By ANNA-CATHERINE BRIGIDA
In El Salvador, just being suspected of having an abortion can put a woman behind bars. In February 2008, Teodora del Carmen Vásquez was sentenced to 30 years in prison for aggravated homicide after she had a stillbirth.
“It was the worst thing that I could have lived,” Vásquez, 34, told 50.50 over the phone from her house, about 30 minutes outside San Salvador. “For me, those were difficult moments, more than anything because they separated me from my son and from the people who love me – my parents and siblings.”
Vásquez was released from prison in February 2018, after a decade behind bars, when her sentence was commuted by the supreme court.
She has not been absolved of the crime, however, and the government has not apologised for her long detention. Nor can she get back the time she lost with her son, now 14 years old.
More than 100 women have been convicted of abortion-related crimes in El Salvador since abortion was illegal under all circumstances, in 1997.
Religious groups lobbied for the ban more than 20 years ago. They continue to protest any loosening of the restrictions that have been proposed in the country’s legislative assembly, the latest of which failed to pass in April 2018.
El Salvador is historically a Catholic country, but in the past few decades, Protestant, including pentecostal and evangelical Christian communities have grown here and in Honduras, Guatemala and Nicaragua. Between 36 to 41% of the population in these countries now identifies as Protestant, according to the Pew Research Center.
This changing religious landscape has not been good news for women like Vásquez. Evangelical and pentecostal Christians in El Salvador often support right-wing policies and promote conservative ideas about sexuality, LGBT rights, and reproductive health.
As NGOs fighting for reproductive rights have fought to change the abortion ban over the past 20 years, evangelicals have been among their staunchest opponents. Throughout Latin America, Protestants are even more rigid in their opposition to abortion than Catholics, according to a study by Pew Research Center.
“You’re talking about a very conservative group of people, so abortion is wrong 90 plus per cent of the time and homosexuality is always wrong. It’s very conservative in regards to reproductive and social values like those,” said Timothy Wadkins, professor of religious studies and theology at Canisius University in the US.
Evangelical churches have had a presence in El Salvador since at least the 19th century, according to Wadkins, but they didn’t significantly expand until the late 1970s.
At that time, El Salvador, Guatemala, and Nicaragua were all facing intense internal strife with leftist guerrilla insurgencies rising up against conservative land-owning elites. El Salvador was the last of the three to enter into a full-blown civil war, in 1980.
The 12-year conflict fractured the historic control over land and resources by a small group of elites, many of whom were allies of the Catholic church. Amid this change, the teachings of evangelical Christians, which focus on the individual, and were not associated with the traditional social order, became more appealing to some citizens.
“Most of them just started to think of the Catholic church as irrelevant because it represented something old and antiquated and these are new… ‘masterless individuals’ who think for themselves and make choices for themselves,” said Wadkins.
During this period, he continued, “what you have is a massive decline in Catholic allegiance and that is where the evangelicals came in and did a masterful job of working with these unchurched Catholics.”.
At the time, a small part of the Catholic church was moving towards liberation theology, a movement that emphasised the church's responsibility to fight for social justice. But US politicians favoured evangelical Christianity in the context of the Cold War.
Michael Cangemi, professor at Binghamton University, in New York, says that evangelism was “appealing in a political sense to both political dictators in Central America, but also to policymakers in the US” as it was the politically-conservative “antithesis” of liberation theology” and “ardently anti-communist.”
The US had their hands deep in Central America in the 1980s, but Wadkins says that evangelical ‘conversion campaigns’ were led mainly by churches already in the country, rather than foreign missionaries.
Today, El Salvador’s evangelicals continue to protest any changes to the country’s extreme anti-abortion laws.
The right-wing ARENA party won the most seats in March 2018 parliamentary elections. Shortly after, pro-choice activists began to push to legalise abortion in certain cases, aiming to achieve this before the newly-elected officials took office.
But the backlash was fierce. In April, a consortium of religious organisations, both Catholic and evangelical, organised a “March for Life” through the capital San Salvador to protest the proposed loosening of the country’s abortion laws.
The official organiser of the march was the Movimiento de Transformación Nacional, a religious coalition led by evangelical pastor Numa Rodezno. “What they are thinking of doing is a crime. It’s something murderous,” said Rodezno of the proposed legal, according to Salvadoran media outlet La Prensa Gráfica.
On 26 April, El Salvador’s congress closed for the 2015-2018 period without approving proposed legal amendments that would have relaxed the country’s ban on abortion in cases of rape, a foetus that is not viable, or risks to the woman’s health or life.
“Some people are incredibly conservative and religious, and they don’t think about the kids that are growing up and the women who are in prison,” Vásquez told me. “[I hope that] they open their minds."
Published on Open Democracy on June 18, 2018
By Sophie Tatum, CNN
Just days after Iowa's Republican governor signed the most restrictive abortion law in the country, Planned Parenthood is announcing what it says is its largest volunteer training event ever.
Kelley Robinson, the National Organizing Director at Planned Parenthood Action Fund, said the July training event, called The Power of Pink, will bring together 3,000 activists and leaders in Detroit and give them various resources for going back into their communities to then build upon the organization's network.
"Being in Detroit is a really intentional thing for us," Robinson said, describing the city as a "beacon for progressivism."
The organization has already been working to develop its grassroots efforts in various states, using programs like the Raiz initiative, described on the Planned Parenthood website as a "national effort to work with the Latino community on fights for reproductive health, sex education, and access to care."Melissa Garcia, a manager of the Raiz program, said the training will be tailored for the individuals who attend and that it's a culmination of many years of organizing.
Planned Parenthood Action Fund, the organization's political arm, has already been active in various midterm elections endorsing candidates.
The legislation that was passed in Iowa, dubbed "the heartbeat bill," prohibits doctors from performing an abortion if a fetal heartbeat is detected. Fetal heartbeats can be detected as early as six weeks into a pregnancy.
Planned Parenthood said in a statement it planned sue the state over the legislation.
"We're seeing more and more state politicians emboldened to advance extreme policies, regardless of how many people it hurts," Dawn Laguens, the executive vice president of Planned Parenthood Federation of America, said in a statement last week. "We're also seeing a groundswell of organizing and action that only continues to grow. People will not stand for it. Now is the time for us to unite and fight for every person's right to access the care they need."
Last week, three Planned Parenthood affiliates sued the Trump administration over Title X, a decades-old federal program that provides birth control and other reproductive health care services to millions of low-income people each year. The Title X lawsuits, filed last Wednesday in the federal district court of the District of Columbia, seek to block funding changes that could financially hurt organizations like Planned Parenthood.
In Wisconsin, where more than 70% of counties are experiencing a shortage of health care providers, there are seven counties for which Planned Parenthood is the only option for Title X care, said Tanya Atkinson, president and CEO of Planned Parenthood of Wisconsin, one of the three affiliates to file suit (the others are in Utah and Ohio), CNN previously reported.
"Planned Parenthood is going to court to stop the Trump-Pence administration from trying to impose its ideology on people," Laguens said in a statement. "Our bodies are our own and shouldn't be at the mercy of the Trump-Pence administration. We are going to court to fight for our patients' health and rights — and for the millions of people in this country who need to access quality reproductive health care."
Liliana Trejo Vanegas is one of the Planned Parenthood volunteers who said she plans to attend the training this summer, and said she hopes to gain access to tools that will help her mobilize ahead of upcoming elections.
"I'm just really pumped," she said, describing the organization as an anchor in her community.
Published on CNN on May 7, 2018
By midnight, Khurshid (35), already five months pregnant, was in serious trouble.
Bleeding heavily, she had passed out from severe pain at home, and her family had carried her unconscious body to the nearest, and only, health station in the remote and mountainous Chesht-e Sharif district of Afghanistan’s Herat Province.
“Her state shocked me, but I knew quickly that it was a miscarriage,” recalls Amena (22), the midwife on duty at the clinic, known locally as a Family Health House, that is supported by the Italian Agency for International Development and the United Nations Population Fund, UNFPA.
In more developed environments, maternal deaths through miscarriage are almost always preventable. But in Afghanistan, a country with one of the highest maternal mortality rates globally, at around 1,291 maternal deaths per 100,000 live births, miscarriages are one of the biggest contributors to that grim statistic.
Recognising the danger, Amena quickly checked Khurshid’s vital signs, revived her to better determine that a miscarriage was indeed the cause of the bleeding, and worked fast to stop the flow and stabilise her.
“I am so thankful to God that I was able to help save her life,” recalls Amena, who has worked at the Family Health House for over two years. “The relief and gratitude was plain to see on her family’s faces.”
Leaving no one behind
Across much of Afghanistan, a combination of rugged terrain, poor infrastructure, poverty and conflict makes accessing life-saving health facilities difficult for many.
Since 2009, UNFPA has helped set up 123 Family Health Houses, like Ameena’s, in some of the hardest to reach areas in the provinces of Faryab, Daikundi, Herat and Bamyan.
Midwives and healthcare providers, on call at all hours, provide skilled birth attendance, family planning services and basic health care and referrals, and today, across Afghanistan, around 60 per cent of the population live within an hour’s travel from a health facility, with 88 per cent within two hours’ travelling time.
In first for Ameena’s home province of Herat, UNFPA has teamed up with the provincial Institute of Health Services to offer a community midwifery education programme. The first batch of 35 newly-trained midwives, recruited from remote villages, will soon be deployed to Family Health Houses across Herat.
With newly-trained midwives, and others working in remote areas, UNFPA supports a 24-hour midwifery helpline, which provides on-call technical support to ensure quality maternal and reproductive health services and to midwives manage complex and dangerous cases.
“At UNFPA Afghanistan we have been working with government partners to ensure quality, professional and regularized midwifery services to reach the furthest behind”, says Dr. Bannet Ndyanabangi, UNFPA representative for Afghanistan, “The training of midwives and establishment of family health houses in remote and underserved Afghanistan is key to such efforts, and we are working to expand this project to more provinces.”
“Further, with the help of midwives and other health professionals, we’re also ensuring that crucial maternal and reproductive health services are being made available to people displaced by conflict. In 2017, through mobile health teams including midwives, and by providing emergency reproductive health kits, we reached 112,00 displaced people, people who have recently returned home, as well as host communities.”
As for Khurshid, back at the Family Health House in Herat, she’s looking forward to getting back home to family life and her four young children.
“Now I feel healthy and am very much thankful to Amena, who has saved my life and helped me recover.”
Published on UNFPA on May 5, 2018
By José Miguel Vivanco
Last month, the government of President Sebastián Piñera of Chile issued rules that could seriously undermine access to legal abortion in the country.
The rules issued by the Health Ministry, which modify the ones issued under former President Michelle Bachelet, are a setback to recent progress on reproductive rights. In 2017, the Chilean Congress passed a long-awaited reform that ended a 28-year blanket ban on abortion. The law decriminalized abortion under three circumstances: if the life of the pregnant woman or girl is at risk; if the pregnancy is the result of rape; and if the fetus has severe conditions not compatible with life outside the womb. The Constitutional Tribunal upheld the constitutionality of the reform in August, protecting women’s lives and fundamental rights.
It was a landmark change in Chile, but the reform—and the court’s response—left certain barriers to women’s access to abortion intact, even in those three dire circumstances. Notably, while the reform allowed doctors to refuse to perform abortions on the basis of conscience, the court went further, allowing entire private hospitals to invoke conscience and refuse to provide abortions. Earlier this year, a UN human rights body rightly pointed out that that such conscientious objections may unintentionally constitute barriers to access for women and girls. Still, even after the court’s ruling, private hospitals had to articulate reasons to to justify their refusal to provide abortion services.
The new rules eliminate that requirement. Hospitals can now simply inform the Health Ministry that their doctors will not terminate pregnancies. They don’t have to provide any reason.
This opens a Pandora’s box of potential obstacles to women who need these services. A woman carrying a non-viable fetus, or a 12-year-old rape victim, could find herself unable to get an abortion simply because her local hospital does not want to deal with the headaches that might come with offending local politicians, or anti-abortion groups.
The protocol requires hospitals that won’t perform abortions to refer patients to other facilities. It also rightfully says that women should not pay the costs associated to these transfers. But in some parts of the country, it might be very hard to find a health care provider where women could get these services. In rural areas with fewer doctors this could mean that women will encounter significant barriers to legal abortion.
The new rules undermine access to abortions in other ways too. The previous rules required doctors who were conscientious objectors to register as such in a timely manner. That requirement was a way of ensuring that clinics and hospitals would always have a doctor available to terminate a pregnancy. The new rules eliminated this assurance of continuity of coverage.
It is not unreasonable for Chile to allow some scope for health care providers whose religious or moral convictions lead them to decline to perform abortions. Yet the space for such refusals should be closely and appropriately regulated to protect the rights of women and girls. Under international law, religious freedom protections have distinguished between the freedom of religious belief, which is inviolable, and the freedom of religious exercise, which may be limited when it infringes upon the rights of others or the state’s interests. A medical professional’s conscientious objection should not cause anyone to be denied effective access to needed care, including an abortion.
The Chilean government should review and amend the rules to ensure that access to legal abortion is protected. Otherwise it risks letting conscientious objection be used as a pretext to deny important newly recognized rights of women and girls.
Published on HRW on April 16, 2018
By Sola Ogundipe
WOMEN seeking family planning and allied health services for themselves and their babies are beginning to bear the brunt of the expanded Global Gag Rule, GGR, introduced via presidential memorandum by US President Donald Trump.
The widely regarded anti-choice policy, also known as the Mexico City Policy, blocks funds to organisations involved in abortion advice and care, however, Trump’s version of the GGR applies to the vast majority of US bilateral global health assistance, including funding for family planning, HIV, maternal and child health, malaria, nutrition, and other programmes.
Concerned parties had earlier warned that slashing of funding by the world’s biggest donor to family planning and women’s health programmes in developing countries would portend dire consequences.
According to the Bill and Melinda Gates Foundation, Trump’s gag rule could create a void and cause a shift that could impact millions of women and girls around the world that even the Foundation would be unable to fill. “It’s likely to have a negative effect on a broad range of health programes that provide lifesaving treatment and prevention options to those most in need.”
The collateral effects will potentially endangering lives of millions in Africa’s most populous nation. Just last week, hundreds of pregnant women in Akure, Ondo State, took to the streets in protest against introduction of higher levies for antenatal, postnatal and other maternal health fees by the State administration.
Several of the women who called for reversal of the increase, accused the state government of insensitivity towards the plight of women that only fulfiling their biological task of childbearing. “We are protesting the levies. How can pregnant women be asked to pay N25,000 for normal delivery in the government hospital? It is outrageous,“ said Mrs Tayo Olowo who is eight months pregnant.
Feyisola Akinseye, another expectant mother, complained that the women were overtaxed. “We are already paying for most of the hospital consumables such as syringes, cotton wool, gloves, drugs and all required delivery materials among others, now this,” she noted. While the state government excused the increment, it was gathered that the upward review was not unconnected with dwindling funds from donor agencies towards the state’s Agbebiye Maternal Health programme introduced by the previous administration in the state.
Reacting to the development, Mrs Uche Daoudu, the CEO Global Health Foundation, Akure, described the protest as a sign of the times. “When you look at it, what they are protesting is reasonable, but not unusual however knowing what is happening in Nigeria right now, and also globally particularly in relation to the global gag rule.”
Unconfirmed reports said the state government was compelled to take the measure, amongst others, following withdrawal of funding support for the successful maternal and child programme that once drew attention of the World Bank.
“It is in the effort to increase the state’s Internally Generated Revenue, IGR, so as to maintain qualitative healthcare. “It is true that the cost of medical services has increased but it is duty of government to ensure that the interest of women is protected.”
The Executive Director, Centre for Women & Children Development, Mrs Olanike Dare, said introduction of such policies would only worsen the already precarious maternal health indices in the state and country as a whole.
“As a woman I am against this increment. Why increase the burden of women who are already weighed down by nature and socially by society’s problems? “In Nigeria, health care workers generally consider the Trump administration’s decision not just to block funding for abortion services, but also cut resources for contraception and family planning programmes as a vicious cycle.
“Without contraceptives, there can be no effective family planning programme, and without proper contraception, more unintended pregnancies and ultimately, more unsafe abortions are recorded.”
Published on Vanguard on April 10, 2018
The Puntland State of Somalia is stepping up the fight against maternal and newborn deaths with the First Lady Dr. Hodan Said Isse taking lead in her capacity as Puntland’s Goodwill Ambassador for the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA).
The First lady, the Puntland Ministry of Health and UNFPA convened a high-level advocacy forum on the CARMMA on 19 March 2018 to rally political commitment and leadership in support of the new Acceleration Plan on Mother and Child for 2018 to 2021, and to increase public awareness about the seriousness of the problem of the maternal and neonatal death and morbidity.
Somalia has one of the highest lifetime risk of maternal deaths in the world, with women facing a one in 22 lifetime risk of maternal death. The maternal mortality ratio is estimated at 732 deaths per 100,000 live births.
In May 2009 the African Union launched the CARMMA to trigger concerted and increased action towards improving maternal and newborn health and survival across the continent. The main objective of CARMMA is to expand the availability and use of universally accessible quality health services, including those related to sexual and reproductive health that are critical for the reduction of maternal mortality. The focus is not to develop new strategies and plans, but to ensure coordination and effective implementation of existing ones. CARMMA aims to renew and strengthen efforts to save the lives of women who should not have to die while giving life. CARMMA believes in ensuring accountability: every single loss of a mother’s or child’s life should be reported.
Activities of the campaign include mobilizing the necessary political will to make the lives of women count, coordinating and harmonizing interventions around country-led plans/roadmaps and supporting ongoing efforts and initiatives to improve maternal, newborn and child health.
The advocacy forum in Puntland attracted high-level participation from the Ministry of Health, Ministry of Women Development and Family Affairs, UNFPA and other development partners, Puntland Midwifery Association, women and youth groups, media houses, education and health institutions, private sector and Somalis from the diaspora.
Speaking during the forum Dr. Isse emphasized the importance of a collective responsibility towards addressing the high maternal and neonatal mortality rates in Somalia.
“The key priority is to ensure that facilities are well-functioning, located where mothers can access them and services are being used by all women, including the most marginalized and underserved”, said the First Lady.
She said it was also important to intensify awareness raising on maternal and child health issues through community initiatives, radio and TV, social media, documentaries, and advocacy forums.
Dr. Isse also said that since the beginning of 2018, she has participated in two fundraising events, in collaboration with the Somali diaspora. “We have raised $ 90,000 for improving maternal and child health facilities in Somalia and an additional $ 190,000 in support of maternity care for Somali-Americans in Virginia and Minnesota”, said the CARMMA Goodwill Ambassador.
The Minister of Health, Dr. Abdinasir Osman Isse, provided an overview of the overall strategic progress and vision for CARMMA 2018 to 2021 and thanked the CARMMA Goodwill Ambassador and UNFPA for working tirelessly on the CARMMA initiative.
“We have achieved tangible progress in tackling maternal and neonatal mortality in Puntland State of Somalia with the support from UNFPA. For instance, we have supported life-saving emergency maternity and neonatal care facilities and outreach maternity services across Puntland. We have also supported six midwifery schools and as a result, 255 midwifery students have graduated and now work in rural areas”, said the Minister of Health.
He said the Ministry of Health is committed to implementing the new Acceleration Plan on Mother and Child Health for 2018 to 2021. “We want to ensure that every single woman has access to skilled birth attendance in Puntland State,” said Dr. Osman Isse.
Minister of Women Development and Family Affairs, Honourable Maryan Ahmed Ali also pledged support towards the CARMMA and highlighted the positive link between women’s development and maternal health.
“Increasing women’s access to resources and ensuring a wide range of opportunities such as adequate access to information, education and employment, will surely lead to a healthier and empowered society. Women’s access to health care is not a privilege, it’s a right and our ministry is committed to do its part in ensuring that women from all corners of Puntland are well informed and are empowered to seek health care,” stated Honourable Ali.
Director General of Puntland Diaspora Affairs Agency (PDAA), Omer Shere, shared various success stories of how the Somali diaspora has contributed to improving the maternal and child health situation in Puntland. “The Somali diaspora constructed health facilities, supported fistula repair surgeries and brought life-saving medical equipment, such as oxygen concentrators and incubators,” said Mr. Shere, adding: “our agency welcomes the new Acceleration Plan on Mother and Child Health. We are committed to mobilizing more resources and attract more diaspora expertise to the country.”
UNFPA Reproductive and Maternal Health Programme Specialist in Puntland Ms. Jihan Salad thanked the national leadership and dignitaries for their efforts and commitment to improving the health of Somali mothers and children in Puntland.
“In close collaboration with the CARMMA Goodwill Ambassador, the Ministry of Health and other ministries, UNFPA pledges its support to the achievement of three universal and people-centered transformative results; end preventable maternal deaths, end the unmet need for birth spacing, and end gender-based violence and harmful practices,” said Ms. Salad.
Published on UNFPA on March 26, 2018
By Nazeem Muhajarine, The Conversation
As the world awakens to deep injustices for women globally, an ambitious project led by University of Saskatchewan researchers in Mozambique is striving to reset the course —reducing maternal mortality and improving newborn health by empowering women and girls.
Although maternal deaths worldwide have decreased by 45 per cent since 1990, about 800 pregnant women still die daily from largely preventable causes before, during and after giving birth.
Mozambique has one of the highest maternal death rates in the world, estimated at 489 deaths per 100,000 live births in 2015. One in five of these maternal deaths occur in women under age 20.
The neonatal mortality rate (deaths during the first 27 days of life) in the country was 30 per 1,000 live births in 2011 —also one of the highest in the world.
A gender-equality perspective
In Mozambique, sexual, reproductive, maternal and infant health is challenged by a range of factors that include gender-based violence, early marriage and early pregnancy—all of them products of widespread gender inequality.
As the government of Mozambique has identified in its National Strategy to Prevent and Combat Early Marriage (2016-2019), education about sexual and reproductive rights, and access to safe contraceptive methods and safe abortion are all important tools in reducing barriers to women's and girls' sexual, reproductive and maternal health.
However, many more interventions that work in an integrated manner are also required.
In April 2017, we launched the Mozambique-Canada Maternal Health Project. This five-year project in Inhambane province will improve access to health-care services for mothers, and work to reduce maternal deaths and improve newborn health.
Funded by Global Affairs Canada, this project takes a strong gender-equality perspective in its work.
Working in 20 communities within five districts, the project aims to support and empower women within their families and communities. It will increase access to health care services, increase management and leadership capacity in the health care system and provide professional education for health practitioners.
The project will also build infrastructure such as maternal clinics and waiting homes, provide much-needed ambulances and medical equipment and increase the use of research-based information in decision-making.
A village to support safe childbirth
The project partners with the provincial health directorate, Mozambique's health ministry, and two health training centres in Inhambane. It builds on more than 15 years of continuous partnership with Mozambican colleagues.
We also partner with the NGO, Women and Law in Southern Africa (WLSA), which has extensive experience with developing knowledge and advocacy in issues related to gender, law and power. WLSA will provide a gender-perspective to our work.
Our community engagement activities are underway with community mapping to identify local resources. Community leadership teams —or "núcleos" —that consist of equal numbers of women leaders, prioritize topics for local, participation-based education about maternal, reproductive and sexual health.
These teams are also prioritizing micro-enterprises to engage community members, especially women, and improve their incomes.
The teams participate in creating a formal and identifiable community-based network of resources to support women in childbirth. These networks include madronas, or midwives, and traditional healers, who exert influence in local communities.
It's said that it takes a village to raise a child. It also takes a village to support a woman to have a safe childbirth.
Building local support networks
For rural women, reaching health services for deliveries without undue delay can be a problem. They are often far from a clinic, and without means of transport.
Our project will provide local ambulances. We will also provide maternal waiting homes, which meet evidence-based standards for infrastructure and care, close to the clinics.
Most importantly, we will support local midwives to improve their ability to support women in reaching health services without undue delay. We work with community-based health workers to create an ongoing updated list of pregnant women and plan support strategies in advance of delivery.
We are providing education to health practitioners in clinics and hospitals about improving care for deliveries and newborns, but also about reproductive and sexual health issues. Some topics focus on technical skills and others on improving attitudes towards rural women.
To contribute to overall health system quality, we are working with the management of the provincial health department to provide training on topics such as leadership, conflict resolution and data collection and analysis. With the health system managers, we are exploring the feasibility of using "near-miss" methodology (an approach to preventing maternal death by preventing near-miss cases) to improve practice.
The World Health Organisation suggests that "a grand convergence" is within our reach, that is, through concerted efforts and well-placed resources we can eliminate gender-based disparities, of which maternal mortality is one.
To do so would be a great achievement for gender equity and reflect a shared commitment to a human rights framework for health.
Published on Medical Xpress on March 26, 2018
By CASEY QUACKENBUSH
It has now been a little more than a year since President Donald Trump, on his first full day in office, reinstated the Mexico City Policy, also known as the “Global Gag Rule,” and a picture of its impact is beginning to emerge. The law prohibits allocation of U.S. funding to foreign non-governmental organizations that offer abortion services or information about the procedure. While the measure has been on and off the books for decades, typically enacted by Republican administrations and repealed by Democrats, its scope has expanded under Trump, which healthcare workers say has had a big impact on communities and care providers around the world.
In just one year, health care workers say the policy has had disastrous effect; as expected, clinics are shutting down, unsafe abortions are predicted to rise sharply and families are losing critical services across the globe. While no death count has been directly linked to the policy, providers do have estimates of how many life-saving procedures could have been offered by the funding they are now denied, and the numbers are in some cases staggering.
What is the ‘Global Gag Rule’?
The Mexico City Policy, first enacted in 1984, prohibits U.S. federal funding to NGOs that provide abortion counseling, services or referrals, and any that advocate for decriminalization, even if those activities are wholly detached from U.S. funds. It requires foreign NGOs to pledge that they will not perform or inform patients about abortions. (Some exceptions may be made in cases of rape or incest.) The policy applies to some $8.8 billion in federal funding given toward global health assistance. It formerly applied only to family planning assistance provided through the State Department and the U.S. Administration for International Development (USAID), but Trump’s new provisions expand its application to all global health assistance. The U.S. is the world’s largest provider of such aid.
What kind of impact has it had over the past year?Not good, especially for women in the developing world. As has happened each time the policy was put back into effect, the diversion of aid has shuttered clinics servicing some of the world’s most vulnerable communities. Closures have been particularly devastating in parts of Africa where clinics run by non-governmental organizations are the primary source of women’s health care. Many of these centers offer HIV/AIDS prevention and treatment, maternal health, and counseling on sexual violence like rape and female genital mutilation. “Women are basically stranded,” Amos Simpano, the director of clinical services for Family Health Options Kenya, told the Associated Press.
The International Planned Parenthood Federation, which operates in more than 150 countries, faces setbacks not only in family planning but also in HIV/AIDS and Tuberculosis services for both men and women. IPPF says that for $100 million in lost funding, the organization could have prevented 20,000 maternal deaths in 29 countries affected by the ban. Marie Stopes International, a London-based abortion and contraception provider that operates in 37 countries, estimates that more than 2 million women it serves will lose their access to contraception. This could lead to a further 6,900 maternal deaths. Just those two organizations’ loss in funding could lead to a combined total of about 7.5 million unwanted pregnancies and 2.5 million unsafe abortions.
What do health advocates say?
Those estimates could be the tip of the iceberg. Health providers in Kenya, which is particularly dependent on foreign aid to combat HIV/AIDS and provide reproductive services, have called the measure a “death sentence.” Others claim the policy holds life-saving aid hostage to ideology. Development actors have warned that endangering women’s health and reducing family planning services risks broader instability and economic hardship that will only exacerbate the need for long-term assistance in some of the world’s poorest places.
“Evidence shows that by blocking funding to the world’s largest NGO providers of modern contraception, unintended pregnancies and abortions go up,” Marjorie Newman-Williams, vice-president of Marie Stopes International, said in a statement. “As a result, women and girls are less likely to complete their education, have a career, or pursue their dreams for the future.”
Published on TIME on February 4, 2018
A group of leading health experts have highlighted a number of key issues in reducing maternal, neonatal and infant mortality as a means to achieving SDGs in Africa. Particularly notable was the need for improving the quality of health care provision.
The speakers were participating in a recent webinar, organised by the Aid and International Development Forum, ahead of a major event on Aid and International Development in Africa.
Approximately 500 people from 67 countries registered for the webinar and were keen to learn about the latest innovations and policy developments in maternal, neonatal and infant mortality.
Dr. Lutomia Mangala, Health Specialist - Maternal, New-born and Child Health, UNICEF noted that despite a global improvement in maternal, neonatal and infant health Sub Saharan Africa lags behind.
He explained that the Millennium Development Goals focused on access to healthcare but the primary reason that Sub Saharan Africa has not met expectations is due to the lack of quality in healthcare provision.
Dr. Lutomia highlighted a need to recognise the role of communities, health facilities and district level policies in improving access to quality healthcare. Through the combination of these strategies maternal, neonatal and infant mortality will be more effectively reduced.
John Nyamu, National Coordinator at Reproductive and Maternal Health Consortium-Kenya, agreed and highlighted the need to improve basic health provisions.
Utilising emerging technologies such as mobile technology, drones and the internet is another key aspect of improving maternal, neonatal and infant health, John Nyamu explained.
The introduction of technology such as mHealth and drones is becoming increasingly common in developing countries. John Nyamu noted the sustainability of this method as in Africa access to mobile phones is high, for example in Tanzania it is reported that 97% of people have access to a mobile phone.
The use of technology can be coupled with social support programmes to provide women with spaces for education and knowledge sharing.
Dr. Lutomia noted that the community level can often be reluctant to change and there is a critical shortage of trained healthcare workers. The incorporation of emerging technologies such as mHealth and drones into community healthcare could make significant improvements.
However, the speakers agreed that ‘context specific programme interventions’ were needed as most research into maternal, neonatal and infant health takes place in developed countries. Dr Lutomia further explained that contextualising health care policies for developing countries is likely to bring interventions that are more popular and effective.
The webinar recording will shortly be posted on the Aid & International Development Forum website and YouTube channel.
Hear from other health experts at the Aid & Development Africa Summit on February 27-28 in Nairobi.
Published on Reliefweb on February 7, 2018
By Michelle Thompson (CEO of Marie Stopes Australia)
In July last year the New York-based Commonwealth Fund ranked Australia's healthcare system number 2 in the world. The study found that our public/ private universal approach to the delivery of healthcare services has led to a healthier society than those we ranked against. When it came to equity, however, the same study ranked Australia well below average. In fact we came in at number 8 on the list of 10.
An acute example of inequity in our universal healthcare system is the delivery of sexual and reproductive health services, namely women's sexual and reproductive health and specifically abortion access. Abortion is one of the most common medical procedures for women, yet we have a problem providing for it in Australia. Varied state and territory laws, health policies and health funding means that infrastructure and clinicians to deliver services are either non-existent or reliant on private providers to establish and run these services.
As a national provider of sexual and reproductive health services, including medical and surgical abortions, we see stark contrasts in service delivery between states and territories and within these states and territories.
In Queensland, women in the far north and west of the state must travel days to access surgical abortion services. They have no service within a day's drive. In Tasmania women can no longer access surgical abortions without crossing to the mainland. And for the past year, the future of surgical and medical abortion access in the ACT hung in the balance with the ACT government silent on whether Marie Stopes would be able to continue to operate from a government health facility. We have heard this week that the future of the clinic is secure and that services can continue for ACT women.
The problem is that we are not, as a nation, getting it right when it comes to the delivery of sexual and reproductive health services. State and territory governments are often unwilling or unable to talk to us about abortion provision. It is either deemed too hard, too controversial or not the right time. That needs to end now. In 2018, we need to stop treating women's sexual and reproductive health services as being too hard, too controversial, or a case of bad timing.
Our universal health system in Australia relies on strong relationships between the public and private health sector. The private health sector has a long history of being commissioned to deliver services to Australians on behalf of government. We have seen this through the commissioning of private providers to run public hospitals and through the commissioning of primary health care including General Practice services. With sexual and reproductive health services, we have an opportunity to deliver them to public health patients using existing private providers under a commissioning model.
This approach will streamline healthcare service delivery and enable greater access to services. At the same time it will ensure that our public hospitals can remain focused on delivering tertiary referral services such as chronic disease management while also not placing further pressure on hospital emergency departments, operating theatres and ambulatory care centres.
At the end of the day sexual and reproductive health, including abortion, is primary health care and should be delivered as such. It's time to stop sweeping this important form of women's healthcare under the carpet. If the state and territory governments cannot deliver for women, then it is time for the federal government to step in.
Published on The Sydney Morning Herald on February 4, 2018
About sexual and reproductive health
"Women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health. This means that States have obligations to respect, protect and fulfill rights related to women’s sexual and reproductive health. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health maintains that women are entitled to reproductive health care services, goods and facilities that are: (a) available in adequate numbers; (b) accessible physically and economically; (c) accessible without discrimination; and (d) of good quality [see report A/61/338]."