Archive for July 14th, 2009
Also Causes Delays for Many Who Do Obtain the Procedure
Approximately one-fourth of women who would obtain a Medicaid-funded abortion if given the option are instead forced to carry their pregnancy to term when state laws restrict Medicaid funding for abortion, because they lack the money to pay for the procedure themselves. According to a new report, “Restrictions on Medicaid Funding for Abortions: A Literature Review,” by the Guttmacher Institute and Ibis Reproductive Health, Medicaid funding restrictions also delay some women’s abortion by 2–3 weeks, primarily because of difficulties women encounter in raising funds to pay for the procedure.
Currently, 32 states and the District of Columbia allow Medicaid funds to be used for an abortion only in cases of rape and incest, or if the woman’s life is endangered, in accordance with the federal Hyde Amendment; only 17 states have policies to use their own funds to pay for all or most medically necessary abortions. Lacking insurance coverage, some poor women need a considerable amount of time to come up with the money to pay for an abortion, and may have to pull resources from other family necessities, like food or rent, if they are able to find the funds at all. As the cost of the procedure increases with gestation, many poor women become trapped in a vicious cycle of scrambling to raise enough money before the cost—and risk—increase further, while others are left with no recourse but to carry an unwanted pregnancy to term.
“The research literature clearly shows that restricting Medicaid funding for abortion forces many poor women—already at greatest risk of unintended pregnancy—to carry an unwanted pregnancy to term,” says Stanley Henshaw, Guttmacher Institute senior fellow and the study’s lead author. “Antiabortion advocates are using these restrictions in a misguided attempt to reduce the nation’s abortion rate. Instead, we should be focusing on reducing the underlying cause of abortion—unintended pregnancy—by ensuring better access to and use of contraceptives.”
The Hyde Amendment allows federal funding for abortion only in cases of rape, incest or life endangerment. In addition, Congress has enacted legislation essentially banning coverage of abortion for women whose medical insurance is provided by the federal government, including federal employees, military personnel, women in federal prisons and low-income residents of the District of Columbia, which does not have a state funding option. The issue of federal funding goes to the heart of who has access to abortion in the United States and under what circumstances.
“In his recent budget proposal, President Obama had the option of calling on Congress to end the funding restrictions imposed by the federal Hyde Amendment. We are disappointed that he did not do so,” says Heather Boonstra, a Guttmacher senior public policy associate. “It is time for Congress to repeal the Hyde Amendment and restore Medicaid coverage for abortion so that every woman, regardless of her economic circumstances, has the right to decide when and whether to have a child.”
Click here for the full report “Restrictions on Medicaid Funding for Abortions: A Literature Review,” http://www.guttmacher.org/pubs/MedicaidLitReview.pdf by Stanley K. Henshaw, Theodore J. Joyce, Amanda Dennis, Lawrence B. Finer and Kelly Blanchard.
The Guttmacher Institute – http://www.guttmacher.org – advances sexual and reproductive health worldwide through research, policy analysis and public education.
A dramatic plunge in international donor funding for family planning is threatening to undermine other humanitarian goals such as fighting poverty and hunger, as well as efforts to counter global warming, according to the UN and other specialists.
An estimated 200 million women lack contraception; the potential surge in the world’s population could well reverse humanitarian gains, experts say.
The largest amount earmarked for family planning since the 1994 International Conference on Population and Development in Cairo was in 1995, with US$723 million committed, remaining above $600 million for all but one year to 1999. The latest estimate, for 2007, is about $338 million.
“That’s a hell of a decline,” UN Population Fund (UNFPA) senior demographer Stan Bernstein told IRIN. Nor does it take account of inflation, making the drop even sharper in 1994 dollars. The word disaster is “entirely appropriate”, he said, noting that the issue seemed to have been pushed to the backburner by donors and media alike.
Akinrinola Bankole, director of international research at the US-based Guttmacher Institute, an NGO focused on reproductive health research and policy analysis, said: “Unless there is a renewed attention on population and funding for family planning, high fertility, especially in sub-Saharan Africa, in spite of desires for smaller families and high unmet need for contraception will aggravate the negative consequences, some of which are already horrendous.”
UNFPA executive director Thoraya A Obaid is calling for an increase in funding regardless of the financial crisis. “We have to protect the gains made and ensure that these gains do not slip back as more and more people are slipping back to poverty.”
In an effort to push the issue up the development agenda ahead of World Population Day on 11 July, UNFPA convened 30 leading family planning experts in New York at the end of June, including representatives from Bangladesh, Colombia, Guatemala, Kenya, India, Senegal, Tanzania, Uganda, the UK and USA.
“In one sense the issue is a victim of its own success,” Carmen Barroso, western hemisphere director at the International Planned Parenthood Federation, told IRIN, adding that “enormous progress in certain countries, regions, and segments of the population” had blinded people to the problems in other regions where the poor continue to be neglected.
“This is like declaring the marathon is over when the fastest runners have crossed the finishing line; people don’t appreciate the level of unmet demand in poorer countries,” Bernstein said, citing Kenya and Pakistan as examples of countries where fertility rates that had been falling are now stalled.
“There are a growing number of countries where there has not been the progress that there was in the past and some of that was because the expectation was that things were on the right track and so you could start putting money elsewhere,” he said.
“The difficulty of course is that every year more young women are ageing into their reproductive years and they would not have heard information campaigns that were done 10 years ago… It used to be that when you arrived in a developing country you would see billboards or hear radio spots advocating family planning; now all you see are HIV/AIDS billboards. That’s where all the money went.”
Bankole also said a decline in fertility in regions other than sub-Saharan Africa had nurtured the belief that a decline in all regions was inevitable.
“The issue of family planning has been demonized by the extreme conservatives who have [made] it … a taboo issue,” Barroso said.
Bernstein cited the link some people made between family planning and abortion. “And they are linked,” he added. “The link is family planning services reduce recourse to abortion, it’s as simple as that, but some people put family planning and abortion in the same category of wrong choices.”
He also noted that reproductive health in general and family planning in particular were not originally in the Millennium Development Goals because reproductive health and issues about women’s rights were felt to be too controversial. Universal access to family planning by 2015 is now included under the MDG of improved maternal health, but its absence at the start slowed things down, he added.
Finally there is the fatigue resulting from the very long-standing persistence of the issue. “There’s a little bit of ‘this is an old story, didn’t we talk about population growth and its impact in the 70s and the 80s,’ and it sort of doesn’t have the grab of the new,” Bernstein said. “It’s not that there have been that many new contraceptive technologies invented since; it’s always the new thing, the new invention that gets attention.”
A recent meeting in London on climate change and population noted that while the links were complex, population growth was clearly one of the drivers, particularly on a local scale, with regard to such issues as deforestation and water sustainability.
“It’s not a very simple relationship but it’s certainly one of the important factors in climate change,” Barroso said.
As with most such issues, it is the poor, especially in Africa, who bear the brunt of the funding shortfall.
“Many African countries are going to double or even triple in size between now and mid-century. And that I think poses huge problems for development. We need to debate population issues openly and honestly in a way that we haven’t been prepared to do in the last 10 to 15 years,” John Cleland, professor of demography at the London School of Hygiene & Tropical Medicine, told a news conference in June.
Obaid agreed: “I would like to stress that investments in women and reproductive health are not only decisive for overcoming poverty, managing the speed of population growth and achieving the MDGs; they are also cost-effective,” she told IRIN.
“An investment in contraceptive services can be recouped four times over – and sometimes dramatically more over the long term – by reducing the need for public spending on health, education, housing, sanitation and other social services.”
She called on decision-makers, now more than ever, to increase resources for family planning. “I do not think that any of the crises we are facing today – whether it is the food crisis, the water crisis, the financial crisis or the crisis of climate change – can be managed unless greater attention is paid to population issues,” she said.
A new maternal mortality study names HIV and AIDS as the cause of one in four maternal deaths in Zimbabwe.
The first comprehensive assessment of deaths resulting from pregnancy or childbirth revealed that 725 Zimbabwean women out of every 100,000 who deliver, die due to complications.
“The study findings have confirmed our worst fears: that indeed the maternal mortality ratio and the perinatal mortality rate are high, and present the biggest challenge for attainment of MDGs [Millennium Development Goals],” said Hilary Chiguvare of the UN Population Fund (UNFPA), which partnered with the University of Zimbabwe and other UN agencies to produce the report.
She noted that the HIV/AIDS responses in maternal health programmes appeared to be “very weak”: of the 91 percent of pregnant women who visited antenatal clinics, only 4.7 percent knew their HIV status, and only 1.8 percent of HIV-positive pregnant women received antiretroviral (ARV) drugs to prevent mother-to-child transmission.
The second highest cause of death was postpartum haemorrhaging (excessive bleeding after delivery), followed by hypertension (high blood pressure) and sepsis (infection). Most maternal deaths occurred at home, where women had no expert care when they experienced complications.
Many women could not afford transport to distant health facilities, but even those who could often failed to get drugs or assistance from skilled health professionals. The fees charged by health facilities were another barrier.
Temporary shelters near health facilities, set up for expectant women unable to arrange emergency transport, had improved access to care. The Ministry of Health and Child Welfare, with funding from the Japanese government, recently started a programme to revitalize the “Mothers Waiting Homes”, Chiguvare said.
The report also revealed that the 29 percent of pregnant women who belonged to the Apostolic Faith Christian sect were at greater risk of maternal death due to their belief that health problems should be treated only through prayer.
“The major challenge will be to develop a sensitive approach to the sect, which respects their right to religious freedom but also asserts women’s right to health.”
The study concluded that nearly half the maternal deaths could be avoided by successful prevention and treatment of complications, and that “None of the interventions are complex or beyond the capacity of a functional health system in Zimbabwe.”
The well-being of millions of people could be put at risk as HIV prevention and treatment programmes fall victim to funding cutbacks as a result of the global economic crisis, warns a new report released today by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank.
The report, “The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact,” says that eight countries – which together are home to more than 60 per cent of all those receiving AIDS treatment – are already facing shortages of antiretroviral drugs or other disruptions to treatment.
In addition, 34 out of the 71 surveyed countries report that HIV prevention programmes focusing on high-risk groups such as sex workers, injection drug users and men who have sex with men are already feeling the impact of the crisis.
“This is a wake-up call which shows that many of our gains in HIV prevention and treatment could unravel because of the impact of the economic crisis,” said UNAIDS Executive Director Michel Sidibé.
He added that any interruption or slowing down in funding would be a disaster for the 4 million people on treatment and the millions more currently being reached by HIV prevention programmes.
In 2006, the General Assembly pledged to achieve universal access to comprehensive HIV prevention, treatment, care and support by 2010. A report by Secretary-General Ban Ki-moon on progress on HIV/AIDS commitments shows that achieving national universal access targets by 2010 will require an estimated annual outlay of $25 billion within two years.
According to a news release issued by the agencies, there are no reports of major cuts in donor assistance for 2009. However, it was reported that current funding commitments for treatment programmes in nearly 40 per cent of the countries examined will end in 2009 or 2010. It is feared that external aid will not increase or even be maintained at current levels.
“This evidence shows us that people on AIDS treatment could be in danger of losing their place in the lifeboat and bleak prospects for millions more people who are waiting to start treatment,” Joy Phumaphi, the World Bank’s Vice President for Human Development, stated.
“We cannot afford a ‘lost generation’ of people as a result of this crisis,” she added. “It is essential that developing countries and aid donors act now to protect and expand their spending on health, education and other basic social services, invest effectively and efficiently, and target these efforts to make sure they reach the poorest and most vulnerable groups.”
The joint report outlines several steps to maintain and expand access to HIV treatment and prevention during the economic crisis, including using existing funding better, addressing urgent funding gaps and monitoring risks of programme interruption. It also recommends looking at sources of financing that can be sustained over the long term.
Addressing a meeting of the General Assembly convened last month to assess progress in the response to the global epidemic, Mr. Ban said the economic crisis should not be an excuse to abandon commitments. Rather, it should be an impetus to make the right investments that will yield benefits for generations to come.
“Now is not the time to falter,” he said, noting that a vigorous and effective response to the AIDS epidemic is integrally linked to meeting global commitments to reduce poverty, prevent hunger, lower childhood mortality, and protect the health and well-being of women.
A law will be passed banning female genital mutilation (FGM) in Uganda, Ugandan President Yoweri Museveni announced Friday. In his announcement, Museveni referenced a resolution passed last year by the United Nations that declared FGM a violation of women’s rights.
President Museveni said in his announcement, “The way God made it, there is no part of a human body that is useless. Now you people interfere with God’s work. Some say it is culture. Yes, I support culture but you must support culture that is useful and based on scientific information,” reported the Mail and Guardian http://www.mg.co.za/article/2009-07-03-uganda-to-outlaw-female-circumcision.
FGM is the partial or total removal of external genitalia. The practice both increases the risk of HIV transmission and increases infant and maternal mortality rates. In many cases, FGM decreases women’s sexual satisfaction. Approximately 3 million young women annually are forced to undergo FGM as a form of birth control and as initiation into womanhood. FGM is practiced as a rite of passage in 28 African countries.
Syrian President Bashar al-Assad issued a decree last week that increased the penalty for honor killing to a minimum prison sentence of two years. The law previously limited the maximum sentence to one year. According to the BBC, activists believe about 200 women are the victims of honor killings every year, murdered by male family members who suspect them of committing adultery. In a statement to a Syrian news agency, Justice Minister Ahmad Hamoud Younes said, “The number of wife killing has increased recently on the pretext of adultery, and the canceled article number 548 of the penal law pardoned those crimes.”
The new law reads, “He who catches his wife, sister, daughter, or mother by surprise in the act of committing adultery or having unlawful sex with another and then unintentionally kills or hurts either of them can benefit from attenuating circumstances, provided that he serves a prison term of no less than two years in the case of killing.”
Women’s rights groups in Syria are acknowledging the new law as a small step in the right direction, while maintaining that it does little to discourage honor killing. The group Women of Syria released a statement saying, “This is only a small contribution to solving this problem, for in this new version too the paragraph (law) still invites murder,” according to the Deutsche Presse Agentur.