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Victory in BraZil

| alexandersanger

This past Friday, Supreme Court Justice Luís Roberto Barroso issued landmark decisions in three major cases led by Fos Feminista partners — ADPF 442, ADPF 989, and ADPF 1207 — marking a transformative moment for sexual and reproductive rights in the country. In one of the cases, Justice Barroso reaffirmed the unconstitutionality of criminalizing abortion up to 12 weeks of pregnancy, strengthening the path for decriminalizing abortion in the country. In the other two cases, his decisions pave the way for expanding access for those seeking abortion under the current exceptions (rape, risk to life and anencephaly) allowed in Brazil.

There is much work ahead, but this is a great first step for the women of Brazil to reproductive Justice.

Birth rates, Fertility and What To Do

| alexandersanger

The CDC reported last week that births increased by just 1 percent in 2024 with the fertility rate (TFR) remaining level at about 1.6, well below the 2.1 level needed to maintain the population level through births alone (i.e. without immigration). 

At the same time, the Guttmacher Institute estimated that clinician-provided abortions in 2024 in states without a total abortion ban increased also by slightly less than 1 percent from 2023. There were additional abortions of an undetermined number that were not clinician provided. 

The Trump Administration is considering ideas to increase the birth rate, among them a $5,000 baby bonus, tax credits for children, increasing the availability of IVF, and awarding medals to mothers of a certain number of children. Worldwide incentives of this sort have been largely money wasted. My October 16, 2024 post talks about Norway and Hungary’s futile efforts to increase their birthrates. At most, incentives have speeded up childbearing but not increased the number of desired children. Russia awards an Order of Parental Glory to parents of large families. It hasn’t stopped the decline in the Russian TFR. A similar award in France has had no effect either.

The Administration’s cutting of Title X funding for family planning and threatened cuts to Medicaid program (as well as criminalizing abortion if they seek a nationwide ban) will perhaps serve to increase unintended childbearing, especially among teens. The decrease in the national TFR has come because of a reduction in teen pregnancy over the years largely due to better and longer-lasting contraception. Teens and young adults are also reporting having less sex. Criminalizing abortion further and reducing access to contraception may serve as further deterrents to sex and hence pregnancy, but I suspect the pregnancy and childbearing rates will rise among those without access to private family planning services, i.e. the poor and minorities, exactly the groups that the conservative White Replacement Theory folks don’t want to reproduce. 

The issues around infertility and IVF are tying the Administration in knots given the sway of absolutist anti-abortion people in policy circles. The imperatives of couples wanting a child by any means often outweigh their beliefs on abortion. 

The causes of infertility in males and females are debated, but one thing is sure: sexually transmitted infections can cause infertility. And the Administration by cutting reproductive health care programs will be increasing STIs and hence infertility. 

Who ever said politics makes sense. 

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

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