Archive for the ‘Global News’ Category

January 23, 2014

Free, Online Course on International Women’s Health and Human Rights

International Women's Health and Human Rights Course

Interested in learning more about women’s health and human rights? A free, online course offered by Stanford University kicks off Friday, Jan. 24.

The course is open to everyone — you just need an interest in health and social justice and an online connection.

Anne Firth Murray, founding president of the Global Fund for Women and a consulting professor in human biology at Stanford, is leading the course. A contributor to “Our Bodies, Ourselves,” Murray moderated a panel on global activism at OBOS’s 40th anniversary symposium.

Participants can join in as their schedule allows. Course materials will be released Friday afternoons at 5 p.m. PST, and you can watch lectures and interviews with scholars and NGO leaders, complete interactive activities, and join fellow students in the forum on your own time.

In the video below, Murray explains how this class uses a lens of human rights to look at health issues, going beyond the traditional material on maternal and infant health.

“I knew there were many more issues than that, that women were concerned with,” says Murray.

Here’s the course write-up:

This course provides an overview of women’s health and human rights, beginning in infancy and childhood, then moving through adolescence, reproductive years and aging. We consider economic, social, political and human rights factors, and the challenges women face in maintaining health and managing their lives in the face of societal pressures and obstacles.

We focus on critical issues, namely those that may mean life or death to a woman, depending on whether she can exercise her human rights. These critical issues include: being born female and discrimination; poverty; unequal access to education, food, paid work and health care; and various forms of violence. Topics discussed include son preference, education, HIV/AIDS, reproductive health, violence in the home and in war and refugee circumstances, women’s work, sex trafficking, and aging.

Our open online course (often abbreviated as a “MOOC”) will have a special focus on creating an international network of engaged students. We will ask students to take part in interactive discussions and cooperative exercises and to share their own experiences. We also ask students to engage with the communities they live in, in order to deepen their understanding of the issues and tie academic ideas to real-life circumstances.

The course textbook will be Murray’s book “From Outrage to Courage: Women Taking Action for Health and Justice,” a terrific resource that Our Bodies Ourselves Executive Director Judy Norsigian used when teaching a women’s health advocacy course at Suffolk University. Individual chapters will be posted online.

Participants who complete the course will receive a statement of accomplishment from Stanford University.

Interested? Learn more at InternationalWomensHealth.org.

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December 24, 2013

Striving for Gender Equity: My Journey to Armenia

Dilijan Armenia workshop Oct 2013

Judy Norsigian and Dr. Meri Khachikyan, coordinator of the Armenian edition of “Our Bodies, Ourselves,” present organizers with copies of the book.

Looking back on 2013, one of the highlights for me was a trip to Armenia where I spoke about gender equity and witnessed a dozen young women organizing around the lack of sexuality education in their community.

I was a featured speaker at a discussion on “Promoting Gender Equity and Breaking Gender Stereotypes,” hosted by the American University of Armenia (AUA), the Women’s Support Center in Yerevan, and the Armenian International Women’s Association. Dr. Bruce Boghosian, AUA president, and Dr. Meri Khachikyan, coordinator of the Armenian “Our Bodies, Ourselves” translation/adaptation project, attended, along with students, faculty, Peace Corps volunteers, and NGO staff and directors,

Domestic violence is a major concern in this small country — as it is in all of the countries where OBOS has global partners. As part of OBOS’s efforts to encourage men’s engagement in violence prevention, we connected a young man on the AUA panel with staff at Jane Doe Inc., the Massachusetts Coalition Against Sexual Assault and Domestic Violence, which provided him with slides about the role men can play in stopping violence.

Another concern addressed by panelists was the growing problem of sex-selective abortion in Armenia (also common in the neighboring countries of Georgia and Azerbaijan). Approximately 115 boys are born for every 100 girls; only China has a more skewed rate.

Following the AUA event, I attended several meetings with members of groups involved in the Coalition to Stop Violence Against Women in Armenia. In a country where government officials and church leaders have at times endorsed or congratulated those committing homophobic and sexist acts of violence, these courageous activists have been known to disrupt high-level meetings to draw attention to women’s and LGBT rights in Armenia.

I also traveled to rural Dilijan with Dr. Khachikyan, where I witnessed the initial organizing efforts of about a dozen young women (and one young man) concerned about the lack of sexuality education in their conservative community. They came up with several excellent ideas about meeting venues that would be safe spaces for young women, as well as ideas for outreach via social media, and were ready to take on problematic cultural practices.

For example, many parents of young women still do a “check the bed for blood” test after a newly married couple spends its first night together, looking for signs their daughter remained a virgin before marriage. If they find blood, they take a basket of red apples to the groom’s parents to acknowledge the young woman’s “purity.” Plastic surgeons now do a brisk business with hymen reconstruction in many parts of the country, even though this is technically illegal.

Despite the numerous issues women face in Armenia, the intergenerational advocacy and critical support provided by a number of European and American funders contribute to the continued growth of a grassroots movement that will improve the health and well-being of women and girls.

Before leaving, Dr. Khachikyan presented each of the young organizers with their own copy of the latest Armenian edition of “Our Bodies, Ourselves.” I was moved by their enthusiasm — as I have been so many times when talking with women about how the book changed their lives.

Plus: Earlier this year, Taleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, wrote about her experience providing health services in Armenia. Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.


December 19, 2013

Cross-Border Surrogacy: How OBOS is Advancing Public Discourse and Action

Women's Rehabilitation Center facilitators in Kathmandu

Women’s Rehabilitation Center facilitators lead community discussions on cross-border surrogacy in Kathmandu / Photo courtesy of WOREC

by Ayesha Chatterjee & Sally Whelan

In an episode that aired on primetime television in 2007, America’s favorite talk show host portrayed cross-border surrogacy as a win for everyone.

Oprah Winfrey blazed her spotlight on an American couple that traveled to a fertility clinic in the Indian city of Anand to commission a baby. In front of an audience of millions, she extolled the benefits of the arrangement for the couple, who can finally have a baby, and for the woman who is paid to become their surrogate, who can finally send her child to school. Yes, many in the audience agreed, there seem to be benefits all around!

Cross-border surrogacy is a contract-based arrangement that uses assisted reproductive technologies, such as in vitro fertilization. It is a lucrative global industry — the heart of which beats in India — and part of a wider, multi-billion dollar market in assisted reproduction. Thousands of individuals, straight and gay, married and not, have hired surrogates to bear their children.

So who would rain on this parade? Why are there “concern trolls” raising difficult questions about a “solution” that seems a boon for everyone involved?

The answer demands a closer look at the supply side — at the lives, motivations, and vulnerabilities of the women who carry and deliver babies for others, most often to pull themselves and their families out of dire poverty. Their marginalized social and economic status creates a power imbalance that makes it impossible to negotiate dignified and fair “working” conditions and, in fact, allows recruiting agents and clinics to get away with exploitative practices.

Scratch the surface, and these arrangements are replete with health and human rights problems: gestational mothers, otherwise known as surrogates, unable to read the contractual obligations to which they consent; minimal compensation and unfair payment schedules; forced seclusion from family (including young children) and community, in dormitories with round-the-clock monitoring; high-risk medical procedures, including high doses of hormones for embryo transfer and mandated cesarean sections; and little or no postpartum follow up, even in cases of unexpected birth outcomes and health emergencies such as hemorrhage, which can occur days or weeks later with fatal results.

In the middle are the children born as a result of these arrangements. Without best practices and regulation, their rights as citizens in cross-border arrangements, their legal parentage and best interest in custody disputes, and their safety in the absence of adequate screening of commissioning parents, hang in limbo while the world catches up.

This is the untold story of cross-border surrogacy — one on which Oprah did not dwell, one that many of us – including many commissioning parents — know little about. In such a story, where the scales are tipped from the start, only one side wins. The other simply settles.

Here is another story. OBOS, with the Women’s Rehabilitation Centre (WOREC) and Sama Resource Group for Women and Health, is responding to ethical conundrums and human rights issues raised by the largely unregulated cross-border surrogacy market and its ability to adapt to lucrative regional niches.

Sama, based in India, uses action research to critically examine cross-border surrogacy practices, articulate the impact on the lives of women, and make policy recommendations. Sama and OBOS provide technical support to WOREC in Nepal as it builds awareness in its nationwide network of Women Human Rights Defenders, assesses the status of an emerging fertility sector — especially along the country’s border with India — and crafts a preemptive response.

Our goal is simple: develop evidence-based, objective and accessible information to ignite broader social dialogue and action on an issue that is layered, laden, and, most importantly, misrepresented by recruiting agents and fertility clinics.

This collaboration is a call for best practices and regulation of assisted reproduction, and a stepping stone to engaging with commissioning parents as allies who can hold the industry accountable. It embodies OBOS’s legacy of bringing important sexual and reproductive rights issues from the periphery to mainstream dialogue.

And, as policy lags behind technology and markets and the media continue to color public perception of a complex human rights dilemma, this collaboration positions us on the cutting edge to ensure cross-border surrogacy moves forward a an ethical option for growing our families and financial stability — making it a true win for everyone.


June 25, 2013

HIV/AIDS Policy and Prevention Cannot Succeed if Sex Workers Are Stigmatized

by Anna Forbes

In a ruling praised by organizations working on HIV/AIDS policy and prevention, the U.S. Supreme Court last week struck down a decade-old law forcing groups that receive government money in a global anti-AIDS program to embrace a policy opposing prostitution.

By a vote of 6-2, the Court ruled that the Anti-Prostitution Pledge in the President’s Emergency Plan for AIDS (PEPFAR) violated the First Amendment rights of U.S.-based organizations and was therefore unconstitutional.

PEPFAR funding is allocated to implement the 2003 United States Leadership Act against HIV and AIDS, Tuberculosis, and Malaria. While a major step forward in terms of overall investment in global health (and particularly in the HIV/AIDS response), the Act contains some insidious provisions, one of which is the Anti-Prostitution Pledge (APP), which states that “no funds, “may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking,” and that “[N]o funds…may be used to promote, support, or advocate the legalization or practice of prostitution.”

The APP required, as a condition of funding, that all PEPFAR grantees write and adopt an explicit agency policy condemning sex work. Under this policy, grantees could not use any of their funding (including money received from other sources) on activities in any way related to sex workers’ rights. This resulted in the reduction or complete elimination of HIV prevention and treatment services for sex workers in numerous countries — including the de-funding of USAID-identified best practices programs.

Legal challenges to the constitutionality of the APP were brought by the Alliance for Open Society International (AOSI) and Pathfinders International in 2004; InterAction and the Global Health Council later joined the case.

Chief Justice John G. Roberts wrote in the majority opinion: “This case is not about the government’s ability to enlist the assistance of those with whom it already agrees. It is about compelling a grant recipient to adopt a particular belief as a condition of funding. By demanding that funding recipients adopt — as their own — the Government’s view on an issue of public concern, the condition by its very nature affects ‘protected conduct outside the scope of the federally funded program.’”

He added that although the government has a legitimate interest in controlling how PEPFAR funds are spent, it cannot require grantees to “pledge allegiance to the government’s policy of eradicating prostitution.”

The majority opinion was supported by Justices Samuel Alito, Stephen G. Breyer, Ruth Bader Ginsberg, Anthony Kennedy, and Sonia Sotomayor, with Justices Antonin Scalia and Clarence Thomas dissenting. Justice Elena Kagen, who had worked on the case while Solicitor General, recused herself.

It remains to be seen whether the Supreme Court decision will enable funded organizations based outside of the United States to abandon compliance with the APP without risk. The Court’s decision affirmed that U.S.-based agencies are protected under the Constitution but was not clear on whether agencies based outside of the United States, without the Constitution’s First Amendment purview, were similarly protected.

Despite this ambiguity, the decision is a clear win for those who uphold the human rights of sex workers and support access to the peer-based programming that has been shown to effectively reduce their vulnerability to HIV, as well as other health risks and human right violations.

Globally, sex workers are identified by UNAIDS and others as one the three “most at risk populations” (MARPS). In its 2011 report “Guidance for the Prevention of Sexually Transmitted Infections,” USAID wrote that countries receiving PEPFAR funding “should take steps to ensure that scale-up of prevention programs for MARPs is accompanied by appropriate protections of their rights, including the review of policies and regulations that criminalize or deter MARPs seeking services and training for service providers to reduce stigma and discrimination.”

Grantees’ ability to follow this guidance, however, was directly impeded by the APP requirement that grantees not only adopt an anti-prostitution policy but also distance themselves from any “organization that engages in activities inconsistent with the recipient’s opposition to prostitution and sex trafficking.”

Rather than risk funding loss, many grantees simply eliminated any sex worker-related services they had been providing. In a survey of staff in PEPFAR-recipient agencies, the Center for Health and Gender Equity (CHANGE) found that “19 of the 31 people interviewed in the field reported that they censored themselves or their organizations as a result of the pledge. Almost all contracting agencies reported that they have cleared their websites of references to sex workers or rights.”

In Bangladesh, for example, a drop-in center program recognized as a UNAIDS “best practices” model was defunded (losing 16 of its 20 centers) after the international NGO funding them decided to err on the side of caution in compliance with the APP. These drop-in centers provided homeless street-based sex workers with sanitation facilities, a place to sleep, temporary safety, condom counselling and promotion, and skills-building opportunities to facilitate transitioning out of sex work for those wishing to do so.

Hazera Bagum, director of the Bangladesh program, told CHANGE, “They came in and rested, educated themselves and talked to each other about effective HIV prevention … The monthly condom distribution rate used to be very high, but since the closings, there is less access, so sex workers are not using as many condoms. They distribute fewer every month.”

It is impossible for the U.S. government, or any government, to stigmatize people on one hand and simultaneously help them to reduce their HIV risk on the other. Gay men know the truth of this, as do women, as do people of color, as do sex workers, as do we all.

Now, at least, the Supreme Court has stopped Congress from insisting that its U.S.-based grantees attempt the impossible in this particular case. We have a long way to go, but this is progress.

Plus: For a broader view of how this fits into advocacy for sex workers rights, particularly with regard to HIV, read “Solidarity with Sex Workers: On the Agenda or Under the Bus?

An advocate, organizer and writer, Anna Forbes has worked on HIV/AIDS policy since 1985 and on women’s health and rights since 1977. Now an independent consultant with an international client base, her work centers around women, HIV, gender, health and rights.


June 21, 2013

WHO Releases Global Report on Health Effects of Violence Against Women

Violence Against Women: Health Impact

The World Health Organization has released a new report, “Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence,” [PDF] that attempts to quantify how many women around the world are exposed to physical and sexual violence at some point in their lives, and describes many of the associated poor health outcomes.

The findings are probably not surprising, but they are still disturbing.

WHO reports that 35 percent of women worldwide — more than 1 in 3 — have been physically and/or sexually abused. These figures do not include emotional/psychological abuse.

Most of the violence is committed by intimate partners. WHO estimates that almost one third (30 percent) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner, while 7 percent of women have been sexually abused by a non-partner.

Among the key findings on health outcomes:

• Globally, as many as 38 percent of all murders of women are reported as being committed by intimate partners.

• Forty-two percent of women who have been physically and/or sexually abused by a partner have experienced injuries as a result of that violence.

• Women who have experienced partner violence have higher rates of several important health problems and risk behaviours; compared to women who have not experienced partner violence, they:
– have 16 percent greater odds of having a low-birthweight baby;
– are more than twice as likely to have an induced abortion;
– are more than twice as likely to experience depression.

• In some regions, they are 1.5 times more likely to acquire HIV, and 1.6 times more likely to have syphilis, compared to women who do not suffer partner violence.

The authors describe a number of factors that likely contribute to high levels of violence against women, including economic factors, social norms that support male dominance over women, cultural acceptance of violence against women, and gender inequality in access to wages and education.

The report ends with an important call to action:

This report unequivocally demonstrates that violence against women is pervasive globally and that it is a major contributing factor to women’s ill health. In combination, these findings send a powerful message that violence against women is not a small problem that only occurs in some pockets of society, but rather is a global public health problem of epidemic proportions, requiring urgent action. As recently endorsed by the Commission on the Status of Women, it is time for the world to take action: a life free of violence is a basic human right, one that every woman, man and child deserves.


May 23, 2013

Adapting “Our Bodies, Ourselves” for Iranian and Vietnamese Women and Girls

Friends of the Vietnamese OBOS project

Committed friends of the Vietnamese OBOS project Susan Bailey (left) and Roslyn Feldberg and Nancy Hammett (right), join Project Director Khuat Thu Hong (center) and OBOS’s Judy Norsigian and Sally Whelan.

The Our Bodies Ourselves Global Network is a dynamic coalition of social change organizations, all of whom talk the talk and walk the walk when it comes to the health and human rights of women and girls.

This year, OBOS welcomes two new partners into its growing network.

The Roshan Institute for Persian Studies, in collaboration with the Department of Women’s Studies at the University of Maryland, is adapting sections of “Our Bodies, Ourselves” into Farsi. This is a critical effort to reach Iranian women and girls, especially those living in Iran and routinely subjected to oppression and censorship, both by government and other forces.

Fatemeh Keshavarz, director of the Institute, told OBOS that the Farsi resource, which will be available online, will lead the Institute’s effort to integrate gender into a broader social change framework.

“We have so far been an academic institution with a fairly small reach,” said Keshavarz. “I am trying to expand our reach to Persian speakers across the globe, particularly inside Iran, mostly through the internet. I am also adding gender to the range of lenses we have used for understanding and instigating social change. The current project is one of the very first steps in that direction.”

Further away, in Vietnam, OBOS is working with the Institute for Social Development Studies (ISDS) in Hanoi to provide nearly 3 million women and girls evidence-based, culturally appropriate information based on Our Bodies, Ourselves.

Toolkits with discussion guides, stories and proposed actions will cover such topics as relationships and sexuality, sexual health and reproductive choices, bodies and identities, and post-reproductive years. ISDS will use the resources in trainings across the country, and tap a large, close-knit collaborative network that spans the provinces to maximize print and digital access. One of ISDS’s allies, the Vietnamese Women Union, has 13 million members.

The timing and impact of our Vietnamese partnership are critical. The UNFPA reports that about half the country’s population is under 25, with high rates of unplanned pregnancies, abortions and HIV infection. Yet condom use is low, and young people are continually exposed to inaccurate and misleading information.

In a country where nearly 38 percent of the population subsists on less that $2 a day, millions of poor and rural Vietnamese women and girls are unable to pay for reliable information and services. Access is further limited by the lack of capacity and neglect exhibited by state agencies overseeing sexual health education. A strong response is needed — and the ISDS is well positioned and equipped to lead the way.

Established in 2002, the ISDS is renowned in Vietnam for the quality of its research and ability “to inform as well as influence,” as it applies academic knowledge to meet national challenges. At the community level, the ISDS is strongly rooted in the philosophy of “knowledge as power,” and has successfully adopted an approach that keeps women and girls front and center as it builds public awareness around gender, sexuality and sexual health.

With support in place from Oxfam Novib, the Dutch affiliate of Oxfam, ISDS and OBOS are responding to a growing health crisis in Vietnam. In November 2012, Khuat Thu Hong, ISDS co-director and director of the adaptation project, met with OBOS staff and a circle of committed friends in Boston to formalize our partnership and launch the project.

OBOS is honored to collaborate with ISDS and the Roshan Insitute to bring Our Bodies, Ourselves to Vietnamese and Iranian women and girls. These projects speak to the urgent need for evidence-based, culturally appropriate health resources – and underscore our commitment to ensuring the health and human rights of all women and girls.

Ayesha Chatterjee is the OBOS Global Initiative program manager.


May 22, 2013

Supporting Women – At Home and Around the World

First in an occasional series by OBOS staff about their work and their lives.

Ayesha and her daughter, Tara

Ayesha and her daughter, Tara

I was welcomed into the Our Bodies Ourselves family in January 2006, soon after I moved to Boston from India. As a die-hard reproductive justice advocate (and unabashed “Our Bodies, Ourselves” fan), I was euphoric to join the team.

The OBOS Global Initiative, which supports women’s organizations developing and using culturally specific materials based on “Our Bodies, Ourselves,” offered the perfect opportunity to weave together my commitment to women’s rights and cross-cultural movement building.

Eight years later, I have helped shepherd the development of resources based on “Our Bodies, Ourselves” in 12 additional languages (with more in development), and coalesced a global network of social change activists.

I have been privileged to meet, learn from, and grow to love this group of women, each on the frontline of human rights work in her country. I know that OBOS’s partnerships with these visionary and tenacious leaders represent a community of shared interests that is pivotal to protecting the lives of women and girls on the ground.

Beyond OBOS, I nurture my decade-long love affair with reproductive justice by supporting families with newborns. As a postpartum doula trained by DONA International, the oldest and largest doula association in the world, and young mum (and as a child who benefitted enormously from the loving arms of extended family), I am personally affected by and committed to changing the state of postpartum care in the United States — one mummy at a time!

My doula-ing started rather unexpectedly and informally in 2009, with the birth of my niece. Though I have always been acutely aware of the growing global crisis in maternal and postpartum care through my work overseas and at OBOS, being with my sister and her family during and after the birth was transformative — the proverbial eye-opener. I quickly became aware of the awesomeness of their task; a task that really does take a village.

At the time, my goal was simple: to love and provide everything my sister and her partner needed to stay nourished and focused on their baby and each other. From hot meals and daily grocery runs, to endless loads of laundry and late-night, sleepy-eyed banter to keep my sister awake (and laughing) through yet another round of pumping, I did my best and loved (nearly) every moment of it.

OBOS, with its four-decade journey and networks of women’s health activists, has connected me with women who, like me, are drawn to the sides of expectant and new mothers. With these relationships, I am now gaining stride in my doula-clogs.

I thank the families that have let me into their homes and lives; I am honored and humbled by their trust. As OBOS expands its global reach, I thank the women who have become our steadfast co-conspirators in a collective struggle. I am inspired by the fire in their bellies.

And to all of you: I thank you for cheering us on and hope you will remain our committed partners as we plough ahead, forging a global community where women live without fear, with dignity, wrought as a fundamental human right.

Ayesha Chatterjee is the OBOS Global Initiative program manager.


April 17, 2013

“Can We See the Baby Bump, Please?”: Film on Commercial Surrogacy in India Screens in Boston

Can We See the Baby Bump, Please

Update: A second public event has been added, also co-sponsored by Our Bodies Ourselves: “Systemic Violence or Informed Consent? The Politics of New Reproductive Technologies and Medical Experimentation in India” is the theme of the program at MIT on Tuesday, April 23, which will include the film screening and remarks by Sama’s co-founder, Sarojini N. The event will take place in MIT Bldg. 5, Room 217, at 7 p.m.

The rise of commercial surrogacy has led to numerous concerns and conversations involving women’s health and medical ethics. On Monday, April 22, Our Bodies Ourselves will sponsor a screening of “Can We See the Baby Bump, Please?” — a documentary film about commercial surrogacy in India that explores the ethical challenges.

The screening will take place at Boston University’s Bakst Auditorium at 5 p.m. and is free and open to the public. Co-sponsors include the Health Law, Bioethics and Human Rights Department of the School of Public Health and the student-led Health and Human Rights Caucus.

From film director Surabhi Sharma’s website:

The global reach of medical tourism and commercial surrogacy spawns a range of clinics and practices across big cities and small towns in India. Anonymous, often with limited choice, woman’s labour is yet again pushed into the background. A whiff of immorality, the absence of regulation and the erasure of the surrogate’s experience collude to produce a climate of callousness. May we see the baby bump please? meets with surrogates, doctors, law firms,agents, and family in an attempt to understand the context of surrogacy in India.

The film was commissioned by the Sama Resource Group for Women and Health in New Delhi (view Sama’s blog for more on the film and a recent study on commercial surrogacy).

Sarojini N., the director and co-founder of Sama, will attend the screening and discuss her organization’s recent research on surrogacy practices, and strategies to address medical malpractice and the exploitation of women hired to be gestational mothers.

In 2012, Judy Norsigian, OBOS founder and executive director, traveled to Kathmandu to lead a workshop with Sarojini and Renu Rajbhandari, founder of the Women’s Rehabilitation Centre, OBOS’s Global Network partner in Nepal, on the growing popularity of cross-border surrogacy arrangements. Their presentation included effective strategies that could be used to educate and empower women.

“Already a booming business in India, where estimates suggest that 25,000 couples a year travel to arrange surrogacy contracts and there are about 1,000 surrogacy centers, this practice is soon expected to extend to Nepal, where poor women with limited economic opportunities will likely be attracted by the prospect of earning money by bearing children for others,” wrote Norsigian.

Read about her experience and learn more about the growing market in cross-border reproductive health care.


March 5, 2013

Europe Takes on Review of Birth Control Pills Containing Drospirenone

While most birth control pills currently available in the United States are safe for most women, some newer pills that contain the progestin drospirenone have come under scrutiny because of an increased risk of blood clots. Birth control pills containing drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin, Yaz and Zarah.

The European Medicines Agency (EMA) announced late last month that it would take another look at so-called third and fourth generation oral contraceptives, including those with drospirenone, and consider whether use of these drugs should be limited.

The agency also plans to review whether current product information is enough to properly inform women and their health care providers of the risks. The agency has also said, though, “There is no reason for any woman to stop taking her contraceptive” — a rather confusing message for women wondering if they should switch to other types of pills.

The EMA previously reviewed whether this type of drug (specifically Yaz) could be marketed for use in preventing acne, but decided it could not based on concerns about the clot risk; it factored in that if women who no longer needed contraception or no longer needed the acne treatment continued on the drug, they would be exposed to unnecessary additional risk.

The U.S. FDA also did a review of pills with drospirenone, and is requiring language about the higher risk of blood clots to be added to the labels. As we noted last year, women’s health experts, including OBOS, have concerns about that review, and about leaving these pills on the market when safer alternatives exist.

That’s a key point in considering pills with drospirenone. While the risk of clots is small, we know the risk is higher with these pills than with other oral contraceptives. As one expert testified before the FDA, “I don’t usually vote against choices, but this time I did. And the reason is because on the benefit side, I didn’t see any improved benefit over the existing available choices.”

In the Women’s Health Activist newsletter in spring of 2012, Amy Allina, program and policy director of the National Women’s Health Network, wrote:

The question for a woman is, what should she weigh these risks against? As some have pointed out, the blood clot risks of pregnancy are greater than those of drospirenone pills. Is that the right basis of comparison? The Network does not believe it is. There are other, safer, ways women can avoid the risks of pregnancy – including contraceptive pills that don’t contain drospirenone. Drospirenone pills don’t provide a unique benefit over other available contraceptive pills. We’re also concerned that most women using drospirenone pills are unaware that other contraceptive pills are safer.

The NWHN has asked the FDA to remove these pills from the market. Allina wrote: “We believe that women who are looking for contraceptive options to help them postpone or prevent pregnancy should not be unnecessarily exposed to a higher risk of blood clots when there are safer alternatives with the same benefits available.”


February 6, 2013

In Armenia, Abortion Rates are High and Access to Contraception is Limited

Taleen MoughamianTaleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted  health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

 

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions
For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions
Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

Barriers to Contraception
As part of my work with the Children of Armenia Fund (COAF), I counseled women on birth control options. This has been quite a challenge, as there are so many myths surrounding birth control, and it’s expensive for rural women. One pack of birth control pills costs about $15-20 a month in Armenia. For a village family barely making $100 a month, it is completely unaffordable.

Besides the cost and access issues, social factors also influence a woman’s reproductive health. Although many husbands are supportive, others do not allow their wives to use birth control.

Sometimes the mother-in-law gets involved, too. When a woman in Armenia gets married, she moves in with her husband and his mother. The mother-in-law is usually the matriarch of the family, so she has a lot of pull in decision-making, even when it comes to her daughter-in-law’s reproductive health.

Changing Patterns, Changing Lives
During my last week in Armenia, I met a woman who had come to her village clinic for an abortion. She had two children and this was going to be her fourth abortion. She told me that her husband wants to have another child, but that he’s an alcoholic -– has been since the day they got married –- and he beats her.

She doesn’t think it’s right to bring a child into this world when her life at home is so unstable, and yet she is completely dependent on him for financial security. Living in the village, there are very few resources for either of them to get any help.

Stories like this are difficult to hear; you quickly realize how vital organizations like COAF are to these women. COAF provides free screenings for breast and cervical cancer and free treatment for STIs. With the help of the UNFPA, I inserted intrauterine devices (IUDs) for free to eligible women. This provides them with one of the most effective forms of birth control for up to 10 years.

On my final day working with COAF, one of the women was so thankful that as soon as the IUD procedure was complete, she jumped up and gave me a big kiss. She had had six surgical abortions, and she could not remember how many times she had taken Cytotec to end her other pregnancies.

It amazed me how much the women opened up to me. They are yearning for accurate information and resources, and they are deeply grateful not only for the health care that is provided but for the conversations about their bodies and their health.

Some women may not change their minds about birth control right away, but I know they at least have the information they need to consider it, and sometimes that is enough to start changing attitudes.

Despite all the economic and cultural barriers, I believe things are changing for women in Armenia -– slowly, of course, but moving in the right direction. There is no reason why Armenian women should have to keep relying on abortions for family planning, or why they should be misinformed about their reproductive health.

My hope is that educating women about their health and family planning options will empower them to take control of future. At the very least, they know where and when to seek care if they need it.

Related: Learn more about OBOS’s partner in Armenia, “For Family and Health” Pan Armenian Association (PAFHA), and efforts to adapt and distribute women’s health information based on “Our Bodies, Ourselves.” The preface to the Armenian edition is available in English.
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Ed. note about mifepristone and misoprostol:
Mifepristone and misoprostol are now frequently used together to produce what is called “medication abortion” for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Mifepristone, often known by its manufacturing name RU-486, is almost always used for abortion or to end missed miscarriages. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS).

Under the supervision of a health care provider, women choosing a medication abortion typically use an oral dose of mifepristone first, followed by either an oral or vaginal suppository dose of misoprostol several hours later. In slightly more than 90 percent of women, this induces abortion within two days, provided it is used in early pregnancy. Misoprostol becomes increasingly less effective in more advanced pregnancies, and other, more effective drugs may be chosen for pregnancies that are more than eight weeks along.

The different actions of mifepristone and misoprostol explain their effectiveness in inducing abortion. Mifepristone works to separate the placenta from the uterine lining, and it causes uterine contractions. Additionally, the drug has some effect on the cervix and may cause it to soften.


December 13, 2012

Our Bodies Ourselves Goes to Nepal: Women’s Health Activists Discuss Cross-Border Surrogacy

Women in Udaipur, eastern Nepal with WOREC founder Dr. Renu Rajbhandari (far left) and the OBOS Nepali booklets to which they contributed. Photo / Judy Norsigian

In early October, I had the honor of co-leading a workshop in Kathmandu on the growing popularity of cross-border surrogacy arrangements with two colleagues from the New Delhi-based Sama Resource Group for Women and Health and Dr. Renu Rajbhandari, founder of the Women’s Rehabilitation Centre (WOREC).

Already a booming business in India, where estimates suggest that 25,000 couples a year travel to arrange surrogacy contracts and there are about 1,000 surrogacy centers, this practice is soon expected to extend to Nepal, where poor women with limited economic opportunities will likely be attracted by the prospect of earning money by bearing children for others.

In some parts of India, women are now offered fees ranging from $5,000 to $7,000, amounts that represent up to 10 years of earnings for people in rural areas.

The workshop, hosted by WOREC, OBOS’s global partner in Nepal, brought together women’s right activists from across the country to better understand the growing market in cross-border reproductive health care, its implications for Nepal, and the most effective strategies to educate and empower women.

Surrogacy Legislation in India
Participants included two nurses from the Kathmandu-based IUI (intrauterine insemination) clinic, several health counselors, a psychosocial counselor for women with fistulas, a family planning coordinator, the editor of a quarterly women’s magazine, several members of Women’s Human Rights Defenders, a nursing professor, an advocate with Save the Children, and a staff person from a rural women’s radio station in eastern Nepal. Languages used during the workshop were primarily Hindi and Nepali, with English translation offered as needed.

Sarojini and Preeti, our colleagues at Sama, provided an excellent overview of surrogacy in India, including a description of assisted reproductive technology (ART) legislation now being hotly debated in Parliament. One provision in the controversial bill would require that a woman entering into a contract surrogacy agreement undergo an embryo transfer rather than be inseminated with the intended father’s sperm.

Since insemination would be much safer, many workshop participants felt that a choice should be offered. An embryo transfer places the woman at greater risk by exposing her to powerful hormones that prepare her body for the pregnancy and to surgical procedures required to physically transplant the embryo into her uterus.

The proposed law assumes that a woman using her own eggs will be more likely to change her mind at birth and decide she wants to keep the baby than a woman who becomes pregnant with an embryo created with another woman’s eggs. There is poor evidence to support this assumption.

Participants at the Kathmandu workshop on cross-border surrogacy arrangements.

Preparation in Nepal
By their very nature, commercial surrogacy arrangements are created by contracting couples and agencies whose primary interests typically do not reflect the needs and concerns of women recruited as gestational mothers.

This is why groups like Sama and WOREC are advocating for public policies that will protect gestational mothers and ensure they receive evidence-based information about risks and benefits in a manner they fully understand. Policies must also ensure follow-up care and effective recourse if things go wrong.

The women at the workshop want to be better prepared in case a similar bill is introduced in Nepal. Sarojini, Preeti and I shared practical information about the various ART techniques involved in surrogacy and explored, with our Nepali colleagues, ways to preserve the health and rights of women agreeing to be surrogates. Most participants were quite unfamiliar with the whole topic of ARTs and asked many questions about the medical, social and economic impacts.

Why Language Matters
We also screened two documentary films about surrogacy – Made in India, by New York City-based filmmakers Vaishali Sinha and Rebecca Haimowitz, and Would Like to See Baby Bump Please, a new film just released in India by Sama — and discussed the importance of using language sensitive to all the parties involved in a surrogacy arrangement.

For example, the term “reproductive tourism” carries the image of couples vacationing in their pursuit of parenthood. In most cases, these trips are stressful and a far cry from the typical tourist experience. Using alternative language such as “cross-border commercial surrogacy” is one way to avoid such innuendo.

Similarly, referring to a gestational mother as a “surrogate mother” or “gestational carrier” can belittle and objectify her central role as the woman carrying a pregnancy for nine months and then giving birth. Many at the workshop preferred the descriptive, less diminishing term “gestational mother.”

At the end of the workshop, we developed a number of recommendations for moving forward.

Meeting Local Activists
After the workshop, I traveled with Renu to Udaipur in eastern Nepal, where she introduced me to many younger women at the WOREC center, including some who contributed to WOREC’s set of six Nepali health booklets, recently adapted from Our Bodies, Ourselves.

I also visited a group of young women who are the sole staff for a radio station in Udaipur, where egg cartons provide the sound proofing in their recording studio. They frequently address women’s health topics in their programming and invite community conversations about sexuality, domestic violence and the environment.

Although I had met Renu briefly when she traveled to Boston for OBOS’s 40th anniversary symposium in 2011, the many hours of chatting while we drove over mountainous terrain cemented a special friendship I now treasure. I have a new appreciation of her remarkable leadership over the past several decades and was deeply impressed by her efforts to pass the torch to a younger generation.

A trip to a fairly remote mountain village was particularly inspiring. The women had successfully lobbied for village development council funds to create a small multipurpose women’s center. Though a bit run-down, it was getting a lot of use and clearly a sign of how effective some women’s groups have been over the past decade.

The provisional constitution for the country still has not passed, but its contents – including funding for legal abortion – offer great hope for the future of women’s reproductive rights and justice in Nepal.

This article was originally published in the winter 2012/2013 Our Bodies Ourselves newsletter. View the full newsletter.


December 13, 2012

From Prevention to Palliative Care: Changing the Face of HIV/AIDS Outreach in Rural Nigeria

By Eyitemi Mogbeyiteren

In 2011, three members of our outreach team were kidnapped in the Delta State of Nigeria. We were held captive for several weeks, during which we were repeatedly raped, and only released after a ransom was paid to the kidnappers. Soon after, we learned that all three of us had tested positive for HIV.

My name is Eyitemi Mogbeyiteren, and I work with Women for Empowerment, Development and Gender Reform. Our goal is to ensure that poor grassroots women in the South-West region of rural Nigeria have information on their bodies and health, adapted from the trusted book Our Bodies, Ourselves, so they make choices that protect their reproductive and sexual needs and dignity.

HIV is rarely talked about in our community, and people living with the virus are inevitably discriminated against and cast out by their friends and family. Over the years, our organization has worked hard to unravel myths about the virus — its transmission, prevention and treatment — and fight the terrible stigma and isolation faced by those infected.

But as more people become ill, we continue to see families despair and grieve as their loved ones die without medicines, care and support. Drugs cost approximately $15,000 per person in my community — an amount that is beyond the grasp of many people!

After being diagnosed, I experienced a lot of the same discrimination and isolation. I was shunned in my community and my family stopped speaking to me for a long time. With my own health failing, there were many moments when I felt I could not live, could not stand people saying things about me.

It felt like the end of the road, until I decided to raise my voice and change the fear and shame into something positive.

We are now expanding our HIV/AIDS outreach to include palliative care — care that relieves not only the physical but also the emotional, spiritual and socially generated suffering faced by a person infected with the virus. It is one of the most valuable services that can be offered to someone with terminal illness and their family. Unfortunately, it’s availability in my community is zero!

Using Our Bodies, Ourselves as our tool yet again, our plan is to train ourselves on this holistic and critical model of care, and bring our services to our women via support groups and home visits. We will also develop a training manual for other caregivers, including family and community health workers, so they can comfort their loved ones and clients.

And, to get word out, we will organize an “itinerant exposition” on board a bus. This vehicle — our Anti-Rape, Anti-Kidnap and HIV/AIDS Bus — will carry 12 activists around the country for 18 months, unleashing our materials, our knowledge and our passion. It will allow us to serve women beyond our community, to empower them with information on HIV/AIDS and self-defense skills to protect them from rape and kidnap.

And if we are able to raise the funds, we will distribute the drugs needed to prolong life — drugs that are the right of every human being to access, drugs that are impossible to find in my community.

OBOS is assisting Eyitemi and her colleagues at WEDGR with strategies, promotion and in-kind donations, and by generating funds for this critical work. If you would like to help with this effort, contact Ayesha Chatterjee at ayesha AT bwhbc.org.

This article was originally published in the winter 2012/2013 Our Bodies Ourselves newsletter. View the full newsletter.


November 16, 2012

Savita Halappanavar’s Death from Being Denied an Abortion Leads to Shame and Searching

The story of Savita Halappanavar, who died last month as a result of Ireland’s abortion ban, has sparked much debate over Ireland’s abortion laws and, in a broader sense, the issue of access to reproductive health care.

Savita went to a hospital in Ireland while experiencing severe back pain. The medical staff diagnosed her with miscarriage of a fetus with no chance of survival, but refused to perform an abortion because they detected a fetal heartbeat.

Several days passed before the heartbeat ceased and removal was allowed. But by this point, Savita had developed an infection that led to her death.

This is a tragic example, but one that unfortunately is quite predictable when women are unable to obtain legal abortion care. Abortion has been banned in the Republic of Ireland since 1983 by constitutional amendment, but traces back to an 1861 law. According to the Irish Family Planning Association, more than 4,000 women living in Ireland traveled to England and Wales for abortions in 2011, because the service is not legally available in Ireland.

Earlier this year, The Guardian reported that despite apparent declines in this number, more women may simply be disguising their home country, as “The number of women contacting a charity that helps people in Ireland seek abortions in Britain is set to double for the third year in a row.” (For more on the history of abortion law in Ireland, see this timeline, and “Ireland’s abortion ban: a history of obstruction and denial.”)

Here are some of the articles and analysis stemming from Savita’s death:

  • Justice for Savita — Jessica Valenti gets to the bottom line for The Nation: “It’s not just our lives and health that are in danger, but our human dignity.”
  • Hospital Death in Ireland Renews Fight Over Abortion – Douglas Dalby at The New York Times writes of a state of Irish politics that will not be entirely unfamiliar to U.S. readers: “Given the divisiveness of the abortion issue in Ireland, which has prompted two bitterly fought referendums, successive governments have avoided passing any legislation.”
  • Death in Ireland is a Wake Up Call to Fight Bans on Later Abortion Here at Home – Susan Yanow at RH Reality Check contemplates the U.S. implications and concludes: “We have a sobering lesson to learn from Ireland — when doctor’s medical judgement is compromised by restrictive abortion laws, it is women’s health and women’s lives that suffer.”

Several writers have referred to the “X case” in covering this story. This was a controversial 1992 Irish Supreme Court case in which a 14-year-old girl expressed suicidal thoughts after being raped by a neighbor and becoming pregnant as a result. The girl planned to have an abortion elsewhere, but was prevented from doing so. The court eventually ruled that women have the right to seek abortions in life-threatening situations, including possible suicide.

Despite this 20-year-old ruling, Irish legislators have not passed a law to codify this right, leaving women in dangerously uncertain territory.

A Choice Ireland spokesperson explained:

Today, some twenty years after the X case we find ourselves asking the same question again — if a woman is pregnant, her life in jeopardy, can she even establish whether or not she has a right to a termination here in Ireland? There is still a disturbing lack of clarity around this issue, decades after the tragic events surrounding the X case in 1992.

Ireland’s Deputy Prime Minister Eamon Gilmore has said that the government would act “to bring legal clarity to this issue as quickly as possible.”

See also these additional commentaries on the failure to pass relevant laws after the X case to make abortions clearly legal in life-threatening situations.

Emer O’Toole writes at The Guardian about the struggles of pro-choice activists in Ireland, pointing to the culpability of doctors, legislators, journalists, and others in perpetuating the lack of justice in abortion laws. She issues an apology to Savita’s family that is also a call to action to supporters of abortion rights:

To her family, I want to say: I am ashamed, I am culpable, and I am sorry. For every letter to my local politician I didn’t write, for every protest I didn’t join, for keeping quiet about abortion rights in the company of conservative relations and friends, for becoming complacent, for thinking that Ireland was changing, for not working hard enough to secure that change, for failing to create a society in which your wife, your daughter, your sister was able to access the care that she needed: I am sorry. You must think that we are barbarians.

Related: Study Examines How Inability To Obtain Abortion Care Affects Women’s Lives


September 28, 2012

My Body is Mine! – Global Day of Action for Access to Safe and Legal Abortion

Sept 28 Global Day of Action: Accessible Legal Safe Abortion

Globally, 47,000 deaths occur each year as a result of unsafe abortion, accounting for 13 percent of all maternal mortality.

Today, activists are calling attention to the need for safe, legal abortion in all countries, urging scrutiny of governments that restrict or forbid abortion.

The Global Day of Action for Access to Safe and Legal Abortion campaign site includes a public statement that reads in part:

[P]regnancy-related deaths and unsafe abortion remain a major public health problem in large parts of the world. Most countries that allow women to die in childbirth also allow them to die and suffer from unsafe abortions. Why? Because they do not value women’s health and lives, including when they are pregnant. This is what makes women’s right to safe abortion a public health and human rights issue.

The number of maternal deaths has declined substantially globally between 1990 and 2008, while the number of deaths from unsafe abortion has fallen to 47,000 per year in 2008. However, the proportion of all maternal deaths due to unsafe abortion has not been reduced but remained at 13% of all maternal deaths in that period. In 2008, of the 43.8 million induced abortions globally, 21.6 million were unsafe, 98% of them in developing countries. (Sedgh et al, Lancet 2012) And an estimated 5 million of those 21.6 million women each year had to be hospitalised for treatment of complications of unsafe abortion, (Singh et al, Lancet 2007) putting a heavy burden on scarce hospital resources (up to 50% of hospital maternity beds in some countries). [...]

Adolescent girls suffer the most from complications of unsafe abortion and have the highest unmet need for contraception. More than 40% (8.7 million) of the 21.2 million unsafe abortions in developing countries in 2008 were in young women aged 15–24 years. Of these, 3.2 million were adolescents aged 15–19 years, and 5.5 million were aged 20–24 years. (Shah, RHM May 2012)

The website also explains the clinical, legal and social health determinants that characterize what is meant by “unsafe abortion”:

  • Illegal or legally restricted
  • Dangerous method
  • Untrained/unskilled provider
  • Unsafe conditions
  • Self-induced without help or information
  • Incorrect usage (of pills)
  • Little or no access to treatment for complications
  • Stigma and fear and isolation
  • Violence, rejection (by family, school, work) and murder, including of doctors providing abortion care
  • Threat of prosecution
  • Prosecution and imprisonment

Actions taking place around the globe are listed here by country. A letter has been written by young feminists to the United Nations, urging the UN to commit to women’s reproductive rights as human rights in upcoming negotiations. You can sign on to the letter via this petition site.

You can also keep up with the campaign on Twitter at @mybodycampaign and via the hashtag #safeabortion.


July 27, 2012

Women on Waves Launches Global Directory of Sexual/Reproductive Health Services & Abortion Providers

Women on Waves ShipWomen on Waves works to increase access to safe abortions for women in countries with restrictive abortion policies. The organization offers hotlines for information, details on obtaining medical abortions (drug-induced rather than surgical) via the web, and a map with summary info on each nation’s abortion laws and misoprostol (a medication that induces abortion) brand names and availability.

The organization also sometimes runs ship campaigns, in which women who can’t get abortions in their home countries ride out to international waters for medication abortions.

The group has put together a directory of Sexual Health Services Worldwide, with information on who to contact and where to go for abortions and other reproductive health services in countries around the world. In most cases, the directory information is provided in the main language of the country, and it sometimes includes information on abortion funds for those who need assistance paying.

Nations with extremely restrictive abortion laws are also included. For example, if you check out the listing for Ireland, where abortion is illegal unless a woman’s life is endangered, the site provides information on nearby countries a woman could travel to, information on organizations and clinics in those countries, and which nations might be cheaper for travel costs.

Reminder: To get involved in our current campaign promoting voting and reproductive rights in the United States, check out Our Bodies, Our Votes!