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U.S. abortion politics felt globally: The chase of the global gag rule

On January 23rd, 2017, U.S president Donald Trump issued Presidential Memorandum reinstating the Mexico City Policy popularly referred to as the Global Gag Rule within Civil Society Organizations due to its restrictive nature on health services and advocacy particularly on Sexual Reproductive Rights for women and marginalized groups in societies that receive U.S. funding. Trump`s administration renamed the policy as Protecting life in Global Health Assistance; as the name suggests, the policy now applies to all U.S. global health assistance amounting to nearly USD $9 billion and includes funding for HIV/AIDS, tuberculosis, malaria, maternal and child health, family planning and reproductive health, nutrition, global health security, zika virus, and WASH at household and community levels. Non- U.S. NGOS who receive any global funding have 2 choices; Accept U.S. global health assistance and restrict their activities on abortion or refuse U.S. global health assistance and find other funding.

This policy has instilled fear on NGOS and caused them to self – censor and not ask questions about the policy because they are afraid of potentially losing U.S. funding. This has led to them over restricting their activities to be sure they are in compliance with the policy. Other NGOs have discontinued partnerships, stopped participating in coalitions, and no longer apply for some grants and unnecessarily stopped certain activities, which causes irreparable damage to their beneficiaries and civil society partnerships. President Trump’s policy masquerades under the guise of preserving life, but it endangers life. Restricting abortion information and access threatens and endangers women’s lives and families at large socially and economically.

Impacts of the Global Gag Rule have resulted into shut down in clinics, reduced access to contraceptives and HIV services, limited rural communities` access to health care, disrupted referral networks, and weakened civil society partnerships, coalitions, advocacy efforts around unsafe abortion. These impacts will worsen over time as more NGOs lose funding and are forced to restrict activities. Trump’s policy does not protect life. Women’s sexual reproductive health rights and health rights of marginalized persons are important and should matter.

Together we can make a difference by standing tall against the GGR and rising above its inhuman nature. It is important to monitor, document and report changes in relationships with sub-grantees and organizations affected by declining the funds or refusing to comply to continue mitigating or countering the impact of GGR to feed into data to push for the repealing of the unjust policy targeted at dehumanizing marginalized groups in society globally. This should be a wakeup call for the Ugandan government to prioritize Heath funding in the national budgets rather than largely depend on foreign aid that often comes with strings attached to the disadvantage of its citizens.

 

By Amuron Dorothy

Launching the standards and guidelines on unsafe abortions to confront the public health crisis in Uganda

The Ministry of health launched the “Standards and Guidelines for the Reduction of Maternal Mortality and Morbidity Due to Unsafe abortion in Uganda on 4th April 2015.” According to the Uganda Demographic and Health Survey (UDHS) 2011, Uganda has a maternal mortality ration of 438 per 100,000 live births, 26 percent of these deaths are attributed to unsafe abortions.

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As an intervention, in 2013 the Ministry of Health in collaboration with Development partners, implementing partners, and stakeholders including; the Center for health human rights and development (CEHURD), IPAS Reproductive health Uganda (RHU), Association of Obstetricians and Gynecologist of Uganda (AOGU), Makerere University department of Psychiatry, Ministry of Justice and Constitutional Affairs, Makerere University School of Laws PACE, Health GAP, Marie Stopes Uganda, and the Coalition to Stop Maternal Mortality Due to Unsafe abortion (CSMMUA) started a consultative process for the development of Standards and Guidelines to address the mortality and morbidity as caused by unsafe abortions in the country.

These guidelines will be implemented in all health facilities nationwide and will also be used by health professionals as well as policy makers to take steps in the area of service delivery, advocacy and capacity building all aimed at reducing maternal mortality and morbidity caused by unsafe abortion in Uganda.

The launch of the Standards and guidelines which has marked the end of the two years multi-stakeholder consultative journey has been officiated by the Director of Health services at the ministry of Health Professor Anthony Mbonye on behalf of the State Minister of Health (in charge of primary health care) Honourable Sarah Opendi. In his statement during the launch, the Professor noted that Uganda like any other country pledged to meet the obligation under the Maputo plan of Action, MDG 5 on reduction of maternal mortality as well as other Global initiatives in order to ensure that lives are not lost as a result of unsafe abortions. “This has therefore remained a key Government concern,” he added.

The chief executive officer of CEHURD, Mr. Mulumba Moses said that the standards and guidelines document is a step towards stopping women from turning to backstreet alleys. Mr. Mulumba added that it is encouraging to hear that the ministry is ready to tackle the problem head on by developing a policy structure that aims to deal with an issue that has been ignored for far too long.

In Uganda, termination of pregnancy is restricted and only permitted to preserve the life, mental and physical health of pregnant mothers. There have been challenges due to limited understanding of the legal environment by health providers, policy makers and patients hence formulating these guidelines which will help in solving this issue.

Dr. Charles Kigundu, president of the Association of Gynecologist and Obstetricians of Uganda noted that as health workers dealing with maternal health issues still find a lot of women coming to them with complications such as infections and punctured uteri. The guidelines will help solve the situation greatly since many health professionals believe that abortion is totally legal yet the guidelines provide a better picture on how, when, and in what circumstances a safe abortion can be performed.

Uganda: The Deadly Hours for Women to Give Birth

BY CAROL NATUKUNDA

Woe unto a mother who goes to deliver in Mulago hospital at night or early morning. Chances are she could die.

A new report shows that the highest number of maternal deaths (14.2%) occurs between 9 am- 10am. Other “deadly” hours to be admitted are 7-8pm, 1-2am and 9-10pm.

In other regional referral hospitals combined, the highest number of deaths (13.2%) occurred between 7-10pm, followed by the 5-6am and 1-2pm.

The revelations are contained in a report titled “maternal mortality reviews in three referral hospitals in Uganda” 2009-2011. About 300 deaths of mothers were reviewed in Fort portal, Masaka and Mulago referral Hospitals.

According to the report, these time periods, in which mothers died relate to health worker fatigue and the periods of changeover of the medical staff.

Although 42% mothers died within 24 hours of admission, 20% died in the first six hours of admission. These were considered as the “walk in” dead, which suggested that they came to hospital when it was a little too late and nothing little could be done for them.

The report is the first of its kind and was carried out by the Association of Gynecologist and Obstetrics in Uganda, to explore why women continue to die in labour. An estimated 6,000 women die every year due to birth related problems.

Months of death

Overall, many mothers admitted at Mulago Hospital died in January and in July. These two months a number of changes on the calendar- the university examinations and holidays for the lecturers and some medical students, as well as recruitment of new interns.

“These personnel changes, impacted on the quality of services, provided at these hospitals,” the report states.

Furthermore, June and July was cited as the end of the financial year, and the hospitals were generally faced with challenges in procurement of essential supplies.

Causes of death

Presenting the findings at a conference on Thursday, Dr. Jolly Beyeza, a senior gynecologist and obstetrician said heavy bleeding ranked the highest cause of mortality at these hospitals, which often resulted from complications in labor, and delivery.

Other top complications, according to Beyeza were abortion, infections, and hypertentive disease in pregnancy. “Among mothers who died from abortion and ectopic related conditions had never had any antenatal care,” said Dr. Beyeza. Among the mothers whose mode of delivery was recorded, 11% died undelivered. Seven mothers were brought in hospitals when they were already dead, while the majority of mothers who came in with abortion or after delivery were critically ill.

Should abortion be legalized?

During the conference, participants debated on whether to legalise abortion or not.

Joy Asasira, a lawyer with the Center for Women’s Rights and Development said a lot of women are unnecessarily dying from crude methods of abortion.

“If a woman wants to have an abortion, it does not matter what the law says. She’ll have it anyway,” Asasira said.

“Many people don’t want to talk about it, but it happens. If you don’t talk about abortion, yet we want to achieve the Millennium Development Goal of improving maternal health, we are deceiving ourselves,” she added.

Asasira argued that the government was spending sh7.5billion every year to treat complications resulting from unsafe abortions. The World Health Organization estimates that in Uganda, about 300,000 abortions are carried out every year.

Statistics show that the use of contraceptives is still low in Uganda. About 26% of women in Uganda are using modern contraception methods, while about 16 women die every day due to maternal health problems, including abortion.

Asasira stressed that nearly all unsafe abortions are because of unwanted pregnancies.

She also acknowledged that while the law in Uganda does not criminalize abortion, terminating a pregnancy had to be done within constraints of the law.

Quoting Section 224 of the Penal Code Act, Asasira said: “The law doesn’t prohibit abortion absolutely. It has a provision that acknowledges that to save the life of a mother, in case of a severe illness, that is threatening the life of a mother; a safe abortion should be carried out. But most people are not aware of this fact.”

However, doctors were skeptic, arguing that if safe abortion is readily available, women might choose to use it as a form of family planning, rather than an emergency solution to an unwanted pregnancy.

“The best thing is preventing pregnancy itself. You cannot start solving a problem from the bottom of it. Even if you made removal of pregnancy available, women will decide to use abortion as a family planning method,” argued Prof Donald Amoko, a Ugandan gynecologist based in South Africa.

Dr, James Batwala, a senior consultant obstetrician and gynecology was also pessimistic. “I am sure as we talk now; abortion is going on either legally or illegally. When you think about it, a woman has a right [to abort]. But what about the child? Don’t they have a right to life? We need to draw a line. What is more important right now is that abortion is a killer,” Batwala said.

Reacting to the concerns, Asasira, argued: “As a lawyer, rights begin at birth. I am a woman, I love babies, but there are some issues beyond the woman.”

What mothers say

The median age at death was 25 years. According to the study, only 57% of women in Uganda deliver in a health facility. “We are wondering. Where do the rest go?” asked Beyeza.

Many mothers cite lack of transport from home to the health facilities in time, staff lacking expertise and shortage of doctors among others. But doctors also complained that patients came to hospital when it was way too late. They also lacked essential facilities in health centers to carry out emergencies.

Way forward

Participants noted that most the complications were treatable. Dr. Florence Mirembe, a gynecologist said involving men in the maternal health fight would make a difference. “The men need to walk with us,” she said.

The ministry of health permanent sectary Dr. Asuman Lukwago said the government was committed to give more resources to the sector. He also announced that a women’s hospital at Mulago Hospital would be ready within two years, and called for the need for training of more gynecologists and obstetricians to work at the center.

Frank Tumwebaze, the incoming minister of presidency said the government would look into recruitment of midwives. He also called on parliament to advocate aggressively for the increase of doctors and nurses salaries, saying it would make them motivated.

Source: http://allafrica.com/stories/201209220493.html

More than 500 abortions in Gulu last year, says report

By Cissy Makumbi 

Gulu hospital management has called for government intervention following the release of a report showing an increase in cases of abortion in the district.

The report released on Wednesday shows that up to 568 babies were aborted in the year 2011/2012.

The authorities, who compiled the report, say there is need to save the unborn babies from the practice, common among girls who have unprotected sex for money.

In 2010/2011, about 500 unborn babies were terminated, according to the same report, although it still remains unclear whether the culprits were brought to book, since the practice is a crime under the law.

The director of the hospital, Dr Anthony Onyach, however, attributed the increase in the vice to failure by many mothers to use family planning methods, thus conceiving against their will.

“Most abortions occur among girls who report to the hospital when they are very sick after administering herbs and other drugs on themselves, while others seek help from shrines,” Mr Onyach said.

The same report indicates a drastic decline in the number of mothers seeking family planning services at the health facility. It shows that although in 2010/2011 there were at least 1,239 mothers who visited the hospital’s family planning unit, in 2011/2012, the number reduced to only 770.

Health experts attribute the increasing number of women with cervical cancer to unsafe abortions. Under the law, abortion is illegal and punishable, a situation that sees many women do it undercover with support from ill-equipped health personnel and traditional healers.

The Ministry of Health is considering the recommendations of a report it commissioned into the safety and legality of abortion. The report proposes legalising abortion in specific cases such as rape.

However, the debate on legalising abortion has not been met with open arms, with the proposal opposed by many Ugandans, most arguments based on religious, cultural and moral grounds

Source: http://www.monitor.co.ug/News/National/More+than+500+abortions+in+Gulu+last+year++says+report/-/688334/1506654/-/vx98ym/-/index.html

Secret Hoax Campaign Is Another Abortion Wars Tactic

By Leslie Kantor, MPH, vice president of education for Planned Parenthood Federation of America (PPFA) and Dr. Carolyn Westhoff, senior medical advisor for Planned Parenthood Federations of America (PPFA)

In recent weeks people who oppose Planned Parenthood, and our mission to provide high-quality reproductive health care, have been conducting a secret, nationwide hoax campaign in an attempt to undermine women’s access to services.

For years opponents of reproductive health and rights have used secret videotaping tactics with fictitious patient scenarios and selective editing to promote falsehoods about Planned Parenthood’s mission, services, and policies. Recently, one group has escalated these hoax visits in many states, apparently using secret recorders while inquiring about sex selection abortions. We anticipate that this group, likely in coordination with a broad range of anti-abortion leaders, will soon launch a propaganda campaign with the goal of discrediting Planned Parenthood, and, ultimately, furthering legislation that blocks access to basic reproductive health care, including birth control.

We can expect this propaganda campaign to further escalate the political battles over access to health care, rather than focus on the best ways to help women and their families get the care they need.

As a nonprofit health care provider with nearly 800 health centers, PlannedParenthood provides access to professional, nonjudgmental, affordable reproductive health care, ensuring nearly three million patients receive preventive and lifesaving care every year. Without Planned Parenthood, many women would have nowhere else to turn for breast and cervical cancer screening, well woman exams, birth control, STD testing and treatment, sex education, and pregnancy options.

As a women’s rights advocate for nearly 100 years, Planned Parenthood finds the concept of sex selection deeply unsettling. Planned Parenthood does not offer sex determination services; our ultrasound services are limited to medical purposes.

Gender bias is contrary to everything our organization works for daily in communities across the country. Planned Parenthood opposes racism and sexism in all forms, and we work to advance equity and human rights in the delivery of healthcare. Planned Parenthood condemns sex selection motivated by gender bias, and urges leaders to challenge the underlying conditions that lead to thesebeliefs and practices, including addressing the social, legal, economic, and political conditions that promote gender bias and lead some to value one gender over the other.

Recent attempts to restrict or deny access to safe abortion under the guise of preventing gender bias is harmful to women’s health, counter to a human rights agenda, and primarily a political tactic of groups who work to make abortion illegal. Planned Parenthood opposes legislation that intrudes on the doctor/patient relationship by requiring doctors to become investigators and patients their suspects, and that strips nonjudgmental, high-quality care from women in need.

The world’s leading women’s health and rights organizations, including the World Health Organization, do not believe that curtailing access to abortion services is a legitimate means of addressing sex selection, and are clear that gender bias can only be resolved by addressing the underlying conditions that lead to it. And we agree. We support efforts that ensure girls and women have access to economic opportunity, including fair wages, basic healthcare, political participation, education, and a life free of violence and discrimination. Planned Parenthood works to ensure women and their familieshave access to high-quality nonjudgmental health services free of coercion,supported by information and counseling.

From the questions that were repeatedly asked in these recent hoax visits, we expect that the materials eventually released will focus on Planned Parenthood’s non-judgmental discussions with the various women who posed aspossible patients. So, we would like to address that subject directly.

Planned Parenthood insists on the highest professional standards, which among other things means we offer nonjudgmental, confidential care in accordance with relevant laws. That doesn’t mean we always agree with the decisions made by people who seek our help, but it does mean that we realize that we can’t know all of the circumstances faced by any patient and that requiring women to justify the care they seek is a dangerous healthcare model for an organization. Four decades ago women in the United States were forced to justify their decision to seek abortion to a panel of doctors, and thankfully we’ve come a long way since then. We provide information that women seek, but ultimately the decision to seek legal abortion is a private one.

Planned Parenthood has extensive guidelines and training requirements for all staff who may encounter difficult or unusual questions, such as those posed by the hoax patients. If a health center learns of an instance where a staff member has not fully followed policies or procedures, swift action is taken to remedy the situation. Our rigorous and ongoing training and quality assurance help identify potential issues, and all health centers respond to any training or personnel needs with professionalism and respect. Planned Parenthood cares about staff, and conducts retraining or other personnel action responsibly.

People rely on Planned Parenthood for accessible and affordable quality care; that’s why one in five women have turned to us at some time in their lives for professional, nonjudgmental, and confidential care, and we value the trust they put in us.

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Planned Parenthood is the nation’s leading sexual and reproductive health care provider and advocate. We believe that everyone has the right to choose when or whether to have a child, and that every child should be wanted and loved. Planned Parenthood affiliates operate nearly 800 health centers nationwide, providing medical services and sexuality education for millions of women, men, and teenagers each year. We also work with allies worldwide to ensure that all women and men have the right and the means to meet their sexual and reproductive health care needs.

Source: plannedparenthood.org