New study recommends doula support during abortion procedures

image from exhaleprovoice.orgMany women choose to have a doula–a lay support person–present during their labor process. A doula’s support has been connected to maternal and child health benefits such as pain control, shorter labor, decreased rates of cesarean delivery, and breastfeeding assistance. In full-spectrum reproductive health care, doulas can provide support for women during not only labor and delivery, but also for a variety of reproductive experiences, including miscarriage, adoption, and abortion.

While each of these reproductive experiences has unique physical and emotional challenges, a doula’s role is consistent: be a source of emotional, physical, and social support.

Section faculty Dr. Julie Chor researches the effect and role of doulas in abortion care. Her most recent publication, co-authored with Dr. Melissa Gilliam and Dr. Brandon Hill, appeared in the June 2014 online edition of the American Journal of Obstetrics and Gynecology.

In this study, Dr. Chor hypothesized that women having a first trimester abortion with doula support would have significantly less pain than women randomized to usual care.

She found that the although the majority of women who had an abortion were satisfied with the procedure, doula support did not statistically impact recalled pain. However, 96.2% of women who received doula support recommended that doula support be routinely used during procedures and 60.4% expressed interest in training to become a doula. Additionally, more than 70% of women who did not receive doula support said they would have wanted someone present to provide support during their procedure.

Furthermore, women receiving doula support were less likely to require additional clinic support resources. Doula support, Chor suggests, may address patient psychosocial needs.

Dr. Chor’s findings are relevant and timely, as volunteer abortion doula groups are organizing across the country and increasingly being used in clinics.

Click here to read more of Dr. Chor’s research on expanding the role of doulas into abortion care.

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Abortion & Reproductive Health Care for Incarcerated Women

orange-is-the-new-black-01Orange is the New Black returned for a second season to Netflix last Friday and continued a major plot line involving a pregnant inmate and the father of her baby, who happens to be a guard in the prison. What started as a secret romance escalated quickly due to the difficulties pregnant women face while behind bars. Legally speaking, a sexual relationship between an inmate and prison official can never be considered consensual and so the characters hatched a series of plans about how to deal with the pregnancy. Could she secretly terminate the pregnancy without anyone finding out? Could she continue the pregnancy and receive adequate health care? Could she hide the pregnancy and the true father? What happens when she goes into labor? What punishment(s) will the couple endure for their actions?

While the TV show mixes fact and fiction, it does honestly depict the reality of what happens when a woman becomes pregnant in prison or enters prison already pregnant. In addition to this ongoing pregnancy plot line, in the first season an inmate entered prison pregnant, went into labor and delivered in a hospital, and was separated from her baby shortly afterwards and returned to prison. Between six and 10 percent of women are already pregnant when admitted to a prison or jail and they can become pregnant during private visits with partners, home visits, while in work release programs, or as a result of sexual assault [ACOG]. Studies also show that approximately 14 percent of girls are pregnant when they arrive to juvenile detention.

In recognition of the prevalence of these realities, the Section published a policy brief on Abortion & Reproductive Health Care for Incarcerated Women. Although our brief focuses on Illinois policies and programs, incarcerated women in state and federal facilities across the United States face myriad barriers to receiving reproductive heath care, including abortion services. Despite having the constitutional right to have an abortion (as guaranteed under Roe v Wade), accessing the procedure while incarcerated presents many challenges, including facilities’ ad hoc responses to abortion requests and the logistics and challenges of organizing transportation and payment.

The brief also discusses the practice of shackling, prison nursery programs, and policy reforms needed to address the gendered needs of women prisoners.

Although Orange is the New Black errs on the dramatic side of storytelling, it does provide an overdue platform for discussing the basic human rights of incarcerated women who have the same rights as civilians to make decisions about their own bodies.

Success in School: Efforts to Improve Education for Students who are Pregnant, Parenting or Survivors of Violence

Pregnancy and parenthood does not have to mark the end of education for young men and women. Yet, according to the National Women’s Law Center, nearly half of all female dropouts say that becoming a parent played a role in their decision to leave school, and 33% of female dropouts said pregnancy was a major factor. Additionally, 24% of male say that becoming a parent played a role in their leaving school, and 19% said it was a major factor.

Life becomes increasingly difficult for young parents who drop out of school. Only 51% of women who have a child before age 20 earn a high school diploma before age 22. Education prospects for pregnant or parenting young women become bleaker at the higher-education level. Two percent of women who have a child before age 18 earn a college degree by age 30. This lack of education means that young parents who drop out of school are more likely than their peers to be unemployed or underemployed, and those who obtain work, earn significantly less than their peers who graduate from high school.

These statistics and studies were recently reviewed at a Town Hall held by The Illinois Caucus for Adolescent Health (ICAH) following the national release of the U.S. Department of Education’s recommendations to support the academic success of pregnant and parenting students under Title IX.

Image from ICAH

Image from ICAH

Before Congress passed Title IX in 1972, pregnant or parenting students were often discriminated against and sometimes dismissed from high school. Title IX prohibits sex discrimination, including on the basis of pregnancy, childbirth, and parental status.

The recommendations in the Office of Civil Rights’ June 2013 publication include:

  • A pregnant student must be allowed to remain in her regular classes and school if she chooses. Any alternative arrangement must be comparable to the regular school program in academic, extracurricular and enrichment opportunities.
  • Schools must treat pregnant students in the same way that they treat other students with temporary medical conditions. Thus, any special services and arrangements in place must also be provided to pregnant students, such as at-home tutoring and extensions on assignments.
  • A school must excuse a student’s absences because of pregnancy or childbirth for as long as the student’s doctor deems the absences medically necessary. When a student returns to school, she must be allowed to return to the same academic and extracurricular status as before and have the opportunity to make up missed work. Similarly, parenting students must have excused absences when they need to care for sick children or take them to doctors’ appointments.
  • A school must provide assistant to a pregnant or parenting student, such as providing a larger desk or designating a private room for breastfeeding during the school day.
  • A school must be aware and ensure that their teachers and staff follow Title IX requirements and know their rights. This may involve collaborating with a school district’s Title IX coordinator to provide workshops for administrators on laws related to the provision of services to pregnant and parenting students. A grievance procedure must be in place and adhered to by students, parents, and employees.
  • Schools must work with pregnant and parenting students to create a graduation plan tailored to each student’s needs. This may include an academic credit-recovery option for parents who take time off from school or the option for dropouts to return to school.

Although the recommendations focus on secondary schools, the statues apply to all recipients of federal funds, including post-secondary institutions.

Efforts to pass state-level legislation to ensure these and other protections have also been ongoing — the Ensuring Success in Schools Act was first introduced in 2007. This legislation would promote successful school completion for pregnant and parenting students as well as those affected by domestic or sexual violence by:

  • enabling expectant and parenting students as well as student victims of domestic or sexual violence to succeed in school;
  • providing guidance to school districts in responding to and alleviating the barriers to academic success for students who are parents, expectant parents, or survivors of domestic or sexual violence;
  • encouraging the safe and meaningful involvement of parents of students.

A state-designated Ensuring Success in Schools Task Force issued a report in 2010 which made recommendations for accomodating and supporting pregnant and parenting students, but also made recommendations for policies affecting student survivors of domestic and sexual violence. According to the report:

Students who experience dating violence or sexual harassment have a hard time paying attention in school and often participate less in class or do not go to class at all, whether the violence happened on or off school grounds. Testimony at Task Force hearings indicated that student survivors of sexual violence experienced sharp declines in grades following incidence of violence. Witnesses told stories of schools that refused to respect orders of protection, denied reasonable accommodations requested by the survivor, placed the burden of change and compliance on the survivor and not the perpetrator, forced the survivor to repeat her story several times and in front of other people, denied the survivor basic confidentiality, and punished the survivor for minor offenses related to the violence while overlooking the acts of violence committed by the perpetrator. Students who are survivors of domestic and sexual violence want to stay in school and graduate, but fear for their safety and well-being often forces them into involuntary homeschooling or alternative programs or forces them to drop out entirely.

In response, the authors suggested that schools:

  • waive minimum attendance requirements for students who are survivors of domestic or sexual violence and recognize absences as valid if they are due to safety concerns, to having received victim services, or to recovering from physical or psychological injuries;
  • allow students to make up missed work and provide appropriate academic supports, including the option of homebound instruction;
  • allow in-school accommodations—including changing classes, lockers, lunch hours, or any other appropriate safety measures—as necessary to facilitate school attendance and participation;
  • honor any order of protection and civil no-contact order;
  • allow student survivors of violence to transfer to another school without penalty for reasons of safety and well-being; and
  • place the burden of compliance on the perpetrator whenever possible.

Race and Reproductive Politics: An Editorial

In Race, Reproductive Politics and Reproductive Healthcare in the Contemporary United States, an editorial published in Contraception, authors Carole Joffe and Willie Parker discuss how the United States, a country marked by extreme stratification on both racial and economic grounds, has had a history of both targeting the birth rates of people of color while also fueling deep political divisions about the provision of reproductive healh services – particularly abortion and contraception.

The authors discuss their dismay at the contemporary state of reproductive politics in the United States, particularly the manipulation of racial themes by opponents of abortion and birth control.  However, they reference the “mixed legacy” of the United States history and acknowledge the complexity of alandscape “containing both liberatory and coercive possibilities, and always with particular implications for people of color in a white-dominated society.” Ultimately, the authors warn against the “manipulation of the history of race and reproduction by those involved in the [recent anti-abortion] billboard campaigns” and similar efforts which obscure “the contemporary facts of life faced by the most vulnerable black women.”

The authors note that the current climate has galvanized a countermovement of health activists  and they see hope for women’s reproductive rights. At the same time, the authors conclude that “the stakes in this “war” are inevitably the highest for the most vulnerable in our society; Parker calls on fellow health care providers “to trust women to make the good and tough decisions about when and whether to expand their families” and assure them the resources to do so.

State-by-State Analysis of Laws that Help New Parents

In Expecting Better: A State-by-State Analysis of Laws That Help New Parents, a report published by the National Partnership for Women & Families, the authors documents workers’ rights under current state laws and the progress that states have made in promoting the economic security of new parents. An additional section discusses state policies that more broadly assist family caregivers — both parents and workers overall — in addressing the needs of their children and other family members.

The report notes that the U.S. (which does not offer paid leave protections for new parents) falls behind the 178 nations that guarantee paid leave for new mothers and the 54 nations that guarantee paid leave for new fathers. Just three national laws, addressing pregnancy discrimination, family and medical leave, and nursing mothers’ rights at work, help some new and expecting parents upon the birth of a child.

New parents must rely on the policies of their employers, but only 38% of workers have access to employer-provided short-term disability insurance and only one-tenth of the workforce has access to employer-offered paid leave to care for a new child. Significantly, workers in low-paying jobs — those with the greatest need for both job protection and wage replacement during leave from work — are far less likely to have access to either of these employer-provided benefits.

The report points out states that are doing better than others (e.g., CA and CT), but 18 states were graded with an “F” for “failing to provide a single benefit or program to help support families before and after the birth, adoption or foster placement of a child.”

Benefits of Nurse-Community Health Workers for Low-income Mothers

In Maternal Perceptions of Help From Home Visits by Nurse–Community Health Worker Teams, published in the American Journal of Public Health, authors Lee Anne Roman, et al, explored how low-income mothers perceive the type of help they receive in home visits, whether mothers’ perceptions of help are consistent with program evaluations, or whether there are differences in perceptions of help based on type of home visiting provider.

The authors developed a nurse–community health worker (CHW) team intervention in the context of a Medicaid, state-sponsored enhanced prenatal and infant services (EPS) home visiting program in Michigan. Given low enrollment in EPS during pregnancy (only 28% of Medicaid-enrolled women in Michigan participated in EPS), the team intervention was designed to use CHWs to improve engagement, increase service delivery, and address stress and mental health. Trained CHWs used empowerment strategies to provide intensive, relationship-based support; deliver health education; and help with service navigation. The team model was tested in a trial comparing usual community care (CC)—that is, EPS delivered by nurses—and EPS delivered by a nurse–CHW team.

In both the nurse–community health worker (CHW) group and the community care (CC) group, more mothers endorsed “gave you things to read when you wanted to know something,” “helped you learn about child development,” and “taught about birth control” than other types of help. More mothers in the nurse–CHW group than in the CC group reported receiving help in all of the categories assessed. For both groups, assistance with health education ranked highest among the types of assistance received. A higher percentage of women in the nurse–CHW group than the CC group reported that they received psychosocial help.