News Health Systems

Lack of Contraceptive Access: The Public Health Emergency in Eastern Burma

Anna Clark

A report released today details how the public health emergency in eastern Burma continues to undermine the health and well being of millions of people affected by decades of war. Women in eastern Burma face the worst pregnancy outcomes anywhere in Asia, and access to contraception is virtually nonexistent. 

Also see Cari Siestra’s and Angel Foster’s article about unsafe abortion practices in Eastern Burma.

Though the historic ceasefire in Burma between the government and the Karen National Union (KNU) has been called into question, the nation is continuing to move rapidly through a series of astonishing changes. After 60 years of internal conflict, 651 political prisoners were released from Burma’s prisons this past month, including both convicted military leaders and prisoners of conscience. Aung San Suu Kyi, the Nobel Peace Prize-winning opposition leader formerly under house arrest is running for parliament in Rangoon. President Thein Sein is urging Western nations to remove sanctions on Burma.

But “Separated by Borders,” a report released last week from Ibis Reproductive Health and the Global Health Access Program, details how the public health emergency in eastern Burma continues to undermine the health and well being of millions of people affected by decades of war. The resulting decay of healthcare-related infrastructures and a long legacy of human rights violations—including the military’s policy of denying health care to certain ethnic groups—have all taken their toll. Burma’s maternal mortality rates now dwarf the rates in Thailand and Burma (Myanmar) as a whole, leaving women in eastern Burma with the worst pregnancy outcomes anywhere in Asia.

Access to contraception is virtually nonexistent: an estimated 80 percent of women in eastern Burma have never used birth control. This naturally results in high numbers of unplanned pregnancies. Post-partum hemorrhage and unsafe abortion are the leading cause of maternal mortality for Burmese women. Small wonder given the scarcity of hospitals, the difficulty of traveling through conflict zones, and the generally low priority given to women, period, let alone when they are pregnant.

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Dr. Angel Foster, an affiliated scholar with Ibis and one of the report’s authors, is returning to the region this week to support the training of local health workers.

“Too often, those working with refugees, migrants, and cross-border populations in Thailand do not coordinate a common standard of service,” she explained. “The patchwork practice leads to misinformation among Burmese people.”

Dr. Foster offers emergency contraception as a prime example. It’s key to preventing unintended pregnancies, which is particularly important given the high rate of sexual assault in the immigrant camps along the Thai/Burma border. But some clinics only provide EC to patients if they can document that they are assault victims; others do not provide EC to teenagers, or unmarried women. “If you happen to go to one of the clinics where you don’t get it, you tell your friends about that experience, and they don’t know that other organizations will make EC available,” Dr. Foster said. “People aren’t asking for it because they don’t know it’s possible.”

Now that the European Union has lifted its ban on travel to Burma, human rights organizations will once more have the opportunity to bring first-world reproductive health care to the region. Cari Siestra, a lawyer and the report’s co-author, hopes the unprecedented information collected in “Separated by Borders” will assist the outside groups moving towards providing aid to eastern Burma. “The time has come to rebuild the health and human rights of the millions of men, women, and children affected by this conflict,” she said.

Both Foster and Sietstra believe that the reproductive health emergency must be a priority during this period of transformation. Said Foster:

“When women don’t have control over their fertility, when to have a child and how many, it limits their ability to fully participate in political life, or in wage employment, or in education opportunities.”

Sietstra adds, “Women’s autonomy is tied to their reproductive choices. If the families of eastern Burma are to return to health and wellness, women and families absolutely need to control fertility – to choose whether or not to have a child, and to have access to services that allow them to have a child safely.”

News Law and Policy

Anti-Choice Groups Try ‘Texas Playbook’ in Attempt to Block Health-Care Access in California

Jessica Mason Pieklo

The fight to open a Planned Parenthood health-care clinic in El Centro, California, shows that national anti-choice groups are intent on rolling back reproductive health care gains in even the most progressive parts of the country.

California may be traditionally progressive with a history of protecting reproductive rights, but Imperial County has become a new front in the anti-choice movement’s effort to erode abortion access well outside the confines of GOP-controlled red states.

Imperial County sits on California’s southeastern corner, bordering Arizona and Mexico. Go west and you’ll hit San Diego; north, and you’ll hit Palm Springs. About 80 percent of the county’s households identify as Latino and 65 percent speak predominately Spanish at home, according to the last census.

Despite its desert landscape, Imperial County has wide swaths of farmland thanks to irrigation fields fed by the Colorado River on its eastern border and the Hoover Dam. Jobs in agriculture account for about a quarter of all employment in the county, and even though the state is in a historic drought, water for the area is all but guaranteed because of local politics.

The same cannot be said for reproductive health care, as national anti-choice activists have focused their attentions on a Planned Parenthood health-care facility opening in the valley’s El Centro, California.

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“Imperial Valley statistically is now rated fourth highest in the state for teen births,” Tracy Skadden, general counsel for Planned Parenthood of Pacific Southwest, told Rewire in an interview. “It has one of the highest rates of unemployment in California; the high schools sometimes have day care centers.”

Skadden said Planned Parenthood agency members spent about five years on the ground in Imperial Valley meeting with members of the community and local organizations to get an understanding of the area’s unique health-care needs before putting together the effort required to open a new facility.

“We know that they don’t have any reproductive health-care access specifically as it relates to abortion services,” Skadden said. “We know that they have very long waits to get in to see a doctor. A lot of the men and women who come to see us, because they don’t have any insurance coverage they really don’t go to doctors very often.”

“Some of the women in their 30s and 40s who come to see us have never had a pap smear,” she continued. Through the Planned Parenthood facility, “they get wellness checks, they get their cholesterol checked, possibly they get screened for diabetes. We don’t treat those things, but we do refer them to other health-care clinics that can.”

The El Centro facility is the only one to provide abortion care anywhere in Imperial County. Still, despite a chronically underserved population in need of comprehensive reproductive health care, Planned Parenthood faced what Skadden described as opposition that was “unprecedented for California” in opening the new facility in El Centro, the heart of Imperial Valley.

After funds for the new facility had been raised, architectural plans were approved by government officials, and all necessary permits were obtained, Planned Parenthood broke ground and finished building the facility this spring.

Then the protests started.

“The thing that triggered the protesters from the very beginning was our ‘now hiring’ sign that we put up under our logo,” Cita Walsh, vice president of marketing and communication, said in an interview with Rewire. “When we put the sign up we had hundreds of people apply for jobs at our health center.”

While the facility applied for a standard transfer agreement for patients with the city-owned El Centro Regional Medical Center, an area church organized about 500 protesters to come to the hospital’s board meeting and complain that by signing the transfer agreement, local officials were “authorizing abortions to occur in Imperial Valley.”

The city, in response to the anti-choice backlash, agreed to hire a third-party law firm to review the transfer agreement. That law firm told the city council the transfer agreement was legal and there was no reason the center should not open.

Walsh said that harassment escalated after the transfer agreement was complete, with more than 2,000 anti-choice protesters complaining to the El Centro city council about the opening of the health-care center.

“The National Right to Life Movement inserted themselves as outsiders into the Imperial Valley in an attempt to embed Imperial County and ignite the local churches and help them organize,” Walsh said.

National anti-choice activists, from former Minnesota Rep. Michele Bachmann (R) to Alveda King, came to the Valley to raise funds for efforts to stop the clinic’s opening.

“They brought in people from out of state to try and get the Imperial Valley Coalition for Life funded in order to teach them how to use the Texas playbook,” Walsh said. The Texas playbook, as described by Walsh, is centered on pressuring local officials into endorsing TRAP (targeted regulations of abortion providers) measures.

“It starts with you try to stop them with transfer agreements and then you have a lot of protesters,” Walsh said. “It felt a little like Mississippi or Texas, but right here in California.”

Days before the facility was set to open, after city officials had told Planned Parenthood of the Pacific Southwest to invite trained staff in to begin setting up, El Centro city officials denied Planned Parenthood of the Pacific Southwest its occupancy permit on the grounds that the building had been improperly classified and would need significant, additional upgrades before opening.

No other comparable facility in California is subject to the more burdensome requirements city officials want to impose on the El Centro facility.

The decision to reclassify the building just prior to its opening was made by El Centro Fire Chief Kenneth Herbert. Herbert explained to Rewire in an email that architects made the initial occupancy classification, but that “[b]ased upon conditions observed,” he decided the building needed more stringent requirements and denied fire clearance.

Herbert declined to elaborate on what conditions he observed that prompted his decision that the facility needed a more stringent classification. He told Rewire that since the initial permit denial, there have been changes made to the building in an attempt to comply with the “occupancy classification B requirements.” After a five-week delay, the city issued the facility a temporary certificate of occupancy.

In other words, the state-of-the-art health-care facility meets all the health and safety requirements it was required to all along.

In signing the licensing document, however, Herbert put in special conditions for their license to remain in place, Skadden said. One condition provides the fire chief with the authority to revoke the document pending a review of the building code by the state’s Fire Marshall Department. Herbert has requested from the State Fire Marshall’s office “a formal interpretation of the occupancy based on the use of the building.” That process could take up to 90 days.

“We complied with all the building, fire, and safety requirements for licensure, but the City of El Centro fire chief made an arbitrary and unilateral decision to deny our final documentation,” Skadden said. “The dispute is over a California building code. But it was clear this was about our abortion services.”

Planned Parenthood of the Pacific Southwest successfully fought back this round of challenges to providing reproductive health care in Imperial County, but more challenges lie ahead. The Imperial Valley Coalition for Life reported on its Facebook page that “friends” of its organization purchased the property right next to the new Planned Parenthood clinic.

The anti-choice group charged that the property is now “available to our prayer warriors from the 365 days for life to park and to pray and it will be available for sidewalk counseling also.”

Meanwhile, those opposed to legal abortion care continue to protest outside the El Centro facility. “We’ve had some vandalism already, but we are very vigilant with our security and our number-one priority is to the safety of our patients and staff,” Skadden said. “California has a long history of protecting reproductive rights, which, thankfully, we were able to rely on our safety and health codes and our California Constitution and other laws that do protect reproductive health care.”

The hope for Planned Parenthood of the Pacific Southwest is that the political fight to provide reproductive health care in Imperial Valley is over. “We intend [to] provide health care in Imperial Valley and to work with the city,” Skadden said. “We all have a mutual goal of increasing the health outcomes of the community in Imperial Valley.”

News Law and Policy

Obama Administration Throws Science and Public Health Out the Window in Appeal of Plan B Ruling

Jessica Mason Pieklo

The Obama administration announced it was appealing a federal court order that lifted age-restrictions on the sale of emergency contraception.

Just one day after the Food and Drug Administration (FDA) announced it would allow one brand of emergency contraception to be sold over-the-counter and without a prescription to people ages 15 and up, the Obama administration capitulated further to anti-choice conservatives and appealed a lower court ruling directing the agency to make emergency contraception available over-the-counter and without prescription to anyone who needs it, regardless of age.

On April 5, U.S. District Court Judge Edward Korman ordered the FDA to make levonorgestrel-based emergency contraception available without a prescription and without point-of-sale or age restrictions within 30 days. The ruling, a significant victory for science-supported public health policy, was in response to the Center for Reproductive Rights’ renewed lawsuit against the agency to expand over-the-counter access to the morning-after pill to women of all ages. In his 59-page decision, Judge Korman specifically called out the government’s stalling tactics, noting the “FDA has engaged in intolerable delays” amounting to an “administration agency filibuster” that plainly put politics before science.

The Obama administration has also asked Judge Korman to stay his April court order pending the outcome of the appeal.

Nancy Northup, president and CEO at the Center for Reproductive Rights, said in a statement:

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Women who urgently need emergency contraception have been delayed in getting it or denied access entirely for more than a decade because of the political maneuverings of the last two presidential administrations.

The federal court has made clear that these stalling tactics were based purely on politics, not science.

We are deeply disappointed that just days after President Obama proclaimed his commitment to women’s reproductive rights, his administration has decided once again to deprive women of their right to obtain emergency contraception without unjustified and burdensome restrictions.

The appeal will not affect the FDA’s decision on Plan B but instead will likely address the broader issue of whether the agency acted arbitrarily and capriciously in setting the age restrictions to begin with and could challenge the precedent of a federal judge striking down an order by Department of Health and Human Services Secretary Kathleen Sebelius, a sitting White House cabinet member. With the administration in the end stages of negotiating a final compromise on the contraception benefit in Obamacare, the decision to appeal the emergency contraception ruling could have as much to do with the contraception benefit as the FDA.

It’s also unclear what, if any, explanation the administration can offer in its decision to advocate for limiting access to emergency contraception, beyond the belief—expressed by the president but wholly unsupported by science—that individuals younger than 15 would be potentially harmed by having access to it. And while administrative agencies like the FDA have broad rule-making authority, Judge Korman, a conservative judge, decimated the administration’s purported concerns in a scathing opinion that detailed the politics and utter disregard for settled science exhibited by HHS in over-ruling the FDA’s original decision. The science is not on the administration’s side in this decision, and the politics shouldn’t be either.

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