Statement of Solidarity from IPPFWHR

IPPFWHR NEWS, STATEMENTS – June 2, 2020

OUR STATEMENT OF SOLIDARITY


The International Planned Parenthood Federation/Western Hemisphere Region stands in solidarity with activists for racial justice in the United States and throughout the world.

The murders of George Floyd and Breonna Taylor, and so many more victims of police brutality in the United States, are the result of state-sanctioned violence and systematized racial inequality that permeates every aspect of our society, including reproductive health. You can see in the eyes of a pregnant woman in Austin who was shot in the stomach while protesting at police headquarters.  You can see it in the eyes of the woman fearing for her child’s life every time he walks out the front door.

These oppressive forces have generated pain, outrage, and frustration throughout our nation’s history, yet we have found hope in the images of countless activists marching in cities both big and small; in the voices crying out for an end to the senseless murders of and violence against Black bodies.

Make no mistake about it: this is a global fight for racial justice that requires each and every one of us to take action.  This weekend, we also saw an uprising in the favelas in Rio de Janeiro, where hundreds of demonstrators converged to protest crimes committed by police against Black Brazilians.  A week ago a Black youth was killed by police at his home in a favela in Rio de Janeiro, while respecting the social distancing measures with his family. We see the effects of structural racism in the United States and our region day-in and day-out and know we all have a role to play in demanding racial justice, having difficult conversations, and putting pressure on our leaders to act.

Everyone has the right to live in peace and free of violence. Everyone has the right to be treated with humanity and equal dignity. This is the time for change.

Our heart goes out to the family of George Floyd and the countless others in our nation whose loved ones have died at the hands of the forces that claimed to protect them.

The End of Babies?

The End of Babies?

By Alexander Sanger

 

In its November 17, 2019 edition, The New York Times published a two-page Opinion Essay by Anna Louie Sussman entitled, “The End of Babies”. The gist is that Modern Capitalism is inimical to reproduction: economic, social and environmental factors, and moral ones too, are hostile to having babies. The article compares capitalism and its effects in low-fertility Denmark and China. Late Capitalism, she argues, “has become hostile to reproduction”. The system in such countries, where basic needs are met and there is seemingly limitless freedom, may make children an afterthought or an unwelcome intrusion in a life that offers rewards of a different kind – career, hobbies, holidays. Women often defer childbearing or finally realize they actually want children at an age where they are forced to turn to assisted reproduction.

 

The story did not look at fertility rates in non-capitalist countries, like Russia or North Korea, where fertility is equally low, or lower.

 

Nor did the word “biology” appear. There are two paragraphs on men and male attitudes and behaviors, including that one in five men in Denmark and the U.S. will not become a parent. The rest deals with the female experience, including her own, and female advocates for reproductive justice.

 

I went back to Ms. Sussman’s article when Dr. Sarah E. Hill’s book, How the Pill Changes Everything, arrived on my desk last week. The book examines declining birthrates but from a biological angle. The word, “biology” appears throughout. As do the words “men” and “males”.

 

The default position, indeed, the primary focus of our work at International Planned Parenthood, is rightly on women and girls, and providing them sexual and reproductive health services and advocacy for reproductive justice. We are a proudly feminist organization. Yet, as my grandmother said 75 years ago when IPPF was founded in Bombay, India, “We won’t get anywhere without the men.” Women, who want children by means other than assisted reproduction, won’t get anywhere without the men either. As Ms. Sussman noted, “Reproduction is the ultimate nod to interdependence. We depend on at least two people to make us possible.”

 

So, with all the focus in her article on the social, economic, educational, urbanization etc. factors and their effects on female fertility, might human biology and men have something to do with the declining birthrate? Might our Darwinian mating system, which has evolved since the time any life appeared on the planet, not be working? If not, why not? The answer might lie in changes to our biology, not just in the changes in the socio-economic system, or systems. Dr. Hill focuses on this and raises the issue of whether the Pill’s mere existence affects fertility in ways beyond its obvious contraceptive effects.

 

I wrote in Beyond Choice: Reproductive Freedom in the 21st Century of hormonal contraception’s effect on the Major Histocompatibility Complex. There is evidence, I wrote, about the interference of the Pill with the normal mechanism of sexual selection as reflected in MHC preference. This preference leads males and females to choose mates with differing MHCs, thus leading to a better chance of a successful pregnancy and of their offspring having a better genetic quality and chance of survival. Hormonal contraception, I wrote, appears to interfere with a female’s mating preferences by leading them to choose males with a similar, not dissimilar, MHCs.  This can lead to difficulties in getting and keeping pregnant and in healthy progeny. Furthermore, hormonal contraception also interferes with a male’s mating preferences. Males avoid mating with females who are on hormonal contraception, whether they consciously know it or not. Thus, the Pill interferes with natural mate choice and hence successful reproduction by both males and females. I wrote that more study was needed, but that women and men needed to be aware of these possible unintended consequences of hormonal contraception.

 

Dr. Hill brings this research up to date, which confirms what I wrote 15 years ago. Dr. Hill states that hormonal contraception affects … ta da…a woman’s hormones and that, in turn, affects everything, including their mate choices, the chances of a successful long-term relationship and the chances of becoming pregnant and having healthy offspring. Women seem to prefer different types of men when on and off the Pill. A woman’s natural hormones, unaffected by the Pill, may guide women to men who have healthy compatible genes. Hormonal contraception, however, may guide women to men who have less compatible genes, thereby making it more difficult to get pregnant and have healthy children. Dr. Hill warns, correctly, that the science has not proved this conclusively and that any conclusions are speculative.

 

Ms. Sussman does state in her article that, “Chemicals and pollutants seep into our bodies, disrupting our endocrine systems,” but she is not referring to hormonal contraception and its effects on mate choice. She also does not mention the multiple studies surrounding declining sperm count in males and reduced sperm quality.

 

Dr. Hill points out that the Pill has also been seen to reduce the sex drive of some women. Certainly, celibacy was not one of the intended consequences of this method of contraception. But also, the Pill may make men less interested in having sex with women on the Pill and thus less likely to be chosen as a mate. The Pill appears to reduce the boost in attractiveness that comes with a pre-ovulatory estrogen surge. Hence, the mating system is at risk of being thrown out of whack.

 

Dr. Hill argues that the pill, by changing women’s biology, has the ability to have cascading effects on everyone and everything a woman encounters, including potential male mates. And when you multiply this type of an effect by the many millions  of women around the world on hormonal contraception, the pill changes the world. (At IPPF, hormonal contraception constitutes about 45% of the methods we distribute: Injectables at 11%, Oral Contraceptives at 11% and Implants at 23%. In addition, some IUDs we distribute contain hormones.)

 

There is no doubt that the mating system is more than biological. With women achieving more, thanks to contraception, men are achieving relatively less. Men, as an economic matter, are thus less attractive as mates. The mating market is thus bifurcated into two markets – the dating-sex market and the marriage market. The Pill enables the former and has a depressing effect on the latter. In the U.S., for the first time in history, single women out number married women. Hence more single motherhood (and sometimes fatherhood), delayed motherhood and assisted reproduction. The fertility rate of single women is about half that of married women, hence the low overall fertility rate, and, in some countries, a declining population. How much do biology and the hormonal effects of the Pill on women and men contribute to this quandary and this outcome? As Dr. Hill says, this is still undetermined but not outside the realm of biological possibility.

 

Reproduction is too often seen by commentators as a rational lifestyle choice affected only by socio-economic factors. It is far, far more that. The Unknown Unknowns, to borrow a phrase, are staggering.

 

 

Letters to the Editor: The lie that Planned Parenthood’s founder was a virulent racist

Clyde W. Ford wrongly lumps my grandmother, Planned Parenthood founder Margaret Sanger, with far-right immigration opponents.

Her version of eugenics was far different from that described by Ford. It sought to address the manner in which heredity and other biological factors, as well as environmental and cultural ones, affect human health, intelligence and opportunity. My grandmother hoped to locate birth control in a larger program of preventive social medicine to improve the condition of all people.

She spoke out against immigration acts and other measures that promoted racial or ethnic stereotypes. She worked for more than 50 years to provide reproductive autonomy to poor women, including women of color, because she saw it as an essential tool of individual liberation and social justice, not of social control.

Alexander Sanger

New York

The writer chairs the International Planned Parenthood Council.

With thanks to Ellen Chesler — she and I spend too much time rebutting these falsehoods.

Chile Expands Abortion Access

For the last two years, our partner, APROFA, has been working hard to officially register the abortion pill. The pill is actually two medications called Mifepristone and Misoprostol that safely end pregnancy when taken together. Access to it reduces barriers for many women and healthcare professionals, especially because it is non-invasive and can be done at home. The Chilean Government has finally approved APROFA’s application to register the abortion pill.

While abortion is only currently legal in certain circumstances in Chile, this win brings us a step closer in the fight for global reproductive rights.

APROFA will begin distributing the combination pill in early 2020.

Indigenous women and the patriarchy of conquest

By Debora Diniz, a Brazilian anthropologist and researcher at Brown University,
and
Giselle Carino, an Argentinean political scientist and director of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR)

The word “poop” emerged from the sewers and became news in Brazil when President Bolsonaro positioned it as an environmental threat. First, he suggested disciplining one’s intestines: one should only defecate “every two days” as a means to protect the environment. Then, pressured by what many see as an attack on indigenous territories through his environmental policies, he mocked indigenous communities by stating that their “petrified poop” would render the land useless for economic exploitation. This nonsense is an authoritarian amusement of power, the “political ridiculousness” described by Marcia Tiburi: he mentioned the unmentionable in the public sphere, and his environmental policies promote deforestation and the dispossession of indigenous lands.

Bolsonaro’s vulgar maneuver is also spontaneous discourse because he views indigenous nations as human waste. The repetition of “poop” when talking about the environment is an ideological metonymy to dehumanize indigenous lives. But, since political life is chaotic, historical events can be simplified and seen as the “cause and consequence” of the abuses of power. During the same week that Bolsonaro reveled in his scatological vocabulary, 2,000 indigenous women from 120 groups met in Brasilia for the first march of indigenous women in Brazil’s history—Territory: our body, our spirit. They joined forces with 100,000 other rural women workers known as the Margarida’s March, the largest permanent movement of Latin American women. Ro’Otsitsina Xavante, who does not see herself as the leader of the indigenous women’s movement but rather as a spokeswoman said, “we want to join the Margaridas to show that we have an alliance.”

The alliance will jumpstart an effort to unravel the historic patriarchy that never ceased to exist in Latin America: indigenous and rural women are among the main victims of what Rita Segato calls “patriarchal crimes.” By joining the Margarida’s March, indigenous women are defying the patriarchal arrogance that describes them as a residue of history, while also defying the restrictive cultural rules of their participation in the “white world.” During the march, indigenous women chose to occupy a symbol of white power—the government building where indigenous health policies are elaborated. The occupation was a gesture designed to show how the indigenous massacre took place in Latin America: by the spread of disease and by the exploitation of the environment.

The violations imposed on indigenous bodies is an extension of the expropriation of indigenous territories to advance capitalism. Indigenous lands are described as “unexplored territories” and their conquest aligns with the patriarchal order of power. The expression “colonization of power” is found in Latin American critical theory to describe how the intersection between capitalism and racism is entrenched in political power throughout the region. Rita Segato prefers to call it the “conquestiality of power,” an endless male mandate for the feudalization of indigenous territories based on racism and patriarchy. It is through this framework of colonial predatory power that fascist leaders shape the war against women and the environment: the crimes of the patriarchy were already established as a hallmark of power before the spread of the misogynist world order.

If the patriarchy of “conquestiality” was perpetrated through possession and arrogance, so was the installation of the Catholic-evangelical and military order of our countries. Indigenous and rural women have suffered this permanent looting of life, as seen in the alarming rates of domestic violence and femicide in countries as diverse as Mexico, Bolivia, and Brazil. If indigenous and rural women rise up and shout “we are united and we will not be silenced,” it is up to women in the “white world” to listen and request participation in the alliance. According to Segato, all forms of power gravitate around the issue of gender. This is exactly where unexpected narratives about the perversion of patriarchal and racist power will emerge to transform politics.

REDUCING INFANT ATTACHMENT INSECURITY

REDUCING INFANT ATTACHMENT INSECURITY: A LONG-TERM APPROACH TO PROMOTING GENDER EQUALITY


The Thula Sana Project in El Salvador

El Salvador is a small country nestled in Central America, about the size of Massachusetts, with a population of 6 million. The countryside is beautiful. It’s volcanic, has stunning beaches, and its hilly roads are drawing more tourists each and every year. Coffee used to be the main crop, but now they also grow rice, beans, corn, sugar, and harvest coconuts.

But despite the natural beauty, over half the population lives in poverty, and fifth of the population lives in extreme poverty.

Sexual and reproductive rights have a long way to go in the country. Abortion care is illegal in all circumstances, including the life of the woman. Dozens of women are serving jail sentences for alleged abortions and miscarriages. Early childbearing is almost universal, with about 70% of women giving birth before reaching 18. Violence against women is endemic, with about a quarter of all women reporting being a victim of physical or sexual violence—and regardless where you are in the world, gender-based violence is severely underreported.

Poverty, lack of autonomy, limited social networks, and low level of schooling makes it challenging for young mothers. Infants whose experience with a caretaker are negative are more likely to develop attachment insecurity. Specifically, infant attachment insecurity is a result of a poor emotional relationship that does not make them feel secure, and social studies have found a clear link between infant attachment insecurity and gender-based violence. Witnessing violence and cognitive development also have an impact.

Pro-Familia, a non-profit organization in El Salvador, is dedicated to advancing sexual and reproductive health and rights in the country. Also known as the Demographic Association of El Salvador (ADS), it has twelve clinics across the country dedicated to family planning, cancer screenings, and STI testing and treatment. The organization has trained over 1000 volunteer health promoters who are well-known and trusted in their communities. Many of them do this work at great personal risk—violence against clinic staff and outreach workers is a real possibility. Outreach staff is careful to meet with gang leaders ahead of time, gain their trust, and operate with their permission.

Recently, ADS has been working on an initiative called the Thula Sana project, with the goal of evaluating whether a community-based intervention model would be successful at lessening maternal depression and promoting secure early attachment between adolescent, first-time mothers and their infants. Community outreach workers identified over sixty families to work with and divided them into two groups, a control group and one that would receive training. Those who received training would receive two ante-natal visits and 14 post-natal visits over six months. Outreach workers do a series of exercises with mother and baby to build the mother’s confidence and train her to better recognize infant needs. 

Interestingly, outreach workers found that the role of the extended family became an obstacle. In cases where there was marriage or cohabitation with parents, the adolescent was often controlled by her mother or mother-in-law and often disempowered and scared. They concluded that cooperation of the adolescent’s mother or mother-in-law was vital, so they focused on building trust with the younger mother and the extended family.  

I visited one mother, Veronica, and her daughter Angelica. They live with her parents and her brother in a home with a dirt floor. There’s no electricity or running water, and chickens and puppies roamed in and around the home. The parents and brother work on a nearly coffee plantation. 

I’ve traveled to many remote places, and one of the things that always impacts me is the hospitality and generosity that I encounter, even in the most impoverished places. Veronica roasted fresh coffee beans, bought us pastries, and made the best coffee I have ever had. Her family had been angry when they found out she had gotten pregnant, and even angrier when her partner left to live with another woman—whom he also got pregnant. But, “you can’t abandon your family,” her mother said. 

Veronica was most appreciative of learning how to breast feed, and how to observe what her baby was doing and how to respond to her actions. Angelica lived up to her name, she was bubbly and clearly comfortable with her mother, her grandmother, and eventually, me. It was a beautiful experience. 

The second home we visited belonged to Julia and her husband, Esteban. It was made out of cinder blocks, had electricity, running water, and even a fridge. But it was in a rough area, so we had to take vehicles that were familiar to the local gangs to avoid creating suspicion. The outreach workers even wore ADS vests that identify them whenever they go into the neighborhood (in the moment, I had wished they had given me one too!)  

Julia was thankful for the training. She particularly enjoyed the encouragement to express her emotions—in Salvadoran culture, women are sometimes conditioned to suffer quietly and endure whatever is thrown their way. She was also thankful to have somebody to answer the many questions she had about child-rearing, and was so inspired by the training she decided to become a volunteer for ADS. She now organizes other mothers in neighborhoods and provides information on family planning. 

The unsung heroes of the program, though, are the outreach workers themselves. Many of them are mothers, and despite the dangers, they are fearlessly committed to their work. Their compassion, dedication, and professionalism is reflected by the affectionate bonds they created with adolescent mothers in need.

The results of the program are inspiring. When compared to the control group, the intervention proved to create stronger bonds between mothers and their infants. It provided adolescent mothers with parenting skills, improved their communication, and taught them tools to deal with conflict management and stress. Most importantly, the feedback from the mothers who participated was overwhelmingly positive. There was also little opposition from gang members to the program, even though one of the long-term goals of the program is to reduce violent tendencies. 

ADS receives no funding from the Salvadoran government, nor does it receive foreign aid. It does receive funding from the International Planned Parenthood Federation (IPPF), and ADS would like to expand the program across El Salvador. The positive results from the project inspired other non-profits within the IPPF network to get involved in similar efforts to prevent gender-based violence. Iniciativas Sanitarias in Uruguay, for example, is working with public health authorities to train midwives using the Thula Sana methodology. Most exciting are the plans in the works to scale up the intervention to encourage secure attachment between infant and primary care giver, a factor that plays an unfortunate role in long-term chances of gender-based violence.  

Profamilia Colombia

I paid a visit last week to the Profamilia clinic in Cartagena, Colombia. The waiting rooms were full of women seeking education and clinical services. The clinic offers full sexual and reproductive health care, including GYN surgery, tubals, vasectomies and surgical and medical abortions (85% of women choose medical abortion). They see about 3,000 patients a month. The staff was dedicated, hard working and focused on providing what the clients need.

I met two dozen youth educators, 3 boys and the balance girls – we clearly need more boys in the mix. There were outgoing, ebullient and knowledgable, ready to give answers to teens who need answers.

Go Argentina

No, not for the World Cup, but for the vote today in the lower house of its Congress to decriminalize abortion up to 14 weeks gestation. The vote was 129-125. The bill next goes to the Senate. It will be close. We are ready and actively lobbying.