The government of Panama approved
the free distribution of the HPV vaccine to all 10-year-old girls, but in Colombia, a bill that would
introduce the vaccine into the public health care system of Bogotá has
just failed for the third time.
Last October, Panama announced
the historic decision, the first county in Latin America
to approve a free distribution of the HPV vaccine. The vaccination campaign has already begun with the Cervarix vaccine, produced by the Belgian company
In Latin America and the Caribbean,
33,000 women die each year as a result of cervical cancer, a disease
caused by the Human Papilloma Virus. HPV infects 20% of women and men
in this region, and up to 30% of young women 15-24 years old. This data
was revealed in a comprehensive report on the impact of the virus in
the Americas, researched by the Pan-American
Health Organization (PAHO)
and the Sabin
Vaccine Institute, among
other relevant health organizations.
To achieve such massive vaccination,
Panama is investing USD 5.6 million, according to EFE. The vaccine’s cost has been
the major obstacle faced by the local bills of Bogotá. Three local
bills have been submitted to the Concejo (the legislative body of Bogotá).
The most recent bill proposed the free or low cost distribution of the
vaccine by the public health care system to
girls from 9 to 26 years old. However, the Secretaría Distrital de
Salud (the local executive
body in charge of health care), declared that this vaccine will not part
of the Plan Obligatorio de Salud (Mandatory Health Package).
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In Bogotá, cervical cancer has become
the second cause of deaths by cancer, after breast cancer, for
aged 30 to 59.
The 2005 National Population and Health
Survey (ENDS), the most rigorous research available in sexual and reproductive
health, showed that the cervical cancer death rate in Colombia had increased
from 54% in 1995 to 69% in 2000, among women aged 40 to 69. The survey
was conducted by Profamilia, a private, non-profit health provider. It
also revealed that among 20 to 49 year old women this rate had increased
from 34% to 37% in the same period.
Martha Velandia, the Coordinator of
the Plan Ampliado de Inmunización (Enhanced Plan to Immunize of Bogotá)
stated that "the ideal scenario would be the free distribution of
all vaccines, but that is not possible because we have limited funds."
On average, Colombia includes a new
vaccine in this Plan every two years. Currently there are other vaccines
in the waiting list, starting with the one against influenza. The three
shots of the vaccine against the HPV could represent 1,050,000 pesos
(USD 500) per woman, added Velandia.
Early this year, the government health
agency INVIMA authorized the Gardasil vaccine.
It is ironic that in Colombia
the vaccine is still out of the public health system while behind the
vaccine there is a Colombian scientist. In fact, Nubia Muñoz Calero,
physician and pathologist, is member of the committee of scientists
in charge of supervising the Gardasil’s clinic tests, and was nominated
for the Nobel Prize for Physiology and Medicine 2008. Recall that
Prof. Harold zur Hausen, a German virologist, received the award for
his studies in the same field: the links between human papilloma virus
and cervical cancer.
Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.
The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.
“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”
Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”
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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.
All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.
Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”
For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.
“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”
“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”
Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.
Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.
“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”
Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”
The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.
In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.
Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.
“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”
Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.
LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
“Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”
In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.
“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”
Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.
“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.
While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.
“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”
The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.
Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.
Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.
“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”
Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.
“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”
Sen. Kelly Ayotte's defenders have made claims about her commitment to "strengthening women's health" through action on various measures; reproductive rights advocates point out, however, that most of these measures would have done more harm than good.
The tight race between incumbent Sen. Kelly Ayotte (R-NH) and challenger Gov. Maggie Hassan (D) could help determine which party takes control of the U.S. Senate after the November elections. In recent months, a key point of contention has emerged among Ayotte’s supporters and critics: the senator’s record on reproductive rights and women’s health.
Planned Parenthood Votes released an ad in April claiming Ayotte is “bad for New Hampshire women,” signaling the continuation of the heated narrative in the lead-up to the election.Ayotte’s defenders have responded to the accusations with claims of her commitment to “strengthening women’s health” through action on various measures; reproductive rights advocates point out, however, that most of these measures would have done more harm than good.
“For months, Senator Kelly Ayotte has followed party bosses, refusing to fill the Supreme Court vacancy. And for years, Ayotte has waited for an opportunity to push for someone to end access to safe, legal abortion and overturn Roe v. Wade,” claims the Planned Parenthood Votes ad, before playing an August 2010 clip of Ayotte advocating for the Supreme Court to overturn Roe. “For New Hampshire women, the consequences of letting Kelly Ayotte play politics with the Constitution could last a lifetime.”
The $400,000 ad buy, slated to run on broadcast and cable in New Hampshire, has beenPlanned Parenthood Votes’ first on-air ad targeting a Senate race in the 2016 election cycle. The organization, a national independent expenditure political committee, is criticizing Ayotte for claiming to protect women but failing to protect reproductive rights, also drawing on her pledge to obstruct filling the vacant Supreme Court seat in the aftermath of Justice Antonin Scalia’s death.
“Kelly Ayotte may try to paint herself as pro-woman, but her record tells a very different story. Every chance she’s gotten she’s voted to ‘defund’ Planned Parenthood and cut women off from essential health care like birth control and breast and cervical cancer screenings,” said Deirdre Schifeling, executive director of Planned Parenthood Votes, in a statement on the organization’s new ad. “She has been advocating for years to ban women’s access to safe, legal abortion, and it’s clear she now sees her chance in the Supreme Court process. Kelly Ayotte is refusing to do her job, and abdicating her constitutional duty, in order to push an extreme agenda that no one in New Hampshire wants.”
Ayotte’s campaign manager, Jon Kohan, meanwhile, defended the senator’s record on women’s health and rights in a press release. He wrote, “Kelly’s long record of standing up for New Hampshire women and families is clear, and she cares deeply about ensuring all women have access to health services.” The release included a bulleted list providing examples of Ayotte’s work “strengthening women’s health care,” “supporting working women,” and “protecting domestic or sexual assault victims.”
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The claims may be familiar to those following the New Hampshire race. After Hassan announced her candidacy in October, for example, One Nation, an issue-advocacy organization that does not need to disclose where their funding comes from and is affiliated with Karl Rove’s American Crossroads super PAC, pushed a 17-day, $1.4 million ad campaign toutingAyotte’s record on women’s health.
Hassan, on the other hand, has the support of organizations such as EMILY’s List, whose stated mission is to help elect pro-choice women into office. After endorsing the governor in the Senate race, the group added Ayotte to its “On Notice” list for “voting for anti-woman legislation and standing in the way of policies that give working families a fair shot.”
But with both sides of the race simultaneously claiming opposing positions on whether Ayotte has been good for women and reproductive rights, what is the truth?
Ayotte has made no secret of her desire to defund Planned Parenthood, and she “has shown support for defunding the organization or opposition to continued funding in at least six votes,” according to PolitiFact, though some of those votes were procedural. Though she famously chided Sen. Ted Cruz (R-TX) for attempting to shut down the government over his crusade to strip the reproductive health provider of money in the wake of anti-choice front group Center for Medical Progress’ deceptively edited videos, it was because she didn’t view his methods as a winning strategy for accomplishing that goal—not because she didn’t believe in the cause.
In a letter to Cruz, Ayotte told the Republican presidential candidate that she too is “deeply disturbed by” CMP’s videos and doesn’t believe Planned Parenthood should have federal funding.”This callous disregard for the dignity of human life is heinous, and I do not believe taxpayer dollars should be used to fund a private organization that performs hundreds of thousands of abortions each year and harvests the body parts of unborn children,” wrote Ayotte. She went on to ask what Cruz’s “strategy to succeed in actually defunding Planned Parenthood” really was, given that their mutual efforts to redirect the organization’s funding to other clinics had failed.
Planned Parenthood does not use its federal funding to provide abortions; its fetal tissue donation program has been cleared of wrongdoing in multiple state and federal investigations. And despite claims from conservatives, including Ayotte, that other facilities could provide Planned Parenthood’s patients with health care should the organization lose funding, the Guttmacher Institute found that “credible evidence suggests this is unlikely. In some areas, Planned Parenthood is the sole safety-net provider of contraceptive care.”
“Our analysis shows unequivocally that Planned Parenthood plays a major role in delivering publicly supported contraceptive services and supplies to women who are in need of such care nationwide,” the Guttmacher Institute concluded.
Ayotte has also supported numerous other anti-choice restrictions and legislation, including a 2015 20-week abortion ban based on the medically unfounded claim that fetuses feel pain at this point in pregnancy.
According to NPR, Ayotte has “been a hero to anti-abortion activists since 2005, when as New Hampshire attorney general she defended a parental notification law all the way to the U.S. Supreme Court.” The law required doctors to notify parents of minors seeking an abortion at least 48 hours prior to the procedure, and contained no exceptions for the health of the patient. The Court ultimately ruled against Ayotte, affirming that states may not enact abortion laws that don’t protect women’s health and safety.
National Right to Life found that the New Hampshire senator voted “with” the anti-choice organization in all 14 of the scored votes from 2012 to 2015it examined.
In 2012,Ayotte co-sponsored the failed “Blunt Amendment,” which would have allowed exemptions from the Affordable Care Act’s birth control benefit for any employers or insurers that had moral objections to providing contraceptive coverage to their employees. And in a 2014 commentary for the Wall Street Journal,Ayotte and Sen. Deb Fischer (R-NE) defended the Supreme Court’s ruling in Burwell v. Hobby Lobby, which grants someemployers the right to deny contraceptive coverage to their staff based on the owner’s religious beliefs, falsely claiming that the ruling did “not take away women’s access to birth control.”
Ayotte’s campaign is quick to point to legislation sponsored by the senator that would have allowed over-the-counter contraception as proof that she cares aboutwomen’s health. Reproductive health advocates, however, called Ayotte’s Allowing Greater Access to Safe and Effective Contraception Act a “sham” when it was introduced in 2015. Though the American Congress of Obstetricians and Gynecologists (ACOG) generally supports over-the-counter birth control, the organization’s president Dr. Mark S. DeFrancesco, said in a statement that Ayotte’s measure “would actually make more women have to pay for their birth control, and for some women, the cost would be prohibitive.”
Paid leave is yet another issue in which Ayotte has put forth legislation in the name of helping women. Ayotte introduced the Family Friendly and Workplace Flexibility Act of 2015 in March of that year, claiming it would “allow greater flexibility for workers who are looking to better balance their work-life demands.” Analysis by ThinkProgress, however, found that the measure “could weaken already weak rules that require workers to be paid extra for working extra hours, thus ensuring that workweeks don’t grow out of control and employees are compensated fairly.”
Earlier in 2015, Ayotte signed on as a co-sponsor of the Working Families Flexibility Act. According to a statement from the National Partnership for Women and Families (NPWF) condemning the legislation, the act claimed to “give hourly workers more flexibility and time with their loved ones by allowing them to choose paid time off, rather than time-and-a-half wages, as compensation for working more than 40 hours in one week.” However, the bill did “not promote family friendly or flexible workplaces,” explained the nonprofit organization in a fact sheet. “Instead, it would erode hourly workers’ ability to make ends meet, plan for family time, and have predictability, stability, and true flexibility at work.”
Ayotte’s record on equal pay has been similarly debunked by advocates. One of the policies highlighted by Ayotte’s campaign in the wake of Planned Parenthood Votes’ ad was the senator’sintroduction of the Gender Advancement In Pay (GAP) Act in September 2015, which she reintroduced ahead of Equal Pay Day thisApril. The measure was meant to make clear that “employers must pay men and women equal wages for equal work, without reducing the opportunity for employers to reward merit,” according to a press release from Ayotte’s office upon the initial release of the bill.
Critics argued that Ayotte’s bill was nothing other than an election-year stunt. New Hampshire state Sen. Donna Soucy (D-Manchester) told NH1 News that Ayotte’s move was an attempt to look “for some cover … in an effort to be more in line with” New Hampshire voters, after Ayotte voted against other fair pay measures. However, Soucy said, the legislation didn’t really address the issue of pay equity. “Sen. Ayotte’s bill attempts to create paycheck fairness but doesn’t in fact do so because employers could preclude their employees from discussing what they make with their fellow employees,” claimed Soucy.
Similar arguments were made when Ayotte co-sponsored another equal pay measure, the Workplace Advancement Act, with Sens. Deb Fischer (R-NE), Susan Collins (R-ME), Joni Ernst (R-IA), Thad Cochran (R-MS), and Shelley Moore Capito (R-WV) in April 2015. Though the legislation would ban employers from retaliating against their staff, it failed to garner support from Democrats. According to the National Women’s Law Center, the bill would have done “more harm than good” as it “entirely [ignored] the many loopholes and inadequacies in current equal pay laws and simply [stated] that pay discrimination ‘violates existing law.'”
Their arguments are bolstered by Ayotte’s repeated votesagainst the federal Paycheck Fairness Act, though as Politifact again pointed out, some of these votes were procedural and not against the bill itself. Ayotte did cast one vote in favor of ending debate on the measure and advancing it; the fact-checking site noted, though, that Ayotte’s office reportedly did so in the ultimately denied hopes of changing the bill.
Had it passed, the legislation would have updated the Equal Pay Act of 1963 to include protections such as prohibiting retaliation against employees who share their salary and strengthening penalties for those who violate the law. Ayotte claims she voted against the measure because it “could reduce the ability of employers to award merit pay for good performance and limit the opportunity for women to have flexible work schedules,” according to a press release on the matter.
Speaking at a town hall event in 2013, Ayotte had previously justified her vote against equal pay legislation by asserting that it “created a lot of additional burdens that would … make it more difficult for job creators to create jobs.” The New Hampshire senator went on to add that there were already laws in place that could help address the issue.
There are, however, some examples of Ayotte supporting and introducing legislation that would help women. In June 2015, Ayotte co-sponsored the Pregnant Workers Fairness Act to protect pregnant people from workplace discrimination. Though the legislation never came to a vote, it would have helped “end … discrimination and promote healthy pregnancies and the economic security of pregnant women and their families,” according to the NPWF. That same year, the New Hampshire senator co-sponsored the Protect Access to Lifesaving Screenings (PALS) Act, bipartisan legislation that would have safeguarded access to free annual mammograms for women ages 40 to 74. Ayotte co-sponsored the bipartisan Campus Accountability and Safety Act in 2014 and 2015, which, according to Democratic New York Sen. Kirsten Gillibrand’s website, would “protect students and boost accountability and transparency at colleges and universities” when it comes to sexual assault. Ayotte also co-sponsoredthe Combating Military Sexual Assault Act of 2013 to address the issue in the military.
Overall, Ayotte has signed onto or supported numerous pieces of legislation that at face value seem to promote reproductive health and women’s rights. Further examination shows, however, that—with a few exceptions—they largely failed to hold up to scrutiny. While Ayotte’s campaign alleges that many of her measures would have helped women and families, analysis suggests that her conservative solutions to addressing these issues often would have made the problems worse. This, coupled with the senator’s fierce anti-choice advocacy, will no doubt keepthis portion of Ayotte’s record under tight observation as November’s election approaches.