Archive for the ‘women’s health’ Category

The Mexico City Policy: Misunderstood, Misguided, and Malignant for Maternal and Child Health

August 20, 2017

Imagine a woman seeking medical care in the direst of circumstances and a sole health worker prepared to deliver her these services. Now imagine that although the worker’s organization is committed to provide these safe, legal, quality services, a single policy financially incapacitates the care because a minority of citizens in a country thousands of miles away opposes even discussion of certain topics with the patient. This is wasted human spirit. This can mean life or death. And this is the Mexico City Policy, a U.S. federal restriction recently re-enacted and expanded under President Trump as the Protecting Life in Global Health Assistance (PLGHA) policy.

PLGHA requires foreign NGOs to agree not to “perform or actively promote abortion as a method of family planning” as a condition for receiving U.S. government funds NOT ONLY for family planning assistance, as the previous Mexico City Policy declared, but for ALL health programs, including those for HIV/AIDS, maternal and child health, malaria, and global health security, putting billions of annual U.S. aid dollars and, thus lives, at risk. An increase in abortions has previously been found under this intervention and models predict staggering numbers of unintended pregnancies, abortions, and maternal deaths. Not surprisingly, advocates of women’s health around the world from International Planned Parenthood Federation to the United Nations have outlined the deadly consequences of the PLGHA and not only stated their firm opposition to it but have created movements against it.

 

The clearest course of action for advocates of women’s health and Global Health in general is to promote passage of the U.S. Global Health, Empowerment, and Rights Act (HER Act), introduced by Senator Jeanne Shaheen and Representative Nita Lowey. The HER act would create a permanent, legislative repeal of PLGHA and the Mexico City Policy, allowing NGOs to continue to operate U.S.-supported health programs without being forced to sacrifice the provision of appropriate care. The HER act fights the financial coercion of the PLGHA and may offer the best chance to restore global faith in the U.S. as the leader of Global Health worldwide.

 

 

 

 

 

 

 

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Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Stop restricting access: Prevent the “Rape Insurance” bill from going into law.

August 20, 2017

On August 15, 2017 Texas Governor Greg Abbott signed House Bill 214 (HB 214). HB 214 is a bill by Rep. John Smithee (R-Amarillo) that bars standard coverage of elective abortions by private, state-offered and Affordable Care Act insurance plans. While it has a very narrowly defined exception for medical emergencies, it makes no exception for rape, incest, or fetal abnormalities. To obtain coverage for abortions due to rape, women would have to have previously purchased supplemental coverage which has led critics to dub this the “Rape Insurance” bill.

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Mandel NGAN/AFP/Getty Images

The authors of the bill claim this legislation is about not requiring those who philosophically and fundamentally disagree with abortion to have to subsidize the procedure. Governor Abbott states this bill only limits insurance coverage for abortion procedures, not abortions themselves. But he himself cites this bill as part of his pro-life agenda stating “I am grateful to the Texas legislature for getting this bill to my desk, and working to protect innocent life this special session.”  In truth what SB 214 really does is limit a woman’s access to appropriate and timely health and abortion care. This legislation also unfairly and disproportionately targets low-income women. Abortion is concentrated among low income women.  Low-income women also shoulder a higher financial burden in terms of healthcare in general.

Under the bill, insurance companies would not be required to carry this supplemental “rape insurance”. This adds additional burden to women of all income levels. Ultimately, insurance companies may simply stop covering abortion altogether as the profitability of an “abortion-only” add-on would be questionable at best, further limiting access to care. Lastly, rape is an unpredictable life event, as is pregnancy as the result of rape. Under SB 214 women are expected to somehow anticipate the need for abortion care and purchase supplemental coverage, defying the point of insurance.

What’s missing from this photo? The women this law impacts.

What can you do?  SB 214 goes into law on December 1, 2017. Support Texas pro-choice groups in their prevention efforts. Reach out to Governor Abbott and remind him that “Texas Values” are not synonymous with his personal values. Get informed about women’s healthcare law in Texas.

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via Trust.Respect.Access

Don’t live in Texas? There are 25 states with restrictions on abortion coverage in plans set up by state exchanges as part of the Affordable Care Act. There are 10 states (now 11) which have laws restricting insurance coverage of abortion in all private insurance plans written in the state. Find out what the laws are in your state. Contact your elected officials and tell them how you feel about laws limiting women’s access to healthcare.

Put Down the Weapon: Helping to Prevent Gun Violence in the Home

August 20, 2017
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Source: The Trace

Under House Bill 294, the Maryland state legislature proposed the regulation that those with probation before judgement (PBJ) for second degree assault for domestically-related crimes be prohibited from retaining or possessing a firearm. Touching on the highly politicized issue of gun control, this bill was introduced to the House and successfully passed in May 2017.

 

Domestic violence is a public health issue often exacerbated by gun violence. Victims of partner violence are five times more likely to die if their partner owns a firearm. Even when homicide is avoided, those who physically assault their partners are more likely to utilize firearms in subsequent situations. Respected organizations such as the Maryland Network Against Domestic Violence and the Johns Hopkins Center for Gun Policy and Research have long acknowledged and advocated to address these dangers through legislative measures.

To obtain a PBJ, an individual assumes guilt but is not convicted of the actual crime, allowing them to be placed under probation with varying supervision. Often those who are first time offenders are allowed this sentence. After 15 years, these individuals can be expunged, in which case they can once again own firearms. This suggests that this law is only a temporary solution to the problem.

Still, as a nurse researcher who works with women experiencing domestic violence, I am in favor of House Bill 294. Through my work, I have found there to be inconsistent gun control policies throughout the United States. Therefore, I feel this bill is an important step forward. I further advocate for Maryland lawmakers to devise legislation that firearms are kept out of potentially violent domestic environments, even in cases of expungement, to ensure a more hopeful future for the survivors of violence.

Opposition takes aim at Rhode Island’s successful HPV mandate

August 18, 2017

In 2015, Rhode Island led the fight against cancer by mandating that all students be vaccinated against Human Papilloma Virus (HPV) prior to the seventh grade. As a result, Rhode Island now has the highest rate of compliance in the country with the Center for Disease Control and Prevention (CDC) recommendation. However, several interest groups have recently mounted legislative opposition to the mandate in an effort to dismantle the policy.

HPV is recognized as the leading cause of cervical cancer, and also contributes to several head and neck cancers. The CDC recommends protecting children early in life by providing two doses of an HPV vaccine at least 6 months apart between ages 11 and 12. Since its introduction, the vaccine has been shown to be safe and highly effective in reducing the rates of HPV by 64% among women aged 14-19.

The 2015 HPV mandate in Rhode Island to provide free HPV vaccines was championed by the Department of Health, under the authority of state statute. The Rhode Island Medical Society, the American Medical Association, the American Academy of Pediatrics and the CDC all strongly supported this decision. Appropriate medical and religious exemptions to the HPV vaccine are granted, but in the interest of child welfare, the process to seek exemptions is rigorous to ensure that no child’s health is neglected.

In April 2017, two opposing bills were introduced into the Rhode Island General Assembly which proposes that guardians be allowed to opt their children out of the HPV vaccine and any other vaccines in which “non-casual contact diseases are transmitted by sexual contact”. A third bill proposes a philosophical exemption to the vaccine, while a fourth bill attempts to revoke the Health Department’s legislative ability to mandate the HPV vaccine entirely. These efforts were led by interest groups including The Gaspee Project and Rhode Islanders Against Mandated HPV.

Children are counting on Governor Gina Raimondo to stand up for their health by continuing to defend the legislative authority of the Department of Health and oppose these bills which attempt to overturn a critical public health policy.

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Rescinding the Mexico City Policy

March 12, 2017

The Mexico City Policy, also commonly known as the “Global Gag Rule,” was first introduced in 1985 during the Reagan administration and has been rescinded by most Democratic presidents and reinstated by most Republican presidents since then. This policy was most recently reinstated by President Trump, and prohibits foreign NGOs that receive US government funding from performing abortions, providing counseling and information on abortions as a method of family planning, or promoting any changes in a country’s legislation regarding abortion. The Trump administration’s reinstatement, however, does not apply only to family planning assistance. It expands to limit all U.S. global health funding, including global HIV and maternal child health (MCH) assistance.

Many organizations, including Marie Stopes International, Doctors Without Borders, Population Action International, and International Planned Parenthood Federation, have released statements in opposition to the Global Gag Rule. Foreign governments have also stepped forward, with some creating international funds or pledging money in an effort to fill the funding gap. While these are a good start, we need greater mobilization to fight for women’s health and empowerment.

Unsafe abortion is one of the main causes of maternal mortality worldwide, and disproportionately affects women in low- and middle-income countries and in vulnerable contexts such as refugee camps and conflict zones. Research has shown that policies preventing providers from educating women about abortion and family planning methods lead to more unwanted pregnancies, more unsafe abortions, and higher rates of STIs. This policy also threatens progress on many other fronts, such as HIV, child malaria, tuberculosis, and immunizations. Healthcare providers, public health professionals, and all concerned citizens need to speak out for global reproductive rights, support international aid organizations, and push Trump and US Congress for the repeal of the Mexico City Policy.

Brazilian Women At Risk of Zika Deserve Better Access to Reproductive Health Services and Education

March 12, 2017

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Photo credit

In the 1960s, the Brazilian government adopted a laissez-faire attitude, which lead to the predominance of private organizations in the provision of family planning services. Since then, Brazil has witnessed one of the most dramatic reductions in family size in modern history in part due to increased access to family planning services.

However, in early 2015, the widespread epidemic of the Zika fever caused by the Zika virus in Brazil caused persisting gaps in access to contraception to resurface. Since it was first detected it has instilled fear and uncertainty in pregnant women whose fetuses could be at risk of Zika-related birth defects like microcephaly should the virus be contracted during pregnancy. This makes access to comprehensive reproductive health services and education a critical need for women who are pregnant or considering becoming pregnant.

While contraceptive use is fairly high in Brazil with 75.2% of women using modern forms of contraception, barriers to access remain. Some women face challenges, some of which include but are not limited to incomplete insurance coverage or lack of reimbursement for long-acting reversible contraceptives (LARCs), high up-front costs, low number of contraceptive service sites, and/or a lack of supply of the implants in the public sector . This may be one driver behind why LARCs only make up 0.5% of all contraceptive sales. Furthermore, 55% of all pregnancies in Brazil estimated to be unplanned and 20% of all lives births are attributed to teenage girls, indicating that there may be substantial reproductive knowledge gaps  in how to effectively prevent pregnancy.

Amid the spread of a virus that poses unique health risks to pregnant women and their fetuses, there is an urgent need to address these gaps in reproductive health access and education. First, the Brazilian National Health System, which laudably provides most contraceptives free of charge to about 74% of the population, needs to reevaluate existing policies that may be still limiting access to contraceptive services. Secondly, organizations like the Brazilian Society for Family Welfare (BENFAM), which provides reproductive health services and education to underserved Brazilian communities, need greater financial and political support from policymakers, civil society, and even organizations traditionally opposed to such services like the Catholic Archdiocese.

Despite Brazil’s great strides to improve access to contraception and reproductive health education in recent years, Zika’s arrival highlighted gaps in the existing system that must be addressed through policy reform and greater political and financial support. Especially in the time of Zika, Brazilian women deserve no less.

Group members: Linda Cho, Linda Chyr, Rebecca Earnest, Sarah Rosenberg

 

The Global Gag Rule

March 11, 2017

The Mexico City Policy, introduced at the 1984 United Nations International Conference on Population, was an expansion of the 1973 Helms Amendment that restricted NGOs receiving US federal funds from providing abortions as a family planning method. This policy, commonly known as the Global Gag Rule (GGR), prevents NGOs from performing or promoting abortion as a condition of receiving US federal funds earmarked for family planning purposes. This controversial policy has been repealed or reinstated by Executive Order with each presidential administration since the 1990s.

The Trump Administration iteration of the GGR goes a step further and applies the same limits to all US global health funding.

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via NPR

Groups currently receiving US global health funds are either remaining quiet about the policy or speaking against it. Those rejecting the policy stand to lose millions of dollars typically allocated to sexual and reproductive health (SRH) services globally, which could result in the closure of clinics, decreased access to care, and the associated increases in unplanned pregnancies, unsafe abortions, and maternal mortality.

Organizations working in SRH not reliant on US funding are coming out in opposition to the policy, signaling to other organizations their resistance to limitations on free speech in the delivery of care. Despite not receiving funds, these organizations will be indirectly impacted by the GGR as women seek care in areas where access is limited as a result of the GGR.

In the face of the GGR, the international community has stepped forward, with governments pledging funds for SRH organizations in an effort to cover the loss of funds, services, and care resulting from the policy.

To continue to undermine the efficacy of the policy, international NGOs and governments should reject the Mexico City policy while advocating for women’s rights and health globally. The US government should follow the lead of other western nations, permanently block the GGR (and Helm’s Amendment)and fight for the quality of SRH services, rather than their existence.

New Child Marriage Law in Bangladesh Can Undo Decades of Progress

March 10, 2017
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A child bride with her newborn daughter (Photo credit: Sam Nasim/Creative Commons)

Child marriage, usually defined as individuals married or in union before the age of 18, is a common occurrence in many countries globally. Girls who marry before the age of 18  are not as likely to finish secondary education, and more likely to experience domestic violence, die due to complications of pregnancy and childbirth, and produce children with a higher risk of neonatal mortality and/or morbidity when compared to women in their 20’s.

Though often cited as a development success in terms of poverty and mortality reduction, the nation of Bangladesh ranks 5th highest in prevalence of child marriage, with an estimated 52% of women married by age 18. Common drivers of child marriage are poverty, beliefs that marriage will ensure economic and social security for girls, and an emergency response to natural disasters.

Bangladesh’s current law on child marriage prohibits marriage before the age of 18 for women and 21 for men, as dictated by the Child Marriage Restraint Act 1929. Despite child marriage being illegal, the law is not often enforced, especially in rural areas of the nation.

In 2017, parliament adopted a new act which would allow child marriage in “special cases”, with no definition as to what constitutes a special case (Child Marriage Restraint Act 2017). Additionally, it gives harsher punishment to individuals who marry children: two years of imprisonment and/or a 100,000-taka fee ($1200). The law has passed the parliamentary phase and is awaiting presidential approval.

Many Bangladeshis and the international community have stated that given the ambiguous wording of the act, such a law would practically authorize child marriages across the country as one could easily justify the marriage being a special circumstance, such as rape cases. International organizations such as the Human Rights Watch have openly spoken against the act,  citing it as a “destructive law”.

Other than direct presidential rejection of the law, some have suggested that added regulations to this act are the only way to prevent increased prevalence and acceptance of child marriage in Bangladesh. Though it would be ideal to abolish the ambiguous segment of the act completely, regulations can specify under what rare circumstances child marriage would be allowed in, require consent of the minor her/himself, assign social workers to such cases, and completely ban all marriages before the age of 16. Local NGOs, along with international organizations that specialize in protection of women and girls, can be involved in coordination with local judges and government officials to assign social workers to such “special cases”.

In the coming months, the president of Bangladesh will make a decision on the finality of the law.