For Healthy Mothers, Value Women

Andrea Lynch

Why is improving maternal health the "most elusive" of the UN Millennium Goals? Perhaps because it requires us to talk about how much societies value women.

Though babies' sizeable heads may make birth dangerous for a certain percentage of women, the corresponding big human brains are good for something: they give us insight into how birth works, which translates into routine skilled support, as well as lifesaving interventions in an emergency. As I'm learning from recent books like Tina Cassidy's Birth and Jennifer Block's phenomenal Pushed (and as doulas and midwives I've encountered over the years have always maintained), for the most part, birth works. Usually, it's a natural, physiological process that women's bodies know how to manage, and that can be helped along with minimal intervention by a skilled midwife or other birth attendant. Of course, there can be complications – not all pregnancies and not all births are safe, and some put women and babies at risk. That's why we are fortunate to be living in a time when medical technology – properly applied – can save women and babies when things go wrong. We can't eliminate the risks entirely, but we can save a lot of lives.

So why is it, then, that every minute, a woman still dies as a result of pregnancy or childbirth? Ninety-nine percent of these deaths occur in developing countries (primarily in Africa and Asia), and the vast majority of them are preventable. Two recent issues of id21 – a publication that distills the latest development research on various topics – are devoted to understanding why improving maternal health remains, in the words of one editorial, "the most elusive of the Millennium Development Goals."

The first issue, "Improving the health of mothers and babies: breaking through health system constraints," takes a closer look at why pregnancy and childbirth still claim half a million women's lives every year, with a particular focus on how health systems and governments can address the crisis. One article looks at the shortage of skilled health professionals equipped to attend birth, one examines how weak health infrastructures impact the process, and one looks at how poverty and bad birth outcomes reinforce each other (poor women are more vulnerable to risky pregnancies and substandard maternity care, but complicated births can also deepen poverty when families have to pay for expensive lifesaving interventions).

I was particularly interested in an article dealing with the overmedicalization of birth in developing countries, which increases risk to both mother and baby. I assumed that the prevalence of non-evidence-based interventionist medical practices related to birth – including unnecessary c-sections – was primarily an issue for women in wealthy countries, but it turns out that women in the developing world are also subject to continuous fetal monitoring, overmedication, routine enemas and episiotomies, and laboring flat on their back with their legs in stirrups. Worse yet, in some developing countries, women of means are often urged into unnecessary c-sections, while poor women in the same countries often lack access to lifesaving emergency c-sections. As the article points out, "Exaggerating the risks of normal birth to women who are able to pay, or who can borrow the money, for both the convenience and the financial gain of medical institutions, is a damaging development in low-resource settings." No kidding.

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Another article breaks down the financial resources necessary to improve maternal health in the places where women are most at risk, and a final article speculates that it is not a lack of resources, but rather a lack of political will, that's keeping maternal mortality rates so high worldwide, even when we know what we must do to bring them down. As the lead editorial points out, "Debates in safe motherhood have emphasized various technical approaches to solve the problems inherent in reaching the MDG for maternal health. We now know that good maternal health is based on good sexual and reproductive health, including family planning and safe abortion care." Now the oh-so-elusive nature of the seemingly straightforward MDG 5 is beginning to make a bit more sense: to improve maternal health, we might actually have to talk about sex, pregnancy, reproductive choice, and how much societies value women. Now we're in trouble.

One in eight of those women dying every minute as a result of pregnancy and childbirth are women dying from unsafe abortions, after all–totaling 68,000 women every year, a figure that hasn't changed in nearly two decades. Nearly half of these deaths occur in Africa, where abortion is largely illegal, and rarely available even under circumstances where it is legal. Getting to the heart of the matter, a special id21 supplement focuses on the death toll, as well as the financial strain, caused by the global unsafe abortion epidemic. One article details the health risks associated with unsafe abortion, one looks at its global economic impact, one looks at how health systems can offer the procedure most safely and cost effectively, and one looks at unsafe abortion as a major cause of maternal death, matter-of-factly pointing out that "It is paradoxical to identify reducing maternal mortality as a priority but fail to put in place effective interventions to prevent unwanted births." Using Mexico City as a case study, another article compares the cost of providing safe and legal abortion (US$53 to US$143 per procedure) to the cost of dealing with complications from unsafe abortion when abortion is illegal (US$601 to over US$2,100 per woman suffering from complications).

Reading through all this, I'm reminded of the paradoxical nature of reproduction in women's lives. On the one hand, your experience of reproductive health is highly dependent on the specifics of your identity: your country's laws, customs, and resources; your race; your geographic location; your age; your socioeconomic class. On the other hand, pregnancy and birth – and reproductive oppression – cut across the female experience, and all women (rich and poor, Northern and Southern, rural and urban) suffer in a world where women's reproductive health and well-being is a low priority. Which is why the fifth MDG, elusive as it may be, affects us all. As id21's lead editorial points out:

Maternal mortality is an indicator of how well a health system functions, as it encapsulates a substantial part of both primary and secondary health care. However, maternal mortality has also been described as a "litmus test" for the status of women in a society. Given that most women will give birth, a health system that is not designed to cope with this does not value women and their babies enough to provide protection against possible death or disability.

They said it, not me.

Analysis Human Rights

El Salvador Bill Would Put Those Found Guilty of Abortion Behind Bars for 30 to 50 Years

Kathy Bougher

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would heighten the likelihood that those charged with abortion will spend decades behind bars.

Abortion has been illegal under all circumstances in El Salvador since 1997, with a penalty of two to eight years in prison. Now, the right-wing ARENA Party has introduced a bill that would increase that penalty to a prison sentence of 30 to 50 years—the same as aggravated homicide.

The bill also lengthens the prison time for physicians who perform abortions to 30 to 50 years and establishes jail terms—of one to three years and six months to two years, respectively—for persons who sell or publicize abortion-causing substances.

The bill’s major sponsor, Rep. Ricardo Andrés Velásquez Parker, explained in a television interview on July 11 that this was simply an administrative matter and “shouldn’t need any further discussion.”

Since the Salvadoran Constitution recognizes “the human being from the moment of conception,” he said, it “is necessary to align the Criminal Code with this principle, and substitute the current penalty for abortion, which is two to eight years in prison, with that of aggravated homicide.”

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The bill has yet to be discussed in the Salvadoran legislature; if it were to pass, it would still have to go to the president for his signature. It could also be referred to committee, and potentially left to die.

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would worsen the criminalization of women, continue to take away options, and heighten the likelihood that those charged with abortion will spend decades behind bars.

In recent years, local feminist groups have drawn attention to “Las 17 and More,” a group of Salvadoran women who have been incarcerated with prison terms of up to 40 years after obstetrical emergencies. In 2014, the Agrupación Ciudadana por la Despenalización del Aborto (Citizen Group for the Decriminalization of Abortion) submitted requests for pardons for 17 of the women. Each case wound its way through the legislature and other branches of government; in the end, only one woman received a pardon. Earlier this year, however, a May 2016 court decision overturned the conviction of another one of the women, Maria Teresa Rivera, vacating her 40-year sentence.

Velásquez Parker noted in his July 11 interview that he had not reviewed any of those cases. To do so was not “within his purview” and those cases have been “subjective and philosophical,” he claimed. “I am dealing with Salvadoran constitutional law.”

During a protest outside of the legislature last Thursday, Morena Herrera, president of the Agrupación, addressed Velásquez Parker directly, saying that his bill demonstrated an ignorance of the realities faced by women and girls in El Salvador and demanding its revocation.

“How is it possible that you do not know that last week the United Nations presented a report that shows that in our country a girl or an adolescent gives birth every 20 minutes? You should be obligated to know this. You get paid to know about this,” Herrera told him. Herrera was referring to the United Nations Population Fund and the Salvadoran Ministry of Health’s report, “Map of Pregnancies Among Girls and Adolescents in El Salvador 2015,” which also revealed that 30 percent of all births in the country were by girls ages 10 to 19.

“You say that you know nothing about women unjustly incarcerated, yet we presented to this legislature a group of requests for pardons. With what you earn, you as legislators were obligated to read and know about those,” Herrera continued, speaking about Las 17. “We are not going to discuss this proposal that you have. It is undiscussable. We demand that the ARENA party withdraw this proposed legislation.”

As part of its campaign of resistance to the proposed law, the Agrupación produced and distributed numerous videos with messages such as “They Don’t Represent Me,” which shows the names and faces of the 21 legislators who signed on to the ARENA proposal. Another video, subtitled in English, asks, “30 to 50 Years in Prison?

International groups have also joined in resisting the bill. In a pronouncement shared with legislators, the Agrupación, and the public, the Latin American and Caribbean Committee for the Defense of the Rights of Women (CLADEM) reminded the Salvadoran government of it international commitments and obligations:

[The] United Nations has recognized on repeated occasions that the total criminalization of abortion is a form of torture, that abortion is a human right when carried out with certain assumptions, and it also recommends completely decriminalizing abortion in our region.

The United Nations Committee on Economic, Social, and Cultural Rights reiterated to the Salvadoran government its concern about the persistence of the total prohibition on abortion … [and] expressly requested that it revise its legislation.

The Committee established in March 2016 that the criminalization of abortion and any obstacles to access to abortion are discriminatory and constitute violations of women’s right to health. Given that El Salvador has ratified [the International Covenant on Economic, Social and Cultural Rights], the country has an obligation to comply with its provisions.

Amnesty International, meanwhile, described the proposal as “scandalous.” Erika Guevara-Rosas, Amnesty International’s Americas director, emphasized in a statement on the organization’s website, “Parliamentarians in El Salvador are playing a very dangerous game with the lives of millions of women. Banning life-saving abortions in all circumstances is atrocious but seeking to raise jail terms for women who seek an abortion or those who provide support is simply despicable.”

“Instead of continuing to criminalize women, authorities in El Salvador must repeal the outdated anti-abortion law once and for all,” Guevara-Rosas continued.

In the United States, Rep. Norma J. Torres (D-CA) and Rep. Debbie Wasserman Schultz (D-FL) issued a press release on July 19 condemning the proposal in El Salvador. Rep. Torres wrote, “It is terrifying to consider that, if this law passed, a Salvadoran woman who has a miscarriage could go to prison for decades or a woman who is raped and decides to undergo an abortion could be jailed for longer than the man who raped her.”

ARENA’s bill follows a campaign from May orchestrated by the right-wing Fundación Sí a la Vida (Right to Life Foundation) of El Salvador, “El Derecho a la Vida No Se Debate,” or “The Right to Life Is Not Up for Debate,” featuring misleading photos of fetuses and promoting adoption as an alternative to abortion.

The Agrupacion countered with a series of ads and vignettes that have also been applied to the fight against the bill, “The Health and Life of Women Are Well Worth a Debate.”

bien vale un debate-la salud de las mujeres

Mariana Moisa, media coordinator for the Agrupación, told Rewire that the widespread reaction to Velásquez Parker’s proposal indicates some shift in public perception around reproductive rights in the country.

“The public image around abortion is changing. These kinds of ideas and proposals don’t go through the system as easily as they once did. It used to be that a person in power made a couple of phone calls and poof—it was taken care of. Now, people see that Velásquez Parker’s insistence that his proposal doesn’t need any debate is undemocratic. People know that women are in prison because of these laws, and the public is asking more questions,” Moisa said.

At this point, it’s not certain whether ARENA, in coalition with other parties, has the votes to pass the bill, but it is clearly within the realm of possibility. As Sara Garcia, coordinator of the Agrupación, told Rewire, “We know this misogynist proposal has generated serious anger and indignation, and we are working with other groups to pressure the legislature. More and more groups are participating with declarations, images, and videos and a clear call to withdraw the proposal. Stopping this proposed law is what is most important at this point. Then we also have to expose what happens in El Salvador with the criminalization of women.”

Even though there has been extensive exposure of what activists see as the grave problems with such a law, Garcia said, “The risk is still very real that it could pass.”

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (D-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

CORRECTION: A previous version of this article included a typo that misidentified Sen. Tim Kaine as a Republican. We regret this error.