This year the revolutionary birth control pill will achieve a milestone-it has been fifty years since the contraceptive was introduced to women in America.

In the early years only married women could buy the pill. Looking back the struggle it took to make sure that all women have access to the pill,Campus Progress- a project of Center for American progress says,

“It was available for sale to married women on June 23, 1960, though it took a battle with the Supreme Court to guarantee that right to all married women in 1965. That right was eventually extended to all women in another Supreme Court decision in 1972. Today the pill is so much a part of everyday life for many women. Still, the pill remains controversial; anti-choice groups still try to wrongly claim the pill causes abortions and many family planning advocates worry that public policy would be used to restrict access to the contraceptive rather than expand it. “

Benefits of contraception access

Increasing woman’s access to safe contraceptives also lowers abortion rate. According to The Christian Science Monitor,

“Between 1995 and 2003, the number of abortions performed worldwide fell from 45.5 million to 41.6 million. The global rate of abortions fell as well: from 35 abortions for every 1,000 women of reproductive age (15-44) in 1995, to 29 per 1,000 women in 2003.

The decline corresponds with a growth in contraceptive use worldwide. The proportion of married women practicing contraception rose from 54 percent in 1990 to 63 percent in 2003, Guttmacher reports. Unmarried, sexually active women are also more likely to be using contraception.”

Opposition to the Pill

Although, increased contraceptive use has lowered abortion rate globally, in the Unites States some religious and social lobbies oppose certain kinds of contraceptives-especially Plan B emergency birth control pill, claiming that they cause abortions. Fox News reported in 2007 that,

Some critics — including Roman Catholic leaders — consider the pill tantamount to abortion, although Barr(Barr Pharmaceutical) says it has no effect on women who are already pregnant. Catholic bishops in Connecticut protested in May when the state legislature passed a bill requiring all hospitals, including Catholic facilities, to offer Plan B to rape victims.

Then there is the controversy over whether birth control pills and other forms on contraceptives should be covered by insurers. Jaime Sanderson says that birth control pills should be covered by the insurers. In his blog post he cites a survey commissioned by Planned Parenthood Federation of America, which reported that,

….· Three out of four people (74 percent) favor requiring insurance to cover the birth control pill and other forms of contraception at low or no cost, like they do for other preventive health care measures and medications.

It seems that debate over the pill and access to contraceptives will remain a sensitive issue in the United Sates, no matter how far the country has come since the pill was first introduced 50 years ago.

How do we best ensure modern contraceptive access for over 200 million women worldwide — the one in six women — who currently do not have it?

All Our Lives

Jen Roth and I recently co-founded All Our Lives, a multinational nonprofit group eager to resolve this urgent problem, among others that constrain women’s and children’s lives and well-being.  We are pro every life, born and unborn, and pro women’s right to make their own nonviolent sexual and reproductive choices.  Guaranteeing family planning access for all women on Earth who wish it will help prevent millions of unsought pregnancies and maternal and fetal injuries and deaths.

All Our Lives will not offer preordained answers, but a series of questions that begins and ends where it most belongs: in collaboration with these very women.  After all, they, and any children they conceive, are the ones with the most to lose or gain.

A series of questions

• Who precisely are the 200 million women? When informed about all available methods of family planning today, what do or would they themselves identify as their needs and preferences?

• How exactly do or would their male partners help and/or hinder them in meeting their needs and preferences?  How can men in their societies be best enlisted to bring about positive changes, for example, alleviating rape, domestic violence, and contraceptive sabotage? How to best foster financial and social independence among these populations of women, both for its own sake and for its value in aiding women to leave male partners who persist in violent behavior?

• How can the needs of women who are unserved in terms of contraception be integrated with existing primary health care systems, including maternal child and HIV/AIDS programming?  How to integrate these needs and preferences with the ramping up of all basic health care services?

• How can large-scale funders, such as multilateral agencies, governments, NGOs, and private foundations, be persuaded to increase their stalled or dwindling funds for family planning supplies? Even more, how can they be persuaded to set their funding priorities in accord with the priorities of underserved or unserved women themselves?

• How can human society at all levels, from the local to the global, become more engaged in support for access to modern, universal, but community-grounded family planning services?  Most of all, how can this issue be unburdened of the US-style conflicts over abortion which so often hinder progress on family planning?

Access to contraception

UNFPA’s own policy—not promoting abortion as a means of family planning—suggests that while abortion remains controversial around the globe, people of diverse views about abortion itself already share a widespread consensus in favor of voluntary pregnancy prevention.

In the US, for example, it is not only pro-choicers who support women’s access to voluntary contraception.  According to a poll by the National Family Planning and Reproductive Heatlth Association, eight in ten Americans who identify as pro-lifers take this stance as well. How might the many pro-contraception pro-lifers around the world be better engaged, along with pro-choicers, in the abortion-reducing struggle for universal family planning access?

And what of those who have religious objections to what they term “artificial” means of contraception? Most accept modern fertility awareness/natural family planning methods such as CycleBeads, which UNFPA already promotes. How can they be engaged in promoting such methods among members of their religious communities who share their family planning beliefs?

Most of all, do women whose contraception needs are unserved voice a desire for alternatives to unsought pregnancies and abortions?  And what means of prevention would they choose given the chance?

The Lancet recently released news that the global maternal mortality has declined – these results are controversial in that other estimates don’t exactly agree. I am not going to discuss the controversy surrounding the data as the debates focus on developing countries, not developed countries like the US and Western Europe

One area that struck me was the US maternal mortality rate. This is the chances of a women dying due to pregnancy.

The US always did poorly compared to the rest of the developed world…but the news is getting worse. According to the Lancet article, the US maternal mortality was 13 deaths per 100,000 live births in 2000 (confidence interval 12-15) but in 2008 had risen to 17 deaths per 100,000 live births. To put that in context, this rate is more than twice the estimate for Canada, Japan, Australia, South Korea, Singapore and 21 of the 22 Western European countries.

Some have stated that the apparent increase is related to changes in definitions, but it is also likely that the United States’ poor results in maternal mortality rates are tied to its having the highest teenage pregnancy rate in the developed world. In 1998 there were 1,671 births per 1,000,000 capita compared with less than 700 births per 1,000,000 capita for the other countries listed. Why does this matter? Pregnant teenagers and their infants face significantly greater health risk than pregnancy women in their 20’s; this includes a maternal mortality rate of five times higher in the developing world.

Within all the debates in the United States about health care reform one thing that was missing was a set of clear facts. As people rally for better maternal care around the world, let’s also make sure that the United States takes better care of its own mothers.

On Mother’s Day, Americans recognize the amazing women whose dedication has shaped our families and lives. But let’s not forget to honor mothers worldwide.

They nurture the future by giving children a basic security that no military could ever match. In some parts of the world, however, motherhood is far more dangerous than war.

Consider Afghanistan, where women have a one in eight lifetime risk of dying from pregnancy or childbirth-related causes. Afghan mothers also suffer given the dismal odds their children face. One-quarter of all babies born there never reach their fifth birthday. Any given week, more than 6,000 Afghan children may die — mostly from easily preventable causes, like pneumonia, diarrhea and birth complications.

This weekly children’s death toll equals all Afghan civilian deaths from armed conflict in the last three years – even as the Taliban attacks reached new highs.

These statistics may be more related than you’d think

The Afghan government’s inability to provide basic health services for expectant mothers and children has undermined its credibility and boosted support for the Taliban, according to the U.S. national intelligence director.

Because extremists prey on the discontent of marginalized communities, countries with higher child and maternal mortality rates may be more vulnerable to political upheaval. That’s a point Secretary of State Hillary Clinton has made. But it’s not the only compelling reason to address child and maternal deaths.

Children and pregnant women are dying needlessly

Americans know it’s wrong to let these deaths continue when we know how to prevent them. The tools to stop this are proven and often very low-cost. Using them, we could prevent an estimated two-thirds of 8.8 million annual child deaths and three-quarters of 343,000 maternal deaths. Some poor countries have already made astounding progress — thanks to a combination of foreign aid, national will and sustainable strategies for getting basic health care to poor mothers and their children.

The most effective solutions are not high tech. Exclusive breastfeeding, micro-nutrients, antibiotics, anti-malarials, vaccines, oral-rehydration therapy and ready-to-eat foods could save millions of children each year. Skilled attendance at births, as well as basic prenatal and postnatal care could prevent most maternal deaths.

RELATED BLOG-POSTS

• Theresa Shaver: Mother’s Day: A Countdown to Make Mother’s Day Every Day (huffingtonpost.com)
• Where’s the Best Place to be a Mom? (abcnews.go.com)
• Op-Ed Columnist: Celebrate Mother’s Day by Saving One (nytimes.com)

Click here to view the embedded video.

As a community of visual communicators, we at the Art Center College of Design in Pasadena, California were honored to launch a call-to-action campaign in support of the ‘ICPD’. In 1994, the world came together at the International Conference on Population and Development in Cairo, also known as ICPD, to create a consensus on the relationship between population growth and other areas of development.

At the Art Center College of Design in Pasadena, we have produced youth-oriented, fresh perspectives in the form of posters and PSAs about the interconnectedness between population dynamics, reproductive health rights, and economic and social development.

Sixteen students from Art Center answered the call to become advocates for other youth around the world, in a class led jointly by the Department of Illustration and the college’s social action department, Designmatters. These students from the Art Center immersed themselves in first-hand testimonials from youth around the world.

Interviews with activists from several NGOs and prior victims of human rights violations were primary material for inspiration. The impact of extreme poverty, lack of access to education and medical care, forced marriage of young girls, gender-based violence, and human trafficking were key issues that were examined as a backdrop to developing the advocacy strategies and messaging of a series of posters and three distinct public service announcements (PSAs) that were selected for production.

The public service announcements are receiving international visibility on CNN International, and you will find them here:

Click here to view the embedded video.

Click here to view the embedded video.

Click here to view the embedded video.

The short documentary in the introduction features the class process and outcomes.

Image by Hisham G., photo by Opus

Aicha Ech Chenna has just been awarded the world’s largest faith-based prize for entrepreneurship, the Opus Prize. Her work focuses on unwed mothers

Extramarital sex in Morocco is taboo, technically punishable by imprisonment, though the law is rarely enforced. Unwed motherhood then, is the ultimate taboo, and women who get pregnant out of wedlock are often shunned from their communities. That’s where activist and social worker Aicha Ech Chenna comes in: In 1980, after witnessing an unmarried mother give up her child, Ech Chenna formed a social work practice with the sole purpose of helping unwed mothers.

Now, nearly 25 years after its official inception, Solidarité Féminine employs women at two restaurants, a bakery, four small shops, and a hammam (bath), and provides them with health care, child care, and job skills. The organization also provides women with legal assistance, helping them to officialize surnames for their children (in Morocco, women lack authority to give their children a surname, and without a surname, it is nearly impossible to get an ID card).

And so, in Solidarité Féminine’s 24th year, 68-year-old Aicha Ech Chenna has just been awarded the world’s largest faith-based prize for entrepreneurship, the Opus Prize. The prize will provide the organization with 1 million USD (over 750,000 MAD). The Moroccan-American board, based in Washington DC, held an event for Ech Chenna, capturing the event on video and sharing it via YouTube:

Moroccan blogger Hisham of The Moroccan Mirror started his career as a doctor in Morocco, and has seen the plight of unwed mothers in Morocco firsthand. He writes of the experience, and lauds Ech Chenna for her efforts, saying:

We heard terrible stories about some unwed pregnant women being rejected from clinics by doctors or nurses, and about newborns being abandoned near the gates of hospitals and clinics, and we saw those same abandoned babies and infants (“ben X” they were called, or “son of X”) being brought to the maternity unit, malnurished and dehydrated.

To be fair, those women were reasonably well treated, though one could sense the coldheartedness with which their cases were addressed. It was then that I first heard of organizations like “Solidarité féminine,” “Association enfance espoir Maroc” or “Bayti,” and of wonderful people like Aicha Ech Chenna who took upon themselves the burden of helping those young mothers and abondened children, in a society that continues to put the responsibility of extra-marital relationship, mainly on women. A terrible stigma that only people like Ech Chenna might help erase.

This story was originally published at www.globalvoicesonline.org

These videos, by different human rights organizations, go beyond statistics to tell us the stories of women and their families as they struggle to understand why it is that so many women are dying during childbirth and what needs to be done to stop this.

First, the White Ribbon Alliance produced a four minute video titled Birth and Death explaining the seriousness of Maternal Mortality and how it can be stopped:

Click here to view the embedded video.

UNICEF also created a two minute video to raise awareness about this issue, with 5 steps that can be taken to diminish maternal mortality: education, respect, empowerment, investing and protection.

Click here to view the embedded video.

In this next video, In Silence: Maternal Mortality in India by Human Rights Watch, photographer Susan Meiselas and reporter Dumeetha Luthra traveled to India to follow the story of a woman who died after giving birth:

Click here to view the embedded video.

In Peru, as told by this piece done for CARE by Phil Borges, the Watchmen for Lives program to decrease maternal mortality has proven to be a success: by empowering and educating women from within the communities in the importance of healthcare during pregnancy and by making a chart for midwives with warning signs on when to send women to a clinic, more are going to clinics to give birth, dramatically reducing the numbers of deaths due to complications during labor.

Click here to view the embedded video.

Amnesty International has this documentary piece, 18 minutes long, about Maternal Mortality in Sierra Leone. One in 8 women die in Childbirth there: the inability to pay for medical attention, a practically non-existent healthcare system, lack of trained medical practitioners and understaffed and understocked clinics are the main reasons. As the women in the video tell: everyone there knows a woman who has died during pregnancy or labor.

Click here to view the embedded video.

And from Australia, students from the Nursing and Midwife program at the University of Sydney have created Birthing Kits that they’ve delivered to developing countries to try and prevent unnecessary deaths. It includes a plastic sheet to put under the mother, surgical gloves, scalpel blades, gauze, soap and string to tie off the umbilical cord. In the video, they tell of their initiative and the successful experience they’ve had in Bangladesh.

Click here to view the embedded video.

Imagine a woman giving birth handcuffed and her feet shackled. Do pregnant women in prison deserve human rights, or can pregnancy become a way to avoid jail?

All over the world, pregnant women struggle for basic human rights.

In chains

In the US, pregnant women serving time have been routinely shackled during labor and childbirth, despite the danger to the mother and child, according to Malika Saada Saar, founder and executive director of the Rebecca Project for Human Rights. In a blog-post published at RH Reality Check, she tells us that the issue of shackling pregnant women is still being debated.

The Bureau of Prisons (BOP) in September 2008 ended shackling mothers as a matter of routine course in all federal correctional facilities. State legislatures and Departments of Correction have also responded to the sea change in shackling policy. Most recently, New Mexico, New York, and Texas have enacted laws prohibiting the practice of shackling pregnant women in nearly all circumstances.

Fighting the system

Malika Saada Saar features a video on her blog-post at RH Reality Check about a mother,  Shawanna Nelson, who was shackled during labor, but who brought a lawsuit against the Arkansas Department of Corrections for cruel and unusual punishment:

Click here to view the embedded video.

Malika Saada Saar says:

Thanks to [Shawanna Nelson's] courage and the common sense of a panel of judges, the 8^th Circuit Court of Appeals recently ruled and the shackling of prisoners during labor is unconstitultional.

Pregnancy as a bargaining tool

Why are rights for pregnant women in prison so controversial? Different countries have different viewpoints about the debate.

In Russia Today, a Russian broadcasting channel,  the subject is mentioned:

Skeptics think some mothers deliberately get pregnant simply to ease life in prison. Hospital leave, then lots of scheduled time with your child – it is all better than sitting in a stone cell, they claim.

And there are women for whom it seems that pregnancy is the only way to escape a sentence, as was the case back in June, when a British woman incarcerated and sentenced to death in Laos due to drug smuggling got pregnant in prison and escaped being executed, since the Laos government would not execute a pregnant woman. The claims made according to the Daily Express, a British newspaper, are that she got artificially inseminated “to secure a more lenient term”.

Pregnancy as a get out of jail free card?

In Argentina, according to Ajintem, an information portal for  migration information, a law was passed last year specifying that pregnant women, women with children younger than 5 and those with handicapped children would benefit from spending their prison term at home under house arrest.

This law would benefit not only the mother, who in prison wouldn’t receive suitable health care during her pregnancy. It would also help the child, who would either be raised without a mother, or in prison, an unsafe environment.

However, the message is for magistrates to follow the spirit of the law and grant this permission to those women not involved in violent crimes. The rest of the civilian population shouldn’t see pregnancy as a get out of jail free card.

Children growing up without mothers

In the Canary Islands, according to Prisiones y Penas, a blog about the issues surrounding jails and prisons, women are allowed to keep their children of up to 3 years of age in their cells, but in the company of other inmates – an unsafe environment.

Thus, pregnant women or women with children under 3 are encouraged, upon entry to the prison, to send their child off to family members because it isn’t good for the child to grow up behind bars.

This is also the case in Peru and Russia.

Why doesn’t the US allow women to keep their babies in prison?

In the US, there are only two correctional facilities which allow prison inmates to keep their babies with them, in New York and in Nebraska, as told by renowned photographer Jane Evelyn Atwood in her 3 part photo documentary for Amnesty International,  called Too Much Time, where she visited dozens of prisons all over the world to record and document the lives of inmates.

Atwood explains that the reason the US correctional system does generally not allow women with babies to keep them, is due to the hostage situation. In the Prison Photography Blog they address this claim:

Children are excluded from all but a couple of US prisons. The security threat is cited as the reason: a child inside a prison is a constant vulnerable life and constant hostage target. The claim seems a little bogus when penal systems of other countries are brought into consideration.

The Atwood documentary in the Amnesty International site features both a section on the process of giving birth in shackles as told in Vanessa’s Baby and another on prison systems and motherhood.

Women speak out about their children and prison life

Geraldin Rodríguez, an Argentinean spending time in an Ecuadorian jail due to drug trafficking tells Marcos Brugiati, a writer who contributes with the art related online publication Plastica-Argentina, a story about getting pregnant in prison. She was allowed to keep her baby with her, but decided that the child needed to grow up free:

I decided he should leave to live, I was afraid he would suffer the same traumas I have today. After a year my brother took him away and is caring for him along with his wife.

A motherless child
Juvinete is in a Spanish prison, and was pregnant when she was incarcerated for drug trafficking. She tells her story to regional Spanish newspaper NorteCastilla. Three years after giving birth to her baby in prison, her child had to leave her side, and was sent to a foster family. Juvinete sees her daughter every 15 days and every two months she gets a 2 week leave to spend time with her.

However, things don’t seem to be looking up: there is a chance Juvinete will be deported to her natal Brazil, and she fears for the consequences this change would have on her child. She does have advice for any woman who decide to get pregnant while in jail:

I try to convince them not to get pregnant while inside because seeing a child deprived of their freedom is very hard, it’s irresponsible. They don’t have to pay for our mistakes.

“My family didn’t even know I was in labor”

In Woman and Prison, a website dedicated to women’s experiences in the correctional system, inmate Kebby Warner speaks of her own pregnancy while doing time in a US prison and having her child taken away from her. Here is an excerpt where she writes about the birthing process:

During the labor, no one is allowed in the delivery room. My family didn’t even know I was in labor or had her until after I left the hospital. During the three days some of the guards stayed in the room, but most of the time, when the nurses asked them to sit outside the door, they complied. I have heard horror stories of women being chained to the delivery bed. I am so grateful as to have not experienced this. Most of the nurses treated me as a human instead of a prisoner.

You can read more testimonies about growing up with a parent in prison in Women and Prison.

So what do you think?

There are a few questions that come to mind:

• What is it like to be pregnant and have a child behind bars?
• Should women in prisons be a priority when there are other women outside of correctional facilities without medical assistance?
• Should maternity overrule any other legal conditions to ensure a pregnant woman’s human rights?

Image used to illustrate post is “17 de noviembre” by daquella manera.

When it comes to health campaigns, there are many barriers. Let me give you an example from the real world with a focus on Tuberculosis (TB). TB is one of the great causes of morbidity and mortality in the world today, with the World Health Organization estimating that one third of the world’s population is infected with the TB bacteria.

A day in the life of a man getting tested for TB

One evening, a man working for a farmer in a community is visited by a community health worker in a door-to-door campaign aimed at preventing the spread of TB.

The aim is to raise awareness, and encourage individuals to be tested and treated for TB. The skin test is free and provided by a health clinic in a rural agricultural region.

This well-intentioned health worker who lives in the community is invited into the home of this man, and has an opportunity to educate him and his family on Tuberculosis. The health worker concludes the presentation by encouraging the family to be tested for TB at the free clinic in town. The man, not wanting to put his family at risk, and having been compelled by the presentation of this neighbor, plans to visit the clinic the following week.

On Monday, following a 14 hour day at work, he takes the bus from the farm where he works into town to attend the free clinic. He arrives shortly after 7pm and is dismayed to find a large sign indicating the clinic is closed and hours of operation are 8am to 5pm. After some negotiation with his boss the following morning he plans to visit the clinic first thing the following morning and then head back to work after the testing is complete.

The next morning he takes the bus directly into town and arrives at 8am at the opening of clinic, after 20 minutes navigating the building to find the TB testing area he is only met with more bad news- the free testing takes place from 11am-1pm only.

Having lost a morning’s worth of work he stays until 11am is tenth in line and finally at 12:00noon he is next in line, finally he is called forward and the 5 minute test is completed. He is then told to get the results he will need to come back in two days time between the hours of 11am and 1pm. He heads back to work in time to work the final two hours in the field and then journeys on home.

Use your imagination to hypothesize how this story continues.

Victims of false advertising

It is not until we venture into a ‘Day in the Life Of’ or DILO (a term shared with me by Dr. Everold Hosein) that we truly understand the barriers both individual and systemic that plague even the most well-intentioned campaigns to promote health and other social programs.

Now, the clinic did have some important aspects to their campaign that were culturally sensitive and responsive to the needs of the particular community:

• they utilized key opinion leaders from the neighborhood to implement the door-to-door campaign and
• they eliminated the financial cost of TB testing to encourage participation.

However, there were some crucial elements of the program that were not dissected and thus resulted in loss of income, and physical and emotional stress:

• the health center did not boast clear signage, and therefore potential patients were left roaming around a large building trying to locate the specific TB clinic area.
• the health center was open ‘business hours’, which was totally incompatible with the population they were trying to reach- mostly farmers working 14 hour day.
• the free testing was only available during the middle of the day and almost certainly required the patient to take an entire day off work to get to the clinic, receive testing, and return home.

The way forward?

The story and context detailed above could be equally applied in most communities in the world, switching farm worker for fisherman, and switching TB for HIV/AIDS and so on. We oft move too quickly in our planning to focus on the outcomes we wish to achieve, and spend frighteningly too little time understanding our intended audience of our campaign to create an intervention that is both meaningful to the consumer and appeals to their needs and desires, while also reducing barriers to encourage participation.

While, I cannot offer a comprehensive solution or technique that will insulate the most well meaning campaigns from the challenges that have been touched on above, I endeavor that in our respective fields and roles as advocates and professionals within public health, and international development that we remain mindful of the DILO. This perhaps will reduce health disparities and promote equitable access to health and social programs and services.

An investment of $10 billion annually could save three of every four women who are dying. And just think what that could mean. Just consider what women deliver. Not just babies!

Around the developing world, women operate most of the small businesses. They are workers who deliver firewood and water, immunization and health care. They bring home income. They bring home food. 90 percent of the labour for growing rice in Southeast Asia is done by women. Eighty per cent of Africa’s food is produced by women. And it is the women of Africa, who carry on their heads or in their arms two-thirds of all the goods that are transported anywhere on the continent. Not trucks or planes, but women.

Women are the economic heart of the developing world. But their rights and their health are neglected. This has to change. Women need to be treated with respect and dignity, they need to be healthy, and they need to be able to plan the number and spacing of their pregnancies. If they are able to do this, they can make sure the family has enough income to give each one enough food, clothes, education and medicine. This would be a gain, not just for themselves, but for their families, communities and nations. Investment in women really pays off.

–Visit the Women Deliver’s Blog: Daily Delivery

Click here to view the embedded video.