Ensuring the Human Right to Survive Pregnancy in Southeast Asia

Ramona Vijeyarasa

To combat maternal mortality rates in Southeast Asia far higher than Millennium Development Goal targets, governments must ensure women's right to safe abortion.

Like child mortality in many countries around Asia, maternal
mortality rates remain staggeringly high, despite the global commitment
of reducing maternal mortality
ratios by three-quarters
.
With progress one-fifth of what it needs to be, ActionAid reports that maternal mortality is
the Millennium Development
Goal
on which the
least progress has been made. Not only does it appear that women’s right
to survival is a neglected concern around the globe, but apparently
it is also forgotten amongst the other millennium targets. 

On September
24, 2008, world leaders will meet at a High-Level Event on the Millennium Development Goals
to discuss progress to date and what programs need to be implemented
to bridge the MDG gap as we rapidly approach 2015. This meeting presents
a decisive opportunity to ensure that the limited progress on maternal
mortality is at the center of the dialogue. Interestingly, Africa features significantly amongst the
partnership events being organized in conjunction with the High-Level
Event. Yet many of the counties in South-East Asia have similarly seen
little improvement in their maternal morality ratios. With the World Health Organization
(WHO)
stating that
maternal mortality in South-East Asia contributes to 40% of global deaths,
maternal mortality in the region needs to be put back on the discussion
table. 2005 maternal mortality ratio estimates released by WHO were as high as 540 maternal deaths
per 100,000 lives births for Cambodia, 420 for Indonesia and 230 for
the Philippines as compared to 14 for the Republic of Korea or 11 for
the United States. 

On World Population
Day in July of this year, UNFPA noted that three basic interventions
are necessary if the world is to improve maternal health: skilled birth
attendants, access to emergency obstetric care and family planning.
On this occasion, the Secretary-General reiterated the global commitments
made in Cairo in 1994 at the International Conference
on Population and Development

on access to family planning information and noted its relationship
to combating maternal mortality. Yet, years after the right to decide
the number and spacing of one’s children has become a standard call-cry
for reproductive rights activists, many countries in Asia continue to
fail to guarantee access to all forms of modern contraceptives.  

The interrelationship
between unwanted pregnancies that result from lack of family planning,
unsafe abortion and high rates of maternal death is unquestionable. It is estimated that unsafe abortion,
what has been deemed by WHO as the silent, but preventable,
pandemic
, contributes
to 19% of maternal deaths in South-East Asia in any one year.
In the Philippines, where abortion is illegal and remains a taboo subject,
it is estimated that up to 800 women die each
year
as a result
of unsafe abortions, not to mention abortion-related complications and
their impact on women, their families and the country’s health system.
In many countries in the region where abortion remains illegal, such
as Indonesia, Laos and Myanmar, activists continue to advocate for abortion
reform, to improve access to safe abortion, particularly for marginalized
or poor women. 

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A change in
abortion laws alone is not the solution. In Cambodia, despite the legalization
of abortion in 1997 on broad grounds, many women remain unaware of the change in law and still undergo
terminations carried out by unskilled providers. Education and awareness
raising is a key element to addressing misconceptions about the law,
misconceptions that make women vulnerable to bad care, bribery and corruption,
or no care at all. This is particularly true for adolescents and other unmarried women, where cultural
barriers and taboos about sex outside of marriage exacerbate this vulnerability
to seeking clandestine abortions. The need to address this gap in knowledge
about the legality of abortion should be considered by other legally
permissive countries in the region like China, DPR Korea, Japan, Mongolia
and Vietnam.

The importance
of concerted efforts by countries to stop preventable maternal deaths
has clearly been endorsed by the world community through the MDGs. Whether
abortion is currently legal or illegal, governments must develop an
effective strategy to ensure women’s right to access legal abortion
procedures by skilled individuals under safe conditions. Such much needed
change will move many of the countries in the region much closer to
reaching their MDG target and tackling their maternal death pandemics.
Such progress would also reflect a revaluing of women’s lives and their
human right to survive pregnancy.

News Abortion

How Long Does It Take to Receive Abortion Care in the United States?

Nicole Knight

The national findings come amid state-level research in Texas indicating that its abortion restrictions forced patients to drive farther and spend more to end their pregnancies.

The first nationwide study exploring the average wait time between an abortion care appointment and the procedure found most patients are waiting one week.

Seventy-six percent of patients were able to access abortion care within 7.6 days of making an appointment, with 7 percent of patients reporting delays of more than two weeks between setting an appointment and having the procedure.

In cases where care was delayed more than 14 days, patients cited three main factors: personal challenges, such as losing a job or falling behind on rent; needing a second-trimester procedure, which is less available than earlier abortion services; or living in a state with a mandatory waiting period.

The study, “Time to Appointment and Delays in Accessing Care Among U.S. Abortion Patients,” was published online Thursday by the Guttmacher Institute.

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The national findings come amid state-level research in Texas indicating that its abortion restrictions forced patients to drive farther and spend more to end their pregnancies. A recent Rewire analysis found states bordering Texas had reported a surge in the number of out-of-state patients seeking abortion care.

“What we tend to hear about are the two-week or longer cases, or the women who can’t get in [for an appointment] because the wait is long and they’re beyond the gestational stage,” said Rachel K. Jones, lead author and principal research scientist with the Guttmacher Institute.

“So this is a little bit of a reality check,” she told Rewire in a phone interview. “For the women who do make it to a facility, providers are doing a good job of accommodating these women.”

Jones said the survey was the first asking patients about the time lapse between an appointment and procedure, so it’s impossible to gauge whether wait times have risen or fallen. The findings suggest that eliminating state-mandated waiting periods would permit patients to obtain abortion care sooner, Jones said.

Patients in 87 U.S. abortion facilities took the surveys between April 2014 and June 2015. Patients answered various questions, including how far they had traveled, why they chose the facility, and how long ago they’d called to make their appointment.

The study doesn’t capture those who might want abortion care, but didn’t make it to a clinic.

“If women [weren’t] able to get to a facility because there are too few of them or they’re too far way, then they’re not going to be in our study,” Jones said.

Fifty-four percent of respondents came from states without a forced abortion care waiting period. Twenty-two percent were from states with mandatory waits, and 24 percent lived in states with both a mandatory waiting period and forced counseling—common policies pushed by Republican-held state legislatures.

Most respondents lived at or below the poverty level, had experienced at least one personal challenge, such as a job loss in the past year, and had one or more children. Ninety percent were in the first trimester of pregnancy, and 46 percent paid cash for the procedure.

The findings echo research indicating that three quarters of abortion patients live below or around the poverty line, and 53 percent pay out of pocket for abortion care, likely causing further delays.

Jones noted that delays—such as needing to raise money—can push patients later into pregnancy, which further increases the cost and eliminates medication abortion, an early-stage option.

Recent research on Utah’s 72-hour forced waiting period showed the GOP-backed law didn’t dissuade the vast majority of patients, but made abortion care more costly and difficult to obtain.

News Violence

Fetal Tissue Workers Sue to Stop David Daleiden From Getting Their Names

Nicole Knight

The plaintiffs' lawyer explained that the researchers, who remain anonymous in the complaint, “are very fearful that they may be subjected to the same type of harassment and violence” that abortion clinic employees have faced.

Employees and scientists with ties to the University of Washington’s Birth Defects Research Laboratory have won a temporary reprieve in federal court barring the release of their personal information to anti-choice activist David Daleiden and his cohorts.

Federal judge James L. Robart granted the restraining order on Wednesday, after the plaintiffs filed a class action lawsuit to block the release of a trove of documents requested by Daleiden and a representative from a Washington state anti-choice group. The unredacted records reveal the individuals’ identifying information, such as names, addresses, and phone numbers, according to court documents.

A hearing on a permanent order is expected later this month in U.S. District Court for the Western District of Washington.

Using the Washington state Public Records Act, Daleiden and Zach Freeman, communications director with the anti-choice Family Policy Institute of Washington, had sought records dating back to 2010 related to work at the Birth Defects Research Laboratory. The research laboratory collects, processes, and distributes fetal tissue for research at academic and nonprofit institutions nationwide, according to court documents. Also ensnared in the sweeping document request were various medical and bioscience institutions, including Seattle Children’s Hospital and Planned Parenthood affiliates.

Daleiden had requested purchase orders, invoices, emails, grant applications, contracts, materials transfer agreements, rent/lease agreements, and other documents, according to an exhibit in court documents.

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Janet Chung, counsel with Seattle-based Legal Voice, who is representing the plaintiffs, said her clients wanted to stop the release of the unredacted records.

Daleiden, a self-proclaimed investigative journalist and head of the California-based anti-choice group Center for Medical Progress, was formerly indicted for his role in a string of discredited “sting” videos falsely accusing Planned Parenthood of profiting from fetal tissue donations.

Reached by phone on Friday, Chung explained that the plaintiffs, who remain anonymous in the complaint, “are very fearful that they may be subjected to the same type of harassment and violence” that abortion clinic employees have faced, particularly after the publication of the CMP videos. Releasing the unredacted records would violate the plaintiffs’ constitutional right to privacy and free association, according to the complaint.

Chung called Daleiden and Freeman’s records request a “fishing expedition” intended to “harass and intimidate.”

In an emailed statement, Daleiden said he is seeking the “truth” about a “cover-up” at the University of Washington.

When Rewire asked Daleiden whether he objected to redacting identifying information, such as names and addresses, he said in an email that his records request in February did not ask for the “personal contact information of any individuals whatsoever.”

As he explained to Rewire, however, he is seeking the communications of eight individuals whom he considers public figures:

My request only seeks those of 8 public figures…who are very publicly identified with their work at [Birth Defects Research Laboratory] with fetal body parts or with Planned Parenthood’s abortion program in Washington state.

The eight “public figures” that Daleiden names include a retired birth defects researcher, a research director at Seattle Children’s Hospital, and a top executive at Planned Parenthood.

Chung, however, told Rewire that Daleiden’s request was so broad that releasing the records would disclose the personal information of more than 150 individuals.

Chung said the plaintiffs resorted to court action because the state public records law doesn’t necessarily require the redaction of personal information, and the University of Washington had warned that it would release the records on August 5.

About two weeks before filing the complaint, Chung said they’d discussed redacting the documents with Daleiden, but he declined. She said they’re continuing to try to resolve the matter with Daleiden’s legal counsel.

In affidavits included with the complaint, plaintiffs claim they’ve been threatened, harassed, and exposed to violence —even murder—due to their ties to fetal tissue research.

As an employee at Seattle Children’s Hospital, identified only as John Doe 1 to protect his privacy and safety, writes:

In one case, Seattle Children’s diagnosed a fetus with a lethal disorder, and because of number of weeks of gestation, the patient had to travel out of state to obtain an abortion. I had interactions with the physician who performed the abortion relating to the autopsy that Children’s Labs performed on the fetus. That physician was later killed by someone with anti-abortion views.

In another affidavit, a professor and research scientist who studies congenital birth defects and is identified as Jane Doe 8, writes:

I fear that having my identity and personal information released to the public would lead to harassment, threats, or violence directed against me or my family.

Protecting the privacy and safety of researchers and employees with ties to fetal tissue science has emerged as an issue of growing concern among scientists as anti-choice groups and Republican lawmakers march on with what some have called a Planned Parenthood “witch hunt.”

In June, the head of the U.S. House Select Investigative Panel on Infant Lives revealed fetal tissue scientists’ identities in letters sent to U.S. Department of Health and Human Services—prompting fears in the medical research community the individuals will be subject to harassment and violence by anti-abortion activists.

As Chung told Rewire, “This is all very much rooted in the concern that the same types of harassment and violence that clinics experience are now being targeted on a wider range of people—all with the goal of chilling important research and medical care.”

The lawsuit is the fourth filed against Daleiden and his anti-choice group following the release of the first wave of CMP’s sting videos last summer. Planned Parenthood Federation of America, the National Abortion Federation (NAF), and StemExpress, a fetal tissue processing firm that once worked with Planned Parenthood, have all sued in federal court in California.

Daleiden often frames his work as citizen journalism, but in a brief filed with the NAF lawsuit, 18 of the country’s leading journalists and journalism scholars noted that “calling himself an ‘investigative journalist’ … does not make it so.”

In April, California Attorney General Kamala Harris’ office searched Daleiden’s California apartment as part of an ongoing investigation into the CMP’s secret recording methods.

Officials in a dozen states, including Washington state, have cleared Planned Parenthood of any wrongdoing in its tissue donation programs, and eight additional states have declined to investigate the health-care provider.

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