Ecuador Reduces Maternal Deaths

Jodi Jacobson

According to a report by Gonzalo Ortiz of InterPress News Service (IPS), Ecuador has achieved a steep decline in maternal deaths and illness through a model program "centered on the mother's needs and not those of the doctor or midwife."

If you’ve spent a large part of your career helping craft international agreements and then trying to hold the governments that have signed them accountable to their promises, you have likely become somewhat inured to disappointment.  You give up expecting governments to walk the talk after the headlines fade about how they will save the world, at least without a lot of pushing. And you get depressingly familiar with watching needless death and illness go by due to lack of funding and political will.

Such has often been the case with respect to international promises to improve reproductive and sexual health, including maternal death and illness, long a largely neglected component of international public health efforts

Now, however, in the wake of a study published in the Lancet that suggests maternal mortality may have fallen substantially since the early nineties comes a report that Ecuador, according to a report by Gonzalo Ortiz of InterPress News Service (IPS), has achieved a steep decline in maternal deaths and illness through a model program “centered on the mother’s needs and not those of the doctor or midwife.”

I’ve seen those words so many times in rhetorical statements and so rarely in practice that I just have to repeat them here: “centered on the mother’s needs.”

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During the 1970s, the average annual maternal mortality rate in Ecuador was 188 per 100,000 live births. This fell to 142 in the 1980s, 75 in the 1990s and dropped again to an average of 55 maternal deaths per 100,000 live births for the period 2001-2007, according to IPS.

The fall in maternal mortality rates is being attributed to the Law of Free Maternity and Child Care, which was approved in 1994 and codified in 2006 to ensure a systematic approach to laws, policies and programs addressing maternal health in the country and to ensure financing for specific efforts to improve outcomes during pregnancy, childbirth, and in the weeks thereafter. 

It is a program intended for even the poorest and hardest-to-reach communities where maternal mortality rates remain higher than the national average. 

Poverty is endemic, for example, in Latacunga, about 35 miles south of Quito, the capital of the north-central province of Cotopaxi, one of the poorest in the country.  Sixty-eight percent of the people live on less than two dollars a day, “a poverty rate 20 percentage points higher than the provincial average,” according to IPS.

Ortiz reports:

The principle behind Ecuador’s law is simple. Every woman has the right to free, high-quality health care during pregnancy, childbirth and the postpartum period, as well as access to sexual and reproductive health programmes, says the first article [of the law].

The maternal health law gives communities both resources and the power to manage those resources for the best health outcomes. 

Eulalia Salinas, the secretary of the Latacunga Users’ Committee, tells IPS that training for these community groups and their supervisory responsibilities have been the key to success.

The law stipulates that a committee be created in each of the 221 cantons that are subdivisions of the country’s 24 provinces. However, there are only 59 committees so far.

“Our committee was formed in 2004, through the work of the Women’s Political Coordinating Body,” said Salinas. This non-governmental organisation has fomented the creation of the committees, “which until then were dead letter, so that we could claim our rights,” she said.

“We work on a voluntary basis to ensure that the budgeted funds sent to each canton are used for the free maternity programme, and that the women and children are treated to a high standard, and with human warmth,” she added.

In Quito, Ecuador, Verónica Rocha, head of institutional development for the Free Maternity programme, told Ortiz that the law

“finances medicines, materials, vitamins and minerals, supplies and laboratory tests, for pregnant women, during labour and postnatally, as well as for children up to the age of five.”

Integration and collabortion across departments is key.  The achievements are a credit to “the entire public health system,” Rocha said.

So is attention to the basic dignity and rights of women.

Community leaders note, for example, that the committees have successfully reduced mistreatment of women and discrimination with racist overtones at the hands of the very medical professionals meant to serve them.

“Before, the doctors would treat us badly. When we were giving birth they would shout, ‘you dirty Indian, you opened your legs when you felt like it and now you’re screaming! Shut up now!'” said Giovanna Álvarez, head of the Users’ Committee in Saquisilí, Toaquiza’s canton.

While the focus is on getting women to give birth in health centers rather than at home (where the majority of births now occur), it is also, at least in some communities, on “humanised childbirth.”

Humanized childbirth. These words mean a great deal considering the extent to which women in labor in so many places are treated more like cattle than human beings.

Mothers can have a person of their choice with them during labour, they can have hot herbal tea before labour starts, and they can choose the birthing position they prefer.

“All these things are forbidden in other hospitals,” reports IPS, “but in Saquisilí they were accepted after pressure from indigenous women, as a mark of respect for their traditional customs.”

“Before, the doctor’s convenience always came first. He would sit in front of the woman in labour, who was lying horizontally with her legs spread apart in metal stirrups, a completely unnatural position. The natural way is for the woman to be standing or squatting,” so the baby is born with the help of gravity, Salinas said.

United Nations agencies now refer to Ecuador’s law as a model for other Latin American countries, where deaths of women in childbirth and the postnatal period are either stationary or rising. The average maternal mortality rate in Latin America was 130 deaths per 100,000 live births in 2007. “International organisations and women’s groups warn that this ratio is being reduced slowly or not at all,” reports Ortiz.

I am sure it is not perfect; it clearly is not yet universal; I know there are bumps in the road.  Yet it is refreshing, and worth celebration, to see that women in communities are being given the resources they know they need–and the power that is their right–to determine the best course of action in preventing other women from dying from pregnancy and childbirth.

Analysis Economic Justice

New Pennsylvania Bill Is Just One Step Toward Helping Survivors of Economic Abuse

Annamarya Scaccia

The legislation would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have "a reasonable fear" that they will continue to be harmed while living in their unit.

Domestic violence survivors often face a number of barriers that prevent them from leaving abusive situations. But a new bill awaiting action in the Pennsylvania legislature would let survivors in the state break their rental lease without financial repercussions—potentially allowing them to avoid penalties to their credit and rental history that could make getting back on their feet more challenging. Still, the bill is just one of several policy improvements necessary to help survivors escape abusive situations.

Right now in Pennsylvania, landlords can take action against survivors who break their lease as a means of escape. That could mean a lien against the survivor or an eviction on their credit report. The legislation, HB 1051, introduced by Rep. Madeleine Dean (D-Montgomery County), would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have “a reasonable fear” that they will continue to be harmed while living in their unit. The bipartisan bill, which would amend the state’s Landlord and Tenant Act, requires survivors to give at least 30 days’ notice of their intent to be released from the lease.

Research shows survivors often return to or delay leaving abusive relationships because they either can’t afford to live independently or have little to no access to financial resources. In fact, a significant portion of homeless women have cited domestic violence as the leading cause of homelessness.

“As a society, we get mad at survivors when they don’t leave,” Kim Pentico, economic justice program director of the National Network to End Domestic Violence (NNEDV), told Rewire. “You know what, her name’s on this lease … That’s going to impact her ability to get and stay safe elsewhere.”

“This is one less thing that’s going to follow her in a negative way,” she added.

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Pennsylvania landlords have raised concerns about the law over liability and rights of other tenants, said Ellen Kramer, deputy director of program services at the Pennsylvania Coalition Against Domestic Violence, which submitted a letter in support of the bill to the state House of Representatives. Lawmakers have considered amendments to the bill—like requiring “proof of abuse” from the courts or a victim’s advocate—that would heed landlord demands while still attempting to protect survivors.

But when you ask a survivor to go to the police or hospital to obtain proof of abuse, “it may put her in a more dangerous position,” Kramer told Rewire, noting that concessions that benefit landlords shift the bill from being victim-centered.

“It’s a delicate balancing act,” she said.

The Urban Affairs Committee voted HB 1051 out of committee on May 17. The legislation was laid on the table on June 23, but has yet to come up for a floor vote. Whether the bill will move forward is uncertain, but proponents say that they have support at the highest levels of government in Pennsylvania.

“We have a strong advocate in Governor Wolf,” Kramer told Rewire.

Financial Abuse in Its Many Forms

Economic violence is a significant characteristic of domestic violence, advocates say. An abuser will often control finances in the home, forcing their victim to hand over their paycheck and not allow them access to bank accounts, credit cards, and other pecuniary resources. Many abusers will also forbid their partner from going to school or having a job. If the victim does work or is a student, the abuser may then harass them on campus or at their place of employment until they withdraw or quit—if they’re not fired.

Abusers may also rack up debt, ruin their partner’s credit score, and cancel lines of credit and insurance policies in order to exact power and control over their victim. Most offenders will also take money or property away from their partner without permission.

“Financial abuse is so multifaceted,” Pentico told Rewire.

Pentico relayed the story of one survivor whose abuser smashed her cell phone because it would put her in financial dire straits. As Pentico told it, the abuser stole her mobile phone, which was under a two-year contract, and broke it knowing that the victim could not afford a new handset. The survivor was then left with a choice of paying for a bill on a phone she could no longer use or not paying the bill at all and being turned into collections, which would jeopardize her ability to rent her own apartment or switch to a new carrier. “Things she can’t do because he smashed her smartphone,” Pentico said.

“Now the general public [could] see that as, ‘It’s a phone, get over it,'” she told Rewire. “Smashing that phone in a two-year contract has such ripple effects on her financial world and on her ability to get and stay safe.”

In fact, members of the public who have not experienced domestic abuse may overlook financial abuse or minimize it. A 2009 national poll from the Allstate Foundation—the philanthropic arm of the Illinois-based insurance company—revealed that nearly 70 percent of Americans do not associate financial abuse with domestic violence, even though it’s an all-too-common tactic among abusers: Economic violence happens in 98 percent of abusive relationships, according to the NNEDV.

Why people fail to make this connection can be attributed, in part, to the lack of legal remedy for financial abuse, said Carol Tracy, executive director of the Women’s Law Project, a public interest law center in Pennsylvania. A survivor can press criminal charges or seek a civil protection order when there’s physical abuse, but the country’s legal justice system has no equivalent for economic or emotional violence, whether the victim is married to their abuser or not, she said.

Some advocates, in lieu of recourse through the courts, have teamed up with foundations to give survivors individual tools to use in economically abusive situations. In 2005, the NNEDV partnered with the Allstate Foundation to develop a curriculum that would teach survivors about financial abuse and financial safety. Through the program, survivors are taught about financial safety planning including individual development accounts, IRA, microlending credit repair, and credit building services.

State coalitions can receive grant funding to develop or improve economic justice programs for survivors, as well as conduct economic empowerment and curriculum trainings with local domestic violence groups. In 2013—the most recent year for which data is available—the foundation awarded $1 million to state domestic violence coalitions in grants that ranged from $50,000 to $100,000 to help support their economic justice work.

So far, according to Pentico, the curriculum has performed “really great” among domestic violence coalitions and its clients. Survivors say they are better informed about economic justice and feel more empowered about their own skills and abilities, which has allowed them to make sounder financial decisions.

This, in turn, has allowed them to escape abuse and stay safe, she said.

“We for a long time chose to see money and finances as sort of this frivolous piece of the safety puzzle,” Pentico told Rewire. “It really is, for many, the piece of the puzzle.”

Public Policy as a Means of Economic Justice

Still, advocates say that public policy, particularly disparate workplace conditions, plays an enormous role in furthering financial abuse. The populations who are more likely to be victims of domestic violence—women, especially trans women and those of color—are also the groups more likely to be underemployed or unemployed. A 2015 LGBT Health & Human Services Network survey, for example, found that 28 percent of working-age transgender women were unemployed and out of school.

“That’s where [economic abuse] gets complicated,” Tracy told Rewire. “Some of it is the fault of the abuser, and some of it is the public policy failures that just don’t value women’s participation in the workforce.”

Victims working low-wage jobs often cannot save enough to leave an abusive situation, advocates say. What they do make goes toward paying bills, basic living needs, and their share of housing expenses—plus child-care costs if they have kids. In the end, they’re not left with much to live on—that is, if their abuser hasn’t taken away access to their own earnings.

“The ability to plan your future, the ability to get away from [abuse], that takes financial resources,” Tracy told Rewire. “It’s just so much harder when you don’t have them and when you’re frightened, and you’re frightened for yourself and your kids.”

Public labor policy can also inhibit a survivor’s ability to escape. This year, five states, Washington, D.C., and 24 jurisdictions will have passed or enacted paid sick leave legislation, according to A Better Balance, a family and work legal center in New York City. As of April, only one of those states—California—also passed a state paid family leave insurance law, which guarantees employees receive pay while on leave due to pregnancy, disability, or serious health issues. (New Jersey, Rhode Island, Washington, and New York have passed similar laws.) Without access to paid leave, Tracy said, survivors often cannot “exercise one’s rights” to file a civil protection order, attend court hearings, or access housing services or any other resource needed to escape violence.

Furthermore, only a handful of state laws protect workers from discrimination based on sex, sexual orientation, gender identity, and pregnancy or familial status (North Carolina, on the other hand, recently passed a draconian state law that permits wide-sweeping bias in public and the workplace). There is no specific federal law that protects LGBTQ workers, but the U.S. Employment Opportunity Commission has clarified that the Civil Rights Act of 1964 does prohibit discrimination based on gender identity and sexual orientation.

Still, that doesn’t necessarily translate into practice. For example, the National Center for Transgender Equality found that 26 percent of transgender people were let go or fired because of anti-trans bias, while 50 percent of transgender workers reported on-the-job harassment. Research shows transgender people are at a higher risk of being fired because of their trans identity, which would make it harder for them to leave an abusive relationship.

“When issues like that intersect with domestic violence, it’s devastating,” Tracy told Rewire. “Frequently it makes it harder, if not impossible, for [victims] to leave battering situations.”

For many survivors, their freedom from abuse also depends on access to public benefits. Programs like Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), the child and dependent care credit, and earned income tax credit give low-income survivors access to the money and resources needed to be on stable economic ground. One example: According to the Center on Budget and Policy Priorities, where a family of three has one full-time nonsalary worker earning $10 an hour, SNAP can increase their take-home income by up to 20 percent.

These programs are “hugely important” in helping lift survivors and their families out of poverty and offset the financial inequality they face, Pentico said.

“When we can put cash in their pocket, then they may have the ability to then put a deposit someplace or to buy a bus ticket to get to family,” she told Rewire.

But these programs are under constant attack by conservative lawmakers. In March, the House Republicans approved a 2017 budget plan that would all but gut SNAP by more than $150 million over the next ten years. (Steep cuts already imposed on the food assistance program have led to as many as one million unemployed adults losing their benefits over the course of this year.) The House GOP budget would also strip nearly $500 billion from other social safety net programs including TANF, child-care assistance, and the earned income tax credit.

By slashing spending and imposing severe restrictions on public benefits, politicians are guaranteeing domestic violence survivors will remain stuck in a cycle of poverty, advocates say. They will stay tethered to their abuser because they will be unable to have enough money to live independently.

“When women leave in the middle of the night with the clothes on their back, kids tucked under their arms, come into shelter, and have no access to finances or resources, I can almost guarantee you she’s going to return,” Pentico told Rewire. “She has to return because she can’t afford not to.”

By contrast, advocates say that improving a survivor’s economic security largely depends on a state’s willingness to remedy what they see as public policy failures. Raising the minimum wage, mandating equal pay, enacting paid leave laws, and prohibiting employment discrimination—laws that benefit the entire working class—will make it much less likely that a survivor will have to choose between homelessness and abuse.

States can also pass proactive policies like the bill proposed in Pennsylvania, to make it easier for survivors to leave abusive situations in the first place. Last year, California enacted a law that similarly allows abuse survivors to terminate their lease without getting a restraining order or filing a police report permanent. Virginia also put in place an early lease-termination law for domestic violence survivors in 2013.

A “more equitable distribution of wealth is what we need, what we’re talking about,” Tracy told Rewire.

As Pentico put it, “When we can give [a survivor] access to finances that help her get and stay safe for longer, her ability to protect herself and her children significantly increases.”

News Human Rights

Remaining Charges Dropped Against Officers in Freddie Gray Case

Michelle D. Anderson

Gray, who was Black, died of a neck injury a week after being taken into police custody in April 2015. The 25-year-old’s death led to widespread protest and civil disobedience against racial injustice and a number of reforms in Baltimore and across Maryland.

Three Baltimore Police Department officers charged in the 2015 death of Freddie Gray will not go to trial as originally planned.

Chief Deputy State Attorney Michael Schatzow of the Baltimore City State Attorney’s Office said during a court hearing Wednesday that his office would not prosecute Officer Garrett Miller and Sgt. Alicia White or attempt to retry Officer William Porter, whose case ended in a mistrial in December.

Baltimore City State’s Attorney Marilyn Mosby had charged Miller, White, and Porter, along with Officer Edward Nero, Officer Caesar Goodson Jr., and Lt. Brian Rice, in Gray’s May 2015 death in police custody.

The officers faced an array of charges, ranging from second-degree depraved-heart murder and reckless endangerment to second-degree assault and involuntary manslaughter.

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All of the officers pleaded not guilty.

Judge Circuit Judge Barry G. Williams acquitted Nero, Goodson, and Rice during bench trials that ended in May, June, and July, respectively. Miller’s trial was set to begin Wednesday; White, October 13, and Porter, September 6.

Gray, who was Black, died of a neck injury a week after being taken into police custody in April 2015. The 25-year-old’s death led to widespread protest and civil disobedience against racial injustice and a number of reforms in Baltimore and across Maryland.

Mosby, in filing charges against the officers, attempted to hold law enforcement accountable for failing to secure Gray in a seat belt after transporting him in a police van following his arrest, among other alleged negligent acts. Prosecutors charged that Gray was illegally detained before police officers found a knife in his pocket.

Mosby stood by her decision to bring charges against the six officers during a brief press conference held near the Gilmor Homes public housing project, where Gray was taken into police custody.

“We stand by the medical examiners determination that Freddie Gray’s death was a homicide,” Mosby said.

She touted her team’s success during the trials, including an appellate court victory that led some officers to testify against one another and asserted that a summary judgment was among many reasons she had “legitimate reasons” to pursue criminal charges.

Mosby praised the reforms that had come over the past year, including a new “use of force” policy Baltimore police instituted this year. The new policy emphasizes de-escalation and accountability. It marks the first rewrite of the policy since 2003.

“For those that believe I am anti-police, that’s simply not the case. I am anti-police brutality,” Mosby said.

The conference was the first time Mosby had spoken in months, since a gag order imposed by Williams had kept prosecution and defense alike from commenting on the police trials.

The decision to drop charges stemmed from “an apparent acknowledgement” that convictions were unlikely for the remaining officers, the Baltimore Sun reported.

This was because the prosecution would face major challenges during Miller’s trial since they wouldn’t be able to use anything he said on the witness stand during Nero’s trial in an attempt to convict him. Miller had spoken during Nero’s trial in an immunized testimony and with protections against self incrimination, the Sun reported.

Williams said in previous trials that prosecutors failed to show sufficient evidence to support their stance that the officers acted recklessly and caused Gray’s death. He said prosecutors wanted him to rely on “presumptions or assumptions” and rejected the notion that police intentionally gave Gray a “rough ride” in the police vehicle, according to numerous news reports.

The decision to drop charges drew criticism from many activists and citizens alike, but drew praise from the Baltimore City Fraternal Order of Police Lodge 3 union, which had repeatedly urged the prosecution to drop charges.

Baltimore Bloc, a local grassroots group, said in a statement this spring that Mosby should be removed from office for failing to secure convictions against officers and continued to criticize her on Twitter after the announcement that charges would be dropped.