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You Can’t Have it Both Ways: The Interpretation of Catholic Health Policy and the Consequences for Pregnant Women

12:46 pm in Uncategorized by RH Reality Check

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

Republished with permission from Reproductive Health Matters.

“There is only one way to be sure a woman’s life is at risk, that is, after she dies.” — Christian Fiala, 2012

 

A view of Galway Hospital and parking lot

Savita Halappanavar died at Galway University Hospital.

In 1987, the year the first Safe Motherhood Initiative was launched by the World Health Organization (WHO), there were more than half a million maternal deaths annually. The women who were dying were often anonymous and their deaths never recorded or studied. They were mainly from poor and often rural backgrounds in developing countries, such as India. A study in India published in 1999 comparing 100 maternal deaths in a Rajasthan hospital in 1983-85 to 100 in 1994-96 found that: “Most of the women who died in hospital in 1994-96 would have died at home in the earlier decade.”1 What had changed was that they had reached a hospital and were therefore no longer anonymous, but they were still overwhelmingly women living in poverty with little or no access to skilled pregnancy and delivery care. 

Contrast this with the death of Savita Halappanavar on 28 October 2012, a dentist from a privileged background in India, who miscarried 17 weeks into a very wanted pregnancy and died in the maternity ward of a hospital in Ireland, a country with a very low maternal death ratio.2 Savita’s death was anything but anonymous; her name and photograph circled the globe within days of her death and sparked street demonstrations and protests, not only across Ireland but also in many other parts of Europe and in India. Six weeks later, articles and blogs about her death continued to be published in many countries, demands by her husband for a maternal death audit were headline news, and the Irish government has been forced to consider the effects of her death for the law, health policy and the Constitution of Ireland. 

Savita’s death became iconic for a number of reasons. First, preventing maternal deaths has been a global priority since 1987 when the first WHO Safe Motherhood Initiative was launched. Since 2000, reducing maternal deaths by 75 percent by 2014 has been the main target of Millennium Development Goal No.5, and since 2010 it has been one of five main goals of the UN Secretary-General Ban Ki-Moon’s Global Strategy on Women’s and Children’s Health. Hence, maternal deaths have started to be a news item globally, with journals like Reproductive Health Matters carrying studies and the media in many countries where deaths remain frequent, reporting successes and failures to reduce deaths, and individual stories regularly.

Secondly, holding governments accountable for their failure to provide the required services, both antenatal and delivery care and emergency obstetric care, to prevent avoidable maternal deaths has become the subject of public protests by women’s rights advocates, of court cases, including in India, and of hearings by human rights bodies, particularly CEDAW, examining individual cases and making policy recommendations to governments.3

What was different about Savita’s death, however, was the fact that it was also about whether and when to terminate a pregnancy when it is not viable and the woman’s health and life are at risk, and how that intersected in Savita’s case with individual health professionals’ interpretation of Catholic health policy and the law on abortion in Ireland. 

As a committee of the Irish Parliament considers proposals to offer limited legal abortion in Ireland, this paper explores how these issues came together around Savita’s death, the interpretation of Catholic health policy and the consequences for pregnant women.

Preventing maternal deaths as global policy

Maternal deaths, especially in countries where they remain frequent, are getting more and more media coverage. The Millennium Development Goals have made countries with continuing high maternal mortality ratios4 conscious of their shortcomings, and civil society organizations are beginning to pursue justice and even compensation in individual cases. 

In India, for example, a petition for legal redress was filed in the Delhi High Court in the case of Shanti Devi, who died in childbirth in January 2010 after two high-risk pregnancies in which she received delayed and insufficient care. With the first of these two pregnancies, she fell down the stairs and afterwards could no longer feel the baby moving. Induction of the pregnancy was delayed until she required intensive care which, when she finally received it, was inadequate. With her health still very precarious, she became pregnant again six months later, went into labor prematurely at seven months, delivered the baby at home without a skilled birth attendant or any medical assistance, and within an hour after delivery, began hemorrhaging and died. This case ensured that the Court took into account not just the individual death but also the constitutional and human rights obligations of the central government of India.5

Some communities where women are at high risk because of the lack of routine and emergency obstetric care are also beginning to protest against maternal deaths. One such event took place in Uganda where, in May 2011, hundreds of concerned citizens and health professionals stormed the Constitutional Court in Kampala, Uganda, protesting the deaths of women in childbirth, in support of a coalition of activists who took out a landmark lawsuit against the government over two women who bled to death giving birth unattended in hospital.6

Another example from India comes from Barwani district, Madhya Pradesh, India, where there were local protests against 27 maternal deaths in the period from April to November 2010. In January 2011, an NGO fact-finding team found an absence of antenatal care despite high levels of anemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment.7

Events like these are making the governments concerned highly sensitive to criticism. As an upper middle-class woman, Savita Halappanavar would have been highly unlikely to die in India from the appalling treatment experienced by Shanti Devi or the tribal women in Barwani. Yet, ironically, the Indian government was among the first to criticism those in Ireland who failed to prevent Savita from dying. For example, India’s ambassador to Ireland said that Mrs Halappanavar may be alive if she had been treated in India.

Emergency obstetric care, termination of non-viable pregnancies and Savita’s death

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Myths About Homosexuality Fuel Uganda’s “Kill the Gays” Bill

1:11 pm in Uncategorized by RH Reality Check

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

This week, as we are waiting for the Ugandan parliament to debate whether or not homosexuality should be punishable by death (or at the very least life in jail) it might be helpful to review whatever could make anyone reach such a murderous conclusion.

The short answer is: lack of awareness, sometimes wilful. Lack of awareness about what it means to be lesbian, gay, bisexual, or transgender (no, it is not a lifestyle choice). Lack of awareness about the link between sexual orientation and sexually predatory tendencies (there is none). And lack of awareness about how to adequately address actual harm (for starters, it would make sense not to target those already marginalized for more abuse).

The draft legislation on the table in Uganda is not new. A version of the bill — which ups penalties for homosexuality and allegedly creates new provisions to criminalize the “promotion” of homosexuality — was already circulating last year. Moreover, the belligerent rhetoric directed at anyone who does not look or seem straight is neither innovative nor specific to Uganda. For years, politicians and pundits from the United States to Malawi have spread the notion that gay people “recruit” children and others into homosexuality and that paedophilia and homosexuality are intimately linked.

While these claims have been repeatedly refuted with facts, they stubbornly persist. There are any number of reasons for this, two of the most prominent being that 1) blaming gays for all society’s wrongs is easy and helps to divert attention from any real problems; and 2) that stereotypes about sexual attraction and gender roles — persistent in all societies everywhere — fuel fear of homosexuality. And it is only by tackling the latter that enough people will see through the former and identify it as wrong.

It is with this in mind that I invite you to identify the most harmful gender or LGBT-related stereotype in your society or immediate circle of friends, and to commit to calling it out as damaging whenever it comes up.

Here is mine: gay men and lesbian women are attracted to (literally) everyone of their own gender. I cannot count the number of times I have heard someone say that they are OK with someone being gay, as long as that person doesn’t hit on them personally. Or that they feel uncomfortable in a locker room or sports club with someone who is gay or lesbian. Or similar variations on this theme.

Apart from the obvious delusional aspect of these comments (really, I always want to say, you are not that attractive), they just don’t make any sense. If this proposition were accurate, it would mean that all straight men and all lesbian and bisexual women are attracted to me, a notion which I can personally attest to being false.

More to the point, this myth can be countered by inviting people to reflect on their own patterns of attraction. Everyone has sexual preferences and most of the time we can’t say specifically why we want to have sex with one person and not the other. What we can say — gay, lesbian, bisexual, and straight alike — is that the vast majority of us don’t want to jump everyone we see given they simply have the appropriate genitalia.

The bill which is likely to be discussed in Uganda is fuelled, partially, by the extreme version of this myth: not only do all gay men want to have sex with all men, they also want to have sex all the time. I want to believe that anyone who thinks through this logic for just a moment will find it ridiculous and even humorous in its absurdity. Yet, for the thousands of gay, bisexual, and transgender men and women living in Uganda it is not funny.

Myths can kill. And the only way to prevent that from happening is to kill the myths themselves.

Forced Pregnancy Testing: Blatant Discrimination and a Gross Violation of Human Rights

10:38 am in Uncategorized by RH Reality Check

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

Earlier this month, news spread of a Louisiana charter school’s policy that would have allowed faculty to force any student suspected of being pregnant to take a pregnancy test — and, if the test came back positive, to force her to go on home study.

Forced pregnancy testing in schools is a gross violation of young women’s fundamental human rights. Through legal advocacy, I have been working to get it recognized as such and outlawed — in Tanzania, Kenya, Uganda, in my home country of Nigeria, and in other countries in the African region where it occurs. It is a shock to see a practice I’ve come to associate with schools in the developing world being replicated in the United States.

I have seen the consequences firsthand, and they are devastating. In secondary school, the older sister of a classmate, who was a year ahead of us, was found to be pregnant and expelled by school administrators. We eventually learned that she was the victim of a rape which occurred in her home, but she was too terrified to tell anyone what had happened. As is the case with many victims of this injustice, no other schools would accept her. Her hopes for a better future were doomed.

In Tanzania, where nearly 44 percent of girls have either given birth or are pregnant by the age of 19, school administrators across the country force schoolgirls to undergo demeaning pregnancy tests often just before completing primary school — around the age of 11 — and with increasing, and random, frequency throughout secondary school. Some girls must strip to their underwear to reveal physical signs of pregnancy. Others are coerced into taking urine-based pregnancy tests. No one can refuse to be examined or tested.

The impact is staggering, long-lasting, and far-reaching. About 8,000 girls are expelled or drop out because of pregnancy in Tanzania every year. Too often families abandon their pregnant teen daughters, forcing them to live on the streets with their babies. Faced with the possibility of homelessness, some young women succumb to pressure from their families to seek financial support through early or arranged marriages. The impact of these violations to their rights to health, education, privacy, and freedom from discrimination ripples throughout young women’s lives. Many female leaders of human rights advocacy groups still remember, over twenty years later, how humiliating and disempowering it was to experience forced testing even though they did not turn out to be pregnant.

Government officials do next to nothing to improve the situation despite its epidemic proportions; nearly 60 percent of the country’s adolescents have sex before 18. And in a double standard that’s all too common in many places throughout the world, while young women are stigmatized and penalized for pregnancy, the men and boys involved are rarely identified and face few consequences for their role.

In the United States, the reaction to the news about the Louisiana charter school was swift. Under threat of a lawsuit by the ACLU, the school reversed course and amended its student pregnancy policy, which no longer includes the invasive forced pregnancy testing it initially announced. The revised policy now assures female students the opportunity to continue schooling on campus throughout pregnancy and the option for homeschooling. This is a just and appropriate result.

Nevertheless, the emergence of this idea in an American school should trouble anyone concerned with the protection of our fundamental constitutional and human rights. And it should serve as a reminder of the importance of guarding vigilantly against violations of these rights not just in the developing world, but also — sadly, it seems — in the U.S.

Uganda: Pregnancy and Childbirth Mean Playing Russian Roulette With Women’s Lives

10:13 am in Uncategorized by RH Reality Check

Photobucket

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

Sylvia Nalubowa’s surviving twin is two-and-a-half; Jennifer Anguko’s baby turned one this past winter. Both of their mothers died giving birth to them – they are orphans of maternal mortality, an epidemic that continues to plague Uganda as it does the rest of the developing world. But these babies are also children of history.

Their mothers have become the face of a landmark case in Uganda that seeks, for the first time, to assign blame to the government for the deaths of women in childbirth. Last March, Ugandan human rights groups joined families of the deceased to file Constitutional Petition 16, alleging that the Ugandan Government failed to protect the women’s constitutional rights to life and health by allowing them to die in ill-equipped and poorly managed public hospitals, or failing to provide them with basic maternal care.

“We are seeking a declaration that maternal deaths happening due to avoidable causes is a violation of the right to health,” said Primah Kwagala, a lawyer for the Centre for Health, Human Rights and Development (CEHURD), a lead petitioner of the case. “The government should own up and increase funding towards maternal Health, and fulfill the Abuja Declaration to give at least 15% of the annual budget to the Health Sector.”

One of the key complaints in the petition is the Government spends just one-quarter on maternal health of what it pledged to spend, per capita.

Each woman died of negligence, essentially, as do 1 in 35 Ugandan women during pregnancy or childbirth. From ill-equipped health workers untrained for obstetric emergencies to inaccessible clinics, birth control stock-outs, and unsafe abortions gone very wrong, women in Uganda are forced to play Russian Roulette with a failing health system.

The petition was filed in March and heard in October, garnering impressive and global attention from advocates and media around the world. It seemed a rare breakthrough in an endless news cycle that treats maternal deaths as sad, but inevitable.

“Maternal health has been overlooked, as people seem to look at it as the daily status quo. People do not know that they have a right to good health service provision; they think it is a privilege,” said Kwagala.

An objection was raised during the petitions hearing which derailed promising momentum, and which must first be ruled upon before the actual petition hearing can move forward. Since then, five months have elapsed and the global media has long since packed up. Read the rest of this entry →