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Obstacles to Comprehensive Reproductive Health Care

Obstacles to Comprehensive Reproductive Health Care. Martin Donohoe. Worldwide, every minute. 380 women become pregnant 190 women face unplanned or unwanted pregnancies 110 women experience pregnancy-related complications 40 women have unsafe abortions 1 woman dies. Abortion in the U.S.

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Obstacles to Comprehensive Reproductive Health Care

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  1. Obstacles to Comprehensive Reproductive Health Care Martin Donohoe

  2. Worldwide, every minute • 380 women become pregnant • 190 women face unplanned or unwanted pregnancies • 110 women experience pregnancy-related complications • 40 women have unsafe abortions • 1 woman dies

  3. Abortion in the U.S. • 3 million unintended pregnancies/yr • By age 45 • The average female will have had 1.4 unintended pregnancies • 33% of US women will have had an induced abortion

  4. Abortion in the U.S. 926,200 abortions in 2014 (rate down 50% compared to 1980) Pre-Roe v Wade: between 700,000 and 830,000 women/yr underwent illegal abortions in the U.S. (many of them unsafe; deaths often attributed to other causes)

  5. Abortion Worldwide • 56 million/year • Almost ½ unsafe • 220,000 children orphaned each year by poorly performed abortions

  6. Knowledge BarriersMisconceptions about Sex and Contraception • Common among adolescents and physicians • Discussions with parents/physicians limited / often too late

  7. Educational Barriers • ½ of states mandate (only 1/4 require comprehensive sex ed) • Supported by federal government spending • $90 million/yr vs $180 million/yr on comprehensive sex ed (2016) • Prohibits any discussion of contraceptives beyond failure rates • Presents worst case scenarios of abortions and STDs

  8. Abstinence-Only Education • Attempts to instill guilt, fear, and shame • Stereotypes boys and girls; places responsibility for refusing sexual advances on women • Blurs science and religion • Does not decrease sexual activity, STD rates, teen pregnancies • Does not increase use of condoms and contraceptives

  9. Comprehensive sex education programs • Delay onset of intercourse • Reduce the frequency of intercourse • Reduce numbers of sexual partners • Increase condom and contraceptive use • Reduce numbers of unwanted pregnancies • Supported by large majority of Americans

  10. Availability of Contraception • Use of some form of contraception increasing (approximately 80%) • Male sperm counts also decreasing (50% over last 4 decades): • may have both short- and long-term consequences for our species • Infertility rates climbing • 1/6 U.S. couples trying to conceive fail to do so over the course of 1 yr of unprotected sex

  11. Availability of Contraception • Limited access to health care • Lack of insurance • School-based health centers (< ½ dispense, many require parental consent) • Expense (e.g., IUD post-delivery, OCPs) • Provider/pharmacist refusal (“conscience clauses”) • OCPs available OTC in 3 states, but in 106 countries worldwide (safe, does not increase sexual risk-taking behavior)

  12. Christian Science Pharmacist Refuses To Fill Any Prescription

  13. Availability of Contraception • Economic benefits of contraception: • More contraception → more education • 1/3 of wage gains made by US women since 1960 • $7.09 saved/ $1 spent by federal government

  14. Barriers to Abortion:Awareness/Availability of Emergency Contraception • Public awareness low • Available OTC, but some pharmacies do not stock/dispense (“conscience clauses”) • Cost: $25-$50 • $1.43 cost savings for every $1 spent • Availability decreases abortion rate

  15. Barriers to Abortion:Cost • Medical abortion (mifepristone/misoprostol or methotrexate) > ¼ of all U.S. abortions • Average cost $451 • Surgical abortion • Cost: approximately $483 (1st trimester); $750 – $1,500 (2nd trimester) • ¾ of patients pay out of pocket • Most insured patients reluctant to file due to confidentiality concerns

  16. Barriers to Abortion:Coverage • Medicaid, Medicare, Tricare, Federal Employees Health Benefits Program allow abortion only to preserve the woman’s life or in cases of rape or incest • 17 states allocate Medicaid funding to cover most abortions

  17. Barriers to Abortion:Facility/Provider Availability • 1,800 facilities (2,900 in 1982) • Only 14% of Ob/Gyns provide abortions • Over ½ of providers over age 50 • 89% of counties (38% of female population) have no abortion provider • 30% of metropolitan areas have no provider

  18. Barriers to Abortion:Harassment of Patients and Providers • Acts of violence and/or disruption at clinics in U.S. and Canada since 1977 include: • 12 murders, 17 attempted murders, 41 bombings, 643 bomb threats, 175 arsons, 184 assaults, 100 acid attacks, 661 anthrax threats (487 since 9/11/2001) • 21,715 clinic blockades/picketing incidents (2015)

  19. Barriers to Abortion:Inflammatory Oratory • Former President GW Bush, declaring January 20, 2002 (20th anniversary of Roe v. Wade) “National Sanctity of Life Day,” likened abortion to terrorism: “On September 11, we clearly saw that evil exists in this world, and that it does not value life. Now we are engaged in a fight against evil and tyranny to preserve and protect life.”

  20. Barriers to Abortion:Inflammatory/Misogynistic Oratory Virginia State Legislator Bob Marshall: “(W)hen you abort the first-born…nature takes its vengeance on the subsequent children.” MO Congressman Todd Akin: “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down” (i.e., prevent pregnancy)

  21. Barriers to Abortion:Inflammatory/Misogynistic Oratory Former presidential candidate Rick Santorum: “Back in my days, they’d use Bayer aspirin for contraceptives. The gals put it between their knees, and it wasn’t that costly.”

  22. Hypocrisy Former Rep Time Murphy (R, PN): Supported bill making it a crime to harm a fetus during another crime; allegedly urged his mistress to have an abortion Current Rep Scott DesJairlais, MD (R, TN): Anti-choice legislator; fined by TN Medical Board for sexual relationships with 2 patients, urged (now ex-) wife to have 2 abortions, encouraged mistress to have abortion

  23. Barriers to Abortion:Scare Tactics, Misinformation, and Pseudoscience • “Relying on condoms is like betting on your own death...They [the WHO] are wrong about that [condoms are a highly efficient means of preventing the spread of HIV]” • Cardinal Alfonso Lopez Trujillo (Vatican spokesperson on family affairs)

  24. Starving Third World Masses Warned Against Evils of Contraception

  25. Barriers to Abortion:Legal • Viability: Roe v Wade (1973): 24 weeks • 1973-2015: States enacted 1,074 abortion restrictions (more in last 5 yrs than in any other 5 yr period)

  26. Barriers to Abortion:Legal Mandated waiting periods Spousal Notification Laws Parental Consent and Notification Laws for Teen Abortions Targeted Regulation of Abortion Providers (TRAP) Laws Refusal clauses

  27. Barriers to Abortion:Biased Counseling Laws • Often deceptively labeled “Mandated Informed Consent” or “Women’s Right to Know” Laws • Scare tactics: • Women read a lengthy list of possible but very rare complications from abortion (but not list of benefits of abortion) • Many require providers to state, falsely, that abortion can cause breast cancer and “post-abortion syndrome”

  28. Barriers to Abortion:Publicly-Funded “Crisis Pregnancy Centers” • Over 4500 nationwide, some receive state and/or federal funding • More than twice the number of abortion clinics • Listed in phone book under “pregnancy services” or “abortion services”

  29. Barriers to Abortion:State Laws • Laws requiring pre-termination ultrasound • Unnecessary • Rape when transvaginal (trans-abdominal US does not capture images prior to 10 weeks) • Patients often required to bear cost • “Informed Consent” laws • “Fetal Personhood” laws • “Human Heartbeat” laws

  30. Barriers to Abortion:State Laws “Unborn Victims of Violence” laws “Fetal Homicide Laws” “Partial Birth Abortion” Ban “Teen Endangerment Act” Unborn Child Pain Awareness Act “Fetal Pain Counseling” requirements

  31. Facts re Abortion • One of the safest and most common medical procedures available • Risk of death from legal abortion less than that from a shot of penicillin • 40 times safer than a colonoscopy • 10-30 times more dangerous to carry a fetus to term than to undergo a legal abortion

  32. Facts re Abortion • Unintended pregnancy associated with: • Reduced prenatal care • Lower breast feeding rates • Poor maternal and neonatal outcomes

  33. Facts re Abortion (Turnaway Study) • Women denied abortions: • Experience resentment and distrust • Less employment • More poverty/government assistance • More anxiety/depression • Doubled risk domestic violence (not due to getting into new abusive relationships, but because abortions allowed them to get out of abusive relationships more easily) • Their children may face social and occupational deficiencies

  34. Barriers to Abortion:Politics • Political appointments to government scientific organizations/committees based on ideology, not knowledge and experience

  35. Barriers to Abortion:GW Bush Political Appointments • FDA Advisory Board appointee and Ob/Gyn David Hager • Author of “As Jesus Cared for Women” • Advocated Scripture reading and prayer for PMS and reportedly refused to provide contraceptives to unmarried women • Accused by wife of “serial anal rape”

  36. Barriers to Abortion:GW Bush Political Appointments • FDA Representative Dr. Janet Woodcock: • Selling Plan B OTC would transform it into an “urban legend” that would tempt adolescents to create “sex-based cults”

  37. Christian Right Lobbies to Overturn Second Law of Thermodynamics

  38. Trump Administration Trump: narcissistic, sociopathic, misogynistic, admitted sex offender/sexual predator Pence: passed law banning abortion on grounds of fetal anomaly (including Down’s) and requiring fetal US before termination when governor of Indiana (stayed by courts)

  39. Trump Administration Signed resolution allowing states to restrict how federal funds for contraception and reproductive health are spent Republican House calling for defunding Planned Parenthood Administration rule will greatly expand the number of employers and insurers that could qualify for exemptions from the mandate by claiming a moral or religious objection, including for-profit, publicly traded corporations

  40. Trump Administration • Reinstated and renamed/expanded global gag rule • “Protecting Life in Global Health Assistance” • Requires every global health organization that accepts US funding to pledge it will not carry out abortions anywhere in the world (even with its own money), discuss abortion, or lobby governments to liberalize abortion policy • Almost $9 billion funding hangs in balance (including State Dept, USAID, and Defense Dept aid) covering maternal and child health care, HIV, etc. • IPPF will lose $100 million, since it will not abide by the rule

  41. Trump Administration • Cut off funding for UN Population Fund • US gave $69 million in core funds for its humanitarian work in 2016 • Proposal to cut all overseas family planning aid • $600 million dollars in 2016 • Office of Adolescent Health’s Teen Pregnancy Prevention Program halted

  42. Trump Administration • 2018: Considering re-imposing gag rule and requiring such clinics to maintain a separate facility for abortion services 2018 budget of $100 million for abstinence-only education (up from $85 million in 2016) • 2018: “Conscience and Religious Freedom” division of DHHS opened as agency to investigate discrimination against anti-choice providers

  43. Trump Administration • Nominations and appointments of anti-choice judges • ?Roe v Wade at risk • If overturned, 19 states have laws that could be used immediately to restrict the legal status of abortion; right to abortion would be at risk in 33 states • A step backwards: Democratic Party will support candidates who are anti-choice (2017)

  44. Conclusions • Restrictions on access to reproductive health services remain widespread • Vigilance and legislative efforts at federal and state level and in the courts necessary to preserve and protect women’s right to choose

  45. Conclusions • Provision of full reproductive health care to women worldwide: • Just • Would improve the lives of women and children • Cost-saving

  46. Conclusions Amount of money needed each year ( in addition to current expenditures) to provide reproductive health care for all women in developing countries = $12 billion = Amount of money spent annually on perfumes in Europe and the U.S.

  47. Creating Change Comprehensive sex education Fully-funded access to all forms of contraception and to pregnancy termination upon request up to viability Improved education and training of students, trainees, and providers More public health educators; public education campaigns; bringing contraception and abortion “out of the closet” Increased activism/protests

  48. Contact Information Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org Further Information: Guttmacher Institute: http://www.guttmacher.org/

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