What would Mother’s Day be without reproductive health?

LindaSuttenfield

Working in the global reproductive health arena, I think about the profound grief my own mother experienced having lost a child and then about the millions of women around the world who face this sort of grief as a part of their daily lives because they lack access to reproductive health care. But we can make a change this Mother's Day.

   

Mother’s Day always has many meanings—for me it strikes several chords this year…

I lost my mother last year—a strong and elegant Australian woman, with a wonderful sense of humor. She had a very resilient spirit, but there was one thing that she never seemed to forget. She lost her first baby from toxemia. He was full term and delivered at one of the top teaching hospitals in New York City, but he died from a totally preventable condition. It was a topic that she could never really discuss comfortably—even with her daughters—as the pain remained close to the surface more than 50 years later. But she was a real Aussie and would never let anything bring her down.

Working in the global reproductive health arena at Pathfinder International, I think about the profound grief this loss caused my own mother throughout her lifetime and then about the millions of women around the world who face this sort of grief as a part of their daily lives—and not 50 years ago but every day now in 2010. It’s something we see in the field every day at Pathfinder (watch Ruma’s story below to see one example). So many of these women are still losing their babies during pregnancy or childbirth due to preventable causes or they risk death themselves and the possibility of leaving their existing children motherless.

This is an issue of course on RHRealityCheck that has been explored widely. But we can actually do something about it today. More funding is needed to provide quality health services and change the dire circumstances many women face.

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In the spirit of Mother’s Day, Pathfinder has partnered with a number of other organizations to form a petition asking the Obama Administration to increase funding for maternal and newborn health services as well as family planning and reproductive health programs. As a mother, and a daughter of someone who experienced the loss of a baby from a preventable cause, I feel strongly about this issue and have readily signed the petition. In honor of my mother, and all the mothers around the world who need proper care during pregnancy and childbirth, I urge you to honor your mother by signing this petition on her behalf.


Commentary Abortion

How to Transform Future Health-Care Providers Into Abortion Rights Advocates

Michalina Drejza & Cecilia Espinoza

Medical students’ limited opportunities to train in abortion procedures are a major barrier to care. But as bad as the situation is in the United States for medical students, it’s actually much worse in many international settings—including our own home countries.

Medical students’ limited opportunities to train in abortion procedures are a major barrier to care in the United States. Many schools intentionally choose not to include abortion in the curriculum or only offer “opt-in” training. A national survey of medical schools in 2005 found that only 32 percent offered at least one abortion-related lecture during students’ third-year OB-GYN rotation, and only half of schools offered a fourth-year reproductive health elective that covered family planning and abortion.

Such restricted opportunities for abortion training are, of course, a result of institutionalized stigma, often forcing interested medical students to go above and beyond their school’s curriculum to learn abortion care clinical skills and reinforcing the shame surrounding this simple and common medical procedure.

But as bad as the situation is in the United States for medical students, it’s actually much worse in many international settings—including our own home countries. Michalina is in medical school in Poland, where abortion is not typically included in any OB-GYN class curricula. In fact, Poland’s government attempted to pass a total abortion ban just last year. Polish health-care providers who do manage to obtain training and offer safe abortions do so with great discretion; they risk being ostracized socially and professionally. And in Nicaragua, where Cecilia lived and worked until moving to the United States four years ago, a complete ban on abortion means medical schools offer zero training in this often lifesaving care.

Thanks to these kinds of policies, we have found that many medical students—from all parts of the globe—are in the dark about the fact that the procedure, when done safely and legally, has minimal risk of complications. Medical students without abortion training or knowledge go on to become doctors who cannot and will not perform the procedure, even in countries where it’s legal. Having internalized the stigma around abortion themselves, these doctors may refuse mid-career training on the procedure even if their community has a clear need for the service, and they may judge, scorn and turn away patients who seek safe abortions at health clinics—in turn giving people no other option than to seek unsafe, clandestine procedures.

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That’s why the International Federation of Medical Students’ Associations (IFMSA), one of the world’s oldest and largest student-run organizations, has partnered with Ipas, a global NGO dedicated to ending deaths and injuries from unsafe abortion, to develop a training for future health professionals on the importance of safe abortion access.

Our work together began in 2010 with a collaboration between Ipas Nigeria and the Nigerian Medical Students’ Association, which then evolved into a global-level partnership. IFMSA engages a network of more than one million medical students from 115 countries, and a total of approximately 4,000 students attend annual regional meetings held around the globe. To capitalize on the organization’s vast reach, together we created a training guide that IFMSA student leaders use at their regional meetings to offer a crash course on the public health issue of unsafe abortion and how health-care providers can be advocates for abortion access—regardless of whether they ever provide the service or where they work in the health system. Trainings began in 2013 at a regional meeting in Ethiopia, and Michalina, as a leader with IFMSA’s committee on sexual and reproductive health issues, has now helped facilitate six of these trainings in various regions.

Rather than offer clinical abortion skills training, we recognized that what many medical students need first is an opportunity to talk openly about the myths, misconceptions, and biases about abortion they’ve inherited from their respective cultures. Training participants explore how unsafe abortion affects women and societies and how practicing health professionals can reduce the many barriers to abortion care that patients face. A section of the training also demystifies clinical aspects of abortion care with an overview of safe procedure methods and the importance of patient-centered care. Finally, students learn strategies for advancing abortion rights and access, and practice skills like advocacy and peer education.

You can’t expect a roomful of strangers to instantly feel comfortable discussing such a stigmatized topic, so our training involves many participatory activities that allow students to clarify their own values and beliefs related to abortion and to challenge themselves by considering a variety of others’ perspectives—including those of fellow training participants, as well as people seeking abortions, their families, and the health professionals who provide them. One popular activity asks students to brainstorm all the many reasons why a person may want or need an abortion and then to discuss which reasons society deems more acceptable. The activity sparks conversations about differing cultural beliefs and the subconscious biases we all carry.

The “ah-ha!” moments that occur at these trainings are pretty remarkable. Students from the United States, carrying the burden of their country’s uniquely toxic political climate around abortion, are frequently shocked to discover the wide array of other students’ experiences. For example, students from Western Europe will note that immigrants in their countries struggle to access safe abortions due to factors like immigration status, language barriers, and lack of information, even though the procedure is legal and not highly stigmatized. Meanwhile students from some African nations all know of at least one woman whose life was claimed by unsafe, clandestine abortion—often obtained illegally.

Students are also regularly surprised to learn about the abortion laws in their own countries. Many simply assume tight legal restrictions on the procedure because of the way medical schools and health systems avoid the topic as if it’s forbidden. A group of students from Tunisia, for example, were shocked to learn in early 2015 that their country’s abortion law is quite progressive—and outraged that they had been uninformed. After participating in our training, they started a project to educate other Tunisian medical students about the abortion law and other policies that advance reproductive health and rights.

Perhaps the most rewarding part of these trainings—and we’ve seen it again and again—is when students begin our workshop staunchly opposed to abortion and leave committed to abortion rights advocacy and excited to educate their peers at home on the topic. We’ve been careful not to impose a particular view on abortion in the exercises that comprise our training, and we hear routinely from students that they didn’t feel pushed to adopt a particular outlook. Rather, they feel grateful for the opportunity to have open, honest dialogue—often for the first time. This dialogue, they say, allows them to dispel myths and better understand what their role might be in supporting access to safe, legal abortion in the future.

The first step to ending abortion stigma is education—and making people conscious of the problem. IFMSA regional meetings for the 2015-16 academic year kicked off in Rwanda in December, where we trained 13 medical students from across Africa. In January, we trained 42 students at the Americas regional meeting in Uruguay, and another ten students at the Eastern Mediterranean regional meeting in Jordan. We expect similarly robust and stimulating conversations in the trainings to come this spring. And we hope that region by region, year after year, we are laying the groundwork on a global scale for more pro-choice health systems with providers who advance, rather than restrict, women’s sexual and reproductive health and rights.

Roundups Politics

Campaign Week in Review: Martin O’Malley Pitches Universal Reproductive Health-Care Coverage

Ally Boguhn

Martin O’Malley released his health-care platform promising universal contraceptive coverage, Marco Rubio shifted his position on allowing exceptions to abortion bans, Hillary Clinton suggested that the Helms Amendment be reevaluated, and Republicans convened in Iowa to complain that their attacks on abortion aren’t gaining traction because of political correctness.

This week on the presidential campaign trail, Martin O’Malley released his health-care platform promising universal contraceptive coverage, Marco Rubio shifted his position on allowing exceptions to abortion bans, Hillary Clinton suggested that the Helms Amendment be reevaluated, and Republicans convened in Iowa to complain that their attacks on abortion aren’t gaining traction because of political correctness.

Martin O’Malley Releases Health-Care Platform Promising Support for Universal Access to Reproductive Health Services

Democratic presidential candidate and former Maryland Gov. Martin O’Malley released his health-care policy platform Tuesday, promising to expand health coverage to more Americans and pledging support for universal reproductive services.

Center to O’Malley’s platform is a goal of insuring 95 percent of Americans by the year 2020, which he proposes achieving in part by: building upon the precedent set by the Affordable Care Act (ACA) through the expansion of Medicaid in states that have so far refused to expand it; addressing high deductibles; and implementing a series of fixes to the ACA as it currently stands.

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O’Malley’s plan features a promise to “support universal access to reproductive health care” in order to help people “make the best possible choices for themselves and their future.” To that end, the presidential candidate advocates universal access to both prenatal care and family planning.

The plan outlines how O’Malley “will adopt early access to comprehensive prenatal care as a major quality measure for health systems and states, as a percentage of all births. He will also provide funding and hold states accountable for providing quality prenatal care for those who are uninsured,” should he be elected.

It also details his intention to push states to be held accountable for ensuring access to reproductive health care for their residents, which would “include equity in access to long-acting reversible contraception, and support for education so that women can make choices for themselves based on complete and accurate information.”

O’Malley’s plan did not address whether abortion care would be included in his push to ensure access to reproductive health services.

Another priority listed in O’Malley’s platform would be to tackle health disparities for underserved communities [who] suffer disproportionately from poor health outcomes” through the restoration of funding to community health centers in order to promote access to health services.

Marco Rubio Shifts Position on Abortion Exceptions: “I, As President, Will Sign a Bill That Has Exceptions”

Sen. Marco Rubio (R-FL) again shifted his stance on abortion exceptions, telling a reporter that although he personally doesn’t support allowing the procedure in cases of rape, incest, or when the life of the mother is in danger, he would still sign legislation that included them.

“I, as president, will sign a bill that has exceptions. I’ve supported bills that have exceptions,” said Rubio during an interview with the Associated Press.

“I do not personally require a bill to have exceptions—other than life of the mother—in order for me to support it,” he continued. “But I will sign a bill as president that has exceptions.”

During the August GOP primary debate hosted by Fox News, Rubio denied that he had ever been in favor of such policies. After moderator Megyn Kelly said his voting record favored “a rape and incest exception to abortion bans” and asked him to clarify how the stance was consistent with the belief that life begins at conception, the presidential candidate fired back that she was wrong.

“I’m not sure that that’s a correct assessment of my record,” said Rubio.

“I have never said that. And I have never advocated that,” he continued. “What I have advocated is that we pass law in this country that says all human life at every stage of its development is worthy of protection. In fact, I think that law already exists. It is called the Constitution of the United States.”

Politifact later rated Rubio’s claim “mostly false,” noting the candidate’s prior support of legislation that contained the kinds of exceptions Kelly had outlined despite having found “no evidence that Rubio has generally favored those types of exceptions” or that he had specifically advocated for them.

In 2013, Rubio co-sponsored the “Pain-Capable Unborn Child Protection Act,” which would have banned abortion after 20 weeks of pregnancy, but also included an exception for pregnancies that were the result of rape or incest. When Sen. Lindsey Graham (R-SC) reintroduced a similar measure in 2015, Rubio again signed on despite the legislation containing an exception for rape.

Clinton Suggests Reexamining Law Banning Foreign Assistance Funds From Paying for Abortion

Speaking at a campaign stop in Iowa on Sunday, Democratic presidential candidate Hillary Clinton said that the United States should reexamine a law that bans foreign assistance dollars from paying for abortions.

After a member of the audience of an Iowa town hall event asked Clinton about her position on the 1973 Helms Amendment, which says, “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning.” Given that rape is increasingly being used as a weapon of war, Clinton commented the law may need to be worked around, reported CNN.

“I do think we have to take a look at this for conflict zones,” said Clinton. “And if the United States government, because of very strong feelings against it, maintains our prohibition, then we are going to have to work through nonprofit groups and work with other counties to … provide the support and medical care that a lot of these women need.”

In August, congressional Democrats urged President Obama to reinterpret the Helms Amendment, asking for guidance to be issued clarifying that exemptions to the law could be made “in the events of rape, incest, or a danger to a woman’s life,” calling the current interpretation “both overly restrictive and inconsistent with established legal precedent.”

Democrats again took up the cause in October, explaining in a letter to the president that women in war zones face a reproductive health crisis. “We write to express our deep concern for the reproductive health of women and girls who are kidnapped, enslaved, tortured, raped, and impregnated in conflict-affected zones worldwide,” wrote the senators before asking the law be relaxed. “We encourage you to take this opportunity to ensure that the U.S. is correctly implementing the Helms Amendment.”

Republicans Blast “Political Correctness” for Interfering With Their Campaign to End Abortion

Seven Republican presidential candidates gathered in Iowa on Friday in an attempt to woo evangelical voters at influential anti-choice advocate Bob Vander Plaats’ Presidential Family Forum.

Carly Fiorina, Mike Huckabee, Ben Carson, Rick Santorum, Sen. Rand Paul (R-KY), Sen. Marco Rubio (R-FL), and Sen. Ted Cruz (R-TX) convened in Des Moines late last week for a three-hour Thanksgiving-themed event deemed the “final exam” before Vander Plaats, head of the evangelical advocacy group The Family Leader, announces which candidate he will officially endorse for president.

Among the topics of discussion that night were consistent complaints that “political correctness” had played a role in criticism of the candidates’ anti-choice talking points and their attempts to pass restrictive anti-abortion legislation.

Paul complained that Republicans have “been pushed, we’ve been bullied and we’ve been beaten down” for their views on the issue, calling for lawmakers to stop being “afraid of political correctness.”

“We can win the battle, but we can’t be afraid of political correctness,” said Paul.

Fiorina doubled down on already debunked talking points made during a previous Republican presidential debate about discredited anti-abortion group the Center for Medical Progress’ deceptively edited videos.

“There are literally millions of people in this country who still believe it is not true that Planned Parenthood alters abortion procedures and engages in late-term abortions for the purposes of harvesting body parts,” said Fiorina. “That’s how dangerous this political correctness and mix of media decision about what to talk about and what not to talk about has become.”