Get Real! Questions After Abortion, Miscarriage

Heather Corinna

Will my ob-gyn be able to tell that I've had an abortion? How will an abortion affect sex? Heather responds to women's questions about post-abortion care.

yellow_hat asks:

I
had a surgical abortion at 10 weeks in February. Besides the abortion,
I have never been to an OB-GYN, but because I am getting married in
May, I would like to go soon. Since it is likely that I will move and
never go back to this particular OB-GYN, is it necessary that I tell
her about my abortion? Will she be able to tell during the examination?
I’ve read that the cervical opening looks more like a slit than a
circle after it has been fully dilated, but I doubt I was fully dilated
for the procedure. I don’t want to lie or be tricky, and I know it is
best to tell a doctor everything about your medical history, but since
this will likely be a one-time visit with a doctor I know very little
about (ex. pro-life or pro-choice), I would really prefer to avoid the
topic if at all possible. Thanks!

Heather replies:

Given
when you had your abortion, you’re right: you would not have been
anything even remotely close to fully dilated. Your provider would have
dilated your cervix to some degree, but only as much as is needed for
aspiration, which is nothing close to what is needed for childbirth. At
10 weeks, a fetus is only around an inch in size.

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Might you have been dilated enough that a provider could tell you were pregnant before? Eh…probably not.

It really is important that we are as honest as we can be with
healthcare provider to assure they can actually do their jobs, but I
absolutely hear your concerns. Be aware that overall, OB/GYNs are —
I’d say — more likely to be supportive of all reproductive choices
rather than less, since you’re dealing with a group of people who are
acutely aware of women’s reproductive realities, but it’s still not an
invalid concern. No one wants to deal with judgment in their
healthcare, and it’s understandable to want to avoid it when you can.

However, I think the best way to avoid that is just to choose good
healthcare providers. Ultimately, no patient should ever even know
their doctor’s personal feelings in this regard unless you ask. I’ll be
frank and say that any OB/GYN who, whatever their personal feelings,
cannot respect their patient’s reproductive choices and history, is
probably not a good doctor to see in the first place, since that’s
going to stand in the way of them doing their best for a lot of women.

You could see a healthcare provider you know is supportive of choice, either by seeing someone at a Planned Parenthood clinic, an independent women’s clinic which also provides abortions
(like the one I work at in Washington as well as working here) or by
just asking by phone in advance of making an appointment if a provider
respects all reproductive choices.

If you don’t have a choice with your OB/GYN, or just are not
comfortable putting that you had an abortion on a medical history form,
for all intents and purposes, saying you had a miscarriage and then a
D&C for it would be an accurate reflection of your physical
gynecological history in regard to the abortion without you having to
say you willingly terminated a pregnancy.

I know from working at the clinic that even our own clients will
occasionally be dishonest about having had procedures done. Now and
then, I’ll get a client who will list themselves as having less
procedures than we know they have had since we have their charts in our
hands. In all honestly, we don’t need to know how many procedures they
have had before, or even if they have had any at all to give them sound
reproductive healthcare. Had you had a complication with your
procedure, that would be likely pertinent information, but otherwise,
since legal abortion procedures are medically simple and don’t change
your body or your health unless there is a complication, even if you
just say nothing at all about this, it’s likely to be okay.

Eves asks,

I had an abortion last winter and until now my period
has still not coming back to normal way like before my abortion. After
my abortion my period comes every other month or sometimes within two
months I still don’t get my period. Is this normal?

Within one to two months after an abortion, your periods should
return to normal. An abortion can’t change your regular menstrual cycle
in any permanent or long-lasting way as that cycle is controlled by hormonal systems which an abortion can’t influence.

Did you have the recommended follow-up visit two or three weeks
after your procedure? If you did, and you were well (and not pregnant)
at that point, you can rest assured all is well as far as healing from
your abortion goes.

At this point, I’d suggest seeing your reproductive healthcare
provider regardless. If your periods have become very irregular, you
want to make sure something else isn’t going on, whether that’s being
underweight, having become pregnant again, a hormonal issue or
something else.

Jen asks,

As disappointed as I am in myself, from the age of 16 to
about 20 I have had three medical abortions (never doing it again
promise). I’m 22 now, but since the last time sex doesn’t feel the same
anymore and I was wondering if its because of the abortions. And now
more then ever, every time I have sex I get extremely wet…like too
wet where I don’t even feel my boyfriend anymore and I hate it. I used
to have sex at least once everyday and now I have sex maybe once every
two weeks can this be a reason why I get too wet now? Is there any
medical surgery that makes your vagina tighter?

Your medical abortions likely have nothing to do with these issues.

A medical abortion — the abortion pill — can only be used for very
early pregnancies, and passing the small amount of uterine lining (even
though I know it can look like a lot) and the incredibly tiny
gestational sac, nor the medications used for a medical abortion, are
not things which have anything to do with the glands involved with
vaginal lubrication or the muscles of the vagina. Effectively, while
the bleeding and cramping tends to be heavier for a day, a medical
abortion doesn’t do anything different to your body that your regular
period does.

How much women lubricate is generally about how aroused or relaxed a
woman is. It’s common for women to have a tougher time getting relaxed
and aroused when they’re first sexually active than later, so I’m
unsurprised to hear you reporting that several years after becoming
more sexually active you’re finding you’re lubricating more. As well,
the vagina being less "tight" is usually also about relaxation and
arousal. The frequency of the sex you have is something else that isn’t
going to have any impact here.

And seriously, you don’t even want to get me started on cosmetic labial or vaginal surgeries
for totally healthy women without an actual genital injury. I wouldn’t
endorse anyone going that route regardless, but know that there is not
yet a surgery which makes the vaginal canal (rather than just the
opening) smaller or tighter, and even if there was, it’d not be
necessary. The vagina is a muscle, and a strong one. If you feel like
the tone of those muscles isn’t what it could be, you can work on that
with Kegel exercises, when you’re not having sex, with masturbation and/or during sex with a partner.

I would be sure you are current with your sexual healthcare. If you
are having increased discharges all the time, you want to be sure, for
instance, that you don’t have them due to an infection like Chlamydia
or a bacterial infection. If you get a clean bill of health on that
score, you can rest assured that this is all normal. Lubrication is
healthy, and so is the vagina loosening with arousal and relaxation,
but if you’re finding these things change your experience of sex, you
may just need to make some changes to the sex that you’re having. That
may mean adding other activities to your sex life besides intercourse,
experimenting with new positions or dynamics during intercourse. It
also sounds to me like you might need to just revisit your own
sexuality, separate from your partner: how about investing some extra
time in your own masturbation?

Additionally, if you feel bad about your procedures — and it sounds
like you do — or the situations they were brought about by, your
feelings may have something to do with how you’re feeling about sex.
It’s not at all atypical for women to be less excited about or
satisfied with sex after abortion or childbirth. So much of our
sexuality is really about what’s going on in our hearts and minds, with
reflections of that acutely felt in our bodies. If you feel conflicted
about sex, your body or your genitals, that’s going to tend to be
mirrored in your sexual experiences.

One more thing? You don’t have to promise me or anyone else you will never have another abortion.

If you feel that, for yourself, it’s just not right for you to have
any more, okay. But as far as the rest of us are concerned, it’s just
not our business. Women know what we need to do, we know when it is and
is not right for us to bring a child into the world, and we know what a
big decision that is. I trust you to make the choices that are right
for you, any pregnancy, and for any children you may or may not birth,
and I trust in the choices you have made. I can only presume that, like
most women, you decided to abort after thinking about all of your
options and thoughtfully and carefully made the best choice you could.
That’s what’s important in making reproductive choices and what makes
them good ones: not that a given choice was made or not made, but that
whatever choice was the best one you felt you could make for yourself
and a child.

In other words, I’m certainly not disappointed in you, and I hope
that you can get to a place where you’re no longer disappointed in
yourself, either.

Amber asks,

I don’t know if this is the appropriate place to ask
this question, but so far this is the only place I can find to ask
someone for any kind of advice. I can’t see a counselor or anyone
because I can’t afford it at the moment. Anyway…on with my concern. I’m
18yrs old and recently had a miscarriage in April, three days before my
18th birthday. I was traumatized by the whole event. He (I refer to the
fetus as he as I was hoping for a boy) was my miracle baby because my
fiancé was told he is infertile. And ever since then I can’t become
sexually aroused, and if I do manage to do so, sex is painful.
Emotionally and physically. I’ve been to the ob/gyn and they say I’m
fine. Could my physical pain be a manifestation of my psychological
state? My fiancé is an extremely sexual person and I was just wondering
is there anything I can do? I fear this might ruin my 2 year
relationship and I’m terribly afraid he will call off our upcoming
wedding. (10/31/08) Please help if you can…I would understand if you
can’t. Thank you so much for taking the time to give me whatever help
you can. You have no idea how much I will appreciate it.

Given you’ve got a clear bill of health from your gynecologist, and
because sexual arousal is primarily psychological, I’m inclined to feel
like these issues are probably more emotional or psychological than
anything else.

Miscarriage is something that is thought to occur with as many as
50% of all pregnancies, but while it’s very common, that doesn’t mean
it’s easy to deal with. When a pregnancy is wanted and either
terminates itself or has to be terminated, it is often a substantial
loss for many women. It obviously has been one for you, and I’m so
sorry for your loss.

What really strikes me in all this, however, is that you seem to
feel very pressured to meet your partner’s sexual desires, to the point
that you are concerned he will call off your wedding if you do not.
That, in and of itself, could very easily be part or even all of why
you’re feeling the way you are. It’s pretty tough to get excited about
sex if it feels like a requirement, rather than an obligation. And the
more pressure we tend to be put under — or put on ourselves – the
harder it can get to feel aroused. There’s really just very little to
find sexy about feeling like we have to put out or else we lose someone.

A relationship — even when it is one which is sexual is part — is
a lot bigger than sex. Making a life with someone is bigger than sex.
When we are in a relationship over time, there are usually going to be
times, for any number of reasons, when one or both partners just aren’t feeling it when it comes to sex for a while.
No matter what level of libido we have, it isn’t sound to ever expect a
partner to meet our every sexual desire, or to expect there won’t be
times when it’s best for us to just use our own two hands to satisfy
ourselves.

Certainly, the loss of an unexpected but wanted pregnancy would be
the kind of thing that I’d completely expect to cause sex to be on hold
for a while. It’s pretty darn hard to compartmentalize our sexuality
and our reproduction, so when we’re grieving over something
reproductive, it’s typical for that to impact our sexuality and desire
for sex. And by all means, a reproductive trauma can become a sexual
trauma: in other words, we can feel traumatized by sex when it resulted
in a different trauma, even when it wasn’t sexual in and of itself.

I’d strongly suggest you sit down and talk to your partner about all
of this. Talk about your continued feelings of loss with the
miscarriage, and ask for the support you need. It’s totally okay if you
still need a lot of it, so long as you can understand that your partner
may not be able to provide all you need: it’s probably a good idea to
supplement his support with help from a counselor or support group at
this point.

Talk about your worries with your lack of libido and what that could
mean in terms or your relationship and impending marriage: just opening
that door may well make you feel a lot better in and of itself. get his
assurance — and seriously, if he loves you, he should give it to you
— that he’s okay holding off on sex while you work through this. Heck,
I’d be more concerned about making a lifelong commitment to someone who
couldn’t set sex aside so you can work through something like this than
I would about him calling things off. You want to be sure you’re making
that commitment to someone who can make the same level of commitment to
you, after all.

When it comes to getting back in the groove of things sexually, it
might help to take baby steps. In other words, rather than trying to go
right back into intercourse, how about spending some time with a lot of
cuddling, with things like shared baths, massage or mutual
masturbation, with oral or manual sex for you both? How about making an
agreement that you can both explore some of these things when you do
feel some desire with the understanding that you get to stop at any
time, and that there’s no need for any of it to have to result in
orgasm? And by all means, if it hurts — be that emotionally or
physically — just don’t do it. The physical pain you’re experiencing
is something I’d also talk more to your gynecologist about: you’ll want
to see what he or she suggests you do when it comes to that: it may be
that you need some physical treatment before going back to intercourse
or other vaginal sex.

I know you’re probably getting into the throes of planning for your
upcoming wedding. That can be terribly stressful, and that stress is
not likely to help you out. So, please ask for all the help you need,
delegate as you can, and if you’re having a really hard time right now,
I hope you feel able to push your date back if you need to, or treat
yourself to a weekend away with friends or by yourself to get a
respite. If you haven’t done anything to give yourself some real
closure with this — some of women who miscarry do find that some kind
of service or ritual is helpful for them — do what you need to for
yourself.

Lastly, I don’t know what the context of your partner being told he
was infertile was, but I would find out more about it. It may be that
you should be prepared to have miscarriages if you become pregnant from
here on out if it’s a matter of something being wrong with his sperm —
and you should know that, and obviously if that’s the case, find a good
method of birth control so you don’t have to keep going through this.
It may be that he is not, in fact, infertile at all, which you should
also know, for obvious reasons.

Regardless of whether he is or is not fertile, please also know that
if you want to have a child in the future, you have options, whether
we’re talking about sperm donation, IVF, surrogacy or you two having a
pregnancy the way you already have or about foster care or adoption.
Trite as it might sound, miracles happen all kinds of different ways,
and there are many ways to have a family, and this doesn’t have to be
an ending for you.

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.

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.”