Dec 12, 2011 12:00 AM EST

Jennie McCormack was arrested for terminating her pregnancy with an abortion pill. The case that could transform the reproduction wars.

The last thing on Jennie Linn McCormack’s mind when she realized she was pregnant was that she might, with a single telephone call, upend the vitriolic national debate on abortion.
All she thought about was how it would be impossible for her to take care of another baby. Surviving, barely, on the $250 of monthly child support for one of her three kids, the unemployed, unmarried 32-year-old also knew she didn’t have the more than $500 she’d need for the two-and-a-half-hour trip from her bare-bones rental in Pocatello, Idaho, to Salt Lake City, the closest city with a clinic willing to terminate a pregnancy. She had no computer, no car, no one to take care of her 2-year-old—and like Idaho, Utah had a waiting period for abortions, which meant she’d have to make two round trips. So early this past January, she made the call that may alter history and turn Jennie McCormack into Jane Roe’s unlikely successor: she asked her sister inMississippi to buy RU-486, the so-called abortion pill, over the Internet and send it to her. The cost: about $200.

“My mind just kept going back to my kids, how there was no way I could do that to them, no way I could make their lives even worse,” says McCormack, a petite blonde, as she nearly sinks between the cushions of her sofa, her eyes rimmed with tears. The man who had impregnated her had just been sent to jail for robbery; she did not feel comfortable reaching out to her mother—Mormon, like almost everyone in southeastern Idaho—for help.

McCormack, who thought she was about 12 weeks along, took the pills (the protocol involves two drugs, mifepristone and misoprostol) the afternoon they arrived. The drugs are FDA-approved only for ending early-stage pregnancies; McCormack had no complications, but the pregnancy turned out to be more advanced than she thought—perhaps between 18 and 21 weeks, experts later speculated—and the size of the fetus scared her. She didn’t know what to do—“I was paralyzed,” she says—so she put it in a box on her porch, and, terrified, called a friend. That friend then called his sister, who reported McCormack to the police.

Although RU-486 is legal and the fetus was not yet “viable” (that is, old enough to live outside the uterus), Idaho has a 1972 law—never before enforced—making it a crime punishable by five years in prison for a woman to induce her own abortion. The day after police arrested McCormack, her mug shot appeared above the fold in the local newspaper. “It’s hard to imagine the humiliation and fear,” says her lawyer, Richard Hearn, who is also a physician.

The case was dropped weeks later due to lack of evidence. Without solid proof, such as the envelope in which the pills came, her confession wasn’t enough to sustain the case. But prosecutors retained the right to re-file charges. In response, Hearn got a federal injunction to prevent any woman from being prosecuted under the state’s anti-abortion statute by the district attorney. He also filed a class-action suit against the state, claiming the statute is unconstitutional. But all that took nine months to play out, and McCormack lurched into depression and became a virtual shut-in.

“You’d have to know the climate here,” says Hearn, “to fully imagine the amount of pressure Jennie is under, how hostile people can be, how isolated she is.” Next week, motions will be heard in federal court to certify the suit as a class action. Last week, the prosecutor filed a motion to have Hearn’s injunction lifted. (The prosecutor’s office did not return calls seeking comment.)

The case has become a huge tangle for both sides of the abortion battle—state laws that put abortion beyond the reach of poor women are clashing with the global reach of the Internet. With Hearn ready to take his case to the Supreme Court, Jennie Linn McCormack may be above the fold for years to come.

“It’s a profoundly important case,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. “But it’s one that neither the pro-choice nor the pro-life people want to deal with. And that’s what makes it so crucial.”

It’s a bad case for both sides. The fact that McCormack kept a 4-month-old fetus frozen in the winter chill on her back porch is the sort of ghoulish image pro-choice activists try to avoid. For pro-life advocates, supporting her arrest would contradict a longstanding policy of targeting providers while holding women blameless. “It would require a massive change in direction if the anti-abortion movement now supported the criminal prosecution of women directly, which is why McCormack is troubling,” says Cynthia Gorney, a formerWashington Post reporter and the author of Articles of Faith: A Frontline History of the Abortion Wars. “It would violate everything they built the movement on.”

Neither right-to-life groups nor pro-choice organizations like Planned Parenthood and NARAL Pro-Choice America—usually quick to publicize such human stories as ammunition for their cause—have made public statements on McCormack’s case, and numerous calls to spokespeople on both sides of the issues went unreturned.

“McCormack puts them places that complicate the storyline. It’s the new frontier,” says Gorney, now a journalism professor. “Once you remove the providers, you have no one to picket or pressure. Abortifacient drugs and the Internet change the debate forever. ”

Despite the reticence of pro-choice groups to take up McCormack’s cause, it is exactly what they have been warning of for years: as clinics become inaccessible, poor women are more likely to take abortion into their own hands. In the era before Roe v. Wade, that meant back-room abortions; now it conjures images of a lonely woman in a small town at her keyboard Googling “abortion pill.” Hundreds of online merchants will send RU-486 without a prescription, according to Women on Web, an organization that sends the drugs to women in countries where abortion is illegal.

No one knows how many women in the U.S. have gotten the drugs this way, says Daniel Grossman, a physician who is a senior associate at Ibis Reproductive Health, a research and advocacy group in Cambridge, Mass. “[But] if women were not accessing them, these sites would not be proliferating.” Although the number of abortions nationally has dropped slightly in recent years, some 35 percent of American women will have one at some point in their lives.

The proliferation of sites providing the drugs coincides with the pro-life movement’s highly effective protests and attacks on physicians, clinics, and health-care groups that offer abortions. The number of Planned Parenthood affiliates has been cut in half since 1987, to fewer than 100. Almost 90 percent of counties in the U.S. and 98 percent of rural counties have no abortion services. Many clinics in states where local physicians are pressured not to perform abortions now fly in doctors from out of state to provide abortions, says Melanie Zurek, the executive director of the Abortion Access Project, a Boston-based group that offers training and support to doctors and health organizations.

While Medicaid coverage for abortions has long been outlawed, more than a dozen states now restrict private-insurance coverage of abortion. Texas cut funding for clinics that provide birth control, even if they don’t provide abortion services. A South Dakota bill that would have made women wait 72 hours before getting abortions was recently blocked by a federal judge. A bill in Ohio would ban abortion after a fetal heartbeat is detected, as early as six weeks after conception. In November, Mississippi voters narrowly rejected a referendum that would have defined “personhood” at the time of conception, a notion that would have made even certain types of birth control illegal. Legal scholars on both sides agree that such laws wouldn’t survive a constitutional challenge as long as Roe v. Wade stands. Which is precisely why some pro-life groups are championing them: their goal is to provoke challenges that go to the Supreme Court, which will, in their fever dream, strike Roe down.

This is, of course, the pro-choice movement’s greatest fear. Spooked by the recent strong challenge in Congress to federal funding for Planned Parenthood, pro-choicers are wary about mounting legal challenges to state restrictions, for fear those challenges would end up in front of an inhospitable Supreme Court.

For the clinics that remain, the use of abortion drugs, which require no equipment and far less training for physicians than surgical options, has quietly risen. More than 20 percent of all abortions in the U.S. are now “medical” abortions, according to the Guttmacher Institute, a nonprofit, nonpartisan research group. The drugs are more than 95 percent effective in ending pregnancies up until seven weeks, according to the FDA, and are considered the best method for ending very early pregnancies.

Later-term abortions like McCormack’s, even those done in a clinic, are the Achilles’ heel of the pro-choice movement. Although only 1 percent of abortions in the U.S. are done after 21 weeks (about 88 percent are performed within 12 weeks), anti-abortion advocates have made such procedures their prime target. Since the Supreme Court in 2007 upheld states’ rights to regulate late-term abortions, more than 35 states now have strengthened their prohibitions on clinics that performed the procedure.

Hearn, McCormack’s lawyer, is less wary about challenging statutes—and undaunted by the lack of public support from either camp. The pro-choice lobby “may not think this is a good time to bring something to the court because it’s so conservative,” he says, “but I say no case is perfect, and if not now, when?”

In addition to his challenge of the Idaho statute criminalizing self-induced abortion, he is targeting the state’s new “fetal pain” law, which is basically a clumsy end-run ban on late-term abortions. (Virtually all research on the subject shows that fetuses cannot distinguish pain until as late as the 30th week of gestation.) Four other states have recently passed similar laws, despite the fact that under Roe, abortions are legal until viability, which is around 25 weeks.

While the arguments fly, McCormack waits quietly in her small, dark apartment. A bedraggled bouquet of silk flowers hangs outside her front door along with a plaque that says “Welcome” in Spanish, French, and German. Even if her suit succeeds, there is no victory for her. She says she has “no friends at all, no one to talk to.” She knows no one who’s had an abortion, or at least no one who will admit it. “My mother, she’s Mormon, you know? She’s a proud person, and this is a terrible thing for her to have to look people in the eye.” After her picture appeared in the paper, McCormack got a part-time job at a dry cleaner, using another name, but people figured out who she was and stopped letting her bag up their clothes, so she quit. On a recent trip to a local state office to apply for aid, she was ignored for hours. “They made it clear what was happening,” she says. “For a while I just sat there, sort of amazed that they were just letting me sit there.” Eventually, she picked up her son and went home.

Even her attempts to bury her fetus have been thwarted. Hearn put in requests to the district attorney to have the remains released from the evidence locker, but no one has responded. “I never wanted to be someone public, to make a point,” McCormack says. “This isn’t a cause for me. I just didn’t know what to do. I did what I thought was right for my kids, that’s all.”

by JENNY GOLD

 

States enacted a record number of abortion restrictions in the first half of 2011, many of them requiring 24-hour waiting periods, ultrasounds or parental permission to deter women from obtaining abortions. But these types of “demand-side policies” have not had much of an impact in the past on national abortion rates, according to an article in the most recent edition of the New England Journal of Medicine.

Instead, abortion opponents in several states are making “an aggressive new thrust” at the procedure by focusing on the “supply-side” of abortions: the doctors, hospitals and clinics that provide the services. And the strategy may prove more effective, Theodore Joyce of the City University of New York and the National Bureau of Economic Research writes in a perspective.

Only 14 percent of OB-GYNs provide abortions, and in many states, there are few willing providers.

Planned Parenthood of Arizona president and CEO Bryan Howard, explains it's ending abortion services in three Arizona cities to comply with state laws that place restrictions on abortions, Thursday, Aug. 18, 2011, in Glendale, Ariz.

EnlargeRoss D. Franklin/AP 

Planned Parenthood of Arizona president and CEO Bryan Howard, explains it’s ending abortion services in three Arizona cities to comply with state laws that place restrictions on abortions, Thursday, Aug. 18, 2011, in Glendale, Ariz.

 

In Kansas, for example, legislation recently signed by Republican Gov. Sam Brownback would institute new requirements for abortion clinics, including separate dressing rooms for patients and staff, complete with toilets, washing station and storage, in addition to procedure rooms of at least 150 square feet, Joyce says. Those rules could force two of the state’s three abortion providers to stop offering the service. On July 1, however, a federal judge temporarily blocked Kansas from enforcing the regulations.

Virginia, Arizona and Utah are also implementing new restrictions on abortion providers.

These types of “supply-side” policies against abortion were particularly effective in Texas, Joyce argues. The Texas Woman’s Right to Know Act, which went into effect in January 2004, included two components: for abortions before 16 weeks, it implementing “demand side” restrictions like requiring women to receive mandated information at least 24 hours before an abortion. For abortions after 16 weeks, it implemented “supply-side” restrictions requiring that later-term abortions be performed in a hospital or an ambulatory surgical center with staffing, reporting and facility-structure requirements.

While the restrictions on early abortions had little to no effect, the number of Texas abortions performed at or after 16 weeks “dropped by 88%, from 3642 in 2003 to 446 in 2004,” Joyce writes, and the average distance to a non-hospital provider rose from 33 miles in 2003 to 252 miles in 2004.

http://www.huffingtonpost.com/2011/10/13/protect-life-act-passes-house-of-representatives_n_1009876.html?ref=fb&src=sp

 

WASHINGTON — After an emotional floor debate, the House of Representatives on Thursday passed theso-called Protect Life Act, which prohibits women from buying health insurance plans that cover abortion under the Affordable Care Act and makes it legal for hospitals to deny abortions to pregnant women with life-threatening conditions.
House Majority Leader Eric Cantor (R-Va.), a proponent of the bill, told voters last week that its purpose is “to ensure that no taxpayer dollars flow to health care plans that cover abortion and no health care worker has to participate in abortions against their will.”
In fact, the Affordable Care Act already keeps public dollars separate from the private insurance payments that cover abortion. A federal judge ruled in August that the anti-abortion group Susan B. Anthony List had to stop making the claim on its website that “Obamacare” subsidizes abortions because the assertion is false.
“The express language of the [Affordable Care Act] does not provide for taxpayer-funded abortion,” the opinion states. “That is a fact, and it is clear on its face.”
H.R. 358, introduced by Rep. Joe Pitts (R-Pa.), goes beyond the issue of taxpayer dollars to place actual limits on the way a woman spends her own money. The bill would prevent a woman from buying a private insurance plan that includes abortion coverage through a state health care exchange, even though most insurance plans currently cover abortion.
An even more controversial aspect of the bill would allow hospitals that are morally opposed to abortion, such as Catholic institutions, to do nothing for a woman who requires an emergency abortion procedure to save her life. Current law requires that hospitals give patients in life-threatening situations whatever care they need, regardless of the patient’s financial situation, but the Protect Life Act would make a hospital’s obligation to provide care in medical emergencies secondary to its refusal to provide abortions.
“Congress has passed refusal laws before, but it’s never blatantly tried to override emergency care protections,” said Sarah Lipton-Lubet, policy counsel at the American Civil Liberties Union. “We’ve heard proponents of this bill say that women don’t need emergency abortion care, but that is really just willful blindness to the facts.”
According to the American Journal of Public Health, Catholic hospitals already have a years-long history of ignoring the emergency care law to avoid performing abortions. In late 2009, an Arizona bishop excommunicated a nun who authorized an abortion procedure for a woman who otherwise might have died of pulmonary hypertension at a Catholic hospital in Phoenix.
Rep. Jackie Speier (D-Calif.) said she personally faced a situation in which an abortion was medically necessary.
“I was pregnant, I was miscarrying, I was bleeding,” she said on the House floor Thursday. “If I had to go from one hospital to the next trying to find one emergency room that would take me in, who knows if I would even be here today. What my colleagues on the other side of the aisle are trying to do is misogynist.”
Despite a strong showing in the House, the bill is unlikely to pass in the Democrat-controlled Senate, and the White House said on Wednesday that President Barack Obama will veto the legislation if it ever reaches his desk.
“The Administration strongly opposes H.R. 358 because … the legislation intrudes on women’s reproductive freedom and access to health care and unnecessarily restricts the private insurance choices that women and their families have today,” the White House said in a statement.

by Jodi Jacobson, Editor-in-Chief, RH Reality Check

September 21, 2011 – 6:55pm

Today, the Senate Appropriations Committee adopted an amendment to the FY 2012 State Department and foreign operations appropriations bill that, if signed into law, would block re-imposition of the Global Gag Rule.  The amendment was introduced by Senator Frank Lautenberg (D-NJ), and would prohibit future Presidents from using executive orders to refuse funding to a foreign organization solely because of the legal medical services it provides; the information, counseling, and referrals it offers; or the advocacy it engages in with its own government—using its own non-U.S. funds.

The Foreign Ops bill provides funding for the U.S. diplomatic corps and development, health, and humanitarian assistance programs of the U.S. government. In it, the committee also approved funding for international reproductive health programs and the U.S. contribution to the United Nations Population Fund (UNFPA).

A parallel bill in the House of Representatives approved in committee this summer cuts international family planning funding by 25 percent from current levels, reinstates the Global Gag Rule, and includes a blanket prohibition on U.S. funding to UNFPA.

The current Senate bill includes $700 million for family planning programs, $239 million more than the House bill and $85 million above current funding levels.

According to Population Action International, today’s markup “puts the Senate on record rejecting the House version and sets the stage for a showdown over the final FY 2012 appropriations bill to be negotiated later this year.”

In response to passage of the bill in committee, Lautenberg stated:

“Today we have taken an important step toward permanently ending the global gag rule and protecting access to family planning services for women around the world.  The United States is an international leader for women’s rights, and we must rule out any possibility that this dangerous and harmful policy could return.”

Neither bill is expected to reach a floor vote. Instead, advocates expect that appropriations bills funding the entirety of the federal government will be rolled together into one omnibus or several “minibus” spending bills to be considered later in the year.

The Lautenberg Global Gag Rule amendment was adopted on a largely party-line vote of 18 to 12. All Democrats on the committee, except Senator Nelson (D-NE), voted in favor of the bill. They were joined by three Republicans—Senators Collins (R-ME), Murkowski (R-AK), and Kirk (R-IL)—supporting the amendment.

Senators Collins (R-ME), Feinstein (D-CA), Murray (D-WA), Mikulski (D-MD), and Tester (D-MT) co-sponsored this amendment with Senator Lautenberg (D-NJ).

GHI’s missing piece in Nepal

U.S. law prevents Global Health Initiative funding for abortion.

August 25, 2011 06:11

LAMAHI, Nepal – United States President Barack Obama set up the Global Health Initiative to take a more comprehensive approach to improving health care in developing nations. In particular, his administration has given great weight to saving the lives of women and to supporting countries’ priorities in health care.

But there’s one exception: abortion.

In Nepal, that exclusion is in plain view, and many say the lack of support disregards evidence that safe abortions can save women’s lives. Nearly all experts here — with the notable exception of those employed by the U.S. government — publicly state that the best way to improve maternal health is by offering a wide range of services that includes more awareness about and access to safe abortion.

In a long-standing U.S. law, stretching back nearly 40 years, Congress has prevented any foreign aid for abortions.

The politics in Washington around the issue of funding abortion have become so heated in recent months that many global health supporters on Capitol Hill won’t even talk about family planning services because so many conservatives falsely equate it with abortion.

Anti-abortion advocates have accused Obama and his administration of using the GHI as part of a larger strategy to link abortion rights to universal access to reproductive health. An article in the New American last year by senior editor William F. Jasper argues that Secretary of State Hillary Clinton has used “‘reproductive health’ and other similar code words … in attempts to camouflage policies that promoted abortion.”

Clinton’s State Department has dismissed such claims and stressed that U.S.- funded programs through the GHI are simply trying to offer comprehensive reproductive health within the accepted health practices of the host countries, including saving a woman’s life if she suffered an unsafe abortion and working on family planning issues that adhere to the accepted health practices of the host country.

Some 7,000 miles from Washington and far from the charged debate around international aid and the question of abortion, there is a more pointed question in the villages of Nepal. That is, whether the unyielding U.S. policy against funding abortions is hurting its efforts to improve health care?

Some in Nepal say it does. U.S. officials say that’s not so.

Anne Peniston, the GHI Field Deputy in Nepal, said the best way to improve maternal health in Nepal is by providing more access to family planning services.

She cited a 2010 study published in the British health journal The Lancet, in which the four main drivers of maternal mortality were total fertility, per capita income, maternal education, and skilled birth attendance. Abortion, she noted, was not in the top four.

“Abortion should not be used as a method of family planning in any case,” she said. “It’s too risky for a woman’s health.”

But inside a primary healthcare center in Terai, Nepal’s plains region that runs along the border with India, a program that provides safe abortions is considered an integral part of maternal health.

Lamahi Primary Healthcare Center doctor Mahesh Gautan says that women in the area, like in much of rural Nepal, often have unsafe abortions because they do not know where to have a safe procedure or cannot afford to pay for a private clinic.

“They usually have unsafe abortion, and they’re coming with a complication,” he said. His center has about 40 cases a year of women showing up with life-threatening bleeding or infections from unsafe abortions.

The government-run center in Lamahi, which sits in Dang district, therefore decided it needed to improve its maternal health service beyond providing family planning, and antenatal, postnatal, and delivery services. The center sent nurse Dila Bhusal, 25, for training on safe deliveries and safe abortions.

Nepal legalized abortion in 2002 because so many women were dying due to unsafe abortions. Professor Sharad Onta in the department of community medicine and family health at Tribhuvan University’s Institute of Medicine in Kathmandu said the death rate, while reduced, remains high in part because too many women are not aware of the abortion services.

Onta said that a donor cannot be forced to do something that its country does not allow. But he said that the U.S. Agency for International Development should not claim that they are offering comprehensive health services in Nepal.

“Donors should understand their own limitation and not claim they’re complying with the national health plan [when they’re not],” he said.

The Nepal Ministry of Health in 1998 estimated that 54 percent of gynecological and obstetric hospital admissions were due to women having complications after ending a pregnancy in an unsafe manner, according to a report by Ipas, an international organization that works on increasing women’s access to safe abortion.

An information void

While abortion is now available in government hospitals and at private clinics, health advocates say there is still a serious need for awareness and education about the change in law, the dangers of medical imposters and where to go for a safe procedure. Too many women continue to end unwanted pregnancies by using unsafe methods like inserting pointed bamboo rods or ground up bangles into their uteri, or by following the misguided directions of untrained chemists.

“This is a big challenge for our communities. Most of the young women don’t know about abortion facilities or that it is legal,” said Khem Karki, the executive director of SOLID Nepal, an organization that works on sexual and reproductive health.

Furthermore, advocates say it would be more cost effective, efficient and logical for a woman to be able to receive all services related to maternal health, including abortion, in one place.

“Especially developing countries, poor countries, we can’t afford to offer one service by itself,” said Indira Basnett, the Nepal country director of Ipas. She said all reproductive health services should be delivered like a “package” through the health system.

The Obama administration chose Nepal to be one of its eight GHI focus countries as it redefines how American aid is delivered in developing nations. In Nepal, GHI seeks to strengthen the country’s health care system by boosting the local capacity of health care providers like nurse Bhusal and service locations like the Lamahi Primary Healthcare Center, say U.S. health officials here. GHI, they said, strives to support the government of Nepal’s health plan and promote country-ownership of health care services.

With a focus on gender equality and the inclusion of remote and disadvantaged groups, one of GHI’s main goals is to help Nepal improve its maternal health and thereby reduce the number of women dying during pregnancy or childbirth.

With the exception of abortion services, GHI in Nepal supports a broad range of maternal health services: It provides more access to contraception methods; trains community volunteers to counsel women on family planning and the need for antenatal check ups; collaborates with a private social marketing company to provide counseling and contraceptive services in local pharmacies; lends resources to beef up the number of skilled birth attendants in health centers; and encourages girls to stay in school and delay marriage and pregnancy.

Under GHI, USAID has also shifted its focus to target more remote and disadvantaged communities. For example, it now recruits and trains more community health volunteers who are living deep in Nepal’s mountainous region to provide better counseling on modern contraception as well as the need for antenatal checkups and giving birth at a hospital, primary healthcare center or health post that has a skilled birth attendant.

Abortion, however, has not been part of any overseas assistance since a 1973 amendment was made to the U.S. Foreign Assistance Act, known as the Helms Amendment. It prohibits U.S. funds from being used for abortion services overseas for the purpose of family planning.

Still, USAID officials in Nepal argue that it can help the country boost its maternal health without offering safe abortion services.

The USAID team in Kathmandu gave different reasons for why they do not need to provide awareness about safe abortion or access to such services. They stressed that abortion is not a safe method of family planning and that they can help with other interventions to prevent unwanted pregnancies. The team also said that USAID cannot do everything, and they coordinate with other donors who provide different services.

The government of Nepal and civil society actors say that it would help Nepal’s maternal health strategy if USAID supported the government plan in providing access to safe abortion, but they disagree over its impact.

“It would have been better if they were on board,” said Praveen Mishra, the population secretary at Nepal’s Ministry of Health and Population. But given that USAID legally cannot support safe abortions, he said, at least it can contribute to Nepal’s family planning programs and help manage complications resulting from unsafe practices. Furthermore, he said if USAID gave the government infrastructure for other health services, the government could also use those rooms or buildings to provide abortion services.

The case for family planning

A landlocked nation that has had a tumultuous political history, Nepal is one of the world’s poorest countries with severe social, economic and geographic disparities. Maoist rebels took on the cause of Nepal’s marginalized people and waged an armed conflict against the monarchy in 1996. By the time the civil war ended a decade later, about 13,000 people had died and much of the nation’s rural development had been disrupted. Nepal has spent the past five years trying to transition to a firmly established democratic republic, but an unstable government has struggled to complete the peace process and draft a new constitution.

Despite challenges related to its mountainous terrain, inequalities, corruption, lack of human resources in rural areas and political instability, Nepal has made great strides in improving its maternal health. It had a high maternal mortality ratio of 539 deaths per every 100,000 live births in 1995, but it has successfully brought the ratio down to 281 deaths per every 100,000 live births as of 2006.

USAID argues that the main reason for this drop has been their work convincing more women to use modern contraception and making various options available.

“To our minds it was very clear it was family planning,” Peniston said.

Only 29 percent of married women in Nepal used a modern method of contraception in 1995, but that number jumped to 48 percent in 2006, according to government statistics.

An increase in contraception usage decreases a nation’s maternal mortality because fewer pregnancies mean fewer chances a woman could die while pregnant or giving birth. Plus, spacing out births enables a woman’s body to fully recover from a past pregnancy and be in the best position to have a healthy delivery.

USAID says now they are trying to use GHI funds to target groups of women and girls who have been the hardest to reach with family planning messages, such as those married to migrant workers. With insufficient job opportunities at home, Nepal has seen a dramatic increase in the number of people working abroad. The wives back home benefit from the remittances, but their health can suffer. While the women might not need protection for most of the year, when their husbands come home to visit, they find themselves unprepared.

Sunita Thakur is one of those women. Thakur, who wears a line of red vermillion powder through her parted hair, says her husband works in Delhi and returns to their village in Terai region once every two to four months. Thakur, who estimates her age at about 18, dropped out of school when she was about 11 because she did not live near a secondary school and was already married. She had her first child around age 15 and her second, a little boy with disheveled hair sitting on her lap, nine months ago.

“Two is enough,” she said through a translator as she sat in a family planning clinic in Nepalgunj. USAID pamphlets explaining the various contraception methods available, including implants, intrauterine devices, Depo-Provera, birth control pills and condoms, sit on a nearby table. The young mother said she does not want more children because she wants to ensure she can afford to send her two to school. “I will educate them even if I have to sell my jewelry,” she said as she sat on a bench in the clinic, waiting to meet with a counselor. She hopes that if her daughter can become educated and wait until she is at least 18 to marry, she will have more opportunities than she has had.

“If I had completed my education, I would have a small job. I would be able to manage my home,” she said.

Thakur learned about using modern contraception from a friend, discussed it with her husband and mother-in-law and then accompanied her friend to this clinic, which received staff training as well as maintenance, repair and essential equipment from USAID.

Nepal, though, has a long way to go before all its adolescent girls and women know about and have access to modern contraception. One of the biggest challenges, say reproductive health specialists, is overcoming the myths and misconceptions surrounding modern contraception.

During a recent visit to an abortion clinic in Kathmandu, Mamata Adhikari, a petite, married college student, said she had not been using any form of contraception because she had heard it would make her infertile. Another college student, a 20-year-old with neatly manicured eyebrows and big, powerful black eyes, said she had accidentally gotten pregnant because her husband had insisted on using the so-called withdrawal method.

All the women at the Marie Stopes International clinic easily agreed to talk to GlobalPost about their decision to end their pregnancy. Most also agreed to have their names printed and even photographs taken. They said they didn’t feel any shame concerning their decision. Unlike in the United States, abortion is not a political issue here. To these young women, they said it’s simply a decision they’re making regarding their bodies and families. When GlobalPost asked the doctor present if the clinic ever faced protests, pickets or people handing out anti-abortion pamphlets, she laughed at the questions.

Another woman at the clinic, 23-year-old Rita Tamang, said she and her husband did not use contraception because they had wanted to have another child. But then she changed her mind.

Tamang, sipping a mango juice box and holding a heat pack against her uterus as she recovered from the procedure, said she finished her education when she was 12 or 13 because her mother died and her father couldn’t afford to keep her in school. She married soon thereafter and now has a six-year-old son. Tamang said her husband makes good money working as an agent for those who want to migrate abroad. He earns a hefty commission and makes about 150,000 rupees ($2,100) a month. The problem: He likes to party. Tamang and her son therefore see little of the money.

“Whatever he earns, he spends,” Tamang said. “I want to save before having another baby.”

She has decided she wants to open a small shop so that she can earn some money for her family and keep her son in school.

In a room nearby, a counselor talked to Tamang about the various contraception options. The young woman with straight black hair and purple toenails said birth control pills make her feel dizzy and nauseated. Instead, she will bring home condoms and try to convince her husband to use them.

Nepal still has far to go in educating women about family planning and maternal health, said Onta. “But the level of awareness has gone up dramatically,” he said. “At least we have hope for the future.”

Funding for this project is provided by the Henry J. Kaiser Family Foundation as part of its U.S. Global Health Policy program.

 

Source: Global Justice Center

03/08/2011

Global Justice Center launches “August 12 Campaign” to mark the 62nd Anniversary of the Geneva Conventions by urging President Obama to issue an executive order lifting U.S. abortion restrictions on humanitarian aid for girls and women raped in armed conflict

Thousands of girls and women raped and impregnated in armed conflict are routinely denied critically needed abortions in places like the Democratic Republic of Congo, Burma and Sudan, despite hundreds of millions of dollars in humanitarian aid made available to victims in conflict. These victims are denied abortions for myriad reasons, but one major reason is the blanket abortion restrictions the US places on all its foreign assistance, including humanitarian aid. These US restrictions contain no exceptions for rape or to save the life of the woman and have the effect of preventing all foreign governments, NGOs and humanitarian aid providers receiving US funds from providing the option of abortions to girls and women raped in armed conflict.

In the context of armed conflict, this policy is at odds with the rights of girls and women raped in armed conflict to non-discriminatory medical care as guaranteed by international humanitarian law, in particular the Geneva Conventions. The legal basis for this argument can be found in the GJC legal brief “The right to an abortion for girls and women raped in armed conflict – States’ positive obligations to provide non-discriminatory medical care under the Geneva Conventions.” A PDF of this brief can be found by clicking here.

These overly-broad constraints and the effect they have on the distribution of humanitarian aid from countries other than the US have not gone unnoticed amidst the global community. On November 5, 2011 during the Universal Periodic Review of the United States by the UN Human Rights Council, Norway recommended that the US “remove its blanket abortion restrictions on humanitarian aid covering medical care given to women and girls raped and impregnated in situations of armed conflict.” Furthermore, on March 4, 2011 the Association of the Bar of New York City, on behalf of approximately 22,000 members, wrote to President Obama urging the Administration to lift the abortion prohibitions put on all US humanitarian aid for women and girls survivors of rape in conflict.

In commemoration of the 62nd anniversary of the Geneva Conventions the Global Justice Center is coordinating an international “August 12th Campaign” encouraging key organizations and individuals around the world to send letters to President Obama, asking that he lift the abortion restrictions on humanitarian aid for girls and women raped in armed conflict via an Executive Order.

For more information on these restrictions and the August 12th Campaign please click here.

If you or your organization would like to join please contact Sarah Morison smorison@globaljusticecenter.net Tel: 212-725-6530 Ext. 209

July 28, 2011 — The House Appropriations Subcommittee on State and Foreign operations on Wednesday approved by voice vote a measure that would cut many U.S. foreign aid programs and reinstate the “global gag rule,” which blocks federal funds to international family planning groups that use their own funds to perform abortions or offer abortion information, the Washington Post‘s “Checkpoint Washington” reports (Warrick/Sheridan, “Checkpoint Washington,” Washington Post, 7/28).

The policy — which includes exceptions in cases of rape, incest or when a woman’s life is in danger — has been in and out of law since it was first adopted by President Reagan in 1984. President Clinton in 1993 reversed the ban, but President George W. Bush reinstated it in 2001 as one of his first actions after taking office. President Obama overturned the restriction within his first days in office. Last week, the House Foreign Affairs Committee endorsed reinstating the policy as part of a separate foreign aid bill (HR 2583) (Women’s Health Policy Report, 7/22).

The bill approved by the appropriations subcommittee also slashes support for international family planning organizations. The Post reports that the bill’s prospects are “uncertain” because it not likely to be passed by the Democratic-controlled Senate and signed by President Obama. The subcommittee’s ranking member, Rep. Nita Lowey (D-N.Y.), slammed the measure, pointing out that it cuts disaster relief, health programs and family planning resources.

In a letter to members of the House Foreign Affairs Committee on Tuesday, Secretary of State Hillary Rodham Clinton warned lawmakers that she would urge a veto of any legislation that seeks to impose strict new requirements on foreign assistance to critical allies and populations. The bill “would be debilitating to my efforts to carry out a considered foreign policy and diplomacy, and to use foreign assistance strategically to that end” she wrote. She also said the legislation puts “onerous restrictions” on the department’s operations and to foreign aid (“Checkpoint Washington,” Washington Post, 7/28).