No Cause for Complacency on Maternal Health

Elizabeth Maguire

New estimates suggesting reduced numbers of maternal deaths are cause for celebration but not complacency especially in regard to unsafe abortion.

New estimates of maternal mortality just published in the Lancet suggest encouraging—and long overdue—progress on what for too many years has seemed an intractable problem. According to an analysis by researchers at the Institute for Health Metrics and Evaluation (IHME), maternal deaths fell from more than 500,000 in 1980 to about 343,000 in 2008—a decline that far surpasses previous United Nations estimates.

The global health community is rightfully celebrating this news, which many see as the strongest evidence yet that investing in reproductive health, girls’ education and economic development yields tangible positive results.

Advocates for women’s health also correctly caution against complacency, though, since deaths related to pregnancy and childbirth are notoriously among the most poorly captured health data. Moreover, even the new, much lower numbers are far too high. Almost all maternal deaths can be prevented with known technologies and public-health interventions, and the death of even one woman is too many.

And while more robust scientific evidence and debate are certainly to be applauded, advocates cannot be faulted for worrying that signs of progress could lead to diminished investment in women’s health. After all, the international community does not have a very good record of summoning the political will to address women’s — especially poor women’s — health.

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This too-common failure to muster political will on behalf of poor women is especially true when it comes to unsafe abortion, a critical contributor to maternal deaths and injuries that authors of the new Lancet article do not even mention.

Without adequate access to contraceptive information and methods, about 80 million women and girls around the world face unintended pregnancies every year. Without access to safe abortion —severely restricted by law in most developing countries — many resort to unsafe methods and unqualified practitioners to end those pregnancies. According to the World Health Organization, about 66,500 women die and at least 5 million are hospitalized every year as a result. Unsafe abortion is estimated to account for about 13 percent of global maternal mortality.

Margaret Hogan and her IHME colleagues note that many pregnancy-related deaths are not classified as such in vital registration records, a main data source for their study; they were careful to calculate an adjustment to account for that fact. They fail to note, however, that many deaths related to abortion are likely not to be reported or recorded as such, reflecting the strong, pervasive stigma and secrecy that surround unwanted pregnancy and abortion.

Yet, with known technologies, unsafe abortion is one of easiest causes of maternal mortality and morbidity to address, through improved access to contraception, treatment for abortion complications and safe abortion. Indeed, we now have strong evidence from numerous countries that legalizing abortion — which more and more countries are doing — and making safe services available leads to dramatic improvements in women’s health, saving many lives. For example, South Africa saw abortion-related maternal mortality decline by more than 90 percent after expanding access to legal abortion in 1997. Early results from Ethiopia, which expanded legal abortion in 2005, show that safe, legal procedures are beginning to displace unsafe abortions, reducing women’s need for emergency treatment of complications. 

United Nations agencies are expected to issue new maternal mortality and unsafe abortion estimates soon; we hope that they too will indicate positive trends. But improved systems for data collection are urgently needed, to guide policies and programs to address preventable causes of maternal deaths — especially abortion.

One important contribution Hogan and her colleagues have made is to call attention to the high number of maternal deaths among pregnant women and mothers who are HIV-positive. Were it not for the HIV epidemic, they say, about 61,000 fewer women would have died in 2008. They and others are right to call for better integration of maternal health care and HIV prevention and treatment, which could indeed save many lives.

But even more women and girls could be saved — and more easily — if the global health community at last applied what it already knows about preventing deaths and injuries from unsafe abortion. As we strive together to understand and digest the implications of these encouraging new maternal mortality estimates, and to identify and replicate successful interventions, let us also have the political courage to commit resources to the most controversial public-health issues. Improving access to contraception, postabortion care and safe, legal abortion works, and we must accelerate and greatly expand efforts to address these fundamental women’s rights.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

News Abortion

Parental Notification Law Struck Down in Alaska

Michelle D. Anderson

"The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions," said Janet Crepps, senior counsel at the Center for Reproductive Rights. "This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm."

The Alaska Supreme Court has struck down a state law requiring physicians to give the parents, guardians, or custodians of teenage minors a two-day notice before performing an abortion.

The court ruled that the parental notification law, which applies to teenagers younger than 18, violated the Alaska Constitution’s equal protection guarantee and could not be enforced.

The ruling stems from an Anchorage Superior Court decision that involved the case of Planned Parenthood of the Great Northwest and the Hawaiian Islands and physicians Dr. Jan Whitefield and Dr. Susan Lemagie against the State of Alaska and the notification law’s sponsors.

In the lower court ruling, a judge denied Planned Parenthood’s requested preliminary injunction against the law as a whole and went on to uphold the majority of the notification law.

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Planned Parenthood and the physicians had appealed that superior court ruling and asked for a reversal on both equal protection and privacy grounds.

Meanwhile, the State of Alaska and the notification law’s sponsors appealed the court’s decision to strike some of its provisions and the court’s ruling.

The notification law came about after an initiative approved by voters in August 2010. The law applied to “unemancipated, unmarried minors” younger than 18 seeking to terminate a pregnancy and only makes exceptions in documented cases of abuse and medical emergencies, such as one in which the pregnant person’s life is in danger.

Justice Daniel E. Winfree wrote in the majority opinion that the anti-choice law created “considerable tension between a minor’s fundamental privacy right to reproductive choice and how the State may advance its compelling interests.”

He said the law was discriminatory and that it could unjustifiably burden “the fundamental privacy rights only of minors seeking pregnancy termination, rather than [equally] to all pregnant minors.”

Chief Justice Craig Stowers dissented, arguing that the majority’s opinion “unjustifiably” departed from the Alaska Supreme Court’s prior approval of parental notification.

Stowers said the opinion “misapplies our equal protection case law by comparing two groups that are not similarly situated, and fails to consider how other states have handled similar questions related to parental notification laws.”

Center for Reproductive Rights (CRR) officials praised the court’s ruling, saying that Alaska’s vulnerable teenagers will now be relieved of additional burdensome hurdles in accessing abortion care. Attorneys from the American Civil Liberties Union, CRR, and Planned Parenthood represented plaintiffs in the case.

Janet Crepps, senior counsel at CRR, said in a statement that the “decision provides important protection to the safety and well-being of young women who need to end a pregnancy.”

“The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions. This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm,” Crepps said.

CRR officials also noted that most young women seeking abortion care involve a parent, but some do not because they live an abusive or unsafe home.

The American Medical Association, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine have said minors’ access to confidential reproductive health services should be protected, according to CRR.