Author: alexandersanger

The Forest obscuring the Trees

| alexandersanger

In the midst of the tariff forest, or conflagration to switch the metaphor, we cannot lose sight of the trees – Administration’s devastating attack on reproductive, and general, health of people here and abroad. And the attacks are just beginning.

The Administration has suspended Title X funding for family planning clinics in this country but also USAID grants for reproductive and other health around the world. Title X supports the provision of reproductive healthcare, including family planning and the treatment and prevention of sexually transmitted diseases in family planning clinics in this country. Many of those clinics are operated by Planned Parenthood. None of the funds can be used for abortion services. A total of $66 Million in Title X funding has been suspended, including $21M for Planned Parenthood clinics. These programs have been audited repeatedly to make sure that this does not happen, yet this administration under the guise of fiscal probity has suspended the funds to do yet another investigation. The effect of this suspension will be that clinics will be turning away low-income patients who will have nowhere else to go and will lead to increases in sexually transmitted infections, cervical cancer and pregnancy rates, and therefore abortion rates.

The next shoe to drop is probably Medicaid funding going to Planned Parenthood and other reproductive healthcare clinics. Medicaid funding reimburses clinics for reproductive healthcare visits, including family planning and sexually transmitted disease provision for clients who are eligible for Medicaid. If and when these cuts are enacted, and there are sure to be challenges because these funds are budgetary provisions, enacted by Congress, and it will lead to the closure of many family planning clinics nationwide. Patients will have nowhere else to go. On top of this, the Supreme Court this week heard arguments about whether or not states can prohibit Medicaid recipients from using clinics which also provide abortion services, i.e Planned Parenthoods. Planned Parenthood receives about one-third of its revenue from Medicaid and Title X.

Planned Parenthoods nationwide are facing huge budgetary pressures, as are many healthcare providers, with rising costs, especially salaries for nurses, doctors and other trained personnel. My old affiliate, Planned Parenthood of Greater New York (PPGNY), recently announced that they were putting up for sale the building that houses its Manhattan clinic and would be closing the clinic. They said they hoped to open in Manhattan clinic at another site, but there are no definite plans. The affiliate, along with many other Planned Parenthood affiliates nationwide, have been closing under-performing clinics because they cannot be subsidized in the current climate. PPGNY and PP Illinois have recently closed four clinics each. This has led to greater travel, and other costs, being imposed on rural patients, as well as delay and forgoing of health care.

Planned Parenthoods around the country that provide abortion services are inundated by patients from states where abortion has been criminalized. The resulting subsidy that patients need, including travel costs and accommodations, as well as the fees that they are unable to pay are devastating the finances of Planned Parenthood. This is a human and public health crisis, and states that keep abortion legal must do more to make abortion as safe and accessible as possible. Women are going to resort to do-it-yourself abortion and not under a doctor’s care which could lead to injury and death. Those doctors who are mailing abortion pills internationally and across state lines are not reaching every woman who needs an abortion. About half of women coming to Planned Parenthoods nationwide are using abortion pills, but many are opting for surgery because the procedure can be done in the same day and the woman can return home without delay or risk of needed a followup visit in a state where abortion is criminal.

There is a curious intersection, and disconnect I believe, with much of the conservative ideology about white supremacy. The attacks on Planned Parenthood will reduce reproductive healthcare as well as abortion services in areas with large white populations. If the conservatives hope as a result the white birth rates will go up, that might happen (preliminary data shows an increase in births in criminalized states – the abortion rate has also gone up!). But these attacks will also end up resulting in the closure of clinics serving minority populations, so those birth rates will also go up. In all cases, there will be an increase in sexually transmitted diseases (and illegal abortions), which in many cases cause infertility, thereby decreasing the nation’s ability to increase the birth rate. Talk about counterproductive.

The middle of all this chaos, families have to sort out whether and when to have children. One of the factors that men and women will take into account is how they view the future. Certainly the tariff chaos will give financial pause to many in every state and of every political persuasion. People are now poorer than they were a month ago, and one can question whether they see any light at the end of the Trump tunnel. Some conservatives are beginning to see that they should offer incentives for married couples to have children, though incentives offered in various countries around the world have done little or nothing to increase birth rates.

The intersection of the tariff policy with the anti-immigration policy gives political concern. Many areas of this country have seen population growth and economic vitality from immigration. If these areas are depopulated through deportations, the economies there will stagnate and decline. One US study called it, “Depopulation, Deaths, Diversity and Deprivation: the Four D’s of Rural Population Change.” This scenario played out in the former East Germany recently, an area where people of ability left for greater opportunity in the former West Germany, leaving behind people with fewer opportunities and social services, who were full of resentment, and therefore voted for far right political parties. This would naturally buoy the Trump party even though he was the cause of it all.

Nita Lowey and Alan Simpson

| alexandersanger

What a force Nita Lowey was. Tenacious supporter of women’s and reproductive rights, she was at our side, and leading, in every major Congressional battle over women’s access to reproductive health services here and abroad. Her office was the first we would call when some new threat would emerge from the Neolithic swamps of the Reactionary Right. Nita would pick up the phone herself and lead the counter strategy. She was solid, and we knew she would never waver.

As for Alan Simpson, Republican Senator from Wyoming, I give credit where credit is due. He was a steadfast supporter of reproductive rights when that stand was growing increasingly unpopular in his Republican Party. I met him in Cairo when he attended the 1994 UN Conference on Population and Development, lending the US delegation bipartisan support for an agenda that included expanded family planning efforts. He voted against ban on late term abortions but was not supportive of Federal funding for abortions except in limited circumstances.

Irony indeed that Nita Lowey and Alan Simpson clashed heatedly over Anita Hill and Clarence Thomas, a clash that Simpson later regretted. He voted to put anti-Roe Justices on the Supreme Court, saying, “I wanted people on the court regardless of ideologies. I wanted credible public servants with brains.” I don’t think he got them.

Beyond the global gag rule

| alexandersanger

Given the fast place of announcements out of Washington, by the time you read this parts are sure to be out of date. That said, Fos Feminista has prepared an analysis of the anti-rights, anti-gender views and programs proposed by Geneva Consensus Declaration (GCD),

Women’s Optimal Health Framework (WOHF), and Project 2025 which together attack reproductive rights and bodily autonomy. The threat, as we have seen in the last few days, is real. Whether and in what form USAID (and foreign aid for family planning and disease prevention) survives is an open question.

Just one example of the non-reality thinking, Project 2025 states, “married

men and women are the ideal, natural family structure”. Not so natural in reality though. In Latin America 75% of births are born outside of marriage. And these are Catholic countries.

And sex ed, say the three, is to be abstinence and faith based. The list goes on.

The report is here.

Click to access Beyond-the-Global-Gag-Rule_V2.pdf

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