“Beyond Safe and Legal” – Lack of Access to Abortion as a Form of Gendered Violence

For Day 13 of the 16 Days of Activism, guest blogger Claire McKinney writes about abortion restrictions as gendered violence.

The past two years have been witness to a prodigious amount of new and pernicious abortion restrictions across the United States. According to the Guttmacher Institute, over 162 restrictions have been enacted over the past two and a half years. Many of these restrictions have taken the form of Targeted Regulation of Abortion Providers, or TRAP laws. These laws operate under the guise of making abortions safer for women by creating more stringent requirements for abortion providers, including upgrading facilities to the level of ambulatory surgical centers, requiring doctors who perform abortions to have hospital privileges, and by prohibiting telemedicine, or the provision of medical services over the internet, of use for many rural residents. The regulations have shuttered dozens of clinics across the United States, eliminating access to abortion for countless women, especially poor women in non-urban settings.

This past summer, the Texas legislature’s attempt to pass several of these restrictions in a single bill reached national attention when Wendy Davis, a representative from Fort Worth, filibustered the bill in the closing days of a special session which had been called for the express purpose of passing incredibly restrictive abortion laws that would close the doors of all but five of Texas’ abortion clinics, forcing some women in rural areas to drive anywhere up to 500 miles to reach a provider. Because the filibuster rules of the Texas legislature require that all speaking must be germane to the bill in question, all 10 hours of Davis’ filibuster worked as justifications to reject the abortion restrictions being proposed.

Wendy Davis

Wendy Davis. (Image: huffingtonpost.com)

The testimony Davis introduced, from members of various medical communities as well as from Texas constituents who were barred from testifying during the public hearings on the bills, displayed the full range of justifications for having full access to abortion providers. From a women’s health perspective, what is troubling about these new restrictions is the co-option of the language of women’s health to justify new restrictions. Opponents of abortion have learned to speak that language of science and women’s health without any concern for the validity of their claims. They claim that these laws are necessary to guarantee the safety of abortion, readily ignoring that abortion is safer than childbirth in terms of complications and risk of mortality. When those who object to new restrictions demand evidence for the need for hospital privileges or clinic standards that are only necessary for complicated surgeries demand to see evidence to support these restrictions, the only response is silence. And yet the bad faith co-option of women’s health continues to ensure that women will be refused the care that is medically necessary and socially desirable.

Concerns for women’s health, for women’s citizenship status, and for unjustified interference in medical practice repeatedly echoed through many parts of the testimony. What is striking that often is not present in thinking through the need for access to abortion is how lack of access contributes to gendered violence and is itself a form of economic violence.

In 2012, Karuna Chibber of the Bixby Center for Global Reproductive Health at the University of California San Francisco found that women who were denied abortions were significantly more likely to experience intimate partner violence than women who had safely procured an abortion. It would be easy to speculate how coerced parenthood places women into vulnerable positions in relation to partners such that they could not leave such partnerships, even if they turn violent. Chibber’s work provides a new way of understanding access to abortion to be an issue not only of a choice of one’s life goals but also a crucial resource for women to avoid situations of intimate partner violence. The right to abortion is also the right to be free from violence.

Roe v. Wade anniversary

Image: salon.com

The economic violence associated with lack of access to abortion is more well established and has been a thread of concern for establishing a right to access to abortion since the movements of the 1960s. Many women who seek abortions do so because they know an additional child will place an unsustainable economic strain on themselves and their family. Women lose opportunities such as the time and resources to attend school and to advance or even hold employment when they cannot afford childcare, ensuring that a cycle of poverty will either begin or persist for these women and their families. Furthermore, women in poverty are those who are mostly likely to lose access to abortion providers by the increased restrictions on abortion. Women with financial needs can travel long distances with relative ease, while these restrictions work to create an economic underclass, whose rights are less than those of the wealthy. The differential health results are themselves a form of violence against women that demands that access to abortion remains part of the activist agenda for women’s empowerment.

Davis’ filibuster delayed the passage of the abortion restrictions in Texas, but only by a couple of weeks. Since their passage, they have been held as constitutional by the Texas Court of Appeals and the Supreme Court has refused to hear the constitutional challenge against such laws. Relying on legislative and judicial forums to protect access to abortion has proven to be less than effective. Instead, protecting and expanding access to abortion requires organizations and individuals to articulate demands not only in the language of health which has become too susceptible to cooption, but also in the language of women’s citizenship and right to be free from violence.

Claire McKinney is a PhD candidate in Political Science at The University of Chicago. Her dissertation develops a concept of medicalized citizenship and the centrality of the language of health in the history of and in present day abortion politics. 

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‘The Edge of Joy’: How Religion and Technology Shape Maternal Health in Nigeria

For Day 5 of the 16 Days of Activism Against Gender-Based Violence, guest blogger Jeanne Chauffour recaps Chicago filmmaker Dawn Shapiro’s documentary The Edge of Joy, a chronicle of maternal health in Nigeria.

On November 16th, GlobeMed at The University of Chicago hosted its first Global Health Film Festival, which featured five documentaries. “The Edge of Joy”, Dawn Shapiro’s touching and compelling account of maternal health in Nigeria, was followed by a conversation with the director. The film alternates between documentary footage, interviews, and animation, and splits it focus between Kano, a Muslim city in the northern dry desert, and Oyo, a luscious metropolis in the Christian south.

Nigeria, the most populous country in Africa, has 140 million people equally distributed between these two areas of the country. But in both North and South, health professionals face daily struggles related to maternal mortality and newborn morbidity. Indeed, Nigeria faces the second highest number of maternal deaths in the world, with 36,000 Nigerian women dying in labor every year (2010).

Shapiro lays her first scene at the Murtala Mohammed Specialist Hospital, where thirty babies are delivered every twenty-four hours. Sakina is in her twenties, and in labor with twins. Already the mother of two, she, like fifty percent of Nigerian women, has never given birth in a hospital. While her first twin is born strong and healthy, the second twin is small and sickly-looking. Yet her newborn is not the only one with his life on the line. His mother is suffering from the leading cause of maternal mortality: post-partum hemorrhage. Sakina needs blood transfusion, but the hospital has no stock of her rare blood type. Fortunately, Sakina’s husband owns a car, but although he visits many hospitals and private blood suppliers across the city, he faces a barrier common to many Nigerians in his situation: one pint of blood costs $68, and the average Nigerian monthly salary is $94. These access and financial barriers cause thousands of preventable deaths every year.

Edge of Joy 1

Image courtesy of ‘The Edge of Joy’

In the same ward, we meet Aicha and Kabiru who are expecting their eighth child. Aicha bled a lot when her two previous children were born, so she asked her husband to take her to the clinic. In the North, women’s chances of dying during childbirth are increased because Islam prevents them from traveling without a male escort. When Kabiru’s car breaks down on their way to the hospital, Aicha must wait for her father-in-law’s permission to have another male relative accompany her. When she finally reaches the hospital, she has lost a significant amount of blood. Immediately, doctors strap her into an anti-shock garment. This innovative full-body suit is strapped tightly around the limbs and the stomach, and shoots blood back to vital organs, preventing hemorrhaging women from losing large amounts of blood. A couple minutes later, Aicha’s situation stabilizes and the garment allows her to survive the next five hours it takes Kabiru (who lost his first wife during her seventh delivery, and is the father of thirteen) to find two pints of blood.

Image: openideo.com

Image: openideo.com

The sharia, or Islamic law, dictates the way of life in most conservative Muslim communities. The interplay between Islam and modern medicine is a delicate balance that reproductive health professionals must navigate. Many families perceive the West as imposing ideas on them. Speaking of northern Nigerian men in general, a nurse explains that they have a difficult time understanding that doctors are not asking couples to stop having children, but to space out the births. According to sharia, women should not “take a break” from having children, because Allah disapproves of breaks. Yet, when husbands realize that birth spacing prevents their wives from dying, many consent to the beneficial aspect of contraception and family planning. Preventative community education has been successful as more and more women come to the clinic alone, and depend less on their husbands’ permission to leave home if they get contractions in the middle of the day.

The north of Nigeria is a dangerous and difficult to place to be a woman. If a woman has given birth five times, any birth beyond the fifth is disproportionally dangerous. Moreover, to further decrease maternal mortality, couples are recommended to wait at least two years between pregnancies. Especially for rural families, access to health facilities and emergency care is limited, and the lack of sexual and reproductive health education leads one in five pregnancies to be unplanned in Nigeria every year.

For many rural women like Rachel, who describes herself as “very fertile”, preventing pregnancies has been unsuccessful. After realizing she was pregnant with her fifth child, she tried to give herself an abortion by using local herbs and remedies, but after severe diarrhea and drastic weight loss that put her life in danger, she “accepted her fate” and started the prenatal care recommended by her local midwife.

Source: pulitzercenter.org

Source: pulitzercenter.org

In many parts of Nigeria, men perceive contraception as encouraging women’s promiscuity. While most men are eager to improve the reproductive lives of their families, contraception is a man-only dialogue that has not yet expanded to encompass how family income and wealth depends on maternal health. Strategies have been adopted to creating safe forums for discussions, where religious leaders and health professionals conduct pre-natal classes, and provide outlets for women and men to separately express their feelings, concerns, and ask questions. Especially in the southern city of Oyo, where the premier physician for maternal health lost his own mother at age three, nurses and leaders stress the social consequences of poor health and the multitude of challenges that families and children face without a mother.

To remedy this situation, Nigerian doctors have lobbied for separate maternity blood banks. With these new blood refrigerators in place, the wait time for blood has been reduced by 75%, and maternal mortality rates have significantly decreased. Other free maternal services have been deployed to allow women to travel without male escorts to nearby hospitals. The anti-shock garment has also contributed to 50% less blood loss and 64% fewer deaths in the maternity wards that use them.

After the screening of her inspiring documentary, director Dawn Shapiro spoke about the idea that sparked her interested in maternal health –specifically, the anti-shock garment led her to focus on Nigeria, where it is presently the most widely tested. She mentions how Nigerian hospitals are now very focused on training professional staff and local birth attendants, increasing access to transportation, making technologies like the anti-shock garment or the Odón device (engineered by an Argentinian car mechanic, and pictured below) more accessible, and blood donations more widespread.

Source: bergamosera.com

Source: bergamosera.com

The lesson that Shapiro encourages young global health-oriented students to keep in mind when working abroad is that the best way to understand women’s challenges is by getting community buy-in from health professionals and local leaders. Only in this way can one really come to understand the underlying moral values and ancestral traditions that shape attitudes, decisions, and priorities. And the messages Shapiro wants us to take home with us? “Saving one mother’s life saves a family’s life.”

Jeanne Chauffour is a third-year in the College studying History, Philosophy, and Social Studies of Science and Medicine (HIPSS) and Human Rights. Jeanne is Director of Campaigns for GlobeMed at The University of Chicago, and a Volunteer at Ci3 and the Center for Global Health at The University of Chicago.

Emergency Contraception Controversy & Gender-Based Violence

Access to emergency contraception (EC) has a storied history in the USA and directly impacts victims of sexual violence. Ci3 and the Section of Family Planning & Contraception Research, along with the Center for the Study of Gender and Sexuality hosted a challenging and informative presentation that explored this intersection. Dr. Susan F. Wood, Associate Professor of Health Policy and Director of the Jacobs Institute of Women’s Health at The George Washington University spoke about her role and observations surrounding over-the-counter EC access.

As Assistant Commissioner for Women’s Health at the FDA, Dr. Wood directed the FDA Office of Women’s Health from 2000 to 2005, at which point she resigned on principle over the continued delay of approval of EC over-the-counter.

Dr. Susan F. Wood

Dr. Susan F. Wood

Dr. Wood’s talk, Controversy over Contraception: From Emergency Contraception to Contraceptive Coverage to the Affordable Care Act, began with the historical context of women’s health and federal funding and ended with the implications of the ACA specifically regarding contraceptive coverage and access.Her talk focused primarily on the ongoing struggle to make EC available to all women over the counter.

In her role at the FDA, Dr. Wood witnessed the agency’s attempts to regulate the practice of medicine and pharmacy when it came to emergency contraception, an unprecedented course of action not only in its role as a government agency but also because of the impact on women’s access to family planning services.

The FDA approved Plan B as EC in 1999 as a prescription product for all women of childbearing potential. The manufacturer sought over-the-counter (OTC) approval in 2003.

At this early stage, it was already known that:

  • EC is safe and suitable for all women.
  • EC does not cause an abortion (“The only relation between EC and abortion is that EC prevents the need for an abortion,” says Dr. Wood.)
  • EC needs to be taken soon after (within hours of) intercourse to be the most effective.
  • EC provides victims of rape the option to prevent an unwanted pregnancy.

Despite these facts and extensive studies on the safety for women of all ages, politics and myths about EC — that it would increase adolescent sexual activity, encourage pedophilia, or cause an abortion — delayed FDA approval.

Not until August 2006 did the FDA approve Plan B over-the-counter (OTC) at pharmacies and health clinics, and this approval was limited to women 18 years and older; younger women would still require a prescription. Between 2003-2006, recommendation for approval had been overruled several times, Dr. Wood resigned, and activists across the country lobbied the FDA to make decisions that reflect good medicine and public interest.

In March 2009, a US district court ruled that the FDA decision to restrict access to women under 18 was “arbitrary and capricious” and ordered the FDA to lift restrictions on 17-year-olds within 30 days. Also in 2009, the FDA approved One Step (a one-dose version of Plan B) and Next Choice (a two-dose generic version), but the age restriction remained at 17. In 2010, with the age restriction still in place, The Center for Reproductive Rights filed for contempt of court citing the delays.

In 2011, Teva (One Step) released new data and filed an application to lift the age restriction. With the age restriction ready to be lifted, the FDA was overruled by Health and Human Services Secretary Kathleen Sebelius, who cited the lack of evidence on 11- to 12-year-olds’ ability to use the product. Although this argument was unprecedented and unfounded, President Obama agreed with Kathleen’s lack of evidence argument and the age restriction remained.

It took until June 2013 for the FDA to approve Plan B One Step OTC for all women without age restriction. That is, it took 10 years for women to have OTC access to a safe medicine approved by the FDA for women of all ages.

Plan B as seen over-the-counter. Image from Dr Wood's presentation 11/19/13.

Plan B as seen over-the-counter. Image from Dr. Wood’s presentation 11/19/13.

How does this history of EC approval, restrictions, stigma, and accessibility relate to gender-based violence and the 16 Days of Activism Against Gender-Based Violence campaign?

  1. EC is an essential contraceptive option for women who experience sexual violence. According to the FDA: “Seven out of every eight women who would have gotten pregnant will not become pregnant after taking Plan B, Plan B One-Step, or Next Choice.” Dr. Wood adds, “There isn’t any difference in efficacy for the use of EC for victims of sexual violence.”
  2. EC potentially prevents the extra burden of an unwanted pregnancy for rape victims.
  3. The cost of EC may be prohibitive; EC costs about $50 OTC in most pharmacies. Under the Affordable Care Act, the cost should still be covered through prescription. According to Dr. Wood, in the cases of rape, specifically for populations who cannot afford the $50, access to EC through family planning clinics may reduce the cost.
  4. If a victim of sexual violence seeks care at an emergency room, EC should be provided as part of her treatment.
  5. Even though EC is available OTC, doctors should continue prescribing and counseling EC, especially for victims of sexual violence. According to Dr. Wood, “Time is of the essence, so provision of information, and advance provision of EC can be helpful for all women. In addition, awareness by providers of other EC methods, such as insertion of copper IUD or use of Ella (a prescription only emergency contraception that is effective for up to 5 days) is important.”

V-Day and The Vagina Monologues: My Experience

Founded by playwright Eve Ensler, V-Day is a global activist movement to end violence against women and girls. On Day 2 of the 16 Days of Activism, Ci3 Communications Manager Lauren Whalen reflects on her experience with the V-Day movement. 

When I walked into the green room of my college’s mainstage theater, I had no idea I’d walk out a changed person.

It was late 1999, and I was a theater major at Loyola University Chicago. The department was doing an open call for actresses for their February 2000 production of The Vagina Monologues. The year before, Loyola had been one of the first schools to perform the piece, an original play by Eve Ensler that raised awareness and funds to end violence against women.

Image

I just wanted to be in a show. Though I’d identified as a feminist since eighth grade, I was alarmed by all the anger I’d witnessed around me since I’d started undergrad. I wasn’t an angry person, and I had a boyfriend, therefore I thought I wasn’t a “real” feminist. But opportunity won out, and besides, I was curious about a show that used that word so openly.

After I was cast, I bought a copy of the play at Borders and read it cover to cover. My eyebrows almost disappeared into my hairline. Surely these stories were exaggerated. I knew what rape and abuse were, of course, but until then, they were abstract concepts. I didn’t realize how wildly fortunate and privileged I was, never to have experienced them firsthand. I was shocked by these monologues, the stories of women who’d been victimized by anonymous soldiers, by strangers, by adults they should have been able to trust.

And then, I got angry. Why should this be happening? Why was society so conditioned to accept it, or in my case, why was it so easy to ignore? Why was it still considered tradition, in other countries, to sever a woman’s clitoris? Why were so many women, of every size, shape and color, survivors of violence?

A few months later, I performed my small role with gusto. I felt the collective power of my castmates – a week before the production, posters advertising The Vagina Monologues had been ripped down all over campus, causing us to proudly sport homemade T-shirts with “V” on them, while taping up new posters. And over the next seven years, I would appear in the show six more times (both at Loyola and at Northern Illinois University, where I attended law school). I would spend a day with Eve Ensler herself. I would add an undergrad minor in Women’s Studies, and eventually pay my law school tuition as a Women’s Studies teaching assistant. In 2006, I would direct and act in a university-wide production, and (due to a venue double booking) perform the final monologue in a parking lot in DeKalb, Illinois.

I’ve still never experienced sexual violence or abuse, but I have done my best to advocate for survivors through my work. Sadly, women are often perceived as second-class citizens. And that won’t change unless we make our voices heard, and help others do the same.

Life would have been very different had I not walked into the green room that day.

To learn more about V-Day and The Vagina Monologues, visit http://www.vday.org

16 Days of Activism Against Gender-Based Violence – Nov. 25-Dec. 10

Today marks the first day of the 16 Days of Activism Against Gender-Based Violence. The campaign will run through December 10.

16_days_logo_english

From the official website:

The international campaign originated from the first Women’s Global Leadership Institute, coordinated by the Center for Women’s Global Leadership in 1991. Participants chose November 25 (the International Day Against Violence Against Women) and December 10 (International Human Rights Day) in order to symbolically link violence against women and human rights, and to emphasize that such violence is a violation of human rights.

This 16-day period also highlights other significant dates including November 29, International Women Human Rights Defenders Day, December 1, World AIDS Day, and December 6, which marks the Anniversary of the Montreal Massacre.  The 16 Days Campaign has been used as an organizing strategy by individuals and groups around the world to call for the elimination of all forms of violence against women by:

  • raising awareness about gender-based violence as a human rights issue at the local, national, regional and international levels
  • strengthening local work around violence against women
  • establishing a clear link between local and international work to end violence against women
  • providing a forum in which organizers can develop and share new and effective strategies
  • demonstrating the solidarity of women around the world organizing against violence against women
  • creating tools to pressure governments to implement promises made to eliminate violence against women
Since 1991, over 5,167 organizations in approximately 187 countries have participated in the 16 Days Campaign. This year, The University of Chicago Section of Family Planning and Ci3 (the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproduction Health) will join as participants. We will be posting original content and relevant links for each of the 16 days, ranging from personal experiences to film reviews to research.
To join the conversation:

Thank you for your participation, and for your support.