Women’s health and rights advocates around the world applauded the appointment today of Dr. Babatunde Osotimehin of Nigeria as Executive Director of the United Nations Population Fund (UNFPA), the international development agency that assists countries in developing the technical and health systems capacity to improve reproductive and sexual health. UNFPA, according to its mission statement:
Promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV, and every girl and woman is treated with dignity and respect.
Osotimehin, who will replace outgoing executive director Thoraya Obaid whose term officially ends December 31st, is currently Professor of Medicine at the University of Ibadan, Nigeria, and the African Spokesperson for the Partnership for Maternal, Newborn and Child Health.
He previously served as both Minister of Health and Director General of Nigeria’s National Agency for the Control of HIV and AIDS. Throughout his tenure as Director General of the AIDS agency, he advocated strongly for evidence- and rights-based policies, even as his own government, under pressure from both the Bush Administration and Nigerian clerics, turned toward failed abstinence-only-until marriage programs to secure United States funding. Moreover, he welcomed advocates as partners. In a prior position working on US international policy, I personally had the occasion to meet him in Nigeria and work with him and his staff on advocacy around HIV and AIDS prevention issues.
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The issue of who would take the lead of UNFPA comes at a critical juncture, when ultra-conservative political and religious groups are seeking to limit or completely eliminate women’s reproductive and sexual rights both in the United States and abroad. Advocates expressed confidence in his ability to meet current challenges.
“Babatunde ‘s appointment comes at a pivotal time for sexual and reproductive rights and health,” said Adrienne Germain, president of the International Women’s Health Coalition (IWHC). “Dr. Osotimehin brings to the job substantial knowledge of and an impressive track record in health policies, programs and services.”
“The appointment of Dr. Babatunde Osotimehin as the new head for the United Nations Population Fund (UNFPA) is an opportunity to recommit ourselves to addressing the needs of the world’s women and children,” said United Nations Foundation President Senator Timothy E. Wirth.
“More than 215 million women around the globe want to determine the number, spacing, and timing of their children, but lack access to reproductive health and family planning options,” said Wirth. He continued:
Poor women and adolescent girls in developing countries tend to be disproportionally denied access to these services. A former Minister of Health of the Federal Republic of Nigeria, Dr. Osotimehin has championed reproductive health and rights and global development challenges with a clear understanding of the importance of women and girls in meeting those goals. This kind of experience will be critical in helping UNFPA continue to meet its mission of making certain that every pregnancy is wanted, every birth is safe, every young person is free of HIV, and every girl and woman is treated with dignity and respect.
The IWHC statement lauded Dr. Osotimehin for his:
“unparalleled ability to build consensus, between the capital and state governments, as well as inside and outside the government, on multi-dimensional strategies and investments to address several of the country’s most challenging sexual and reproductive health issues.”
“This makes Dr. Osotimehin particularly qualified to lead an agency whose mandate is to promote and protect sexual and reproductive health and rights,” said the statement.
“As a key partner of the UNFPA, IPPF looks forward to working with Dr. Osotimehin to achieve our joint goals of delivering better services and outcomes for women, men and young people. In particular, our collective pledges to do more to achieve the MDGs and support the new Global Strategy for Women’s and Children’s Health intended to save the lives of 15 million children, prevent 33 million unplanned pregnancies, and prevent the deaths of 800,000 women and girls from pregnancy and childbirth.
“There is a critical need, “continued Greer, “to refocus our efforts on Family Planning to achieve these goals.”
[The] omission [of family planning] from the first 7 years of investment in the MDGs made it invisible and what is invisible is inevitably overlooked and underfunded. So now we must make up for lost time, lost opportunities and lost lives – not only to address the needs of the estimated 215 million women who are unable to access the modern contraception they need and want, but also to address the needs of the 1.8 billion young people who are approaching reproductive age.
Bene Madunagu of the Nigerian group Girls Power Initiative, also praised his appointment. “We at Girls’ Power Initiative (GPI) are overjoyed to hear that Professor Osotimehin will lead this fundamentally important agency,” said Madunagu. “He has been one of our most unfailing defenders and supporters in the struggle to get the rights of girls recognized and ensure that they have the power to exercise them.”
“Thanks to visionary leadership from Prof. Osotimehin, GPI is able to work with the State AIDS Control Agencies to make comprehensive sexuality education and health services available to young people,” said Madunagu. “And my generation of women has also benefited enormously from his devotion to women’s health and rights.”
Osotimehin has made clear his own commitment to these issues:
“We must invest far more in comprehensive reproductive health services, including those that address problems of HIV, in order to reach the girls and women who are not likely to use separate HIV services for fear of stigma and violence…
“…In Nigeria, we are painfully aware that girls and women typically cannot negotiate when, where or with whom they have sex; that far too few have access to affordable health services; and that sex education is not available or accessible to many girls.”
Given the direct threats to women’s lives and health posed by anti-choice groups in every region, he faces serious challenges in his new role.
“As Dr. Osotimehin knows only too well, the task ahead is not an easy one,” said Greer. “It will require promises to be kept, new partnerships to be made. Civil society’s unique role in delivering this agenda is something Dr. Osotimehin has consistently supported.”
Wirth sees Osotimehin’s appointment as critical to the success of the Global Strategy for Women’s and Children’s Health launched earlier this year by UN Secretary-General Ban Ki-moon.
“The strategy ties the health of the world’s women and girls to the achievement of major reductions in infant and maternal mortality, HIV infections and global poverty,” notes Wirth. “Dr. Osotimehin, in his new position, will have the opportunity to significantly contribute to the success of this global strategy and advance full implementation of the International Conference on Population and Development’s Programme of Action, which emphasizes universal access to reproductive health services.”
According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.
But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.
In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.
“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.
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“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”
Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.
Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.
As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.
That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.
She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.
At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.
But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.
Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.
But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.
When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.
According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.
Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.
Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”
While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)
“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”
Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.
Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.
“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.
But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.
That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)
Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.
Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.
Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.
While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”
But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.
As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.
The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.
In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”
Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”
This weekend, the New York Times published the results of interviews with more than 50 people, many of whom attested to the fact that in both private and public life, presumptive Republican presidential nominee Donald Trump made “unwelcome romantic advances” toward women and exhibited “unsettling workplace conduct over decades.” Translation: He objectified, sexually harassed, and made unwelcome comments and advances toward women with whom he worked, whom he met in social settings, or who participated in his reality show empire. He even, according to one person quoted in the Times, sought assurance that his own daughter was “hot.” Yet GOP leadership has been largely dismissive of Trump’s track record—which speaks volumes about the party’s own feelings on women.
While important in its detail, the Times story is anything but surprising. Trump is a historical treasure trove of misogynistic behavior and has talked about it openly. In an interview with Esquire, for example, Trumpstated: “You know, it doesn’t really matter what [the media] write as long as you’ve got a young and beautiful piece of ass.” He has frequently made derogatory comments about the looks of female politicians, journalists, actresses, and executives: He’s claimed that “flat-chested” women can’t be beautiful and mused about the potential breast size of his infant daughter. He’s suggested that sexual assault in the military is “expected” because men and women are working together and that the thought of someone pumping breast milk is “disgusting.”
Forgive me if I am not shocked that reports indicate he’s no feminist. Female voters know this: Even conservative news outlet National Reviewfretted about the fact that both Trump and former presidential aspirant Sen. Ted Cruz (R-TX) are both highly unpopular among female voters, noting that “seven out of ten women (67 percent) have an unfavorable view of Trump, and only 26 percent view him favorably… and [some] polls have his unfavorability ratings among women even higher, at 74 percent.”
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In interviews this weekend, the Times‘ report elicited what was effectively a yawn from Reince Priebus, chair of the Republican National Committee, the guy charged with leading the GOP both in terms of the party’s platform and in helping its candidates across the country get elected. On Sunday, Fox News‘s Chris Wallace asked Priebus whether the reports of Trump’s mistreatment of women bothered him. Priebus responded by asserting that “people just don’t care” about all these stories, although when pressed, he suggested that Trump would have to answer to his own statements.
But that dodges the question. Priebus is the head of the party and also needs to take responsibility for his nominee’s behavior, as does the party itself. He did not say, “I deplore the remarks Trump has made during the campaign,” or, “as a party, we need to reflect deeply on why our candidates and policies are so deeply unpopular among a group that makes up more than half the U.S. population.”
Priebus said none of that. He just shooed the issues away. The fact he did not even attempt to address the substance of the Times article is the most telling news of all.
The reality is that Trump’s “problematic attitude toward women” is not an isolated problem. For the GOP leadership, it is not a problem at all, but the product of their fundamental policies and positions. The GOP has been waging war on women’s fundamental rights for nearly two decades; it’s just gotten more brash and unapologetic about the attitudes underlying the party’s policies. The GOP is full of candidates who think pregnancy resulting from rape is a blessing; who minimize and stigmatize the role of access to contraception and abortion in public health and personal medical outcomes; who demonize and marginalize single mothers; and who won’t pay for basic services to help the poor. The GOP platform is built on policies that seek to deny women access to reproductive and sexual health care, including but not limited to abortion, thereby also denying them the right to self-determination and bodily autonomy. So the fact that both the party leaders and the media spun themselves into a tizzy when Trump suggested he would imprison women who had abortions was all theater. That is GOP policy.
The GOP majority in Congress and in state legislatures continues to deny low-wage workers—the majority of whom are women—living wages, labor protections, and paid family leave. At the state level, Republican governors and legislators have obliterated funding for education, child care, aid to single-parent families, aid to children with disabilities, and basic health-care services. And Trump is far from unique in this election cycle among GOP presidential candidates: Republicans in the running from Ted Cruz on down have used women as objects when it is convenient, with Cruz going so far as to parade his two young daughters on the campaign trail in bright pink dresses, seemingly to underscore their “innocence” and to stoke fear of transgender persons seeking access to the most basic facilities, though many of those are young girls themselves.
It’s not only Donald Trump’s mistreatment of women. It’s that the GOP’s platform is based on sheer misogyny, and the leadership has to ignore it or they’d have to rethink their entire platform and start from scratch.