Global Commitment to Safe Motherhood

Rupert Walder

Rupert reports from Women Deliver on the needs of a Sudanese midwife, the UK's multi-million dollar investment and what the future holds for improving maternal mortality. Also, don't miss the voices of youth from Women Deliver in our special series!

If the Women Deliver conference in London last week was an advocacy campaign, then it seems to have worked.

Ministers of Health and Finance turned up. They made a powerful declaration of support, and concrete suggestions for how to improve the status of maternal health on the international development agenda. Reproductive and maternal health organizations and agencies used the conference to invite other sectors to comment on their work – sometimes critically. And a lot of questions were asked about why 20 years after its launch, the Safe Motherhood Initiative (SMI) is not meeting its targets.

Although these targets have not been met, attitudes have changed. Fred Sai, who chaired the 1987 Safe Motherhood Conference, dismisses any concept that maternal health is a local, cultural issue that should not be tampered with. “There is only one culture that we need to look at. The culture of delay that maintains the terrible difference between rates of maternal mortality in the North and in the South,” he says. A Nigerian conference delegate agrees with him. “We don’t have time to stop and theorize about cultural influences. We see the problem every day, in women’s homes, on their doorsteps. We just need to get on with it.”

Others brought further realism to the conference. On the final day of the conference, The Norwegian Government announced a new financial commitment to Millennium Development Goals 4 and 5, with the proviso that resources will only be awarded to those organizations that can prove their effectiveness at local levels. Mia Faikenberg, a Danish parliamentarian who attended the Women Deliver Ministers’ Forum, said she had enjoyed the “big passion” and the creativity at the conference. “As a parliamentarian a lot of people are asking me about increased funding. It is a good agenda. I understand why it needs to be supported. But I want to know how effectively our existing funding is being spent. The real money should only go to those who are doing the real work.” IPPF Secretary General Gill Greer agrees, "Today, no-one has an automatic right to funding. We need to prove we are making a difference.”

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In Malawi, a huge difference has been made in the fight against maternal mortality, thanks – in no small part – to the determination and vision of its Minister of Health Marjorie Ngaunje. “In my country we have a Road Map to reduce maternal mortality that is fully integrated into the health SWAp,” she explains. “We want pregnancy to become a cause for celebration not a death sentence in Africa. We know what we want, and we are using the development aid structures to make it happen.”

The expectations were high for this conference, but the organizers were optimistic about the outcome. Executive Vice President of Family Care International (FCI) Ann Starrs says “Women Deliver has put maternal mortality on the global agenda in a way that it cannot be ignored.” FCI’s President Jill Sheffield agrees. “This conference got people really thinking about what women deliver to the world. It has articulated the place of women in the broad context of development. And it has opened the doors to new partners outside the health sector.” What does she expect at the 40th Anniversary of the Safe Motherhood Initiative? “We need to meet a lot sooner than then. We need to keep this agenda visible and strong.”

The UK Department For International Development pledged £100 million to UNFPA on the first morning of the conference. The Japanese Government sent a message to the conference announcing its intention to place global health at the centre of next year’s G8 summit in Japan. And The MacArthur Foundation pledged US $11 million to reducing maternal mortality in Nigeria and India.

On the first afternoon of the conference Sudanese midwife Awatif Altayib Mohamad Hussein addressed the plenary for three minutes. Awatif has travelled for up to 10 hours a day on a donkey to reach rural communities where women – as she did once – suffer from obstetric fistula. I asked her what her message to Women Deliver would be. “The US and others need to give more money so I can continue my work,” she says.

Whether or not Awatif gets more money for her work is beyond her control. It is not beyond the control of many others who attended Women Deliver. And to make the next 20 years a success rather than a further failure, some of the candour and pragmatism and good will shown at Women Deliver needs to be disseminated further afield – and the issues translated into a language that those who do not as yet understand the importance of the women deliver agenda will comprehend.

Analysis Human Rights

From Protected Class to High-Priority Target: How the ‘System Is Rigged’ Against Unaccompanied Migrant Children

Tina Vasquez

Vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation.

This is the first article in Rewire’s two-part series about the U.S. immigration system’s effects on unaccompanied children.

Earlier this month, three North Carolina high school students were released from a Lumpkin, Georgia, detention center after spending more than six months awaiting what seemed like their inevitable fate: deportation back to conditions in Central America that threatened their lives.

Wildin David Guillen Acosta, Josue Alexander Soriano Cortez, and Yefri Sorto-Hernandez were released on bail in the span of one week, thanks to an overwhelming community effort involving pro bono attorneys and bond money. However, not everyone targeted under the same government operation has been reprieved. For example, by the time reports emerged that Immigration and Customs Enforcement (ICE) had detained Acosta on his way to school in Durham, North Carolina, the government agency had already quietly deported four other young people from the state, including a teenage girl from Guatemala who attended the same school.

Activated in January, that program—Operation Border Guardian—continues to affect the lives of hundreds of Central American migrants over the age of 18 who came to the United States as unaccompanied children after January 2014. Advocates believe many of those arrested under the operation are still in ICE custody.

Department of Homeland Security (DHS) Secretary Jeh Johnson has said that the goal of Operation Border Guardian is to send a message to those in Central America considering seeking asylum in the United States. But it’s not working, as Border Patrol statistics have shown. Furthermore, vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation. These youth arrived at the border in hopes of qualifying for asylum, but were unable to succeed in an immigration system that seems rigged against them.

“The laws are really complicated and [young people] don’t have the community support to navigate this really hostile, complex system. That infrastructure isn’t there and unless we support asylum seekers and other immigrants in this part of the country, we’ll continue to see asylum seekers and former unaccompanied minors receive their deportation orders,” said Julie Mao, the enforcement fellow at the National Immigration Project of the National Lawyers Guild.

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“A Grossly Misnamed” Operation

In January, ICE conducted a series of raids that spanned three southern states—Georgia, North Carolina, and Texas—targeting Central American asylum seekers. The raids occurred under the orders of Johnson, who has taken a hardline stance against the more than 100,000 families who have sought asylum in the United States. These families fled deadly gang violence in El Salvador, Honduras, and Guatemala in recent years. In El Salvador, in particular, over 400 children were murdered by gang members and police officers during the first three months of 2016, doubling the country’s homicide rate, which was already among the highest in the world.

ICE picked up some 121 people in the early January raids, primarily women and their young children. Advocates argue many of those arrested were detained unlawfully, because as people who experienced severe trauma and exhibited symptoms of post-traumatic stress disorder, generalized anxiety, and depression, they were disabled as defined under the Rehabilitation Act of 1973, and ICE did not provide reasonable accommodations to ensure disabled people were not denied meaningful access to benefits or services.

Just a few weeks later, on January 23, ICE expanded the raids’ focus to include teenagers under Operation Border Guardian, which advocates said represented a “new low.”

The media, too, has also criticized DHS for its seemingly senseless targeting of a population that normally would be considered refugees. The New York Times called Operation Border Guardian “a grossly misnamed immigration-enforcement surge that went after people this country did not need to guard against.”

In response to questions about its prioritization of former unaccompanied minors, an ICE spokesperson told Rewire in an emailed statement: “As the secretary has stated repeatedly, our borders are not open to illegal migration. If someone was apprehended at the border, has been ordered removed by an immigration court, has no pending appeal, and does not qualify for asylum or other relief from removal under our laws, he or she must be sent home. We must and we will enforce the law in accordance with our enforcement priorities.”

DHS reports that 336 undocumented Central American youth have been detained in the operation. It’s not clear how many of these youth have already been deported or remain in ICE custody, as the spokesperson did not respond to that question by press time.

Acosta, Cortez, Sorto-Hernandez, and three other North Carolina teenagersSantos Geovany Padilla-Guzman, Bilmer Araeli Pujoy Juarez, Pedro Arturo Salmeron—have become known as the NC6 and the face of Operation Border Guardian, a designation they likely would have not signed up for.

Advocates estimate that thousands of deportations of low-priority migrants—those without a criminal history—occur each week. What newly arrived Central American asylum seekers like Acosta could not have known was that the federal government had been laying the groundwork for their deportations for years.

Asylum Seekers Become “High-Priority Cases”

In August 2011, the Obama administration announced it would begin reviewing immigration cases individually, allowing ICE to focus its resources on “high-priority cases.” The assumption was that those who pose a threat to public safety, for example, would constitute the administration’s highest priority, not asylum-seeking high school students.

But there was an indication from DHS that asylum-seeking students would eventually be targeted and considered high-priority. After Obama’s announcement, ICE released a statement outlining who would constitute its “highest priorities,” saying, “Specifically individuals who pose a threat to public safety such as criminal aliens and national security threats, as well as repeat immigration law violators and recent border entrants.”

In the years since, President Obama has repeatedly said “recent border crossers” are among the nation’s “highest priorities” for removal—on par with national security threats. Those targeted would be migrants with final orders of removal who, according to the administration, had received their day in court and had no more legal avenues left to seek protection. But, as the American Civil Liberties Union (ACLU) reported, “recent border entrant” is a murky topic, and it doesn’t appear as if all cases are being reviewed individually as President Obama said they would.

“Recent border entrant” can apply to someone who has been living in the United States for three years, and a border removal applies “whenever ICE deports an individual within three years of entry—regardless of whether the initial entry was authorized—or whenever an individual is apprehended by Customs and Border Protection (CBP),” explained Thomas Homan, the head of ICE’s removal operations in a 2013 hearing with Congress, the ACLU reported.

Chris Rickerd, policy counsel at the American Civil Liberties Union’s Washington Legislative Office, added that “[b]ecause CBP refuses to screen the individuals it apprehends for their ties to the U.S., and DHS overuses procedures that bypass deportation hearings before a judge, many ‘border removals’ are never fully assessed to determine whether they have a legal right to stay.”

Over the years, DHS has only ramped up the department’s efforts to deport newly arrived immigrants, mostly from Central America. As the Los Angeles Times reported, these deportations are “an attempt by U.S. immigration officials to send a message of deterrence to Central America and avoid a repeat of the 2014 crisis when tens of thousands of children from Honduras, El Salvador and Guatemala arrived at the U.S. border.”

This is something Mao takes great issue with.

“These raids that we keep seeing are being done in order to deter another wave of children from seeking asylum—and that is not a permissible reason,” Mao said. “You deport people based on legality, not as a way of scaring others. Our country, in this political moment, is terrorizing young asylum seekers as a way of deterring others from presenting themselves at the border, and it’s pretty egregious.”

There is a direct correlation between surges of violence in the Northern Triangle—El Salvador, Guatemala, and Honduras—and an uptick in the number of asylum seekers arriving in the United States. El Salvador, known as the murder capital of the word, recently saw an explosion of gang violence. Combine that with the possible re-emergence of so-called death squads and it’s clear why the number of Salvadoran family units apprehended on the southern border increased by 96 percent from 2015 to 2016, as Fusion reported.

Much like Mao, Elisa Benitez, co-founder of the immigrants rights’ organization Alerta Migratoria NC, believes undocumented youth are being targeted needlessly.

“They should be [considered] low-priority just because they’re kids, but immigration is classifying them at a very high level, meaning ICE is operating like this is a population that needs to be arrested ASAP,” Benitez said.

The Plight of Unaccompanied Children

Each member of the NC6 arrived in the United States as an unaccompanied child fleeing violence in their countries of origin. Acosta, for example, was threatened by gangs in his native Honduras and feared for his life. These young people should qualify as refugees based on those circumstances under international law. In the United States, after they present themselves at the border, they have to prove to an immigration judge they have a valid asylum claim—something advocates say is nearly impossible for a child to do with no understanding of the immigration system and, often, with no access to legal counsel—or they face deportation.

Unaccompanied children, if not immediately deported, have certain protections once in the United States. For example, they cannot be placed into expedited removal proceedings. According to the American Immigration Council, “they are placed into standard removal proceedings in immigration court. CBP must transfer custody of these children to Health and Human Services (HHS), Office of Refugee Resettlement (ORR), within 72 hours.”

While their court proceedings move forward, HHS’s Office of Refugee Resettlement manages the care of the children until they can ideally be released to their parents already based in the country. Sometimes, however, they are placed with distant relatives or U.S. sponsors. Because HHS has lowered its safety standards regarding placement, children have been subjected to sexual abuse, labor trafficking, and severe physical abuse and neglect, ThinkProgress has reported.

If while in the care of their family or a sponsor they miss a court date, detainment or deportation can be triggered once they turn 18 and no longer qualify for protections afforded to unaccompanied children. 

This is what happened to Acosta, who was placed with his mother in Durham when he arrived in the United States. ICE contends that Acosta was not targeted unfairly; rather, his missed court appearance triggered his order for removal.

Acosta’s mother told local media that after attending his first court date, Acosta “skipped subsequent ones on the advice of an attorney who told him he didn’t stand a chance.”

“That’s not true, but it’s what they were told,” Benitez said. “So, this idea that all of these kids were given their day in court is false. One kid [we work with] was even told not to sign up for school because ‘there was no point,’ it would just get him deported.”

Benitez told Rewire the reasons why these young people are being targeted and given their final orders of removal need to be re-examined.

Sixty percent of youth from Central America do not ever have access to legal representation throughout the course of their case—from the time they arrive in the United States and are designated as unaccompanied children to the time they turn 18 and are classified as asylum seekers. According to the ACLU, 44 percent of the 23,000 unaccompanied children who were required to attend immigration court this year had no lawyer, and 86 percent of those children were deported.

Immigration attorneys and advocates say that having a lawyer is absolutely necessary if a migrant is to have any chance of winning an asylum claim.

Mao told Rewire that in the Southeast where Acosta and the other members of the NC6 are from, there is a pipeline of youth who arrived in the United States as unaccompanied children who are simply “giving up” on their valid asylum claims because navigating the immigration system is simply too hard.

“They feel the system is rigged, and it is rigged,” Mao said.

Mao has been providing “technical assistance” for Acosta and other members of the NC6. Her organization doesn’t represent individuals in court, she said, but the services it provides are necessary because immigration is such a unique area of law and there are very few attorneys who know how to represent individuals who are detained and who have been designated unaccompanied minors. Those services include providing support, referrals, and technical assistance to advocates, community organizations, and families on deportation defense and custody issues.

Fighting for Asylum From Detention

Once arrested by ICE, there is no telling if someone will linger in detention for months or swiftly be deported. What is known is that if a migrant is taken by ICE in North Carolina, somewhere along the way, they will be transferred to Lumpkin, Georgia’s Stewart Detention Center. As a local paper reported, Stewart is “the last stop before they send you back to whatever country you came from.”

Stewart is the largest detention center in the country, capable of holding 2,000 migrants at any time—it’s also been the subject of numerous investigations because of reports of abuse and inadequate medical care. The detention center is run by Corrections Corporation of America, the country’s largest private prison provider and one that has become synonymous with maintaining inhumane conditions inside of its detention centers. According to a report from the National Immigrant Justice Center, Stewart’s remote location—over two hours away from Atlanta—hinders the facility from attracting and retaining adequate medical staff, while also creating barriers to visitation from attorneys and family members.

There’s also the matter of Georgia being notoriously tough on asylum seekers, even being called the “worst” place to be an undocumented immigrant. The Huffington Post reported that “Atlanta immigration judges have been accused of bullying children, badgering domestic violence victims and setting standards for relief and asylum that lawyers say are next to impossible to meet.” Even more disconcerting, according to a project by Migrahack, which pairs immigration reporters and hackers together, having an attorney in Georgia had almost no effect on whether or not a person won their asylum case, with state courts denying up to 98 percent of asylum requests. 

Acosta, Cortez, and Sorto-Hernandez spent over six months in Stewart Detention Center before they were released on baila “miracle” according to some accounts, given the fact that only about 5 percent of those detained in Stewart are released on bond.

In the weeks after ICE transferred Acosta to Stewart, there were multiple times Acosta was on the verge of deportation. ICE repeatedly denied Acosta was in danger, but advocates say they had little reason to believe the agency. Previous cases have made them wary of such claims.

Advocates believe that three of the North Carolina teens who were deported earlier this year before Acosta’s case made headlines were kept in detention for months with the goal of wearing them down so that they would sign their own deportation orders despite having valid asylum claims.

“They were tired. They couldn’t handle being in detention. They broke down and as much as they feared being returned to their home countries, they just couldn’t handle being there [in detention] anymore. They’d already been there for weeks,” Benitez said.

While ICE claims the average stay of a migrant in Stewart Detention Center is 30 days, the detention center is notorious for excessively long detainments. Acosta’s own bunkmate had been there over a year, according to Indy Week reporter David Hudnall.

As Hudnall reported, there is a massive backlog of immigration cases in the system—474,000 nationally and over 5,000 in North Carolina.

Mao told Rewire that the amount of time the remaining members of the NC6 will spend in detention varies because of different legal processes, but that it’s not unusual for young people with very strong asylum cases to sign their rights away because they can’t sustain the conditions inside detention.

Pedro Arturo Salmeron, another NC6 member, is still in detention. He was almost deported, but Mao told Rewire her organization was able to support a pro bono attorney in appealing to the Board of Immigration Appeals (BIA) to stop proceedings.

Japeth Matemu, an immigration attorney, recently told Indy Week’s David Hudnall that “the BIA will tell you that it can’t modify the immigration judge’s ruling unless it’s an egregious or obvious miscarriage of justice. You basically have to prove the judge is off his rocker.”

It could take another four months in detention to appeal Salmeron’s case because ICE continues to refuse to release him, according to the legal fellow.

“That’s a low estimate. It could be another year in detention before there is any movement in his case. We as an organization feel that is egregious to detain someone while their case is pending,” Mao said. “We have to keep in mind that these are kids, and some of these kids can’t survive the conditions of adult prison.”

Detention centers operate as prisons do, with those detained being placed in handcuffs and shackles, being stripped of their personal belongings, with no ability to move around freely. One of Acosta’s teachers told Rewire he wasn’t even able to receive his homework in detention.

Many of those in detention centers have experienced trauma. Multiple studies confirm that “detention has a profoundly negative impact on young people’s mental and physical well-being” and in the particular case of asylum seekers, detention may exacerbate their trauma and symptoms of post-traumatic stress disorder. 

“People are so traumatized by the raids, and then you add detention on top of that. Some of these kids cannot psychologically and physically deal with the conditions in detention, so they waive their rights,” Mao said.

In March, Salmeron and fellow NC6 member Yefri Sorto-Hernandez received stays of deportation, meaning they would not face immediate deportation. ICE says a stay is like a “legal pause.” During the pause, immigration officials decide if evidence in the case will be reconsidered for asylum. Sorto-Hernandez was released five months later.

Benitez said that previously when she organized around detention, a stay of deportation meant the person would get released from detention, but ICE’s decision to detain some of the NC6 indefinitely until their cases are heard illustrates how “weirdly severe” the agency is being toward this particular population. Mao fears this is a tactic being used by ICE to break down young people in detention.

“ICE knows it will take months, and frankly up to a year, for some of these motions to go through the court system, but the agency is still refusing to release individuals. I can’t help but think it’s with the intention that these kids will give up their claims while suffering in detention,” Mao said.

“I think we really have to question that, why keep these young people locked up when they can be with their communities, with their families, going to school? ICE can release these kids now, but for showmanship, ICE is refusing to let them go. Is this who we want to be, is this the message we want to send the world?” she asked.

In the seven months since the announcement of Operation Border Guardian, DHS has remained quiet about whether or not there will be more raids on young Central American asylum seekers. As a new school year approaches, advocates fear that even more students will be receiving their orders for removal, and unlike the NC6, they may not have a community to rally around them, putting them at risk of quietly being deported and not heard from again.

News Health Systems

What Happens When a Catholic-Run Clinic Comes to Your Local Walgreens?

Amy Littlefield

“It causes us great concern when we think about vulnerable populations ... [who] may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, told Rewire.

One of the largest Catholic health systems is set to begin running health clinics inside 27 Walgreens stores in Missouri and Illinois next week. The deal between Walgreens and SSM Health has raised concerns from public interest groups worried that care may be compromised by religious doctrine.

Catholic health systems generally follow directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, contraception, tubal ligations, vasectomies, and fertility treatments.

“We are concerned that the clinics will likewise be required to follow the [directives], thereby severely curtailing access to important reproductive health services, information, and referrals,” MergerWatch, the National Health Law Program, and the American Civil Liberties Unions of Illinois and Missouri wrote in a letter to Walgreens on Wednesday. They also sent a letter to SSM Health.

In a statement emailed to Rewire, Walgreens said its relationship with SSM Health “will not have any impact on any of our current clinic or pharmacy policies and procedures.”

SSM Health emailed a statement saying it “will continue to offer the same services that are currently available at Walgreens Healthcare Clinics today.” If a patient needs services “that are beyond the scope of what is appropriate for a retail clinic setting, they will be referred to a primary care physician or other provider of their choice,” the statement read.

A spokesperson for SSM Health demurred when Rewire asked if that would include referrals for abortion care.

“I’ve got to check this part out, my apologies, this is one that hadn’t occurred to me,” said Jason Merrill, the spokesperson.

Merrill later reiterated SSM Health’s statement that it would continue to offer the same services.

Catholic health systems have in recent years expanded control over U.S. hospitals, with one in six acute-care hospital beds now in a Catholic-owned or -affiliated facility. Patients in such hospitals have been turned away while miscarrying, denied tubal ligations, and refused abortion care despite conditions like brain cancer.

Catholic health systems have also expanded into the broader landscape of outpatient services, raising new questions about how religion could influence other forms of care.

“The whole health system is transforming itself with more and more health care being delivered outside the hospital,” Lois Uttley, director of MergerWatch, told Rewire. “So we are looking carefully to make sure that the religious restrictions that have been such a problem for reproductive health care at Catholic hospitals are not now transferred to these drug store clinics or to urgent care centers or free-standing emergency rooms.”

Walgreens last year announced a similar arrangement with the Catholic health system Providence Health & Services to bring up to 25 retail clinics to Oregon and Washington. After expressing concerns about the deal, the ACLU of Washington said it received assurances from both Walgreens and Providence that services at those clinics would not be affected by religious doctrine.

Meanwhile, the major urgent care provider CityMD recently announced a partnership with CHI Franciscan Health–which is affiliated with Catholic Health Initiatives–to open urgent care centers in Washington state.

“We’re seeing [Catholic health systems] going into the urgent care business and into the primary care business and in accountable care organizations, where they are having an influence on the services that are available to the public and to consumers,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Rewire.

GoHealth Urgent Care, which describes itself as “one of the fastest growing urgent care companies in the U.S.,” announced an agreement this year with Dignity Health to bring urgent care centers to California’s Bay Area. Dignity Health used to be called Catholic Healthcare West, but changed its name in 2012.

“This is another pattern that we’ve seen of Catholic health plans and health providers changing their names to things that don’t sound so Catholic,” Lois Uttley said.

 

In the letters sent Wednesday, the National Health Law Program and other groups requested meetings with Walgreens and SSM Health to discuss concerns about the potential influence of religion on the clinics.

“It causes us great concern when we think about vulnerable populations, we think about low-income people… people who… may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the Reproductive Rights Project of the ACLU of Illinois, told Rewire.

The new clinics in Walgreens will reportedly be called “SSM Health Express Clinics at Walgreens.” According to SSM Health’s website, its initials “[pay] tribute” to the Sisters of St. Mary.

“We are fairly forthcoming with the fact that we are a mission-based health care organization,” Merrill told Rewire. “That’s something we embrace. I don’t think it’s anything we would hide.”

 

Tell us your story. Have religious restrictions affected your ability to access health care? Email stories@rewire.news

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