Environmental Sustainability, Women and Health

Tod Preston

Can greater access to family planning and contraception save the earth? Curbing global warming, says Tod Preston, will require empowering women first.

Global warming (aka climate change) is arguably the greatest environmental challenge our planet has faced in modern history. Fortunately, as we mark the 37th Earth Day this month, we can take some degree of satisfaction in the fact that—at long last—policymakers and the public are waking up to the reality of the problem.

According to a recent survey from the Yale Center for Environmental Law and Policy, more than 80% of Americans now say that global warming is a serious problem. With the exception of a handful of largely disgraced global warming skeptics, including "Senator"—I use that term loosely—Jim Inhofe (R-OK), it's no longer in vogue to dismiss global warming as pseudo-science or scare tactics by environmentalists.

So now that there seems to be a consensus that global warming does exist, the question is what can we do about it?

Reducing CO2 emissions and promoting alternative fuels are just a couple of the measures that are needed to tackle global warming. But another important part of the solution is addressing gender inequality, particularly in terms of reproductive health, in the developing world.

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The interconnections between environmental sustainability and the status of women and their health are significant. One of the most eloquent proponents of these linkages is none other than former Vice President Gore.

For more than two decades, Mr. Gore has talked about the critical role that rapid population growth has played in degrading the Earth's resources and fostering global warming. Because of this, he has consistently cited voluntary family planning, along with girls' education and other empowerment-related programs, as part of any solution to the global environmental crisis.


In his 1992 book, Earth in the Balance, Mr. Gore wrote that "No goal is more crucial to healing the global environment than stabilizing human population" and recommended that family planning supplies be made "ubiquitously available" as a key strategy to curb population growth.

Unfortunately, the continuing jihad against family planning (FP) programs by conservative officials and activists has resulted in far less progress than should be expected in making FP supplies "ubiquitiously available."

Today more than 200 million women in poor, developing nations wish to delay or end childbearing but lack access to contraceptives (PDF). In places such as Ethiopia, Haiti, and Pakistan more than one-third of married couples have this "unmet need" for contraceptives. This deprivation of basic reproductive rights—which often leads to larger than desired family size—takes a heavy toll on women and society as a whole.

Consider a few statistics. Since Mr. Gore published Earth in the Balance 15 years ago, world population has increased by 1.2 billion, the equivalent of adding four United States or nearly one China in population. Since the first Earth Day celebration in 1970, world population has grown from 3.7 billion to 6.6 billion.

The world is currently adding 6.3 million people every month and is on track to add another 2.5 billion people by 2050. Believe it or not, these updated projections assume declining birth rates in the developing world. If birth rates remain static, the planet could easily add 5 billion people in the next 43 years.

These statistics should give pause to anyone who cares about the health of our planet—not to mention the health and well-being of women. Despite the best efforts of family planning/reproductive health opponents and—yes—even some proponents in our community, the two are inextricably linked.

A 2005 documentary produced by PAI called "Finding Balance: Forests and Family Planning in Madagascar" really crystallizes these linkages for me. The short video profiles Voahary Salama, a local organization whose innovative approach to conservation provides women in remote rural areas with the health services they so desperately desire in order to choose how many children to bring into this world.

But rather than supporting more efforts like Voahary Salama—programs that empower and improve women's lives and help ease population pressures on the environment—U.S. funding for voluntary family planning programs has been cut more than 35% (adjusted for inflation) since 1995. And the President's budget for next year recommends cutting them an additional 25% (PDF).

Something Mr. Gore wrote back in 1992 speaks uncannily to the situation today: "… in the face of this clear challenge, the United States is—unbelievably—reducing its commitment to world population programs, essentially because President Bush depends upon a political coalition that includes a tiny minority who strongly oppose contraception…"

It's time for this injustice to end. The lives of women and the future of our planet are at stake.

Commentary Health Systems

How We Are Failing Women and Girls in Humanitarian Emergencies

Jamie J. Hagen

“Protecting the sexual and reproductive rights of women and girls in crisis settings is essential and a matter of human rights, but it is also complicated and unsustainable without a change in the way humanitarian assistance is provided and funded,” states a recently published report from the UN Population Fund.

Every day, 507 women and adolescent girls die due to a lack of reproductive health services in humanitarian emergencies. There are now 13 million displaced refugees globally. This number will only continue to grow as more people seek refuge from war and violence.

In addition to this growing refugee population, there is an ever-increasing population of internally displaced people: about 38 million in 2014, equaling 30,000 per day. These individuals fleeing conflict within their own country spend an average of 17 years displaced from their home relying on international humanitarian assistance. Although the international community first recognized providing reproductive health services as a human right with widespread economic and social benefits 20 years ago, barriers remain to meeting these needs for the 25 million women and girls living in emergency settings.

A report from the UN Population Fund (UNFPA), titled Shelter From the Storm: A Transformative Agenda for Women and Girls in a Crisis-Prone World, urges new directions in financing for sexual and reproductive health to address this problem.

“Protecting the sexual and reproductive rights of women and girls in crisis settings is essential and a matter of human rights, but it is also complicated and unsustainable without a change in the way humanitarian assistance is provided and funded,” states the report.

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Two critical ways for the global community to begin making progress include, as the report notes, increasing the international community’s focus on the availability and accessibility of safe abortion and post-abortion care, and cultivating a culture of preparedness and prevention when it comes to providing a full range of such services in communities prior to any crisis. 

Access to Safe Abortion as a Human Right

An oft-cited 1999 UNFPA report estimates that 25 to 50 percent of maternal deaths in refugee settings are due to complications of unsafe abortions. (Little research has been done in the past two decades to learn more about this crisis.) This is a startling statistic, yet abortion remains politicized and difficult for non-governmental organizations and leaders to talk about in the international arena, let alone fund.

Few displaced women are in a position to demand access to abortion or organize to advocate for these services. Societal forces are a large part of this disenfranchisement, including pressure from family and the broader community to bring a pregnancy to term to replace lost family or to hide a pregnancy that is a result of rape, which can increase the stigma they are facing. In addition, clinics in most crisis settings are not outfitted with the necessary medical equipment to provide safe abortion care or even to address complications of abortion. Also, many organizations receiving international funding to provide relief to refugees are religiously affiliated and do not offer reproductive health care, including abortion, according to a report about safe abortion for refugees.

As a result, research specifically addressing the state of abortion and post-abortion care in conflict zones often is neglected, creating a gap in information around this specific program area.

Sandra Krause, director of Reproductive Health at the Women’s Refugee Commission, explained to Rewire that, according to a 2012-2014 Global Evaluation from the Inter-Agency Working Group on Reproductive Health in Crises (IAWG), access to post-abortion care in crisis settings has expanded since 2004 but “comprehensive abortion care—in particular, safe abortion care,” is still lacking. The IAWG has since formed a working group to address this gap.

However, the results of that working group are unknown, and much of this work remains unfunded. On a hopeful note, Krause said that she believes the working group will create a sea change in the conversation around funding safe abortion access in humanitarian emergencies. “We did just receive some funding to update the global guidelines for reproductive health and humanitarian settings to better integrate safe abortion care,” she added.

Economic Case for Funding Reproductive Care Services

In addition to recognizing these services as a human right, the UNFPA report points to obstetric care, safe abortion and post-abortion care, and services for those who experience gender-based violence as keys to achieving sustainable development. There are measurable economic impacts from denying these services to women and girls.

“It prevents girls from being able to go to school, it prevents girls and women from accessing education more generally, and seeking higher education. It pulls women out of the workforce and makes them unable to provide for their families and for themselves,” Katherine Mayall, a global advocacy adviser at the Center for Reproductive Rights, told Rewire.

“There is a strong economic case to be made for meeting the reproductive health needs of a country’s population in humanitarian emergencies,” added Kade Finnoff, an economics professor at the University of Massachusetts. “In lower-income countries where many humanitarian emergencies occur, we now have empirical studies that document the economic impact to individuals and local economies.”

One study of Ghana and Bangladesh about the impact of increased access to reproductive health services found that improved access to family planning services led to “improved birth spacing” and an increase in women’s earnings and participation in paid employment. Further, children of women with access to family planning were better educated than those without these services. Another study of Nigeria found, “reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development.”

A long-term strategic focus on providing sexual and reproductive health services could also allow non-governmental organizations to increase their support for prevention and preparedness before a humanitarian emergency.

As the UNFPA report notes, “Humanitarian funding is mainly directed towards the response to crisis, with relatively little directed to prevention and preparedness.” This lack of preparation often exacerbates already devastating situations, as we’re seeing now in countries affected by the Zika virus. Some government leaders in these affected nations are advising their citizens not to get pregnant for fear that their fetuses will develop a life-threatening anomaly. But many of these same countries don’t have the health-care systems in place to assist the women in need of contraception or abortion care, because of restrictive anti-choice laws.

Ultimately, meeting the needs of every community requires a holistic approach that includes support for prevention and preparedness as well as emergency services.

Cultivating a Local Response

IAWG encourages all communities to implement the Minimum Initial Service Package (MISP) for reproductive health, which is a “life-saving” set of guidelines “to be implemented at the onset of every humanitarian crisis,” the website reads. “It forms the starting point for reproductive health programming and should be sustained and built upon with comprehensive reproductive health services throughout protracted crises and recovery.” For example, a MISP checklist includes a form with sections on how to gather information about the demographics of a humanitarian setting, how to prevent sexual violence and respond to the need of survivors, how to reduce the transmission of HIV, and how to prevent excess maternal and newborn morbidity and mortality. And a yes/no checklist fosters the development of a weekly monitoring initiative at the onset of a response and then tapers down to a monthly review of the status of reproductive health-care services in the humanitarian setting.

“We know in every crisis women and girls are going to have these priority needs, even if it’s in New York City,” said Krause. “Pregnant women are going to need emergency obstetric care because of the breakdown in civil society in cities. There is always an increase in risk for sexual violence and so women are going to need access to care. A certain percentage of women who are pregnant are going to have emergency complications. Newborn care is essential.”

Some local communities are already focusing on prevention and preparedness. “There are some wonderful efforts—led by displaced communities themselves—to address these issues, such as the Adolescent Reproductive Health Network (ARHN) on the Thai-Burma border and Association for Refugees with Disabilities in Uganda,” noted IAWG researcher Sarah Chynoweth. Both organizations work on issues often overlooked in emergency situations.

Rewire reported on the work of ARHN to meet the needs of adolescent refugees, such as providing condoms, peer sex education, and birth control pills. The UN Human Rights Council has recognized the Association for Refugees with Disabilities in Uganda as an example of good practices for allowing refugees living with disabilities to advocate on their own behalf.

Chynoweth emphasized the importance of focusing on those who are particularly marginalized when preparing for emergency response and outreach. “Displaced adolescents, people with disabilities, LGBTQ individuals, and sex workers are particularly vulnerable to sexual violence and exploitation, and they also have specific [sexual and reproductive health] needs. We can’t just keep ‘doing business as usual’—targeted outreach must be conducted to engage these groups, something which humanitarian agencies often neglect.”

As the UNFPA report and other researchers have shown, the best way to provide for immediate and long-term support for sexual and reproductive health services is to fund both global and local initiatives aimed at spurring sweeping improvements in the lives of women and girls.

Culture & Conversation Human Rights

Family-Friendly Policies Benefit Everyone—Even Me

Katie Klabusich

As I was reading The Diversity Advantage: Fixing Gender Inequality In the Workplace, I saw my nontraditional life and needs represented by the policies the author advocates for and realized these are fights I need to be more involved in, for reasons beyond rounding out my reproductive justice advocacy.

I’m not married, I’ve never given birth, and I work for myself—three things I don’t plan to change. Given that, I’m a seemingly unlikely person to advocate for paid family leave and policies that keep women from ending up sidelined into the “mommy track.” As I was reading Ruchika Tulshyan’s new book The Diversity Advantage: Fixing Gender Inequality in the Workplace, however, I saw my nontraditional life and needs represented by the policies the author pushes and realized these are fights I need to be more involved in, for reasons beyond rounding out my reproductive justice advocacy.

I’m fighting for myself.

Tulshyan—a writer with degrees from Columbia’s Graduate School of Journalism and the London School of Economics and Political Science—has covered diversity and leadership in business all over the world. So, her approach is focused on outlining for upper management and business owners why intentional diversity and traditionally “woman-oriented” policies like parental leave are actually good for their bottom line.

By the time I’d consumed Chapter 3—“Give Your Employees Flexibility Without Shame”—and Chapter 4—“Reversing the Mommy Track”—I’d realized that all the anti-woman, anti-family, and anti-diversity standards embedded in our current brand of capitalism here in the United States are also inherently ableist, leave zero room for nontraditional dating lives, punish anyone with a uterus who’s of childbearing age, and trickle down to how organizations and contractors treat freelancers. Just because I don’t have a standard job or family doesn’t mean I am not affected by the values of corporate culture.

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Until the new standard becomes respecting employees’ actual lives and providing what they need to live them, I will continue to struggle with negotiating for time off from contracts, calling in sick to myself and those who contract with me, and worrying about aging parents and a sibling-by-choice whose health care will likely fall on me.

And that was just what hit me while I was reading.

I started paying more attention to my own life and stories in the news about pay discrimination, the challenges of balancing work and life, the frequency of employers ignoring the needs of people with nontraditional families. I went back and re-read The Diversity Advantage with new eyes.

The first thing that stood out was how the flexibility originally designed to comply with maternity and family leave would help those of us in the workforce with chronic medical conditions. To keep flex time from being used against those who need or choose to use it, Tulshyan suggests employers implement what she calls “flexibility without shame.” In doing so, policies of all kinds about flex time, working from home, and number of days in a workweek end up benefiting people of all genders and circumstances.

“[W]e have the ability to perform a multitude of tasks with just a portable laptop and steady Internet connection,” Tulshyan explains. “‘Going to work’ could have been largely transformed by the type of technology that exists today. The keyword here is ‘could.’ Unfortunately even many workplaces that offer flexible work policies in theory still penalize employees who are not always in the office.”

As someone with a mental health profile (dysthymia, anxiety, attention deficit disorder, and possible post-traumatic stress disorder diagnosed so far) that requires me to take medication, assess and revise treatment plans, and spend regular business hours at the doctor, a “regular” job is off the table and even my editors and other clients have to be flexible and patient. I have learned to build flex time into my schedule (though, admittedly I don’t always do this successfully). A change in work culture’s expectations would allow me to thrive more fully even as a self-employed person.

The kinds of challenges “returning” parents face are also issues for people with chronic disorders or with family members they care for.

Western Europe countries offer mothers an average of 40.5 paid weeks of leave and Finland allows over three years per child—but having a job waiting for you when you get back isn’t the only guarantee working parents need.

“Even in countries with very generous paid maternity leave—all of the Scandinavian countries, for example—there’s research to show that women suffer in other ways: They lose out on pay, leadership opportunities and even access to professional networks,” writes Tulshyan. Any activity or required leave that causes a break in active engagement in a field will create similar lags in advancement and missed chances on projects and leads.

Even though the numerous studies and interviews with executives in The Diversity Advantage show that “being able to engage employees fully part time can be much better than engaging them distractedly full time,” anyone who can’t be on board continually is often seen as a less valuable employee or an expendable contractor. Increasingly, though, millennials especially are expecting flexibility. They don’t accept the standard resistance and restrictions on advancement that often come with asking to work flexibly—even in offices and companies that supposedly offer that benefit.

A survey by telecommuting and freelance jobs site FlexJobs found that flexible work arrangements are even better for organizations than the employees. As Tulshyan notes:

82% responded that they would be more loyal to their organizations if they had flexible work options. There are consequences if companies don’t catch on: 39% have turned down a promotion or job or quit over lack of flexibility.

Women in particular have historically been and continue to be affected disproportionately by—and have become less willing to tolerate—a hostile, patriarchal work culture. According to Tulshyan’s research, even though we outpace men in pursuing upper-level degrees, the U.S. female workforce participation has dropped to 69 percent. She explains that if companies want to attract and retain women who increasingly must “balance multiple significant roles,” they’re going to need firm policies that incentivize talent to apply for open positions and stick around.

The only way to effectively implement even baseline paid maternity leave is to make flexibility “a standardized norm,” according to the research and interviews Tulshyan did around the globe. Having incrementally better maternity leave isn’t enough because it creates an inherently unequal situation where those who utilize the leave are punished simply by being absent.

“The key is to have an environment where flexible work arrangements are considered both gender-neutral and an institutionalized part of the culture,” Tulshyan writes, citing executives who continually hear that employees feel judged when they make use of flex-time policies. Those same executives and others charged with human resource development continue to be frustrated because they know the cost-benefit analysis would come out in their favor if their companies took the time to ensure policies were punishment-free.

“Time and again,” she writes, “leaders I’ve interviewed for this book have mentioned the short-term costs of implementing a dedicated flexibility program—money, time, efforts to change culture—as a tradeoff worth making for the long-term benefits of an engaged, loyal and high-performing employee base.”

I certainly know I’m more loyal to the contracts that treat me fairly—it’s a simple math equation for me. I am not in a position to ignore when I’m not paid an appropriate sum or when paying me in a reasonable timeframe is clearly not a priority; when I don’t get paid, I don’t eat.

The attitudes of corporate and “standard” workplace culture roll down to me and even more so to people in service industry and retail jobs. I know from experience, having worked extended periods in both retail and bars/restaurants. Until “skilled” workers are treated well, those of us who freelance and those who work in “unskilled” labor will continue to struggle for fair treatment. Fighting for a higher minimum wage and fair scheduling à la Fight for $15 is a worthwhile endeavor that can trickle up; we should also be fighting for the flexibility and equity policies that trickle down.

That means pushing our candidates and lobbying our legislators, because this country is embarrassingly behind in supporting women, families, parents of any kind, and especially nontraditional families—such as those that include non-primary parents, or shared elder care responsibilities, or anyone who can’t or doesn’t feel the need to be legally bound to their partner(s).

From The Diversity Advantage:

In the U.S., where the majority of the organizations I interviewed for this book are headquartered, paid leave statistics are abysmal. America is the only industrialized country that doesn’t have a government mandate to provide workers with any paid leave. The existing Family and Medical Leave Act of 1993 gives only about half of all workers 12 weeks of unpaid leave for birth or medical conditions. In this regard, the U.S. trails far behind nations like Pakistan (12 weeks paid at 100% of salary) and Sundan (eight weeks fully paid).

It gets worse.

In case you haven’t had to look into it or assume that as a supposed international leader on human rights the United States would at least be doing the bare minimum, this country has no paid maternity leave mandated by federal law. And a frustrating few qualify for guaranteed unpaid leave. Your job is protected when you go on your unpaid leave—but only if you’re a full-time employee who has worked at the company for more than a year and only if the company has more than 50 employees. That leaves a disastrous number of workers out in the cold.

Some states have taken it upon themselves to tackle providing paid leave—a necessary provision of a successful governmental policy to ensure small businesses don’t incur budget-busting costs. This partnership model is used by countries all over the world.

As is the case with so many policies and programs that benefit individual workers, paid parental leave is also good for companies of all sizes. Tulshyan quotes the National Partnership for Women & Families on the subject:

In California, which has had a state paid leave program for more than a decade, 83% of workers in ‘lower-quality’ jobs who used the program returned to their previous employer — a 10-point improvement compared to workers who did not use the program.

The good news about our lack of federal law, according to experts Tulshyan interviewed, is that we have a chance to do paid parental leave correctly:

“Because they are so late to the game, I think the U.S. has a unique opportunity to innovate and lead the way on policies to do with working parents,” said Anna Steffeney, a former IT executive and founder of LeaveLogic, a startup that helps companies implement maternity leave benefits.

Essentially, not only can we lobby our legislators for well-crafted law on the subject, but businesses are not beholden to existing shoddy law, so they are free to implement well-constructed policy changes now.

Tulshyan isn’t waiting for Congress and statehouses to get it together; she’s busy explaining to corporations why paid parental leave is good for business.

“To retain and advance the best employees, especially women,” she writes, “organizations must accommodate workers who are—or want to be—parents.”

Here again, I see myself.

I’m polyamorous—which means, ideally, I have more than one romantic partner to whom I’m committed on some level, though not monogamous with. Unlike most of the poly community, however, I describe myself as “solo” because I don’t thrive with an “anchor” partner—the husband/live-in person with whom daily life and logistics are intertwined. Frankly, I don’t want to live with anyone, and my emotional labor intake and output are really well-balanced with the close friends and partners I have; there simply isn’t a need or space for the traditional life partner most people want and need.

While this means I won’t have what most would consider children of “my own”—which is more than fine because I have intentionally been a non-parent for a decade now—I have discovered I’m open to being a non-primary parent in the context of a close partnership. Poly families are not constrained by a standard structure and it’s commonplace for tight-knit groups of three or four (or more!) to either live together (probably not in my case) or close by and share the duties of caring for children, siblings, aging family members, and other loved ones during times of stress or sickness.

That all may sound lovely or weird or overly ambitious depending on your background, but legally speaking it is a great big mess. I don’t have close immediate family and never plan to get married, which means I’ll never have immediate family. My parents pop in and out of my life at the whim of my mother, which means I will likely be charged with their care. But they are the only people on behalf for whom I have any legal right to take family leave. Just because I’m not married and have no blood siblings doesn’t mean I don’t have anyone who relies on me and whom I would want to care for.

Several of the recommendations Tulshyan makes under her subhead, “The Case for Adequate Paid Maternity Leave,” would help more than just mothers.

“Working mothers could cumulatively save $14 billion if companies offered a global return-to-work policy that allows them to work just four days a week, at full pay, for the first six months after they return to work,” writes Tulshyan. And why not extend that—which you’d have to under the gender-neutral, flexibility-without-shame standards—to people pursuing new treatment plans for medical conditions or taking their turn at home with the children they co-parent so a partner can go out of town to care for a sick parent?

The stats Tulshyan quotes from an op-ed at the Wall Street Journal by Google executive Susan Wojcicki (currently CEO of YouTube) would certainly only improve with policies that benefit people like me.

“When Google increased its paid maternity leave to 18 weeks, the rate at which new mothers left the company dropped by half,” Wojcicki wrote. “It’s much better for Google’s bottom line—to avoid costly turnover, and to retain the valued expertise, skills and perspective of our employees who are mothers. … Best of all, mothers come back to the workforce with new insights. I know from experience that being a mother gave me a broader sense of purpose, more compassion and a better ability to prioritize and get things done efficiently.”

The same would be true for those with other kinds of life experiences. The more diverse your organizational structure and staffing gets, the better your company becomes at catering to a diverse clientele or market.

Here, again, millennials especially are intolerant of organizations without built-in flexibility. In fact, not offering this benefit is increasingly costing companies young talent. I identify completely with the reasoning millennials cite. “[Forty-eight percent] of millennials would avail of paid parental leave when they had children, more than any other previous generation,” writes Tulshyan. “Even if they aren’t planning to ever have children—or any time soon—knowing that they’re working for an inclusive environment that values families is important.”

These values are even more important for someone who does freelance and contract work because I’m already seen as expendable and/or interchangeable too much of the time. I can get “off-ramped” simply because I’m of childbearing age—whether or not I actually want children. Most prospective clients won’t ask; they’ll just go with the male application or proposal so they don’t have to worry about it. But if we had a work culture that neutralized this tendency, I wouldn’t have to screen so hard or be so specific in contract language to ensure any time off—sick time of my own or potential family leave—won’t end or void my contract or lead to it not being renewed.

Tulshyan concludes her chapter on reversing the “mommy track” by turning a current losing situation into a win-win:

[I]t’s devastating that a working mother’s career options and her child’s care can be determined by how progressive her employer is on this issue. … This is an opportunity for employers to differentiate themselves and innovate early to find solutions. It’s good for women, but it’s also great for business.

The most optimistic and far-reaching existing policy about flexibility and paid family leave in The Diversity Advantage is also the simplest, and the one I think should be the new standard. It comes from global technology company SAP’s “best practices policy” and would cover all the imagined and yet to be conceived life challenges:

All employees with a permanent contract, regardless of age or career stage, are eligible for the program for extended absences such as: parental leave for all genders; sabbatical; caring for a relative; sickness.

What a concept: respecting all aspects of the lives of employees, no matter their circumstances. Sign me up!