Roundup: Circumcision and HIV, Patient Care and Catholic Teaching

Brady Swenson

Circumcision benefit doubted for gay men; Catholic hospital under fire for allowing abortion referrals and birth control prescriptions; Ohio top court mulls admission of medical files in Planned Parenthood case; U.S. Supreme Court refuses Missouri prison abortion rights case; Breast cancer vaccine within reach.

Circumcision Benefit for HIV Doubted for Gay Men

Circumcision, which has been shown to slow the
spread of the AIDS virus from women to men during sex by 50%, doesn’t
appear to provide a statistically significant protective effect for men having sex
with other men, U.S. researchers said today

The review is the most comprehensive analysis of the subject to date.
It encompasses data from 15 studies conducted in seven countries,
involving more than 53,000 men, most of whom were Caucasian and
approximately half of whom were circumcised. The authors concluded that
being circumcised reduced a man’s risk of acquiring H.I.V. by 14%. That
finding was statistically nonsignificant, but the authors say it should
be regarded as a launching point for future trials. "This study gives
us a more complete picture than we’ve ever had before," says Gregorio
Millett, the study’s lead author and a senior behavioral scientist at
the Centers for Disease Control and Prevention (CDC). "The next step is
to design better quality studies to see if there is an association we
aren’t detecting."

One such question, says Millett, is whether circumcision can reduce
infection rates among the subset of men who have only insertive sex
with other men, as opposed to those who have only receptive sex or
both. Millett’s review suggested that among the former group,
circumcision lowered H.I.V.-infection risk by 29%, a finding that also
showed statistical nonsignificance. But targeting that distinct
population in future studies may prove useful for distilling the
specific effect of circumcision — and perhaps for future public-health
strategies.

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Catholic Hospital Under Fire for Allowing Abortion Referrals and Contraception Prescriptions

Catholic campaigners and some medical practitioners are criticizing a North London Catholic Hospital for its new ethics code that permits issuing referrals for abortion procedures and prescriptions for birth control.  Months of upheaval and debate over patient care and Catholic teaching at the 150 year-old institution have resulted in a compromise to provide patients who seek abortion care and contraception with a referral so they may obtain it elsewhere.  Some, however, do not see the new code as a compromise: 

Helen Watt, the director of the Linacre Centre, a traditionalist
bioethics facility that campaigns on life issues, said Catholic
teaching was "absolutely opposed" to all deliberate facilitation of
abortion and other "anti-life" procedures.

"A woman who is facing
a difficult pregnancy should be offered not abortion, but positive and
life-affirming support with having her baby. If it is wrong to perform
a procedure oneself, it is also wrong to refer for that procedure. A
Catholic hospital must make this unambiguously clear to everyone
working on the premises."

The code is backed by the hospital’s new chairman:

The hospital’s new chairman, Lord Guthrie of Craigiebank, a former army
chief of staff, welcomed the ethics code, saying "doctors and other
staff are presumed to be of goodwill and good conscience".

The new ethics code at the Catholic institution does retain restrictions on some procedures, however:

To clarify which activities were permissible, the hospital announced
last month that it would uphold its ban on sex changes and permanent
sterilization operations.

 

Ohio Supreme Court Mulls Planned Parenthood Files

The top court in Ohio is considering whether or not to permit patients’ medical files as evidence in trying charges brought against Planned Parenthood that claim the family planning organization failed to recognize and report potential sexual abuse. 

Ohio Supreme Court justices appeared skeptical Tuesday that an
abortion clinic’s medical records on other patients are relevant to a
lawsuit brought by parents of a 14-year-old girl who had an abortion
without their consent.

Lawyers for the girl’s family argued that
the information they seek is necessary to prove that Planned Parenthood
of Cincinnati had a pattern of violating Ohio’s parental consent law
and failing to report abuse. The unusual case pits a single plaintiff
against the privacy interests of a decade’s worth of patients.

The case involves a girl who was 14 at the time of her abortion in
2004, when the state’s parental consent law had not been completely
settled by the courts. She had been impregnated by her 21-year-old
youth soccer coach, John Haller.

The family’s lawsuit accuses the
Planned Parenthood clinic of failing to get parental consent, report
suspected abuse or to inform the girl of risks and alternatives. It
seeks unspecified damages.

Court records say the girl gave
Haller’s cell phone number as her father’s, and clinic officials
thought they had reached the father when they called inquiring about
parental consent. Haller was later convicted on seven counts of sexual
battery.

An appeals court ruled last year that records on other patients weren’t necessary for the family’s lawsuit.

Courts have traditionally been reluctant to permit private medical records as evidence in trial.  During a recent Kansas case in which medical records were subpoenaed by former Attorney General Phill Kline the state’s Supreme Court overturned the subpoena citing insufficient evidence showing the records were relevant to the case.  

 

U.S. Supreme Court Refuses Missouri Abortion Rights Appeal

Yesterday the Supreme Court refused to hear an appeal from the state of
Missouri regarding a woman’s right to abortion in prison:

The original case against the state, Crawford v. Roe, stemmed from a
2005 incident where Missouri prison officials denied a female inmate
transportation to an abortion facility. ACLU sued on behalf of the
inmate, "Jane Roe," who eventually received medical treatment.

In July 2006, the ACLU filed a class-action lawsuit on the behalf of
all female prisoners seeking abortions in Missouri. In the class-action
lawsuit, a Missouri District Court ruled that incarceration does not
deny women’s rights to an abortion. The Eighth Circuit US Court of
Appeals affirmed the lower court’s decision.

Reproductive Freedom Project attorney Diana Kasdan said in an ACLU press release
following the Circuit Court Decision, "Today’s decision is consistent
with rulings from across the country that women prisoners do not lose
their reproductive rights once they are incarcerated. Prison officials
must ensure that women have access to the full spectrum of
pregnancy-related care, including abortion."

 

Breast Cancer Vaccine Within Reach

The Guardian reports that "[e]nough is known about the causes of breast cancer to make a vaccine or prophylactic drug a real possibility."  Interestingly researchers have found that the more children a woman had and the longer she breastfed, the lower her risk was of later contracting breast cancer.

Women in developed countries where small families are the norm have six
times the breast cancer risk of those in rural parts of Asia with large
families.

Professor Valerie Beral of Oxford University, who leads the Million
Women’s Study into the causes of the disease, told the Guardian the
study had put beyond doubt what had long been guessed – that many
breast cancers are caused by the absence of hormonal changes connected
with childbirth.

"But why aren’t we thinking of mimicking the effects of childbirth?"
she said. "We don’t know how this happens and nobody is doing research
on it. We should be looking at hormone production during late pregnancy
and lactation."

"The one hormone that has to do with breast changes doesn’t appear
until late pregnancy. It goes up exponentially. It produces the changes
in the breast that make for lactation," she said. "Why isn’t anyone
looking at it?" Whichever hormone or hormones are responsible, she
said, short-term exposure during late pregnancy and breast-feeding
provide life-long protection which is exactly what is required of a
vaccine or preventive drug.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

 

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

Culture & Conversation Family

‘Abortion and Parenting Needs Can Coexist’: A Q&A With Parker Dockray

Carole Joffe

"Why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place?"

In May 2015, the longstanding and well-regarded pregnancy support talkline Backline launched a new venture. The Oakland-based organization opened All-Options Pregnancy Resource Center, a Bloomington, Indiana, drop-in center that offers adoption information, abortion referrals, and parenting support. Its mission: to break down silos and show that it is possible to support all options and all families under one roof—even in red-state Indiana, where Republican vice presidential candidate Gov. Mike Pence signed one of the country’s most restrictive anti-abortion laws.

To be sure, All-Options is hardly the first organization to point out the overlap between women terminating pregnancies and those continuing them. For years, the reproductive justice movement has insisted that the defense of abortion must be linked to a larger human rights framework that assures that all women have the right to have children and supportive conditions in which to parent them. More than 20 years ago, Rachel Atkins, then the director of the Vermont Women’s Center, famously described for a New York Times reporter the women in the center’s waiting room: “The country really suffers from thinking that there are two different kinds of women—women who have abortions and women who have babies. They’re the same women at different times.”

While this concept of linking the needs of all pregnant women—not just those seeking an abortion—is not new, there are actually remarkably few agencies that have put this insight into practice. So, more than a year after All-Options’ opening, Rewire checked in with Backline Executive Director Parker Dockray about the All-Options philosophy, the center’s local impact, and what others might consider if they are interested in creating similar programs.

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Rewire: What led you and Shelly Dodson (All-Options’ on-site director and an Indiana native) to create this organization?

PD: In both politics and practice, abortion is so often isolated and separated from other reproductive experiences. It’s incredibly hard to find organizations that provide parenting or pregnancy loss support, for example, and are also comfortable and competent in supporting people around abortion.

On the flip side, many abortion or family planning organizations don’t provide much support for women who want to continue a pregnancy or parents who are struggling to make ends meet. And yet we know that 60 percent of women having an abortion already have at least one child; in our daily lives, these issues are fundamentally connected. So why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place? That’s what All-Options is about.

We see the All-Options model as a game-changer not only for clients, but also for volunteers and community supporters. All-Options allows us to transcend the stale pro-choice/pro-life debate and invites people to be curious and compassionate about how abortion and parenting needs can coexist .… Our hope is that All-Options can be a catalyst for reproductive justice and help to build a movement that truly supports people in all their options and experiences.

Rewire: What has been the experience of your first year of operations?

PD: We’ve been blown away with the response from clients, volunteers, donors, and partner organizations …. In the past year, we’ve seen close to 600 people for 2,400 total visits. Most people initially come to All-Options—and keep coming back—for diapers and other parenting support. But we’ve also provided hundreds of free pregnancy tests, thousands of condoms, and more than $20,000 in abortion funding.

Our Hoosier Abortion Fund is the only community-based, statewide fund in Indiana and the first to join the National Network of Abortion Funds. So far, we’ve been able to support 60 people in accessing abortion care in Indiana or neighboring states by contributing to their medical care or transportation expenses.

Rewire: Explain some more about the centrality of diaper giveaways in your program.

PD: Diaper need is one of the most prevalent yet invisible forms of poverty. Even though we knew that in theory, seeing so many families who are struggling to provide adequate diapers for their children has been heartbreaking. Many people are surprised to learn that federal programs like [the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC] and food stamps can’t be used to pay for diapers. And most places that distribute diapers, including crisis pregnancy centers (CPCs), only give out five to ten diapers per week.

All-Options follows the recommendation of the National Diaper Bank Network in giving families a full pack of diapers each week. We’ve given out more than 4,000 packs (150,000 diapers) this year—and we still have 80 families on our waiting list! Trying to address this overwhelming need in a sustainable way is one of our biggest challenges.

Rewire: What kind of reception has All-Options had in the community? Have there been negative encounters with anti-choice groups?

PD: Diapers and abortion funding are the two pillars of our work. But diapers have been a critical entry point for us. We’ve gotten support and donations from local restaurants, elected officials, and sororities at Indiana University. We’ve been covered in the local press. Even the local CPC refers people to us for diapers! So it’s been an important way to build trust and visibility in the community because we are meeting a concrete need for local families.

While All-Options hasn’t necessarily become allies with places that are actively anti-abortion, we do get lots of referrals from places I might describe as “abortion-agnostic”—food banks, domestic violence agencies, or homeless shelters that do not have a position on abortion per se, but they want their clients to get nonjudgmental support for all their options and needs.

As we gain visibility and expand to new places, we know we may see more opposition. A few of our clients have expressed disapproval about our support of abortion, but more often they are surprised and curious. It’s just so unusual to find a place that offers you free diapers, baby clothes, condoms, and abortion referrals.

Rewire: What advice would you give to others who are interested in opening such an “all-options” venture in a conservative state?

PD: We are in a planning process right now to figure out how to best replicate and expand the centers starting in 2017. We know we want to open another center or two (or three), but a big part of our plan will be providing a toolkit and other resources to help people use the all-options approach.

The best advice we have is to start where you are. Who else is already doing this work locally, and how can you work together? If you are an abortion fund or clinic, how can you also support the parenting needs of the women you serve? Is there a diaper bank in your area that you could refer to or partner with? Could you give out new baby packages for people who are continuing a pregnancy or have a WIC eligibility worker on-site once a month? If you are involved with a childbirth or parenting organization, can you build a relationship with your local abortion fund?

How can you make it known that you are a safe space to discuss all options and experiences? How can you and your organization show up in your community for diaper need and abortion coverage and a living wage?

Help people connect the dots. That’s how we start to change the conversation and create support.

This interview has been edited for length and clarity.

CORRECTION: This article has been updated to clarify the spelling of Shelly Dodson’s name.

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