Roundups Sexual Health

Global Roundup: UN Reports on Global Maternal Health; Zambian Constitution Faces Conflicting Reproductive Health Rig

Avital Norman Nathman

Weekly global roundup: United Nations report on global maternal health yields mixed results; South Asian teen girls still marrying at high rates; Zambia sees conflict over various articles on reproductive rights in new constitution draft; Indonesia continues to struggle with reproductive and sexual health as they face growing rates of HIV infection.

India & Nigeria: Top Maternal Death Rate Worldwide

Last week’s release of a United Nations report on global maternal health yielded mixed results. An estimated 287,000 women worldwide died due to complications related to pregnancy and childbirth in 2010, a decline of 47 percent from a decade ago. Despite the decline, the report noted that a woman dies of pregnancy-related complications every two minutes, and many of these deaths could be prevented with proven interventions. 

The greatest struggles with maternal mortality and morbidity remain in Sub-Saharan Africa and Southern Asia. In fact, while countries like China are showing a steady improvement in their rates (most likely attributed to lower birth rates overall due to the country’s one-child policy), India and Nigeria account for one-third of total maternal deaths world wide. The results of this study indicate that neither India or Nigeria will meet the Millennium Development Goal (MDG) target of reducing maternal deaths by 75 percent from 1990 to 2015. Via New York Times & Outlook India.

South Asia: Adolescents Still Seeing High Rates of Child Marriage

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A new report released by the Journal of American Medical Association reveals that while child marriage is becoming less prevalent in South Asia for those under the age of 14, young girls 15 years of age and older are still getting married at the same rate as 20 years ago. Child marriage has declined dramatically in some countries: by 35 percent in India, 57 percent in Nepal, 45 percent in Bangladesh, and 61 percent in Pakistan for girls fourteen and under.  However, those same countries saw steady or, in some cases, increased rates for girls over the age of fifteen.Despite the fact that eighteen is the legal age for marriage in Bangladesh, the study found that the rate of child marriage of 16 year olds rose 36 percent in the country since 1991. 

According to the study’s co-author, Anita Raj:

“There needs to be a greater focus on prevention of marriage among later adolescents. If we cannot impact [the] reduction of marriage in this age group, we’ll continue to see inadequate change on reduction of girl child marriage as a whole.” 

Via International Business Times.

Zambia: Conflicting Reproductive Health Rights In New Draft Constitution

As Zambia works to draft up at new constitution, issues have arisen over conflicting language in separate articles that concern reproductive rights. Article 52 of the new draft constitution states that women have the right to reproductive health, including family planning, as well as access to related education and information. However, as Executive Director of the Planned Parenthood Association of Zambia (PPAZ), Edford Mutuma noted, article 52 seems to be in conflict with article 28, which states that a person has the right to life, and that life begins at conception. 

Mutuma’s concern is that the articles may cause confusion for medical professionals and could possibly lead to implementing restrictions on women’s reproductive health services – including various forms of contraception. Not only could these conflicting articles lead to restrictions, but if the right to life is considered to begin at conception, then some reproductive health services and procedures may become unconstitutional in Zambia. Via All Africa.

Indonesia:Continued Poor Access to Reproductive & Sexual Health Services

According to a visiting UN official, poor access to reproductive and sexual health services in Indonesia is one of the biggest obstacles affecting the country’s success in achieving its targets for the Millennium Development Goals (MDGs) by 2015. The biggest challenge is the decentralization of the country, making it difficult to ensure that contraception and access to sexual health services are available in rural and poor areas spread out among over 17,000 islands. 

Lack of access to these services has had an impact on Indonesia’€™s family planning program, causing it to remain stagnant, with the more severe impact seen in the increasing rates of various STIs. Health Ministry data from Indonesia showed that 186,257 people were infected with HIV in 2009. Without accelerated preventive measures, the country will see that rate increase to over 500,000 infected people by 2014. However, the implementation of new programs, including a pilot program designed specifically to revitalize Indonesia’stagnant family planning programs is providing some hope for the country. Via The Jakarta Post.

Analysis Human Rights

The Flint Water Emergency Is a Reproductive Health Crisis

Kanya D’Almeida

Today, the entire nation is aware of the disaster. But for well over a year, residents in this city of some 100,000 people fought a lonely battle to convince the authorities that they were drinking, bathing, and cooking with poisoned water.

Read more of our articles on Flint’s water emergency here.

At first the signs were subtle—a slight discoloration of the tap water, a strange smell lingering in the shower stall or bathtub. Then the symptoms became more severe. Adults started to lose clumps of their hair and children broke out in rashes. Suspicions grew into fears, which were subsequently confirmed by studies. Families waited anxiously for test results to trickle in.

It all began in April 2014 when the city of Flint, under a state official, switched its water source from Lake Huron to the highly corrosive Flint River in a cost-cutting scheme aimed at saving $5 million in a two-year period. The chloride-heavy water quickly ate away at Flint’s aging infrastructure, leaching lead from the pipes into the water supply. Today, the entire nation is aware of the disaster. But for well over a year, residents in this city of some 100,000 people fought a lonely battle to convince the authorities that they were drinking, bathing, and cooking with poisoned water.

From the very beginning, women were at the forefront of the movement to raise awareness about possible lead contamination, demanding answers from officials and teaming up with independent researchers to conduct their own water tests.

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As households continued to consume the murky, toxic water, mothers started noticing changes in their kids’ behavior, including slower cognitive capabilities, according to reports. Elderly people were developing lesions in their skin. Before long, local, women-led groups like Water You Fighting For and the Flint Democracy Defense League had begun to mobilize their communities to raise the issue as a public health crisis. Families came out to demonstrations holding samples of the discolored water and signs that said, “Stop Poisoning Our Children.”

“I remember one woman who would come out to some of the earliest protests—she was a senior citizen and each time she would show up with a bigger and bigger ball of her own hair,” Sylvia Orduño, an organizer with the Michigan Welfare Rights Organization, said in an interview with Rewire. “She had this really long hair but pretty soon, I was able to see her scalp because she was losing so much of it.”

She said other women were panicking about rashes breaking out in their children’s genital areas. “And one mother even told me her 4-year-old was having trouble speaking: Like, there were words he knew but he was struggling to communicate them.”

Health-care providers, too, began noticing how their patients became particularly anxious about what the water situation meant for their family’s health and well-being.

“Soon after the switch we started noticing a difference in the communities we serve and the patients who were seeking care,” Sabrina Boston, manager of the Planned Parenthood Health Center in Flint, told Rewire in a phone interview.

In June 2015, a full year after Flint residents had first begun to consume lead-contaminated water, the Michigan chapter of the American Civil Liberties Union released a mini-documentary titled Hard to Swallow: Toxic Water Under a Toxic System in Flint. It featured several Flint residents, including LeeAnne Walters, whose five children started falling ill shortly after the switch in 2014. Anxious about her kids’ “scaly skin,” rashes, and rapid hair loss, Walters summoned city officials to test her tap water. The test returned results that showed lead levels at 397 parts per billion (ppb). By comparison, the Environmental Protection Agency warns that anything over 15 ppb can cause “irreversible” damage to a child’s brain.

Subsequent testing by volunteer researchers from Virginia Tech University showed Walters’ tap water to contain lead levels of over 13,000 ppb. According to this ACLU video, a lead-to-water ratio of 5,000 ppb is considered hazardous waste. Walters has since moved away from Flint, but her attempts to get to the bottom of her family’s sudden health problems have been widely recognized as instrumental in galvanizing national attention for the situation on the ground, which state and city officials had long sought to conceal.

Serious Consequences for Maternal and Child Health

Today, much of that cover-up is a matter of public record, with Michigan Gov. Rick Snyder (R) last week releasing official emails revealing his administration’s knowledge of the problem for well over a year.

On January 16 President Obama declared a federal state of emergency in the majority-Black city, days after Gov. Snyder had deployed the National Guard to assist in relief efforts, including distributing bottled water and filters to tens of thousands of households. Federal aid totaling $5 million—the maximum allocation possible under federal emergency laws—was recently made available to help mitigate the crisis. In addition, according to the New York Times, President Obama announced last Thursday Michigan could have immediate access to $80 million that had previously been earmarked for federal water infrastructure development. It is still unclear how this funding will be allocated.

Even as help pours in from around the nation, with big-name celebrities pledging tens of thousands of dollars in financial support, residents in Flint continue to suffer the health impacts of consuming and being in contact with lead-poisoned water, which has particularly serious consequences for maternal and child health.

According to the World Health Organization, there is no known “safe” blood-lead concentration, although the severity of symptoms and likelihood of longer-term impacts increase along with exposure. These include behavioral issues and reduced cognitive functioning in young children, as well as anemia, hypertension, and toxicity to their reproductive organs. WHO research also shows that high levels of lead exposure over a prolonged time period can severely damage a child’s brain and central nervous system, causing comas, convulsions, and in some cases death.

Data from the Centers for Disease Control and Prevention show that pregnant women and lactating mothers who are exposed to lead are at heightened risk of gestational hypertension. And since lead can persist in bones for decades, especially in pregnant and lactating women, mothers and their babies remain exposed to lead long after external sources of contamination have been eliminated.

“This is a reproductive health crisis of monumental proportions that you would not expect to see in a developed country and certainly not in a state … like Michigan, which ironically is surrounded by one of the largest bodies of fresh water in the world,” Dr. John Hebert, director of the Obstetrics and Gynecology Residency Program at the Hurley Medical Center, told Rewire.

By his estimates, based on his department’s observations of the unfolding crisis, between 9,000 and 10,000 children, and at least “a couple of thousand pregnant women” have likely been exposed to lead-contaminated water. For pregnant women this means “a heightened risk of pre-term delivery, increased rates of miscarriage, and low birth weight in infants,” he said.

In fact, one of the earliest notices warning residents to refrain from drinking Flint water, back in September of 2015, was directed at “senior citizens, children, and pregnant women,” after an independent study by the Hurley Medical Center found double the acceptable levels of lead in Flint water.

But simply issuing such an advisory in a city with a staggering poverty rate could not ensure compliance. In its Geography of Poverty article series, MSNBC reported that between 2009 and 2013, nearly half (41.5 percent) of Flint’s residents lived below the poverty line, far higher than the state’s 16.8 percent poverty rate. During the same period, about a quarter of Flint’s families lived on less than $15,000 per year, while the child poverty rate was 66.5 percent—nearly 10 percentage points higher than Detroit’s, which sits about 70 miles south.

“When you live in the affected zip codes you don’t have a choice,” Dr. Hebert explained. “You can’t simply stop drinking the water. Mothers have used this water to prepare formula for their infants; they may have been forced to drink contaminated water and then breastfeed their children. This crisis is absolutely not to be taken lightly.”

“The Damage Has Already Been Done”

Reproductive justice advocates say the situation in Flint not only represents a local public health emergency but also mirrors a larger crisis of reproductive justice for low-income women of color around the country.

“We are seeing so many intersecting issuesfrom economic justice to environmental justice to health-care accessmeeting right in the middle, and landing in a community that is overwhelmingly Black and where low-income communities of color are bearing the brunt of this collision in the most horrific ways,” Monica Simpson, executive director of SisterSong Women of Color Reproductive Justice Collective, told Rewire. A majority of Flint’s residents—about 52 percent—are Black.

Simpson stated, “This is a severe reproductive justice crisis that cannot be ignored.”

Referring to the fact that Michigan’s Republican-led legislature, which was complicit in the water crisis, has a long history of pushing a so-called pro-life agenda, Simpson said, “This is our opportunity to reclaim our language. For too long many of us within the reproductive justice movement have been forced into the ‘pro-choice’ category by default, because we support abortion access. In fact, I consider myself pro-life: I support every woman’s right to live her best and most healthy life possible. But I haven’t been able to embrace that label, which has been hijacked by people who call themselves pro-life but are really pro-privilege and pro-white supremacy. If they cared about life, they would not be hand-picking who gets access to water, they would be ensuring that every woman and child has that right and that access.”

For reproductive health-care providers, the decision to respond to calls from the community was an obvious one. Planned Parenthood’s Boston told Rewire that the Flint Health Center, which sees about 3,200 patients annually, amounting to close to 7,000 visits each year, initially distributed water filters in partnership with the Flint Health Department, and later began to hand out free bottled water.

Flint resident Tunde Olaniran, the outreach manager for Planned Parenthood of Mid and South Michigan, who first brought the crisis to the organization’s attention, said he took his cue from local organizers who’ve been mobilizing since the switch happened back in April 2014.

“I was listening to the voices of women of color and organizations like the Genesee County Healthy Sexuality Coalition and the Coalition for Clean Water, who were talking about the toxicity of water long before any reports were released,” he told Rewire. “There is a lesson here on the need to listen … to grassroots organizers and impacted community members on how to solve very serious issues.”

Boston said that many patients and visitors to the center are “still expressing fears, confusion, and anger.”

“They are looking for guidance on what this means for their children, their families, and their own health,” she explained, adding that the clinic continues to educate patients about possible health risks and steps they can take to mitigate the impacts of lead contamination. Staff at the Flint center are urging women to “pump and dump” their breast milk, especially if they haven’t been tested; advising men on the possibility of lead contamination reducing their sperm count; and handing out resources, including lists of where testing is being done.

As residents fret over their health, the city is continuing to issue bills and past-due notices for water that residents say is good for nothing but flushing the toilet. The Detroit Free Press reported Monday that some 100 residents protested outside the Flint city hall, ripping up their bills—as high as $100—and holding signs reading, “Why Pay for Poison?” According to some sources, Flint residents are saddled with some of the highest water bills in the country, often touching $150 per month.

While the political machine continues to grind on—with groups like the ACLU now pushing for several reforms including the immediate repeal of Public Act 436, which enabled a string of politically appointed emergency managers to override public concerns about the water—health-care providers are preparing for the long haul.

“A lot of the damage has already been done,” Dr. Hebert told Rewire. “There is no magic anecdote that can reverse it. Cognitive deficits and other neurological impacts on infants and unborn children will not become apparent for a long time. We are not talking about weeks or months here—these children are going to have to be monitored closely for several years.”

He said there is an urgent need for thorough follow-through and early childhood intervention programs to give a boost to those kids that wind up with developmental difficulties.

And even these steps, some say, will not be enough. “I think the families and the women who have come forward and put this issue on the map are very brave,” Michigan Welfare Rights Organization’s Orduño said. “But I don’t see how there can ever really be adequate solutions, or recourse, or reparations for any of this.”

Commentary Abortion

Illegal Abortion Is a Maternal Health Crisis

Christine Charbonneau

On Monday, the Global Day of Action for Access to Safe and Legal Abortion, we at Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI) are reminded that legal abortion is critical to improving maternal health and reducing maternal mortality around the world.

Unsafe abortion is a maternal health crisis in countries where abortion is illegal or difficult to access, leading to 47,000 preventable deaths each year, according to the World Health Organization. Women and adolescents with unplanned pregnancies are risking their lives and health to access what should be a routine procedure. On Monday, the Global Day of Action for Access to Safe and Legal Abortion, we at Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI) are reminded that legal abortion is critical to improving maternal health and reducing maternal mortality around the world.

Women who lack access to legal abortion are often forced to continue with unwanted pregnancies. Recently in Ireland, a survivor of sexual assault and attempted suicide who was denied the right to a legal abortion was hospitalized in psychiatric care until her baby could be delivered by cesarean section at 26 weeks’ gestation. Last year in Senegal, an 11-year-old rape survivor gave birth to twins and is now unable to continue her education. Her mother, according to reports, asked the Senegalese women lawyers’ association for financial support so the girl could continue her education, but also stressed that the girl would need to switch schools to avoid being bullied.

Without access to legal abortion, women seeking to terminate a pregnancy face dire options, particularly women with limited resources.

Each year there are 85 million unintended pregnancies globally, with 3.4 million in the United States alone, according to the Guttmacher Institute. In most countries, women with financial resources can obtain a safe procedure; however, where abortion is illegal, women without resources risk unsafe methods, such as seeking care from an unqualified provider; self-medicating; drinking toxic fluids; and self-injury. Such abortion procedures lead to 13 percent of global maternal deaths annually, or eight maternal deaths every hour. Millions of women who survive these unsafe procedures suffer serious—if not permanent—injuries.

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In addition to the immediate health impacts, unsafe abortion makes a negative impact on society. The Guttmacher Institute reports that unsafe abortion reduces women’s productivity, increasing economic burdens for poor families; causes maternal deaths that leave 220,000 children motherless annually; and creates long-term health problems.

Recent changes in abortion laws in several countries have irrefutably demonstrated that access to legal abortion improves health outcomes. Since legalizing abortion in 2002, Nepal has nearly halved its maternal mortality ratio. In South Africa, the annual number of abortion-related deaths fell by 91 percent after abortion laws were liberalized in 1997. And a 2005 decriminalization of abortion in Ethiopia has “had a huge impact on saving lives of girls and mothers,” according to Addis Tamire Woldemariam, general director for the Ministry of Health.

In recent months in El Salvador, two local organizations, La Colectiva Feminista para el Desarrollo Local and La Agrupación Ciudadana para la Despenalización del Aborto Terapéutico, Ético y Eugenésico have called for the Salvadoran media and government to cease their public defamation. These actions, including hate speeches by public officials, as well as by non-state actors, such as religious and community leaders, or fundamentalist groups and news outlets, intend to impede their work to advance sexual and reproductive rights as human rights, the organizations say. Abortion is criminalized in all cases in El Salvador, including when the woman’s life or health is at risk, or in cases of rape or incest.

The World Health Organization states that “ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative” and calls safe, legal abortion a “fundamental right of women, irrespective of where they live.”

We know that some of the lowest abortion rates in the world are in countries where safe abortion is legal and available, along with quality family planning services that enable women to prevent unintended pregnancies. Providing contraception to the estimated 222 million women who want to avoid pregnancy in the developing world would decrease the need for abortion services; however, even when quality contraceptive services are widely available, there will always be a need for abortion. Through our global programs, PPGNHI is working to increase access to contraception, provide sexual and reproductive health education, and advocate for sexual and reproductive health and rights.

Next month, PPGNHI is a proud co-sponsor of the Human Right to Family Planning Conference, held October 9-11 at the University of Washington campus in Seattle. This conference is the first of its kind to be sponsored by a U.S. university in collaboration with community organizations and it will explore the relationship between the right to health and family planning, including abortion, and improving universal access—globally and locally.

The numbers and stories are horrifying indeed, and at the same time make a strong argument for legalized abortion. Surveys suggest people can agree on abortions in cases of rape, but why should we stop there? We as a society, from Seattle to Dubai, must eliminate restrictions on a woman’s ability to decide when and if she has children, because no woman should die from an unsafe abortion.