Global Progress on Maternal Health: The Numbers and their Implications

Maternal Health Task Force

The opening plenary, Global progress on maternal health: the numbers and their implications, of the Global Maternal Health Conference 2010 in Delhi focused on global progress on maternal health and explored recent maternal mortality estimates.

The opening plenary, Global progress on maternal health: the numbers and their implications, of the Global Maternal Health Conference 2010 in Delhi focused on global progress on maternal health and explored recent maternal mortality estimates. Speakers discussed the numbers and asked questions not only about what the numbers mean–but also about how the maternal health community can use the numbers.

Over-arching questions from the session were:

Which numbers should we use, those published in the recent Lancet report or those soon to be published by the United Nations (presuming that the numbers will be quite different)?

Will these two sets of numbers prove to be a hurdle in the struggle to bring unity to the maternal health community? If so, how can we reconcile this and avoid a divide in the community?

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Will the two sets of numbers push the maternal health community to establish better and more robust methods of measuring maternal mortality and morbidity?

Has the maternal health community collectively neglected the measurement of maternal morbidity–and how can we begin to focus on measuring not only mortality but morbidity as well?

Brief insights from the opening plenary speeches:

Rafael Lozano, Professor of Global Health at the Institute for Health Metrics and Evaluation, succinctly summarized the  statistical analysis behind the recent Lancet publication in one slide. (Presentations will soon be available online here: www.maternalhealthtaskforce.org/gmhc2010) He also described many of the lessons learned from the research that led to the Lancet piece–the gaining of ground in the reduction of maternal mortality, an improved picture of what the key drivers of progress really are, the correlation between HIV/AIDS and maternal health outcomes, and the importance of communication with countries and local researchers.

Lale Say, Medical Doctor and Epidemiologist at the World Health Organization, discussed the inter-agency approach of monitoring progress on maternal health–stressing the importance of country level consultations and technical collaboration. While she did not present the latest maternal mortality estimates, she talked in depth about the methodology that the World Health Organization, UNICEF, UNFPA, and the World Bank use to estimate global maternal mortality.

Wendy J. Graham, Principal Investigator with Immpact at the University of Aberdeen, urged the maternal health community to understand that failure is not a bad word.  She explained that we often emphasize the successes of our efforts so much so that we neglect to learn from our failures. Wendy also reiterated the importance of context when implementing maternal health programs saying, “context, context, context”–and explaining that because an initiative succeeds in one place, there is no guarantee that it will succeed in the next. We must consider the unique context of each setting where we work.

Saroj Pachauri, Regional Director for South and East Asia at the Population Council, asked a number of thought provoking questions throughout her presentation; We count numbers but do numbers count for policy change? Is there a culture of evidence-based programming? How can we address measurement challenges and improve the use of information? Saroj also noted staggering inequities in maternal deaths between and within countries. She explained that the lifetime risk of maternal death in South Asia is 1 in 43 compared to 1 in 30,000 in Sweden–citing this as an example of a failure to bridge the divide between rich and poor.

For more brief insights from our conference presenters, follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

News Family Planning

Judge Thwarts Ohio GOP’s Attack on Planned Parenthood Funding

Michelle D. Anderson

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” said Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio.

An effort to defund Ohio Planned Parenthood affiliates by Gov. John Kasich (R) and the Republican-held legislature has come to an end.

Judge Michael R. Barrett of the U.S. District Court of the Southern District of Ohio on Friday ruled in Planned Parenthood’s favor, granting a permanent injunction on an anti-choice state law.

The court ruling will keep Richard Hodges, the Ohio Department of Health director, from enforcing HB 294.

The 2015 law, sponsored by Rep. Bill Patmon (D-Cleveland) and Rep. Margaret Conditt (R-Butler County), would have redirected $1.3 million in state and federal taxpayer funds from Planned Parenthood’s 28 clinics in Ohio.

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The law would have required the state department to keep federal funds and materials that the health department receives from being distributed to entities that perform or promote non-therapeutic abortions, or maintain affiliation with any entity that does.

Funding that would’ve been cut off from the state health department went to the Violence Against Women and Breast and Cervical Cancer Mortality Prevention acts, the Infertility Prevention Project, Minority HIV/AIDS and Infant Mortality Reduction initiatives, and the Personal Responsibility Education Program.

Planned Parenthood in a lawsuit argued that the Republican legislation violated the First Amendment and the Due Process Clause and Equal Protection Clause of the 14th Amendment.

Barrett had temporarily blocked the law after Planned Parenthood affiliates filed the lawsuit and requested a preliminary injunction. The judge had issued an opinion contending that some legislators passed the law to make it difficult for people to access abortion care, as Rewire reported.

Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio, praised the judge’s temporary order.

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” Harvey said in a statement.

Kellie Copeland, NARAL Pro Choice Ohio’s executive director, said in a statement that the Ohio legislature passed the anti-choice measure in an effort to appeal to conservative voters in early primary states during Kasich’s presidential campaign.

Copeland said that while the legislation made no effort to reduce the number of abortions performed, “it actively blocked critical health care for low-income women and families.”

Planned Parenthood said those services included 70,000 free STD screenings, thousands of HIV tests for at-risk community residents, and the largest infant mortality prevention program in the state.

In the 23-page court order and opinion, Barrett, an appointee of President George W. Bush, acknowledged that the law would have deterred “patients from seeking these potentially life-saving services.”

Planned Parenthood noted that the recent ruling in Ohio makes it among the ten states where courts have blocked anti-choice laws following June’s landmark Whole Woman’s Health v. Hellerstedt U.S. Supreme Court ruling.

Commentary Politics

It’s Not Just Trump: The Right Wing’s Increasing Reliance on Violence and Intimidation as a Path to Power

Jodi Jacobson

Republicans have tried to pass Trump's most recent comments off as a joke because to accept the reality of that rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large.

This week, GOP presidential nominee Donald Trump stated that, if Hillary Clinton were elected and able to nominate justices to the Supreme Court, “Second Amendment people” might be able to do something about it. After blaming the media for “being dishonest” in reporting his statement, the Trump campaign has since tried to pass the comment off as a joke. However characterized, Trump’s statement is not only part of his own election strategy, but also a strategy that has become synonymous with those of candidates, legislators, and groups affiliated with the positions of the GOP.

To me, the phrase “Second Amendment people” translates to those reflexively opposed to any regulation of gun sales and ownership and who feel they need guns to arm themselves against the government. I’m not alone: The comment was widely perceived as an implicit threat of violence against the Democratic presidential nominee. Yet, GOP party leaders have failed to condemn his comment, with House Speaker Paul Ryan (R-WI) agreeing with the Trump campaign that it was “a joke gone bad.”

Republicans have tried to pass it off as a joke because to accept the reality of their rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large. The rhetoric is part of a longer and increasingly dangerous effort by the GOP, aided by corporate-funded right-wing organizations and talk show hosts, to de-legitimize the federal government, undermine confidence in our voting system, play on the fears held by a segment of the population about tyranny and the loss of liberty, and intimidate people Republican leaders see as political enemies.

Ironically, while GOP candidates and leaders decry the random violence of terrorist groups like Daeshitself an outgrowth of desperate circumstances, failed states, and a perceived or real loss of powerthey are perpetuating the idea of loss and desperation in the United States and inciting others to random violence against political opponents.

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Trump’s “Second Amendment” comment came after a week of efforts by the Trump campaign to de-legitimize the 2016 presidential election well before a single vote has been cast. On Monday, August 1, after polls showed Trump losing ground, he asserted in an Ohio campaign speech that “I’m afraid the election’s gonna be rigged, I have to be honest.”

Manufactured claims of widespread voter fraud—a problem that does not exist, as several analyses have shown—have nonetheless been repeatedly pushed by the GOP since the 2008 election. Using these disproven claims as support, GOP legislatures in 20 states have passed new voter restrictions since 2010, and still the GOP claims elections are suspect, stoking the fears of average voters seeking easy answers to complex problems and feeding the paranoia of separatist and white nationalist groups. Taking up arms against an illegitimate government is, after all, exactly what “Second Amendment remedies” are for.

Several days before Trump’s Ohio speech, Trump adviser Roger Stone suggested that the result of the election might be “illegitimate,” leading to “widespread civil disobedience” and a “bloodbath,” a term I personally find chilling.

Well before these comments were made, there was the hate-fest otherwise known as the Republican National Convention (RNC), during which both speakers and supporters variously called for Clinton to be imprisoned or shot, and during which New Jersey Gov. Chris Christie, a man not widely known for his high ethical standards or sense of accountability, led a mock trial of Hillary Clinton to chants from the crowd of “lock her up.” And that was the tame part.

The number of times Trump has called for or supported violence at his rallies is too long to catalogue here. His speeches are rife with threats to punch opponents; after the Democratic National Convention, he threatened to hit speakers who critiqued his policies “so hard their heads would spin.” He also famously promised to pay the legal fees of anyone who hurt protesters at his rallies and defended former campaign manager Corey Lewandowski after allegations surfaced that Lewandowski had assaulted a female Breitbart reporter.

A recent New York Times video compiled over a year of reporting at Trump rallies revealed the degree to which many of Trump’s supporters unapologetically express violence and hatred—for women, immigrants, and people of color. And Trump eschews any responsibility for what has transpired, repeatedly claiming he does not condone violence—his own rhetoric, that of his associates, and other evidence notwithstanding.

Still, to focus only on Trump is to ignore a broader and deeper acceptance, even encouragement of, incitement to violence by the GOP that began long before the 2016 campaign.

In 2008, in what may appear to be a now forgotten but eerily prescient peek at the 2016 RNC, then-GOP presidential nominee Sen. John McCain (R-AZ), and his running mate, former Alaska Gov. Sarah Palin, used race-baiting and hints at violence to gin up their crowds. First, Palin accused Obama of “palling around with terrorists,” a claim that became part of her stump speech. As a result, Frank Rich then wrote in the New York Times:

At McCain-Palin rallies, the raucous and insistent cries of “Treason!” and “Terrorist!” and “Kill him!” and “Off with his head!” as well as the uninhibited slinging of racial epithets, are actually something new in a campaign that has seen almost every conceivable twist. They are alarms. Doing nothing is not an option.

Nothing was in fact done. No price was paid by GOP candidates encouraging this kind of behavior.

In 2009, during congressional debates on the Affordable Care Act, opponents of the health-care law, who’d been fed a steady diet of misleading and sensationalist information, were encouraged by conservative groups like FreedomWorks and Right Principles, as well as talk show hosts such as Sean Hannity, to disrupt town hall meetings on the legislation held throughout the country. Protesters turned up at some town hall meetings armed with rifles with the apparent intention of intimidating those who, in supporting health reform, disagreed with them. In some cases, what began as nasty verbal attacks turned violent. As the New York Times then reported: “[M]embers of Congress have been shouted down, hanged in effigy and taunted by crowds. In several cities, noisy demonstrations have led to fistfights, arrests and hospitalizations.”

In 2010, as first reported by the Washington Post’s Greg Sargent, Tea Party candidate Sharron Angle, in an unsuccessful bid to unseat Senate Majority Leader Harry Reid (D-NV), suggested that armed insurrection would be the answer if “this Congress keeps going the way it is.” In response to a request for clarification by the host of the radio show on which she made her comments, Angle said:

You know, our Founding Fathers, they put that Second Amendment in there for a good reason and that was for the people to protect themselves against a tyrannical government. And in fact Thomas Jefferson said it’s good for a country to have a revolution every 20 years.

I hope that’s not where we’re going, but, you know, if this Congress keeps going the way it is, people are really looking toward those Second Amendment remedies and saying my goodness what can we do to turn this country around? I’ll tell you the first thing we need to do is take Harry Reid out.

Also in 2010, Palin, by then a failed vice-presidential candidate, created a map “targeting” congressional Democrats up for re-election, complete with crosshairs. Palin announced the map to her supporters with this exhortation: “Don’t retreat. Instead, reload!”

One of the congresspeople on that map was Arizona Democrat Gabby Giffords, who in the 2010 Congressional race was challenged by Jesse Kelly, a Palin-backed Tea Party candidate. Kelly’s campaign described an event this way:

Get on Target for Victory in November. Help remove Gabrielle Giffords from office. Shoot a fully automatic M16 with Jesse Kelly.

Someone took this literally. In January 2011, Jared Lee Loughner went on a shooting rampage in a Tuscon grocery store at which Giffords was meeting with constituents. Loughner killed six people and injured 13 others, including Giffords who, as a result of permanent disability resulting from the shooting, resigned from Congress. Investigators later found that Loughner had for months become obsessed with government conspiracy theories such as those spread by GOP and Tea Party candidates.

These events didn’t stop GOP candidates from fear-mongering and suggesting “remedies.”  To the contrary, the goading continued. As the Huffington Post‘s Sam Stein wrote in 2011:

Florida Senate candidate Mike McCalister, who is running against incumbent Sen. Bill Nelson (D-Fla.), offered a variation of the much-lampooned line during a speech before the Palms West Republican Club earlier this week.

“I get asked sometimes where do I stand on the Second and 10th Amendment, and I have a little saying,” he declared. “We need a sign at every harbor, every airport and every road entering our state: ‘You’re entering a 10th Amendment-owned and -operated state, and justice will be served with the Second Amendment.’” [Emphasis added.]

These kinds of threats by the GOP against other legislators and even the president have gone unpunished by the leadership of the party. Not a word has come from either House Speaker Paul Ryan or Senate Majority Leader Mitch McConnell decrying these statements, and the hyperbole and threats have only continued. Recently, for example, former Illinois GOP Congressman Joe Walsh tweeted and then deleted this threat to the president after the killing of five police officers in Dallas, Texas:

“3 Dallas cops killed, 7 wounded,” former congressman Joe Walsh, an Illinois Republican, wrote just before midnight in a tweet that is no longer on his profile. “This is now war. Watch out Obama. Watch out black lives matter punks. Real America is coming after you.”
Even after the outcry over his recent remarks, Trump has escalated the rhetoric against both President Obama and against Clinton, calling them the “founders of ISIS.” And again no word from the GOP leadership.
This rhetoric is part of a pattern used by the right wing within and outside elections. Anti-choice groups, for example, consistently misrepresent reproductive health care writ large, and abortion specifically. They “target” providers with public lists of names, addresses, and other personal information. They lie, intimidate, and make efforts to both vilify and stigmatize doctors. When this leads to violence, as David Cohen wrote in Rolling Stone this week, the anti-choice groups—and their GOP supporters—shrug off any responsibility.
Some gun rights groups also use this tactic of intimidation and targeting to silence critique. In 2011, for example, 40 men armed with semi-automatic weapons and other guns surrounded a restaurant in Arlington, Texas, in which a mothers’ group had gathered to discuss gun regulations. “Second Amendment people” have spit upon women arguing for gun regulation and threatened them with rape. In one case, a member of these groups waited in the dark at the home of an advocate and then sought to intimidate her as she approached in her wheelchair.
The growing resort to violence and intimidation in our country is a product of an environment in which leading politicians not only look the other way as their constituents and affiliated groups use such tactics to press a political point, but in which the leaders themselves are complicit.
These are dangerous games being played by a major political party in its own quest for power. Whether or not Donald Trump is the most recent and most bombastic evidence of what has become of the GOP, it is the leadership and the elected officials of the party who are condoning and perpetuating an environment in which insinuations of violence will increasingly lead to acts of violence. The more that the right uses and suggests violence as a method of capturing, consolidating, and holding power, the more they become like the very terrorists they claim to be against.

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