Analysis Maternity and Birthing

In Malawi, Banda’s Succession to Presidency Could Dramatically Improve Women’s Lives

Jessica Mack

With all due respect to the late President Bingu, his death opened a rare window for reform Malawi, and golden opportunity – especially for Malawi’s women. Joyce Banda is a widely respected and heralded champion for women’s rights and health, and has never been shy to speak her mind about it.

Malawian President Bingu wa Mutharika died of a heart attack suddenly this month, enabling Vice President Joyce Banda to succeed the helm. This will almost certainly change – and perhaps save – the lives of millions of Malawian women.

Banda, the country’s first female Vice President and leader of the opposition party, had been embroiled in a political struggle for months as Bingu had tried to remove her. Bingu’s move to edge her out was part of his tightening grip overall, foreshadowing what could have been another stubborn and potentially bloody transfer of power after 2014 elections, and almost certainly not to Banda.

With all due respect to the late Bingu, his death opened a rare window for reform Malawi, and golden opportunity – especially for Malawi’s women. Joyce Banda is a widely-respected and heralded champion for women’s rights and health, and has never been shy to speak her mind about it.

Banda is Southern Africa’s first female head of state, and the continent’s second (after Liberia’s Ellen Johnson-Sirleaf). Isobel Coleman at the Center for Foreign Relations recently called her “a remarkable person who despite the odds, just might be able to put Malawi on a positive path,” as compared to her “disaster” of a predecessor. Banda left an abusive marriage as a young mother of three, and went on to found several small businesses and organizations for women before being elected to Parliament in 1999.

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She is a woman of both voice and action. Almost immediately upon taking office, she issued a directive to the Ministry of Health to appoint two OB/GYN specialists to the Ethel Mutharika Maternity Hospital to support deliveries there. In a recent press conference, she said she would do anything in her capacity to ensure that the country’s maternal mortality rate is reduced. Banda herself suffered excessive bleeding after giving birth, and nearly lost her life. Though the United Nations estimates that maternal mortality in Malawi was nearly halved between 1998 and 2008, still 3,000 women a year die needlessly in pregnancy and childbirth. Just 42 percent of married women report modern contraceptive use. 

Cultural taboos around women’s sexual and reproductive health, as well as the sheer inaccessibility of services define reality for many Malawian women. A lack of skilled personnel, whether doctors, midwives, or community health workers, to help women deliver safely is also a major factor in maternal deaths. Unsafe abortion is likely a major contributor as well. Abortion in Malawi is prohibited entirely, except to save a woman’s life, and even then spousal permission is required. Perhaps this is something Banda might be willing to step up and address. Systemic devaluation of women’s lives is a problem too, prompting Banda to single out village chiefs as gatekeepers for maternal health in the largely rural nation.

“They are the custodians of our culture and tradition. If you don’t include those chiefs, if you don’t integrate them, you can’t win in the area of maternal health.”

The year 2015 is the deadline to meet the Millennium Development Goals (MDGs), eight major targets to improving the lives and health of the world’s poorest. A recent report by the Malawian Government says the country is on-track to meet five of the eight goals, though MDG 5 – to improve maternal health – is not one of them. African leaders are under increasing pressure from their constituents and donors to turn things around for women in their countries and there are few glimmers of hope. Banda could make huge waves on this issue in just a short while.

Banda is not only an advocate for women’s health, but economic empowerment too. In 1997, she won the Africa Prize for Leadership for the Sustainable End of Hunger. Landlocked Malawi is one of the poorest countries in the world. Its economy relies heavily on agriculture, and women farmers form the engine that runs it. Banda has noted that women in Malawi are conspicuously absent when it comes to economic decision-making, and that it is critical to put more of the country’s money in the hands of its mothers. If anyone can do that, it looks like she can.

Banda is also a staunch supporter of girls’ education. Last year, in a Q&A with the Global Post, she told the story of a childhood friend forced to leave high school after the $12 school fees became too high.

“I went on to go to college and I became the vice president of Malawi. She is still where she was 30 years ago. The vicious cycle of poverty kept her there and took away her options. I made up my mind … whatever would happen in my life, I would try to send girls to schools.”

Such clarity of vision forward and backward is rare in a leader, but seems to be Banda’s defining trait.

She has already distinguished herself as a committed and articulate leader on women’s health and rights. Now with the reigns, in a historic twist of events, she can finally demonstrate what that vision, realized, can do for women. 

News Politics

Democrats in Utah, Colorado Make History as First Openly Transgender Women to Win Congressional Primaries

Ally Boguhn

Though Misty Snow's win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office."I'm not running because I'm transgender. I just happen to be transgender," the Utah candidate said.

Voters in Utah and Colorado made history Tuesday after nominating Democrats Misty Snow and Misty Plowright to run for Congress in their respective states—making them the first openly transgender women to win a major party’s congressional primary nomination.

Misty Snow, according to the bio listed on her campaign’s website, is a 30-year-old grocery store cashier from Salt Lake County, Utah, “concerned by the degree of income inequality in this country: particularly how it disproportionately impacts women, people of color, and the LGBT community.” Among the many issues prioritized on her website are paid maternity leave, a $15 minimum wage, and anti-choice regulations that “restrict a woman’s right to having a safe and legal abortion as well as any attempts to undermine a woman’s access to important health services.”

Though her win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office. “I’m not running because I’m transgender. I just happen to be transgender,” she told the Salt Lake Tribune in May. In later statement to the publication, however, Snow acknowledged that “a lot of people have told me whether I win or lose, I’m already making a difference just by running.”

Snow ran opposite Democrat Jonathan Swinton in Utah, having filed to run for office just before the March 17 deadline. Snow decided to run after Swinton, who was running for the Democratic ticket unopposed, penned an op-ed in September arguing that Planned Parenthood should be investigated—though the government should not be shut down over it. After reading the op-ed and thinking it over for several months, Snow told the Tribune she began to think the people of Colorado deserved a more liberal option and thought, “Why not me?”

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Snow’s win means she will move on to run against incumbent conservative Sen. Mike Lee. As previously reported by Rewire, Lee is stringently anti-abortion and has consistently pushed measures “attempting to limit access to or outright ban abortion.”

Misty Plowright, who is running to represent Colorado’s 5th congressional district, describes herself as an “Army veteran, a self-educated woman, a member of the LGBTQ+ community, and a passionate social democrat,” according to her campaign’s website. An IT worker from Colorado Springs, Plowright billed herself as the “anti-politician” during an interview with the Colorado Springs Gazette, and is running on a platform that includes campaign finance reform and defending voting rights.

Plowright will now challenge incumbent Rep. Doug Lamborn (R) for his seat in the House.

Plowright congratulated Snow in her win in a Wednesday post to her campaign’s Facebook page. “Congratulations from ‪#‎TeamMisty‬ to another progressive candidate in Utah, Misty K Snow,” wrote Plowright’s campaign. “Both women made history last night by winning their Democratic Primary.”

As Slate reported, though the candidates may have both won their primary races, “Snow and Plowright face uphill battles in the coming months”:

Despite a Gallup survey from March 2015 that calculated Salt Lake City’s LGBTQ population as the seventh-highest in the nation, Lee leads Snow 51 percent to 37 percent among likely general election voters according to a poll commissioned by the Salt Lake Tribune and the Hinckley Institute of Politics in early June. And Lamborn, who has represented Colorado’s heavily conservative fifth district since 2007, took nearly 60 percent of the vote in his most recent reelection fight.

Analysis Maternity and Birthing

Pregnant Women Are Being Shackled in Massachusetts—Even Though It’s Been Illegal for Years

Victoria Law

According to a new report, not a single jail or prison facility in the state has written policies that are fully compliant with the law against restraining pregnant women behind bars.

Korianne Gamble was six months pregnant in November 2014 when she arrived at the Bristol County Sheriff’s Office Women’s Center, a jail in North Dartmouth, Massachusetts. Six months prior, the state had passed “An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates.”

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.

According to a new report, Gamble isn’t alone. Advocates have been monitoring pregnancy-related care since the law’s passage. After obtaining and analyzing the policies of the state’s prison and jail system, they found that no facility has policies that are fully compliant with the 2014 law. They issued their findings in a new report, Breaking Promises: Violations of the Massachusetts Pregnancy Standards and Anti-Shackling Lawco-authored by Marianne Bullock of the Prison Birth Project, Lauren Petit of Prisoners’ Legal Services of Massachusetts, and Rachel Roth, a reproductive-justice expert.

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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Medical experts, including the American Congress of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives, have all agreed that shackling during pregnancy is unnecessary, inhumane, and dangerous. Shackling increases the risk of falling and injury to both mother and fetus while also preventing medical staff from assessing and assisting during labor and delivery. In 2014, both the Massachusetts legislature and then-Gov. Deval Patrick (D) agreed, passing the law against it.

“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.”

Since then, both the Public Safety Committee and Health Care Financing Committee approved the bill. It is now before the House Committee for Bills in the Third Reading, which means it is now at the stage where it can be taken up by the House for a vote.

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.”