Commentary Abortion

New Abortion Guidelines in Peru a Victory for Women and Girls, But More Work Ahead

Ximena Casas

Peru has finally issued national guidelines recognizing that women in the country have the right to therapeutic abortion, and outlining the Peruvian government's responsibility to secure this access. It is heartening to see such tireless work pay off, but the work isn't over.

In 2007, a 13-year-old Peruvian girl became pregnant as the result of being repeatedly raped by a man in her Lima neighborhood. Scared, ashamed, and desperate, she flung herself off a neighbor’s roof. Doctors examining the girl after the incident concluded that her spine needed to be realigned immediately, but they refused to operate because she was pregnant, despite the fact that therapeutic abortion—defined in Article 119 of the Peruvian penal code as the interruption of a pregnancy to save the life of the pregnant woman or to avoid serious and permanent damage to her health—had been legal in Peru since 1924. The young woman, known by her initials L.C., is a quadriplegic today.

Sadly, such stories are becoming more and more familiar to those of us who follow women’s health and rights issues around the world. When a woman or girl is denied access to abortion, she frequently suffers devastating consequences.

These cases are not just tragic; they are indefensible. Peru has more reported cases of rape and sexual violence than any other country in South America. Eight in ten of these victims are minors. No woman should be turned away from the care she needs, especially when she is raped or faces a pregnancy that threatens her life and her physical, mental, or social health.

Recently, the Peruvian government took a big step forward for L.C. and those like her. After 90 years of having the law on the books, Peru has finally issued national guidelines recognizing that women in in the country have the right to therapeutic abortion, and outlining the Peruvian government’s responsibility to secure this access.

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This historic win comes after nearly a decade of pressure from many nongovernmental organizations and advocates, including PROMSEX, a leading Peruvian advocacy organization supported by Planned Parenthood Global. In 2009, the Center for Reproductive Rights and PROMSEX jointly brought L.C.’s case before the United Nations Committee on the Elimination of Discrimination Against Women (CEDAW), challenging the government’s lack of accountability regarding the provision of legal, therapeutic abortion. CEDAW agreed, declaring that Peru had violated the human rights of L.C. by failing to ensure her access to safe and legal abortion services, and called for reform. Specifically, the committee declared that Peru must amend its law to allow women to obtain an abortion in cases of rape and sexual assault; establish a mechanism to ensure the availability of those abortion services; and guarantee access to abortion services when a woman’s life or health is in danger—circumstances under which abortion has been legal in Peru since 1924.

In addition to bringing the case before the UN, PROMSEX, with support from Planned Parenthood Global, has been working for years in Peru with medical professionals to develop their capacities and knowledge regarding sexual and reproductive health, and to ensure that the personal beliefs of individual health professionals do not impede women’s effective access to reproductive health-care services, including abortion and post-abortion care.

It is heartening to see such tireless work pay off, and for L.C. and the women of Peru to see a measure of justice. The new guidelines are a big step forward. They create an undeniable basis for expanding access to abortion services for Peruvian women. They provide clarity for both women and health-care providers, and get at the importance of taking on a broad interpretation of the right to health in the future, which would have greatly improved L.C.’s outcome.

Despite these gains, much work remains for advocates. The new guidelines include some unnecessary barriers to accessing safe abortion, such as requiring a review by a committee of three physicians. They also fail to address ongoing issues relating to confidentiality. Currently, Peruvian law dictates that health-care providers must report women for the alleged crime of abortion if they suspect one has been attempted. This policy leaves women afraid of going to health facilities, and consequently increases maternal injury and death—especially among poor women. Still, the guidelines show good faith and demonstrate the government’s ongoing commitment to ensure access to abortion and further women’s rights.

Advocates in Peru, across Latin America, and around the world will continue to work toward improved health outcomes for women and girls. The L.C.s of the world have been denied for too long. With this small victory in Peru in hand, we will together march forward to see justice realized for all women and girls.

Commentary Politics

In Mike Pence, Trump Would Find a Fellow Huckster

Jodi Jacobson

If Donald Trump is looking for someone who, like himself, has problems with the truth, isn't inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn't understand health care, and bases his decisions on discriminatory beliefs, then Pence is his guy.

This week, GOP presumptive presidential nominee Donald Trump is considering Mike Pence, among other possible contenders, to join his ticket as a vice presidential candidate.

In doing so, Trump would pick the “pro-life” governor of a state with one of the slowest rates of economic growth in the nation, and one of the most egregious records on public health, infant and child survival, and poverty in the country. He also would be choosing one of the GOP governors who has spent more time focused on policies to discriminate against women and girls, LGBTQ communities, and the poor than on addressing economic and health challenges in his state. Meanwhile, despite the evidence, Pence is a governor who seems to be perpetually in denial about the effects of his policies.

Let’s take the economy. From 2014 to 2015, Indiana’s economic growth lagged behind all but seven other states in the nation. During that period, according to the U.S. Department of Commerce, Indiana’s economy grew by just 0.4 percent, one-third the rate of growth in Illinois and slower than the economies of 43 other states. Per capita gross domestic product in the state ranked 37th among all states.

Income inequality has been a growing problem in the state. As the Indy Star reported, a 2014 report by the United States Conference of Mayors titled “Income and Wage Gaps Across the US” stated that “wage inequality grew twice as rapidly in the Indianapolis metro area as in the rest of the nation since the recession,” largely due to the fact “that jobs recovered in the U.S. since 2008 pay $14,000 less on average than the 8.7 million jobs lost since then.” In a letter to the editor of the Indy Star, Derek Thomas, senior policy analyst for the Indiana Institute for Working Families, cited findings from the Work and Poverty in Marion County report, which found that four out of five of the fastest-growing industries in the county pay at or below a self-sufficient wage for a family of three, and weekly wages had actually declined. “Each year that poverty increases, economic mobility—already a real challenge in Indy—becomes more of a statistical oddity for the affected families and future generations.”

In his letter, Thomas also pointed out:

[T]he minimum wage is less than half of what it takes for a single-mother with an infant to be economically self-sufficient; 47 percent of workers do not have access to a paid sick day from work; and 32 percent are at or below 150 percent of the federal poverty guidelines ($29,685 for a family of three).

Despite the data and the struggles faced by real people across the state, Pence has consistently claimed the economy of the state is “booming,” and that the state “is strong and growing stronger,” according to the Northwest Indiana Times. When presented with data from various agencies, his spokespeople have dismissed them as “erroneous.” Not exactly a compelling rebuttal.

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As a “pro-life” governor, Pence presides over a state with one of the worst infant mortality rates in the nation. Data from the Indiana State Department of Health reveals a “significant disparity” between white and Black infant mortality rates, with Black infants 1.8 times more likely to die than their white counterparts. The 2013 Infant Mortality Summit also revealed that “[a]lmost one-third of pregnant women in Indiana don’t receive prenatal care in their first trimester; almost 17% of pregnant women are smokers, compared to the national rate of 9%; and the state ranks 8th in the number of obese citizens.”

Yet even while he bemoaned the situation, Pence presided over budget cuts to programs that support the health and well-being of pregnant women and infants. Under Pence, 65,000 people have been threatened with the loss of  food stamp benefits which, meager as they already are, are necessary to sustain the caloric and nutritional intake of families and children.

While he does not appear to be effectively managing the economy, Pence has shown a great proclivity to distract from real issues by focusing on passing laws and policies that discriminate against women and LGBTQ persons.

He has, for example, eagerly signed laws aimed at criminalizing abortion, forcing women to undergo unnecessary ultrasounds, banning coverage for abortion care in private insurance plans, and forcing doctors performing abortions to seek admitting privileges at hospitals (a requirement the Supreme Court recently struck down as medically unnecessary in the Whole Woman’s Health v. Hellerstedt case). He signed a “religious freedom” law that would have legalized discrimination against LGBTQ persons and only “amended” it after a national outcry. Because Pence has guided public health policy based on his “conservative values,” rather than on evidence and best practices in public health, he presided over one of the fastest growing outbreaks of HIV infection in rural areas in the United States.

These facts are no surprise given that, as a U.S. Congressman, Pence “waged war” on Planned Parenthood. In 2000, he stated that Congress should oppose any effort to recognize homosexuals and advocated that funding for HIV prevention should be directed toward conversion therapy programs.

He also appears to share Trump’s hatred of and willingness to scapegoat immigrants and refugees. Pence was the first governor to refuse to allow Syrian refugees to relocate in his state. On November 16th 2015, he directed “all state agencies to suspend the resettlement of additional Syrian refugees in the state of Indiana,” sending a young family that had waited four years in refugee limbo to be resettled in the United States scrambling for another state to call home. That’s a pro-life position for you. To top it all off, Pence is a creationist, and is a climate change denier.

So if Donald Trump is looking for someone who, like himself, has problems with the truth, isn’t inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn’t understand health care, and bases his decisions on discriminatory beliefs, then Pence is his guy.

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.