Pregnant in a War Zone

Sasha Young, LSRJ Summer Intern (’16, Northwestern School of Law)

A couple of years ago a dear friend of mine had her dream wedding “back home” in Palestine. She’s now battling the Atlanta heat through her first pregnancy, and with the recent surge in violence in the Occupied Territories, I thought for the first time what it would have been like for her to be pregnant “back home.”  The Occupied Palestinian Territories are fraught with human rights situations. I’ve thought about many of the different aspects before, but before I imagined my friend, I had never really taken a reproductive justice lens to the conflict. Immediately, my mind jumped from sexual assault, to access to abortion services, to getting maternity care in a place where sanitary napkins were only recently removed from the list of blockaded items.

The implications for pregnant women are predictably scary. An investigation into the 2008-2009 siege in Gaza revealed horrifying stories of women walking for miles through heavy shelling to find safe places to deliver. Hospitals prioritize the injured, travel is nearly impossible, and physicians are overwhelmed by trauma injuries. One woman, Dalal, recounted her doctor shouting at her for putting the ambulance driver’s life at risk when she should have delivered at home. Another woman, Rula, recounted walking alone for more than an hour in active labor only to be turned away from the hospital because there were too many injured people and not enough staff. Another report found that between 2000 and 2007, ten per cent of pregnant Palestinian women in the Occupied Territories were forced to give birth while stopped at Israeli checkpoints. Of the 69 documented births, 35 babies and 5 mothers died.

Obviously Occupied Palestine is not the only place where women are pregnant and give birth under violent and dangerous conditions. Stories like these are undoubtedly repeated throughout Syria, Congo, Timor, and every conflict zone in between. The immediate trauma of violent conflict leaves practically everything else as “collateral damage” of war, but I suppose this is just a little known bullet point on a long list of reasons we need a sustainable solution to the conflict in Israel and Palestine.

Mirena IUD Litigation, Misinformation, and a Few Thoughts on Informed Choice

Gavin Barney, LSRJ Summer Intern (’16, University of California, Berkeley School of Law)

According to a recent commentary in the Association of Reproductive Health Professionals (ARHP) peer reviewed journal, Contraception, reproductive health care clinics are currently witnessing a notable upswing in the number of patients requesting the removal of their Mirena IUDs. Mirena is a hormonal intrauterine system that prevents pregnancy for around five years through the release of levonorgestrel. And like other types of IUDs and long-term birth control, Mirena is very popular among the public health community: the ARHP refers to the device as safe and effective a number of times throughout the commentary. However, many women are choosing to have their IUDs removed and report being frightened by prevalent online and television publicity of common and devastating side-effects, including migration, perforation, and infertility. The problem, explains ARHP, is that these side-effect are not common, and some of them are actually fake – or “medically implausible” as the article puts it.

The supposed dangers of the Mirena device have made their way into the public consciousness as the result of solicitations for plaintiffs in mass litigation against the device’s manufacturer Bayer. This all initially passed me by, but after researching for this blog post I can report back that there is a lot of if-you-or-a-loved-one-has-been… out there. Mirena, like any other form of birth control, has potential risks, but as a result of media and advertising coverage these risks appear hugely magnified. ARHP contends that this hurts women in two ways: 1) by decreasing the number of women using long lasting birth control, and 2) by deterring contraceptive development by threatening that future technology will be met with similar litigation – note that from the 1970s to the 1980s, the number of companies pursuing contraceptive research fell from 13 to 1.*

For me, the most significant impact that misinformation around the Mirena device causes is not a reduction in the overall number of women using long term contraception. Rather, I am most concerned that opportunistic Mirena litigation and junk science could dissuade women from pursuing or keeping a birth control method that they would otherwise have chosen. IUDs do have some common side-effects – especially immediately following insertion – that can range from unpleasant to awful, so there are entirely legitimate reasons to remove the device early. But for those who actually do want to use and keep an IUD, misinformation can be tantamount to manipulation. Therefore, the central question the ARHP article raises is: what does informed and dignified decision making actually look like when we are so often bombarded with misinformation?

A quick search of the word “Mirena” shows just how murky the waters are when it comes to information on this IUD. Case in point: the first search result on Google, after Mirena’s official website, is DrugWatch.com, which describes a terrifying and “frequently encountered complication,” called “migration,” in which the IUD perforates the uterus and enters the body cavity, causing pain, infection, and damage to nearby organs. The ARHP article, on the other hand, scathingly refers to this problem as “fictitious.” Another site, in its review of the truth behind Mirena lawsuit ads, refers to migration as “so rare that even with tens of millions of women using IUDs worldwide, we can’t estimate how often it happens.”

I can easily envision a situation where a woman may encounter that first explanation of migration and immediately visit her doctor to have her IUD removed. Should the doctor simply dismiss her concerns out of hand because she knows that they are unfounded? Or should the doctor obey her patient’s wishes with the knowledge that she may have been manipulated into removing a device she actually wanted? The answer, as answers so often do, falls somewhere in the middle. LSRJ’s definition of reproductive justice holds that people must be able to “exercise the rights and access the resources they need to thrive and to decide whether, when, and how to have and parent children with dignity…” Here, my hypothetical patient has the right to access the resources she actually wants and needs, so it is her doctor’s responsibility to explain the true nature of the risks and dispel the misinformation. Then, should the patient still decide that the risk is too great, that choice should be met with the same degree of respect. Of course this all relies on the doctors themselves being entirely up on the most recent data about the device they are inserting/ removing and that they themselves are not intent on spreading misinformation.  So… fingers crossed on that one.

*From the ARHP article, this appears to have resulted from the litigation concerning the Dalkon shield. I do not think the writer intended to suggest that that was a case of junk science or junk law. I certainly don’t suggest that.

The Changing Abortion Conversation in Latin America and the Caribbean

Sasha Young, LSRJ Summer Intern (’16, Northwestern School of Law)

I recently saw a film that caught me by surprise, “La Espera” (released in the States as images“Expecting”) by Chilean filmmaker Francisca Fuenzalida. The film is devoted to one night, when Natalia and Rodrigo, a teenage couple from Santiago, self-induce an abortion with Misoprostol. The film was released in 2011 to critical praise for great filmmaking and the courage to tackle the subject of abortion in a country with one of the strictest abortion bans in the world.

Earlier this year I traveled to Chile, the skinny country that lines the western coast of South America, with a bit of angst over what I would find. I wondered what a country that in the last 50 years had a socialist president, a revolution, and a dictator [who, despite his human rights violations, brought incredible economic development and one of the most oppressive abortion laws in the world] would actually look like. I’d heard stories from friends about their own botched Misoprostol abortions, and I’d read about little Belén, the 11-year-old girl who was raped by her mother’s partner and then praised by the former president for deciding to continue her pregnancy. What I found was a country where, although it’s not uncommon to see hormonal teens passionately rolling around the manicured lawns of el Cerro Santa Lucía or see street art cursing the bourgeoisie, the conversation about abortion is hard to find.

I worked in an abortion clinic in Bogotá, lived beside an abortion clinic in Mexico City, and marched to stop restrictions on reproductive rights in Atlanta. I’m from a little island where abortion is still illegal, but even there in Aruba, the conversation of abortion happens. So I was really excited a few weeks ago to hear a debate happening around new Chilean president Michelle Bachelet’s plans to introduce therapeutic abortion exceptions to Chile’s abortion law later this year. The controversial president is a physician by profession, a single mother of three children, and possibly made of steel considering the political risk she’s taking with this new initiative. Abortion is a controversial topic, but in a region with one of the highest rates of teenage pregnancy, where bad abortions are the leading killer of young women, and where criminal penalties for abortion disproportionately affect poor women, we have to at least have a conversation about what reproductive justice in our region looks like.  The winds are changing throughout Latin America and the Caribbean, and having an open and honest conversation is the first step to achieving equal access to tools that help us decide when, how, why, and if we want to parent.

 

Reproductive Oppression Comes at a Cost, Literally

Grace Ramsay, LSRJ Summer Reproductive Rights Activist Service Corps (RRASC) Intern (’16, Smith College)

In 2010, I needed emergency contraception.  Asking my moms (yes, moms) for help was out of the question. So, I waited in the CVS parking lot while my 18 year old friend bought it for me because I was sixteen and Plan B was not yet over the counter. If my friend had said no, if I couldn’t afford the $50 upfront charge, or if I lived in a different state, there’s a good chance I wouldn’t have gotten the morning after pill at all.

Contraception access should not depend on your age, your provider or pharmacist’s religious beliefs, or the employer you work for. Naturally, I was dismayed to see the Supreme Court decision that allows corporations to refuse birth control coverage on religious grounds.  Justice Ruth Bader Ginsberg  reminds us that reproductive oppression comes at a cost, literally: “It bears note in this regard that the cost of an IUD is nearly equivalent to a month’s full-time pay for workers earning the minimum wage.” 

My snarky feminist side can’t help but wonder, (as so many have already lamented,) how come Hobby Lobby still covers vasectomies and Viagra? And why are condoms are available at practically any store, to any age, but it took until last year to have OTC emergency contraception? Can it be as simple and paternalistic as men not wanting women to have control over their personal reproductive decisions? I’m trying to remain hopeful that the outpouring of negative response to the Hobby Lobby decision will translate into renewed activism for reproductive justice.  In the meantime, I have to keep remembering that progress does not move in a linear direction and we have to keep up the good fight.

Anti-shackling Laws and Fetal Rights – Finding the Common Ground

Deodonne Bhattarai, Resident Blogger (’12, Northeastern University School of Law)

The “Birthing Justice” panel at the recent Civil Liberties and Public Policy Conference at Hampshire College celebrated Massachusetts’ recent success in passing an anti-shackling bill.  It also highlighted the dangers inherent in treating pregnant people differently from non-pregnant people. These two issues, at first seemingly at odds with each other, point to an important lesson for those pursuing the protection of pregnant people forced to give birth while in state or federal custody – as important as anti-shacking laws are, it is crucial that they be drafted using language that empowers the pregnant woman rather than in a way that protects the unborn fetus.

Fetal separateness laws ultimately convey legal rights upon the fetus, often from the moment of conception. As Lynn Paltrow, Executive Director and founder of National Advocates for Pregnant Women has explained, there is no way to grant rights to an egg, embryo, or fetus without diminishing the rights of the pregnant person. Over the last three decades, hundreds of women have been charged with crimes due to pregnancy related conduct and we have seen the application of existing criminal and civil child protection laws upon pregnant women in unprecedented ways.

For example, pregnant women who test positive for drugs have been charged with assault with a deadly weapon – the deadly weapon in these cases is the drug and the assault is the in-utero transmission of that drug from the woman to her fetus. Pregnant women have also been charged with contributing to the delinquency of a minor, unlawful child neglect, and child endangerment. Even women participating in government sponsored methadone programs have had their newborns taken away due to in-utero “abuse” when the baby tested positive for the drug. Certain conduct including attempted suicide as well as being HIV positive, has subjected pregnant women to charges of murder, feticide, and sentencing enhancement triggers. Late last month, Tennessee passed the nation’s furthest reaching law, a law that subjects any woman struggling with drug addiction to criminal prosecution based upon her pregnancy outcome.

The creative application of laws upon pregnant people is not only destructive to maintaining family unity but is also counterproductive in assisting with any mental health issues or drug addictions the pregnant person might have.  As Paltrow explained in a recent interview with NPR, “The biggest threats to life, born and unborn, do not come from mothers. They come from poverty, barriers to health care, persistent racism, environmental hazards and prosecutions like these that will frighten women away from getting help from the problems they do have.”

The shackling of pregnant, laboring, and post-natal inmates has been outlawed in eighteen states. When asked about Massachusetts’ pending legislation, Megan Amundson, executive director of NARAL Pro-Choice Massachusetts stated, “Shackling pregnant women is unsafe and inhumane, and it is shocking that this barbaric practice continues today.”  As prisoners rights advocates understand, shackling any human, pregnant or not, is inhumane and barbaric but while we wait for greater criminal justice reforms, we must remain vigilant.  As anti-shacking legislation continues to gain momentum, it is incumbent upon reproductive justice advocates to ensure that such laws are constructed carefully so as to protect women’s rights while avoiding language that would strengthen fetal separateness jurisprudence. For not only do fetal rights laws potentially curtail abortion rights by establishing dangerous precedent but they also create a maternal-fetal conflict by pitting the woman’s autonomy, right to privacy, and right to bodily integrity against those of her fetus.

Trans Sex Workers and Reproductive Justice

Candace Gibson, Resident Blogger (’12, University of Utah S.J. Quinney College of Law)

The reproductive justice and LGBTQ liberation movements share the values of bodily autonomy and sexual liberation and believe that all persons should have the resources they need to form the families they want.  However, many of these desires, including bodily autonomy, are often denied to trans persons, especially trans sex workers, many of whom are trans women of color. At a recent conference that I attended, Cyndee Clay, Executive Director of HIPS, painfully articulated the experiences of trans sex workers and their attempts to survive in our economy.  She had mentioned how trans sex workers not only faced violence from their clients but also from the police as they were arrested, how police officers often sexually harassed these individuals. In 2013, a D.C. police officer shot three transgender women in a car after one of the transwomen refused to provide sex for money.  Clay also discussed how often young trans persons were forced onto the streets because their families rejected who they were and that trans persons are excluded and erased from larger conversations on anti-trafficking efforts, unfortunately nothing new to many of us in different movements.

Clay’s comments remind me that we still live in a society hung up with gender, body parts, and the selling of sex.  Unfortunately, through our regulation and, in this case, criminalization of sexual desire for sale, we often harm and kill the most vulnerable without providing critical solutions and resources for those who are merely trying to survive.  Survival should not be the standard for some-we should all have the resources we need to thrive as persons and as members of our community.

Maybe, it’s time for the broader reproductive justice community to center the voices of sex workers, especially trans sex workers, in our conversations.  It may be hard at first but we have never shied away from a challenge.  

Support the HEAL Immigrant Women and Families Act!

This article was originally published by the National Center for Lesbian Rights.

Lauren Paulk is the Law Students for Reproductive Justice Fellow at the National Center for Lesbian Rights.

Though the Affordable Care Act (ACA) will go a long way toward ensuring access to quality healthcare for most LGBT individuals, many LGBT immigrants are still prohibited from obtaining the affordable health care they need. Despite being authorized to live and work in the United States, many immigrants—including LGBT immigrants—are ineligible for affordable health coverage and care through vital programs like Medicaid and the Children’s Health Insurance Program (CHIP).

Many immigrants are subject to a ban that makes them ineligible for federal Medicaid and CHIP for at least the first five years they are authorized to live and work in the United States, and other lawfully present immigrants who do not fall into an outdated and restrictive list of “qualified” immigrants are barred altogether. Since immigrants—particularly LGBT immigrants—are disproportionately low-income, it can be difficult or impossible to obtain the health care they need. That means five years without insurance coverage for critical and life-saving services, including pap smears, mammograms, HIV treatment, mental health care, or pediatric care for children.

Young people granted status through “Deferred Action for Childhood Arrivals” (DACA) are forced to wait even longer. DACA refers to a program enacted in 2012 that allows undocumented people ages 15-30 who arrived in the US as children (and who are currently in school or working) to remain here for renewable two-year periods. While they are considered lawfully present and are eligible to work and pay into public health benefits systems, they are prevented from accessing affordable care. Currently, people with DACA status are ineligible for federal Medicaid or CHIP coverage and the years they live in the United States with DACA status will not count toward the five years of lawful presence required before they become eligible. To add insult to injury, these young people are even ineligible to purchase private health insurance on the ACA exchange—with or without federal subsidies.

Many LGBT immigrants come to the US after fleeing interpersonal and state abuse based on their sexual orientation or gender identity. However, once they arrive, LGBT immigrants face a number of challenges to obtaining affordable and culturally competent health care. While the ACA will continue to combat the discrimination LGBT people face in the health care system due to lack of cultural competency, all of its positive effects are out of reach for LGBT immigrants because of gaps in coverage. The existing barriers to affordable health care disenfranchise hard-working LGBT immigrants who come to the United States to have a better life, only to encounter difficulty getting the care they need. Moreover, because LGBT immigrants are much less likely than non-immigrants to be able to access health care through their jobs, they are putting work into a system that does not support them.

However, new legislation introduced by Congresswoman Michelle Lujan Grisham would change these realities for good. The Health Equity and Access under the Law for Immigrant Women and Families Act of 2014 (“HEAL Immigrant Women and Families Act” for short) restores access to Medicaid and CHIP for immigrants authorized to live and work in the United States who are otherwise eligible. The bill also extends full participation in the ACA to young people granted status under DACA.

The HEAL Immigrant Women and Families Act is especially important for families. LGBT families are more likely to live in poverty than non-LGBT families, meaning health care on the private market is often out of reach. We know that LGBT people deserve the same access to health care as non-LGBT people, and this should include LGBT immigrants. The HEAL Immigrant Women and Families Act would bridge the gaps in the ACA, Medicaid, and CHIP by extending needed care options to immigrants, and in so doing, strengthen our workplace, our economy, and our communities. NCLR applauds Congresswoman Lujan Grisham for introducing the HEAL Immigrant Women and Families Act, and we encourage other members of Congress who support the LGBT community to stand beside her in expanding the health care options for many LGBT immigrants. Please show your support for the HEAL Immigrant Women and Families Act by signing this pledge, put together by the National Latina Institute for Reproductive Health. Please check out @NLIRH’s twitter timeline for more information on how this important bill will impact our communities!

#KeepItConfidential

Ruth Dawson, Resident Blogger (’12, Emory University School of Law)

Under a landmark California bill passed last year, individuals covered under another person’s insurance policy will soon be able to seek sensitive services such as birth control, STD tests, and mental health services, without worrying about the disclosure of these services to the policyholder. This person is usually a parent or spouse, a fact which often prevents people from using their insurance to get the medical care they need. Going into effect January 1, 2014, the Confidential Health Information Act (SB 138) closes a loophole in California law, where insurance plans unintentionally violate patients’ confidentiality by sending information about the services received home to the policyholder.

April is Sexual Assault Awareness Month, and is thus a particularly important time to be focusing on confidentiality of medical and mental health services. In addition to the common problem of young people heading to a free clinic for routine reproductive care and claiming no insurance (as many of my friends did instead of admitting to their parents that they needed care), this law will have a profound effect on survivors of sexual assault, domestic violence, and gender-based violence. Maintaining confidentiality is crucial for survivors of assault to feel comfortable and empowered to access the physical and psychological services they need, without fear of stigma, forced disclosure, or cruel yet common reactions, such as victim-blaming.

For this new law to have the wide-reaching impact advocates desire, we must create a smooth system for patients to request confidentiality, educate patients across the state that they have the option to request confidentiality, and train providers in how to effectively implement this system in service provision. The smoother the implementation of this bill, the more likely the new law will be used as a model for patient confidentiality of sensitive services around the nation.  I’m proud that California is making real strides to #keepitconfidential for all patients.

I’m a fan of birth control and religious freedom

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Admittedly, I’m a huge fan of March Madness. I jumped on board with the madness; making the effort to watch my favorite team (go Bruins!) specifically at the bar that serves as DC’s “official” UCLA bar, hanging out with friends who had brackets so we could enthusiastically and nonstop talk/compare our brackets, and basically addictively watching the games.  While this March Madness is at the end of the day all fun and games, the real madness that is going on this March is the Supreme Court hearing of Sebelius v. Hobby Lobby.
The precise legal question has to do with religious freedom.  As this National Public Radio piece points out, the legal standard for whether a law infringes upon the constitutionally granted right from laws “prohibiting the free exercise” of religion has changed over the years.  And this summer the Supreme Court will issue its decision as to whether  the new law requiring employers to provide health insurance that includes coverage for contraception poses a substantial burden on the corporate owner’s of Hobby Lobby’s right to free exercise of religion and whether as corporate owners they even have such a legal right.  The madness in this all, for me, is the non legal question here is that, for some, the question exists as to whether contraception is even considered a preventive health measure.  
Former Bush administration Solicitor General Paul Clement bemoans that “The federal government for the first time has decided that they are going to force one person to pay for another person’s not just … hip replacement, but something as religiously sensitive as contraception and abortifacients.”  Hobby Lobby, of course, would never challenge coverage of a hip replacement for a 75 year old employee who fell down the stairs.  Nor should they challenge the use of a medication by a 34 year old fertile woman to prevent pregnancy, a medical condition that changes a woman’s body so that she’ll grow a whole new human within her.  According to the world health organization family planning, “allows spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing, and can prevent pregnancies among older women who also face increased risks.”  Spacing of pregnancies, as experts at the Mayo Clinic describe, has medical implications.  So yes, contraception is just another medical treatment that should be included in health insurance coverage as routinely as say, a hip replacement or high cholesterol medication. Hopefully, a majority of the justices see it the same way and publicly identify contraception as a critical, routine and medically accepted preventive health measure.
Today, the Supreme Court is listening to oral arguments on this case and like most women in the U.S., I oppose Hobby Lobby’s attempt to carve out some contraception from the health insurance plan it provides its employees. I’m publicly acknowledging today that I’m a fan of birth control and religious freedom.  You should too.  Make your new cover page this or pledge your support here.

Sterilization Abuse Isn’t a Relic of the Past

Candace Gibson, Resident Blogger (’12, University of Utah S.J. Quinney College of Law)

As many scholars have noted, laws that were passed to involuntarily sterilize those who were poor, those with disabilities, those institutionalized, and those deemed “sexually promiscuous” and others during the beginning of the century also impacted women of color.

In 1903, President Theodore Roosevelt began to fear “race suicide” or that “Yankee ‘stock’ …. would be overwhelmed, numerically and hence politically, by immigrants, nonwhites, and the poor.”

Latinas were impacted on the continental United States as well as in Puerto Rico during the first half of the twentieth century. U.S. policy promoted permanent sterilization in Puerto Rico through door to door visits by health workers, financial subsidies, and employers favoring sterilized women in the hiring process.

Things hadn’t changed much by the seventies.  In Madrigal v. Quilligan, it came to light that medical practitioners at Los Angeles County Medical Center coerced low-income, immigrant women into sterilization within hours of giving birth.  One plaintiff, Maria Hurtado, described her situation: “I was told through a Spanish-speaking nurse, that the state of California did not permit a woman to undergo more than three caesarean section operations, and since this was my third, the doctor would have to do something to prevent me from having another caesarean operation.  They did not explain or describe the tubal ligation, and it was later performed on me without my knowledge or consent.” When the case was decided in 1978, the judge ruled that the practitioners had acted in good faith and without intent to harm.

Latinas in California’s mental health facilities were also subjected to sterilization abuse because they were labeled feeble-minded or because their parents could not support them or for other arbitrary reasons.  However, these women shared similar characteristics: they were of Mexican origin, they had little access to education, and their families migrated back and forth to the United States. This story of abuse started in 1909 and lasted until 1979.

To this day, advocates are hearing stories of abuse and coercion when women are in the hands of the state for their care.

During this past summer, it was reported that 132 women incarcerated in the California prison system were forcibly sterilized between 2006 to 2010.  As you can imagine, many of the women were women of color.  In 2010, Latinas and African-American women made up 59% of the California prison system and these numbers are indicative of the national trend of low income women and women of color serving time in prison for non-violent offenses.  The providers who sterilized these women assumed that these women were repeat offenders or believed these women should no longer parent because they had multiple children.  Many of the women went in for various reproductive health care needs and were misled to believe that sterilization was their only option for treatment.  It is disappointing that these women were deemed to have no dignity or autonomy by their providers. It is more distressing that the mainstream reproductive rights movement has forgotten about these women even though correctional institutions are the second largest provider of reproductive health services in this country.

The situation of these women and their families reminds us that we are a long way off from the right to parent and the social supports needed to actualize this right for many persons in this country.