Author: alexandersanger

The Global Gag Rule is Back

| alexandersanger

We have been here before – the ping pong ball of reproductive rights and health ricochets back and forth as administrations change – now the Global Gag Rule is back, restricting what reproductive health providers can do around the world. The result: reduced services for women and girls (and men and boys) resulting in more unplanned pregnancy and abortion. This has been studied, and the results are enumerated in the following article. The damage is real.

https://www.guttmacher.org/report/evidence-for-ending-global-gag-rule

Cecile Richards

| alexandersanger

What a loss for reproductive rights!

Cecile served as PPFA President during years of unceasing turmoil and represented our movement with intelligence, courage and grace. She never wavered in her commitment to those less fortunate. I had the honor of appearing on several podiums with her and she was always courteous and thinking about how best to rally our supporters and even those unsure or wavering. Our movement has benefitted from the inspired leadership of so many and Cecile was at the top. She will be missed in the tough years ahead.

Cecile Richards

Visit to Mexico

| alexandersanger

I spent the last week in Mexico City. The country of Mexico is now far ahead of the United States in terms of reproductive rights for women.

In addition to the fact that they now have a female president, Claudia Sheinbaum Pardo, who calls herself a feminist and has announced the creation of a Ministry of Women, the National Supreme Court beginning in 2021 has issued rulings that abortion can no longer be considered a crime and eliminated federal criminal penalties for abortion. Hence all federal health facilities in the country are obligated to provide abortion care. Like the United States, Mexico has states, 32 of them, and half have formally decriminalized abortion in their territory. We are working hard with our partner organizations in the remaining states.

The regulatory authority In Mexico, similar to the FDA, recently reduced restrictions for obtaining mifepristone in pharmacies and expanded the indications for misoprostol, two essential medications for self-managed abortions. They are available without prescription. On my visit, I went into three small neighborhood pharmacies in Mexico City asking for mifepristone, but none had it in stock but offered to order it. All had misoprostol in stock. I was assured by our partner organizations that Mifepristone is widely available in pharmacies throughout Mexico. Approximately 80% of abortions are done with medication. Our partners are working on access for the underserved and to de-stigmatize abortion in this deeply religious and patriarchal country.

Women from the US are coming to Mexico for abortion medication. 

Health care in Mexico is fragmented, much like the US, and spotty. There is a proposal to move low-risk pregnancies out of hospitals to midwives. There is a very high rate of unnecessary Caesarians. Teen births are too high but declining. 

The Mexican partners that we met with were: GIRE (Grupo de Información er Reproductión Elegida), Catholics for the Right to Decide (CDD) and the Association of Professional Midwives. 

We had long discussions on the vote of Mexican immigrants to the US. The general feeling from our Mexican colleagues was that Mexican immigrants, while religious, voted on the economy and on personal security. They looked askance on recent illegal immigrants from their home country, fearing for their jobs and personal safety. The Mexican immigrants have achieved a piece of the American Dream and don’t want competition. The Democratic message didn’t hit on Mexican immigrant needs. Trump seemed a leader who related to their issues and beliefs. He represented America more than Harris.

L to R: Maria Consuelo Mejía, Rebeca Ramos (Executive Director of GIRE, the Grupo de Información en Reproducción Elegida), ACS, Marta Lamas (a leading feminist academic, activist, and thought leader in Mexico), and Giselle Carino, CEO of Fos Feminista. Marta and María Consuelo helped found GIRE more than 30 years ago, and María Consuelo also founded CDD, Catholics for the Right to Decide, in 1994.

ACS and Giselle Carino before a wall of green wave scarves. 

family friendly

| alexandersanger

The US Presidential election is fight for various so-called interest groups, and that includes suburban woman and mothers of small children, and want-to-be-mothers of small children. The proposals from the candidates (which evolve daily) concentrate around child care policies, though their stances on abortion rights figure prominently in the calculus of women, or should. In the background, as always in this campaign, are the issues of race and class and ethnicity and country of origin, and who is going to rule this melting pot. And lingering not-so-in-the-shadows, is the Republican Great Replacement Theory where immigrants and their progeny are feared to take over the government. (I wrote on this on July 31).

The Wall Street Journal on October 15, 2024 published an article titled, “Countries Fail to Reverse the Baby Bust.” The article detailed the efforts of two countries and Norway and Hungary to reverse their declining birth rates. The two countries have fertility rates of 1.4 and 1.5 respectively and have been stubborn to change even with programs for parental leave, childcare credits, tax benefits, exemption from income tax and extra vacation days. These programs have made no change in the fertility rates. This is not surprising given other studies showing the same result in other countries. Policies seem to affect, at most, the timing of births and not the number of births.

There is a clear tension between individual reproductive strategies, which tend to parents investing in fewer children since childrearing is so expensive, and government strategies, as one woman said, “to keep the nation alive”, which tend to larger families and less investment in each. Moral issues intrude for some parents who wonder if it is right to have a child in order to get extra vacation time.

In the US, Trump and Harris have leapt into the fray with proposals to help US families raise their children, and in some cases have more. Harris proposed capping child care costs at 7% of income and a $6,000 Child Tax Credit for parents of newborns, with other tax credits for other families with children, including raising the current $2,000 credit per child to $3,600. J. D. Vance has proposed a $5,000 Child Tax Credit per child. How to get well-paid child care workers is another matter, with Republicans seeming to rely on family members to do the job. Paid family leave is another plank that needs attention. Trump’s first term saw the enactment of this policy. It has not been mentioned much so far in the campaign by either side. How to pay for tax credits is left vague, with Trump saying his tariffs on imports would.

These proposals are less drastic than the European models, which have shown virtually no results. It is reasonable to assume they won’t make any difference here either, which shows that the candidates, no surprise, are after votes and not real change to help families.

Reproductive freedom and rights should encompass the ability to have children as well as not to, to have healthy and safe pregnancy as well as to terminate a pregnancy when the woman decides to, to have a healthy child born and thriving with the care the child needs in an environment which makes it all possible. There are massive global forces at work affecting US families – the world economy, prices, environment and pollution, health and pandemics, immigration and migration, education and child care costs. The world’s women in developed and less developed countries have voted with their wombs, saying one or two children is enough. Advances in child and maternal health, as well as contraception and access to safe abortion, have made that possible. Advances in prosperity have been two edged sword, making chances for economic advancement for one’s children more possible and more expensive. Through it all, biology marches on, with parents doing their best, as they see it, for their progeny. Scandinavia generally does a better job supporting parents and children. Our country can do better.

See:

https://www.wsj.com/world/birthrate-children-fertility-europe-perks-family-04aa13a0

Make America/Russia Procreate Again

| alexandersanger

Amid the din about childless cat ladies, you may have missed the NY Times and Washington Post’s articles this week on the movements in Russia and the US to increase the birthrate, or rather the birthrates of some segments of their populations.

There have long been calls in America, starting in the mid 19th Century, for white America to increase its birthrate. The Know-Nothing Party rose in response to Irish-Catholic immigration of 1848 and the fears of white Protestants that they would lose power. Hence the criminalization of birth control and abortion because white men didn’t want their white wives using them (the fact that women of color would be banned also didn’t initially matter in their cradle competition).  The white Protestants went all in on their eugenics when they later targeted poor or immigrant women with hysterectomies, and legislation requiring sterilization for unfit women. 

The Great Replacement Theory that many US conservatives tout is old whine in a new bottle. It is immigration again that is the political lever that these conservatives are using to raise white fears of being replaced. Since they have already succeeded in criminalizing abortion in much of the country, birth control is next. Count on it.

In Russia, the Washington Post reported that Putin said the following: “Many of our grandmothers and great-grandmothers had seven or eight children, and maybe even more,” Putin declared to an audience of ultraconservative religious and political figures who had convened in the State Kremlin Palace in November. “We should preserve and revive these wonderful traditions.”

Russia has a TFR of 1.4. The US is 1.6 (the rate for white women is slightly less than that of African-American and Hispanic women).  Russia is fighting a war, and men are leaving the country. Russia is kidnapping Ukrainian children to replenish the youth of the country. Putin, like US conservatives, seeks a country based on Orthodox Christianity and nationalism. Putin said, “Making sure Russians have as many children as possible is the underlying goal of our state policy.”

Women are a means to this end for both US and Russian nationalists. Women’s rights are disposable. 

See:

https://www.washingtonpost.com/world/2024/07/30/russia-putin-antifeminism-women-children-society/?utm_medium=email&utm_source=newsletter&wpisrc=nl_todayworld&utm_campaign=wp_todays_worldview&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3e88816%2F66a9b812b115535658dc2a42%2F60a4ff32ae7e8a50b536ca00%2F36%2F61%2F66a9b812b115535658dc2a42

https://www.wsj.com/politics/elections/why-jd-vance-worries-about-childlessness-00bb96cb

The Race and Referenda

| alexandersanger

The stakes in the upcoming presidential race have never been higher for women and reproductive freedom and justice.

A report recently issued by 16 United States Senators, entitled Two Years Post-Dobbs: The Nationwide Impacts of Abortion Bans, sets forth the challenges and issues facing American women post-Dobbs. The report concluded that two years after Dobbs women are denied emergency care and life-saving treatments, hardship has been placed on women and families traveling long distances for care and the healthcare system is being strained. More than 23 million American women of childbearing age live in states with abortion bans. There is an unprecedented flow of pregnant patients across state borders risking at times their lives and financial security. It is stressing America’s reproductive healthcare system, like never before, including by impacting care in states that maintain access to abortion. It is driving healthcare providers out of states with abortion bans, creating a healthcare gap that would be difficult to fill since some medical residents are avoiding these states.

Women are being denied care in medical emergencies and doctors have to watch patients go into sepsis and watch their vital signs deteriorate because they are afraid the patient is not sick enough to qualify for a medical exemption, should there be one. For example, there were just 34 legal abortions recorded in Texas during a six-month period in 2023, but researchers estimate the number of women needing abortions in Texas is at least 400 a year for emergencies and 2,400 per year for physical health risks.

Miscarriage care and other emergency care for ectopic pregnancies for instance is the same procedure as an abortion, and this care is routinely being denied in states with abortion bans. Women with fetal anomalies are forced to seek care in states that permit abortion, as are rape and incest survivors.

Just some examples of the impact in states with legal abortion: there are three-week wait times at Kansas and Illinois clinics, wait time at clinics in Ohio forces patients to other states for care, and Wisconsin patients can get quicker care traveling to other states. The expense and difficulties of travel operate as a special hardship on low income patients.

When OB/GYN’s leave abortion ban states they lead to a lack of doctors trained to provide obstetric and gynecological care, including deliveries. A study has found that in Texas the infant death rate increased along the number of babies who died of birth defects. Between 2021 and 2022 there was a 12.9% increase in the deaths of children before their first birthday. Another study found that Texas had approximately 10,000 additional births between April and December 2022 which proportionally included pregnancies with increased risk of infant mortality.

In response to abortion bans, women are switching to long-acting methods of birth control, including IUDs and implants. Anecdotally, women are stocking up on the abortion pill just in case.

In the voting booth, women in at least six states, and probably more, will be able to vote on referenda to legalize abortion, including Florida and Colorado. No abortion rights referendum has lost since 2022. 

Interestingly, when South Carolina ‘s legislature considered an abortion ban in 2023, three Republican female Senators bucked their party and voted against it. The party turned around and primaried them out of office. 

In Poland last week, three members of the ruling coalition voted against a bill to slightly liberalize the strict Polish abortion ban. The bill lost by three votes. The Prime Minister retaliated and stripped two of the three members of their party coalition membership and stripped the third of his leadership position. Poland is hopefully moving towards decriminalizing abortion.

South Carolina doesn’t permit referenda. Poland does. Perhaps they should have a referendum.

Click to access 2024_dobbs_anniversary_national_report_final.pdf

Dr Ruth

| alexandersanger
Dr Ruth Westheimer once worked for PPNYC in our Harlem clinic researching our patients’ contraceptive and abortion histories. She used the material for her doctoral dissertation. Her job done, her position was eliminated. As she repeatedly said to me, “That Al Moran (my predecessor as President of PPNYC) he fired me!” The world is glad he did because she went on to become Dr Ruth. And she never held it against me and eloquently presented me an award at the Pill is 50 celebration. It seems to me that I should have been presenting her an award. Dr. Ruth brought sex into American homes with expertise, forthrightness and humor. Her life story as a Holocaust survivor and as a sniper in Israel seemed to inure her to the brickbracks of the Puritans who thought her some deviant corruptor of American women and youth. She stood firm, all 4’7″ of her, for truth and honesty and fun and pleasure. We are all in her debt.
Dr Ruth

teen pregnancy and premature death

| alexandersanger

A recent study out of Canada reports that women who were pregnant as a teenager were more likely to die before age 31 than their peers who did not get pregnant. The odds were similar for teens who had an ectopic pregnancy, miscarriage, stillbirth, or abortion. The risk increased the younger the teen was when pregnant and also if the teen was pregnant more than once. 

The researchers say that the link between teen pregnancy and early death is likely not causal. The greatest cause of death was injury, both self-inflicted and accidental. How accidental death or suicide relates to early pregnancy is a murky area, but they could result from low educational attainment, adverse childhood experiences and increased risk taking. 

Various experts opined that more needs to be done to prevent accidental pregnancy and unplanned pregnancy. I agree.

But I and others have felt that despite what teens may report about whether their pregnancy was “accidental”, many are in alignment with the shortened life expectancies that disadvantaged teens face whether or not they become a teen mother. This “weathering” hypothesis I have written about before.  The many environmental, social, racial, familial, and pre-existing health factors that a disadvantaged teen faces all point to a life expectancy below that of her better off peers. The same applies to the teen’s mother who might be expected to help care for the baby. Weathering would seem to point a teen, consciously or not, to early childbearing while a) she is still relatively healthy and b) her mother is still with her to help. Researcher Arline Geronimus found that a disadvantaged teen is healthiest at age 16.

Risks of pregnancy are well known, and pregnancy is riskier the poorer the health of the mother. It is no surprise that it can lead to premature death, though as I said above, the researchers did not find a direct causal link. 

But, and this is a big but, the teen has a baby. She has reproduced, and has done so when she is at her healthiest. Yes, there are risks to her and the baby, but perhaps less risks than if she had waited.  

In an ideal world, women would not have to make this trade off. But even in countries with national health systems and with income supports for the most disadvantaged, the health discrepancies are still there. The messages of: wait until you are older, wait until you finish your education, wait until you have a good job, or wait until you are married, don’t resonate with all too many girls. The biological message of: reproduce while you can, does. 

See:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816198

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816201