Archive for the ‘women’s health’ Category

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The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it.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commonly known as the “Global Gag Rule,” was first introduced in 1985 during the Reagan administration and has been rescinded by most Democratic presidents and reinstated by most Republican presidents since then.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.

The Fate of Frozen Embryos

August 19, 2016

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An estimated 600,000 to two million frozen embryos are stored at fertility clinics and cryopreservation facilities in the United States. Some are destined for implantation but many will remain frozen in perpetuity because no one is willing to decide their fate. Intense disagreement over when life begins entangles these embryos in a complex web of legal, ethical, moral and religious debate and results in decisional paralysis. In contrast to Australia and the United Kingdom, the U.S. has no state or federal policies to regulate management of unneeded frozen embryos and the pendulum of support swings from one extreme to the other. Fertility clinics have inconsistent practices and professional societies such as American Society of Reproductive Medicine (ASRM) and American College of Obstetricians and Gynecologists (ACOG) have produced only position statements. With approximately 60,000 babies born via IVF each year and 4-6 frozen embryos for each live birth, the quantity of frozen embryos in storage will grow exponentially if we continue to allow indecision to be the de facto policy.

Federal or state regulations to manage the large population of unneeded frozen embryos is unlikely because religious and right to life groups wield strong political and financial power in this contentious debate.  The onus is on ASRM and ACOG to develop and enforce a comprehensive policy requiring an advance directive prior to creation of any embryos.  The directive, completed by the couple, will determine the fate of the embryos – disposal, donation for stem cell research, or donation to another couple –  if they are not used within a 5 year period.  In addition, the directive must address contingencies such as divorce or death.  Accreditation of fertility clinics predicated on policy compliance will be the mechanism for enforcement.  Only a clear, firm stance will turn the tide from benign neglect to thoughtful action.

 

 

 

 

 

Colorado Can Do 5!

August 18, 2016

Colorado Can Do 5! is a hospital initiative set forth by the Colorado Department of Public Health and Environment to increase breastfeeding rates in Colorado. This initiative is 5 different hospital practices and are half of the ten practices that the gold standard for hospital lactation policy, Baby Friendly Hospital Initiative, calls for implementing. Colorado Can Do 5! asks hospitals to:

  1. Establish breastfeeding in the first hour after birth.
  2. Keep infants in the room with their mothers and not take them to the nursery.
  3. Only feed breastfed infants breast milk and no other supplementation.
  4. Not use pacifiers.
  5. Provide mothers with a telephone number to call for help with breastfeeding after discharge.
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Establish breastfeeding in the first hour after birth. Photo by Andreas Bohnenstengel

These five policies increased longer term breastfeeding rates in Colorado measurably.  This was a collaborative initiative between the Colorado Breastfeeding Coalition, and Colorado WIC. Hospitals were given a presentation and resource kit at 21 key birthing hospitals. The hospitals that implemented these policies saw an increase in breastfeeding duration which equal better health benefits for moms and babies, as well as, lowered health care costs.

A significant number of the hospitals that implemented these practices have, since, gone on to achieve the Baby Friendly Hospital designation! At the start of this initiative, there were two hospitals that had successfully achieved Baby Friendly. Now, eight hospitals have achieved Baby Friendly status and many more are on the way!

Baby Friendly is huge undertaking for a large hospital system. It forces perinatal health staff to undergo significant further training and requires very specific policies to be passed. However, now that the word is getting out about the importance of breastfeeding, expectant families are seeking out Baby Friendly hospitals to deliver their babies.

More Colorado hospitals need to make these vital changes to their policies and perinatal patient care. It’s good for moms. It’s good for babies. It’s good for hospitals.

A Patient Navigator’s Support for the New York State Breast Cancer Initiative’s 4-Hour Leave for Breast Cancer Screening

March 8, 2016

Breast cancer is the most common cancer among women in New York State,[1] and mammography has been shown to be effective at detecting tumors at earlier stages of development than clinical breast exam.[2]

breastcancer_stat_paperworkSource: https://www.ny.gov/programs/new-york-state-breast-cancer-programs

 

All eligible New York State public employees are currently entitled to one annual 4-hour leave from work in order to undergo mammography for early detection of breast cancer. Governor Cuomo wants to expand this policy to cover the private sector, so that all New Yorkers will have the right to life-saving screening without putting their employment status in jeopardy.

As a patient navigator in a cancer center in East Harlem, I believe that this policy will be instrumental in saving lives. Many of the patients we see would be classified as “working poor” – despite often holding two jobs and working constantly, they still live in a state of poverty. Even one day’s lost wages could upset the extremely delicate balance they live and cast them into a state of catastrophe. As a result, many people will often choose the work they need to put food on the table over getting a screening that has little apparent immediate benefit. Unfortunately, this often results in the women who do develop breast cancer only finding out they have the disease at a later stage, making it much more difficult to treat.

Numerous private sector businesses, including M&T Bank and Amneal Pharmaceuticals, have indicated their support for the policy. This is not to say that everyone is on board – there are those organizations[3] who believe that even the state employees’ guaranteed leave for screening is s superfluous use of New York State citizens’ tax dollars. I, however, would disagree – increased screening coverage would not only save lives, but it would also save the state money in the long run. Treating late stage breast cancer is extremely expensive compared to early stage cancer. Since screening should ensure that most breast cancers are caught and treated early, this will reduce the burden on the economy,[4] and especially on the state’s budget by reducing costs for Medicaid and Medicare Services, which insure a great deal of the people who would benefit from the new policy.

References

[1] https://www.ny.gov/new-york-state-breast-cancer-programs/new-york-state-breast-cancer-services

[2] http://www.cancer.org/healthy/toolsandcalculators/remind-me?_ga=1.268218890.549704867.1457131056

[3] http://www.stopthetaxshift.org/employee-relations/29-paid-leave-for-cancer-screenings-

[4] Mandelblatt, Jeanne, Harold Freeman, Deidre Winczewski, Kate Cagney, Sterling Williams, Reynold Trowers, Jian Tang, and Jon Kerner. “Implementation of a Breast and Cervical Cancer Screening Program in a Public Hospital Emergency Department.” Annals of Emergency Medicine 28, no. 5 (November 1996): 493–98. doi:10.1016/S0196-0644(96)70111-7.

 

LARC: Reducing Colorado’s Teenage Pregnancy Rate

March 4, 2016

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Although teenage pregnancy rates have declined over the last twenty years, teenagers in the US are far more likely to give birth than teenagers in other industrialized countries.

However, between 2009-2013, Colorado decreased the number of teenage births by 40% and the number of abortions by 35%; the Colorado Family Planning Initiative used an anonymous grant to provide free, or reduced-priced, IUD implants to over 30,000 individuals. Despite the fact that this was a substantial drop, GOP lawmakers refused to provide taxpayer dollars to further this program. As a result, state officials are still looking for continued funding.

 

Planned Parenthood (PP) and NARAL Pro-Choice America are two stakeholders that will advocate for additional funding, as their organizations advocate for policies that ensure access to reproductive and complementary healthcare services. These organizations advocate for LARC methods, including the IUD, as they are the most effective forms of reversible birth control and last for years.

The Catholic Church and Colorado Family Action (CFA) are two stakeholders that will advocate against providing funding. CFA opposes state funding as they don’t believe tax dollars should be used to “insert the government between teens and their parents”. The Catholic Church will join CFA in opposing funding on moral grounds, as they oppose any form of birth control other than natural family planning.

Providing IUDs have had a substantial impact on birth and abortion rates for Colorado teenagers; Colorado must take action by working with supportive stakeholders to secure funding to ensure the success of this program. PP, for instance, spent over $1.3 million in 2015 lobbying for various health policies and funding. Their support, in terms of finances and lobbying, for additional funding would be extremely beneficial, as they have the knowledge and experience with how to best advocate for this additional funding.

 

Female Genital Mutilation in Egypt Must End

March 4, 2016
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Photo credit: Daily News Egypt 

Female genital mutilation (FGM) is a medically unnecessary procedure whereby parts of the female external genitalia are cut, damaged or removed. In Egypt, this practice dates back to Pharonic times and still persists today, with 92% of ever married women age 15-49 affected. The UN opposes FGM as a human rights violation and form of violence against women. In Egypt, FGM was medically forbidden in 2007 then legally banned in 2008 through a clause to the Child Law. However, it was only recently that the first doctor was prosecuted for an FGM related death, though the full penalties have not been enforced. In addition, the Grand Mufti of Azhar and Coptic Pope have refuted the belief that FGM is religiously mandated by Islam or Christianity.

So why are the numbers still so high? Law enforcement has been severely inadequate, FGM was promoted during the short reign of President Morsi, and many still practise FGM for cultural and traditional reasons. For example, many believe FGM prevents sexual promiscuity, adultery, and maintains a girl’s ‘marriageability’. Proponents of FGM also fail to acknowledge the short and long-term medical, sexual, psychological, emotional and reproductive damage FGM can inflict on women, and subsequently on marriages, families and society. Fortunately, groups such as UNICEF, UNFPA and the Coalition Against FGM are seeing progress through collaborative FGM education programs.

However, even if the ‘demand’ decreases, consistent prosecution of physicians and traditional midwives is still needed to decrease the ‘supply’ of FGM. The Egyptian Medical Syndicate could play an important role through physician accountability and reporting to authorities. Subsequently, the justice system needs to follow the precedent set in the recent prosecution, enforcing the full penalty of the law on FGM physicians and midwives.

FGM is a traumatic procedure that is medically and religiously unnecessary. One by one, family by family, FGM provider by FGM provider, and community by community, FGM must end in Egypt.