Should Young Women be Allowed to Choose Sterilization?

Emily Gillingham, Resident Blogger (’15, Michigan State University College of Law)

I’ve been reading a lot lately about the many young women who, after much careful deliberation and research, have concluded that they want to be sterilized- only to be turned down by their doctors.  The story plays out again, and again, and again, on blog after blog.  This is A Thing That Is Happening, and it really burns my toast.  Some doctors are telling women that they won’t perform the procedure until the women are 30 or even 35 years old, in case they decide later that they want kids.

Let me be clear here- there is a long, complicated, and painful history (and present) of sterilization where the woman is being coerced or forced by a person or by the government, or targeted because of her race, class, religion or disability, or lacks informed consent.  I’m talking about women who are being denied the procedure only because their doctors are worried that they will regret it.

For those women, being denied the procedure is frustrating.  As blogger Bri Seeley wrote, “I was livid. I had asked for a procedure for six straight years with no break in my desires, opinions, or beliefs.  Why did the medical community continue to deny me of my personal right to sterilization?”

Sterilization is safer than pregnancy, and actually reduces the risk of ovarian cancer and pelvic inflammatory disease.  It doesn’t increase women’s risk of breast cancer, unlike a certain birth control method might (I’M LOOKING AT YOU, PILL), and it’s reversible in 25% to 87% of cases.  It also leaves some women options like in vitro fertilization and adoption if they decide that they want to have a child and reversal doesn’t take.  Also, although some IUDs and hormonal implants are actually more effective than sterilization, not every method is a good fit for every woman, so making sterilization available to women who want it is important.

If your brain is exploding with the effort of trying to understand why this is happening at a time where the right to choose abortion is being severely restricted, politicians seem to have some sort of bet going about who can be the biggest jerk about restricting contraceptive access, and raising kids is hella expensive, I totally feel you.

I hesitate to blame the medical community, because although studies vary widely on sterilization regret rates, the strongest predictor of regret is young age.

Nonetheless, there is something creepily paternalistic about medical professionals making women who’ve decided that they don’t want kids risk birth control failure for a decade or more, just in case they’re wrong.  After all, some of the research about young age and sterilization regret that the National Institutes of Health points to is based on procedures performed in the 1970s and 1980s, and our attitudes about women’s role in society and the number of women who wish to remain childless have shifted dramatically since then. It would be interesting to see future research focus on women who are denied sterilization procedures. We could learn a lot from the women’s motives, the doctor’s rationales for denial, and demographic data. The most visible blog posts on this subject are written by white women, and there is value in knowing why we aren’t reading women of color blog on this topic.

Denial of sterilization to young women is related to, and perpetuates, the myth that all women want children and that those who do not will change their minds.  As reproductive justice advocates, we should be fighting for doctors to respect women’s personal decisions about sterilization.

“Do you have a [female] condom?”

Rhiannon DiClemente (’16, Temple University Beasley School of Law)

In case you missed it, September 16 marked the third anniversary of Global Female Condom Day.  Two decades since its introduction, the female condom hasn’t quite lived up to its potential.  Today, less than two percent of all condoms distributed worldwide are female condoms.  When our LSRJ chapter asks local organizations to donate condoms, we are usually sent boxes full of male condoms.  On the rare chance that we do get sent a few token female condoms, they are often met with skepticism and laughter from the student body.

It’s true—the female condom is less intuitive and less familiar than the male condom.  Some may call it aesthetically unappealing and technically difficult to master, but we shouldn’t give up on the female condom just yet…

The female condom is the only woman-initiated technology that prevents both unintended pregnancy and sexually transmitted infections (STIs), making it an important tool in the fight against the spread of HIV.  Women now account for more than half of the world’s population living with HIV.  Worldwide, HIV and AIDS is the number one cause of death for women of reproductive age.  In Sub- Saharan Africa, 72% of new infections among young people age 15 to 24 are women.

Despite these facts, I can’t even give these female condoms away to fellow students.  Only 13% of people have heard of the female condom, and much fewer have ever used one.  However, organizations like PATH, a global health non-profit, are working to reinvent the female condom.  In 2012, the United Nations Population Fund released a new version of the female condom.  The Gates Foundation has also awarded grants for a “next-generation condom,” male or female, that would be easier and more pleasurable to use.  This is an important step.  Greater variety in female condoms can help increase the odds that women even choose to use, or at least try, any female condom at all.

But putting more female condoms on the shelves is not enough.  Advocates need to create education campaigns at the local, national, and global levels on the benefits of female condoms, including the fact that they give women the power to control safe-sex negotiation.

As an LSRJ chapter leader, I hope to start a larger conversation about the benefits, and shortcomings, of the female condom.  I want to encourage women, including myself, to at least try one before we form an opinion about it.  I want men to be involved in this discussion as well; there is no reason a man shouldn’t introduce a female condom to his partner.  Normalizing female condoms in a conversation about pleasurable and safe sex is an important first step.  With informed feedback, the unattractive, clumsy female condom can only get better.

Condom Dispensers are Rad, Cool Things

Emily Gillingham, Resident Blogger (‘15, Michigan State University College of Law)

I lead the chapter of Law Students for Reproductive Justice at Michigan State University College of Law. Whenever we get a chance, we hand out free condoms at the school.

Valentine’s Day? Condoms.

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Halloween? Condoms.

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Student organization fair? Condoms. I can’t tell you the joy I get from pressing a condom into the hand of a 1L who wandered up wondering what reproductive justice is.

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Last year, our then-chapter-president was visiting University of Minnesota Law School and realized that their LSRJ chapter (HOLLA!) was distributing condoms in a way we weren’t: WALLS.

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Our e-board talked it over and decided that we most definitely wanted to see a condom dispenser go up at our school. This June, we got word from the administration that we’d be getting a bulletin board at the school to post news about upcoming meetings and other information about our organization. Just look how fabulous it is.

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The timing couldn’t have been better; the board seemed like a perfect home for our condom dispenser. We expected that approval from the administration would come at a glacial pace, so we put in a request right then to purchase a dispenser and mount it on our board. I have to say, I was pretty surprised when we got word that the plan could proceed as long as it was ‘accompanied by a tasteful message explaining our support for the dispenser.’ Our school’s administration is awesome, but if you have experience trying to integrate reproductive justice, sex education, or sex positive programming into an environment that isn’t built around that ideology (read: law school), you know that asking for something like this can feel like asking the conservative wing of the Supreme Court for a condom.

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We’ve picked out a dispenser that we like. You can check it out here. I’d be lying if I said I wasn’t amused that they’re “made from the same material used in police riot vehicles .”

Our next step is funding. I just submitted our funding request to the Student Bar Association at MSU Law, which feels more like asking Justice Kennedy for a condom- wish us luck!

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Update: Michigan State’s LSRJ chapter has successfully installed a condom dispenser:

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You can purchase your own dispenser here. (It’s actually a lens wipe dispenser, but it gets the job done!) Go Michigan State LSRJ!

Oral Contraceptives and Why We Shouldn’t Count Out Over-The-Counter

SJ Chapman, Resident Blogger (12, Northwestern University Law School)

Recently, some Republican candidates have entered the spotlight for doing a 180 on issues of contraceptive access. Take Congressman Cory Gardner (R-Col.) for example.  Gardner has a sinister record when it comes to matters of reproductive justice.  However, in a recent op-ed, Gardner argued for over-the-counter availability of oral contraceptives.

Practically overnight, leery reproductive justice advocates leapt to attack this position, denouncing it as an insidious political tactic to ultimately decrease access to oral contraceptives.  The logic goes like this: oral contraceptives are widely available without a copay under the Affordable Care Act, but would be costly (as much as $600 a year) OTC.  Women who had previously been able to access oral contraceptives thanks to the ACA would be squeezed out due to the price.

I have to say, although I am against most of Gardner’s positions on reproductive justice, this one might not be as bad as we’ve made it out to be.  In countries where oral contraceptives are sold, most already offer them OTC.  Even Planned Parenthood advocates for OTC oral contraception in the United States.  And I have to wonder – when drugs have gone OTC in the past, there have still been prescription-only versions.  Wouldn’t this be the case with birth control as well?

Even though it comes from someone with history of deplorable stances on reproductive justice, maybe we shouldn’t be so quick to denigrate this one.

Special Prosecution of Women Who Use Drugs During Pregnancy Or … Happy One Month Anniversary Tennessee SB 1391 – and Here I Forgot to Get You a Gift.

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

The start of August marked a somewhat ignominious one month anniversary this year: a short thirty-one days earlier Tennessee became the first state in the union to specifically criminalize drug use during pregnancy. On July 1st, the state enacted SB 1391, which enables prosecutors to bring assault charges on the behalf of a fetus against women who use narcotics while pregnant.  Just over a week later, 26-year-old Mallory Loyola became the first target of the law.

In a twisted kind of way, Tennessee’s approach to criminalizing pregnant women is almost refreshing.  The Volunteer State is by no means the only state to treat drug using and drug addicted pregnant women with prison sentences and loss of parental rights instead of … well … treatment. Not by a long shot. Other states prosecute pregnant women at high levels with three main methods: child abuse and endangerment laws, laws prohibiting delivery of illegal drugs to minors, and fetal murder/manslaughter statutes.

Alabama prosecutes pregnant women in a particularly roundabout and unnerving method. Since 2006, Alabama has arrested at least 100 pregnant women for the crime of “exposing their child to a meth lab” using a chemical endangerment law designed to prosecute people who bring children to dangerous locations. To make matters worse, the Alabama Supreme Court deemed it necessary to affirm this usage of the chemical endangerment laws in back to back years – holding in 2014 that the statute’s use of the word “child” “plainly and unambiguously includes unborn children.”

Medical and public health organization such as the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) have criticized these punitive practices for putting both mothers and fetuses at risk by discouraging women from seeking prenatal care for fear of being turned in.* Additionally, the American College of Obstetricians and Gynecologists (ACOG) has stressed that treatment, not incarceration, must be the approach to these cases.

However, at a broader level, policies like those in Tennessee and Alabama are most horrifying and destructive because they answer the question “are pregnant women still people with full rights?” with an emphatic “hell no they’re not!” Like other personhood-type policies, special criminal prosecutions pits pregnant drug using and addicted women in conflict with their fetus, putting the full force of the law on the fetus’s side (or at least against the woman).

For more information on criminalization of pregnant women, check out LSRJ’s fact sheet on “Regulation of Pregnant Women,” and for LSRJ chapters interested in hosting an event on the issue, LSRJ is releasing an Event Toolkit on Criminalization of Pregnancy and Shackling of Incarnated Pregnant Women.

*Note that fifteen states require health care providers to report suspected drug use during pregnancy.

WHPA Revives Debate over Abortion Restrictions at Senate Judiciary Committee Hearing

Rhiannon DiClemente, Guest Blogger (’16, Temple University Beasley School of Law)

Early Thursday morning on July 15, 2014, the Senate halls were bustling with interns, staff members, and local advocates eager to witness the Senate Judiciary Committee hearing on S. 1696, also known as the Women’s Health Protection Act of 2013 (WHPA). Attendees, who managed to overflow the room, patiently awaited testimony provided by members of Congress, doctors, and activists, both for and against the bill. In light of the decisions in Hobby Lobby and McCullen, it was reassuring to see politicians taking a long over-due stand to protect a woman’s constitutional right to determine whether and when to bear a child or end a pregnancy.

The bill, sponsored by Sen. Richard Blumenthal (D-CT), addresses medically unnecessary state restrictions claimed to “protect” women’s health. It requires that state legislators prove state laws restricting abortion are in fact medically necessary, rather than politically or ideologically motivated. It also requires that states regulate abortion providers in exactly the same way they do other clinics and doctors who provide comparable services. The bill has its shortcomings, such as failing to address clinic violence, insurance prohibitions, and parental consent laws, as a March 2014 blog post highlights. However, it is an important step forward in combatting laws that have a disparate impact on low-income women, immigrant women, LGBT persons, and women of color.

Why is this bill important? As a LSRJ chapter leader at Temple University School of Law and a summer legal intern at the Center for Health and Gender Equity (CHANGE), I know that despite the fact that we have Roe , the web of state restrictions has decimated abortion access. In states like Louisiana, Texas, and Mississippi, the situation is dire. In 2012, the Mississippi legislature passed HB 1390, mandating that any physician performing abortions in the state have admitting privileges at an area hospital (an unnecessary practice). During the Senate committee hearing, Dr. Willie Parker, a board-certified OB/GYN and the last physician providing abortion care in Mississippi, testified that despite 13 attempts to gain admitting privileges at regional hospitals, not one of his requests has been granted. This is just one example of how seemingly ‘safety-oriented’ legislation is really aimed to shut down clinics and restrict abortion access.

At the hearing, Rep. Janet Chu (D-CA27) testified that between 2011 and 2013, states passed over 200 restrictions blocking access to abortion services. This translates to more restrictions on women’s health care in three years than in the entire preceding decade. Sen. Tammy Baldwin (D-WI) highlighted that these restrictions have forced women to travel greater distances and endure longer wait times to obtain an abortion. “The effect of these laws is that a woman’s constitutional right now depends on her zip code,” stated Rep. Chu, “We need laws that put women’s health and safety first – not politics.”

By speaking out against arbitrary restrictions that do not reflect medical best practice standards, supporters of S. 1696 have declared their respect for the constitutional right to access abortion services and trust in a woman’s ability to make the best choices for her own health and life.

Full testimony can be found here.

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.