reproductive privacy, it is not immune to the threats that are being documented around the country.  

A Pregnant Woman is Not a Meth Lab

11:28 am in Uncategorized by RH Reality Check

Written by Alexa Kolbi-Molinas of the ACLU Reproductive Freedom Project for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

In the past four years, more than 20 women in Alabama have been prosecuted for no other reason than that they tried to continue their pregnancies while struggling with addiction. Today, the ACLU and the ACLU of Alabama submitted a friend-of-the-court brief to the Alabama Criminal Court of Appeals, urging that court to reverse the conviction of one of these women, Amanda Kimbrough.

Ms. Kimbrough was convicted under a law that was passed by the Alabama legislature that makes it a crime to allow children into houses where meth labs are operated. However, Ms. Kimbrough was not charged with manufacturing meth — or any other drug; and she was not arrested in a meth lab, but after her extremely premature son was born, and subsequently died, at the hospital.

Confused? You should be. Like so many other women in Alabama who were charged under this statute, Ms. Kimbrough was prosecuted not because she brought a child into a meth lab, but because she tried to continue her pregnancy and give birth to her son, even though she was suffering from a drug dependency.

No one is suggesting that drugs are good for embryos or fetuses. For that matter, neither is smoking (or even just living with a smoker), drinking or eating unpasteurized milk products, or failing to get regular prenatal care. But do we really want to make a pregnant woman’s behavior and choices, any health condition she suffers, or even that she lacks health insurance, a crime because it could hurt the fetus? If we do, then virtually everything a pregnant woman does or does not do could land her in jail, because virtually everything a pregnant woman does or does not do — from what she eats, where she works, and what condition her health was in before she became pregnant — is going to have an affect on her fetus. Allowing the government to exercise such unlimited control over women’s bodies, and every aspect of their lives, would essentially reduce pregnant women to second-class citizens, denying them the basic constitutional rights enjoyed by the rest of us.

Moreover, from a public health perspective, these prosecutions are simply counterproductive. You’ve heard us say this before: Respected medical organizations, such as the American Medical Association and the American Academy of Pediatrics, have long opposed these sorts of prosecutions because they only undermine the health of moms and babies.

If, as a society, we are truly interested in supporting healthy moms and babies, we would not be undermining basic constitutional principles in order to throw the pregnant women and mothers who need health care most into jail. Our efforts should be focused on ensuring that pregnant women get the treatment and support they need. Hopefully, the Alabama Court of Criminal Appeals — as well as prosecutors across that state and the entire country — will finally agree.

Domestic Violence and Abortion: Why Do Anti-Choicers Excuse Abuse?

9:17 am in Uncategorized by RH Reality Check

Written by Amanda Marcotte for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Two thoughts went through my head when I read about a study showing that women seeking abortion experience high rates of domestic violence.  The first thought was that this doesn’t surprise me in the slightest, both because abused women might have more unintended pregnancies and because pregnancy often is the catalyst for abusers escalating the amount of violence.  And the second is that this really demonstrates how wrong anti-choicers are when they claim that forced childbirth is somehow pro-woman.  To be truly pro-woman, you must give women tools to prevent abusers from strengthening their hold over their victims.  Forcing an abuse victim to have a baby against her will by her abuser is doing the abuser’s work for him.

The findings of the study conducted by University of Iowa professors and Planned Parenthood of the Heartland is grim but unsurprising to those of us who know something about the parameters of violence against women.  Fourteen percent of the women coming in for abortions over an eight-and-a-half month period had experienced domestic violence in the past 12 months. There’s reason to suspect that women in abusive relationships are more likely to experience unintended pregnancy. Sabotaging birth control is a common tactic of abusers seeking to increase their power over their victims and reduce their victims’ own sense of control. Preliminary studies have found that it may be that up to three-quarters of women in abusive relationships experience some form of contraception sabotage.    

Once pregnant, women in abusive relationships are quite likely to be more motivated than average to terminate a pregnancy.  Domestic abuse often escalates during pregnancy, probably because abusers feel an even stronger need to control their victims.  They may also feel like they can get away with more abuse, because the child makes it that much harder for a woman to escape.  In fact, homicide, usually at the hands of a male partner, is one of the leading causes of death for pregnant women.  I’m not at all surprised that many women sense this danger, and this influences the decision to terminate.

And that leads me to the one silver lining in this research, which is that it seems many of the women getting abortions are not just trying to survive within abusive relationships, but are also taking steps to get out.  It’s not surprising that an unintended pregnancy and an abortion can be a catalyst for ending a toxic or even abusive relationship, and the research bears this out.  Leaving is a very dangerous time for a woman in an abusive relationship, because the abusers often panic and start escalating the violence or stalking.  But with this research in hand, clinic workers might be able to offer resources to women who are in an abortion clinic as part of a larger journey of escaping a bad situation.

Unfortunately, the anti-choice movement could create a large obstacle for keeping women safe.  Anti-choicers already hail from the conservative, anti-feminist movement and therefore already inculcate hostility towards feminist efforts to dismantle the culture of male domination that permits abuse to flourish.  Indeed, some anti-choice organizations work by stoking the anger of men who were rejected by their female partners after an abortion.  I doubt very much that those promoting angry men blaming abortion stop often to think that perhaps these men were rejected because they threatened their partner’s safety.  The romantic anti-choice myth of an unintended pregnancy leading to happily-ever-after doesn’t leave much room for acknowledging that sometimes “ever after” is less about being happy and more about being abused and unable to escape.

And since abortion is often a necessary step for many women seeking to escape abusive relationships, anti-choicers who are highly focused on stopping abortion at all costs will show an alarming disregard for women’s safety and well being. Take for instance the documentary "12th and Delaware," which is to be released on HBO in August.  The filmmakers recorded a crisis pregnancy center “counselor” trying to talk a woman out of an abortion, even though that woman made it clear that she was in an abusive relationship and felt the abortion was an important step in getting out.  The “counselor” suggested that having the baby would mean an end to the abuse.   In reality, having a baby with an abuser usually means he has more control and leverage over you, something the pregnant woman in this film knew very well.  Thankfully, the anti-choice “counselor” did not talk her out of taking care of herself and her safety.

Because of this basic disregard for women’s well-being, I worried that anti-choicers would immediately start angling to find a way to use this study to try to bully abused women out of getting abortions those women deem necessary.  And sure enough, that’s exactly what happened. Life News deliberately lied about the research to make it seem that the abortion came before the abuse for these women, implying that the women brought violence onto themselves by choosing abortion.  In reality, of course, the abuse predated the abortion in all of these cases, which were taking the histories of women getting abortions.  By implying that the violence came after the abortion, Life News joins forces with wife beaters everywhere by using the threat of violence to control women’s bodies.

And this is why anti-choice claims to be “pro-woman” are so laughable.  You cannot be pro-woman while using the threat of domestic violence to control women’s reproductive choices.  You cannot be pro-woman while telling women lies about domestic violence and pregnancy in hopes they make choices that will usually end up putting them in more danger.  You cannot be pro-woman when you distort the realities of abortion and domestic violence in ways that will, if you’re successful, lead perhaps to fewer abortions but certainly towards more beaten and even murdered women.  

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.