listen up

...young people’s futures are at stake.
Spring 2012
page 4
The fetal
personhood
movement
page 16
It’s about
women’s
empowerment
LISTEN UP
Youth have
something
to say.
Focus on youth
The world now has the largest population of young people ever—1.7
billion between the ages of 10 and 24. As the global population continues to grow, young people face changing environments and circumstances that can affect their reproductive health. Young women and
girls are particularly at risk for unintended pregnancy and unsafe abortion. In fact, between 2.2 and 4 million adolescent girls aged 10–19 in
developing countries undergo unsafe abortions each year. Yet, young
women and adolescents have a right to comprehensive sexual and
reproductive health information.
At Ipas, we know young people have bold ideas for change and hold
solutions to problems that they face. With information, support, and
opportunities to act, young people can improve their own sexual and
reproductive health and advance their rights.
We are dedicated to improving young women’s access to comprehensive abortion care and information. We define abortion care for
young women as care that respects their rights; enables them to participate in design, implementation and evaluation of services; and is
accessible and clinically appropriate. Comprehensive abortion care
for young women includes contraceptive options and other reproductive health counseling.
Our emphasis on young people has led us to work with tremendous
youth-run organizations around the world. In “Youth-run, youth-appropriate, youth-approved” on p. 10, learn about four programs that are
building on the power of young people’s energy, ideas and leadership to
improve sexual and reproductive health information and care. In everything we do at Ipas, in every country where we work, we’re focused on
the experiences of young women and girls and the impact of policies,
social barriers, health-care accessibility and stigma on them. We’re also
focused on giving a voice to youth—because their futures are at stake.
Elizabeth Maguire, President and CEO
Anna de Guzman, Senior Associate for Global Youth Program
Please share Because with your friends
and colleagues.
Read online at www.ipasbecause.org
or to subscribe to the print edition
email [email protected].
Executive Vice President:
Anu Kumar
Executive Editor:
Marty Jarrell
Editor:
Jennifer Daw Holloway
Editorial Staff:
Jennifer Colletti, Margie Snider
Art Director:
Jamie McLendon
Graphic Design:
Kristin Swanson
Ipas is a nonprofit organization that works
around the world to increase women’s
ability to exercise their sexual and
reproductive rights, especially the right
to safe abortion. We seek to eliminate
unsafe abortion and the resulting deaths
and injuries and to expand women’s
access to comprehensive abortion care,
including contraception and related
reproductive health information and care.
We strive to foster a legal, policy and social
environment supportive of women’s rights
to make their own sexual and reproductive
health decisions freely and safely.
Ipas is a registered 501(c)(3) nonprofit
organization. All contributions to Ipas are
tax deductible to the full extent allowed
by law. For more information or to donate
to Ipas:
Ipas
P.O. Box 9990
Chapel Hill, NC 27515 USA
1-919-967-7052
[email protected]
www.ipas.org
Cover photo illustration credits:
{clockwise from bottom left): Top Photo
Group/Thinkstock; Creatas/Thinkstock;
Stockbyte/Thinkstock; Stockbyte/
Thinkstock; Hemera/Thinkstock
BECVOL6-E12
ISSN: 2152-6788
© 2012 Ipas.
Produced in the United States of America
Support Ipas.
www.ipas.org/what-you-can-do
10
Photo credits left to right: © Richard Lord; Creatas/Thinkstock
Contents
4
4 Coming soon to a state near you?
The fetal personhood movement in
the U.S. and beyond
10 Youth-run, youth-appropriate,
youth-approved: Spotlight on four
innovative programs
16 It’s about women’s empowerment
19 Factsheet: Emergency
contraception doesn’t cause
abortion
The photographs used in this publication are for illustrative purposes
only; they do not imply any particular attitudes, behaviors or actions on
the part of any person who appears in the photographs.
16
Coming soon to a
state near you?
© AP Photo/ Hattiesburg American, Ryan Moore
4 www.ipas.org
The fetal personhood movement in the
United States and beyond
By Margie Snider
In 1988, when U.S. President Ronald Reagan signed a
proclamation declaring “the unalienable personhood of
every American, from the moment of conception until
natural death,” it seemed more a nod to his conservative
political base than a genuine threat to women’s health
and reproductive rights.
But fast-forward to 2012 and the “fetal personhood”
movement—which seeks to define life as legally
beginning at conception, thereby outlawing abortion
and many forms of birth control—is gaining political
traction. As of April 2012, more than a dozen U.S.
states had fetal-personhood bills or state constitutional
amendments under consideration. In Mexico, 17 states
have personhood amendments in their constitutions. New
national constitutions in Hungary and The Dominican
Republic also have personhood clauses. And pro-life
advocates in Portugal are gathering signatures to get a
personhood amendment placed on their national ballot.
As the Center for Reproductive Rights notes in its report,
Whose Right to Life? Women’s Rights and Prenatal
Protections under Human Rights and Comparative Laws,
international human rights treaties and jurisprudence
have long held that the right to life does not begin before
birth and that “to protect an absolute right before birth
could contradict human rights protections for women.”
The European Court of Human Rights, for example, has
ruled that restrictions on abortion must be consistent
with women’s fundamental rights.
For pregnant women, the potential consequences
of personhood measures are especially chilling. In
Mexico, where there is no federal constitutional right to
abortion, the Mexican reproductive justice organization
GIRE (Information Group on Reproductive Choice)
says the state personhood amendments have resulted
in “more women…being reported to the authorities
and criminally charged for abortion.” In one case,
according to GIRE, a 15-year-old girl was sentenced to
psychological therapy and required to perform social
services in her municipality.
The developments in Mexico and elsewhere are
worrying for anyone concerned about women’s health
and reproductive rights. But the recent defeat of a
personhood measure in Mississippi shows that working
with allies to educate policymakers and the public on
the extreme implications of personhood can produce
important victories. Abortion rights advocates can
draw lessons not only from the Mississippi experience,
but from the ongoing work by reproductive rights
organizations in Mexico and other nations.
Because 5
Countries with national
or state constitutions
that give fetal rights
before birth
Andorra
Chile
Ecuador
El Salvador
Equatorial Guinea
Guatemala
Honduras
Hungary
Ireland
Madagascar
Mexico (17 states)
Paraguay
Peru
The Philippines
Venezuela
6 www.ipas.org
A battle in the deep south
In Mississippi, voters going to the polls in November
2011 were asked to consider Initiative 26, which would
have amended the state constitution to define life as
beginning “at the moment of fertilization.” It looked to
have an excellent chance of winning. Mississippi already
has several laws restricting access to abortion, and there
is only one abortion provider in the entire state. Prominent
church leaders and political figures, including former
Republican National Committee chairman Haley Barbour,
lined up to endorse the “Yes on 26” campaign. Early
polling indicated 26 would win by a wide margin.
But Mississippi residents such as Angela Worthy, a
registered nurse, and C.J. Rhodes, a Baptist minister,
began publicly speaking out against 26. In radio and
television ads, and through social media outlets such as
Facebook and YouTube, they and others talked about the
far-reaching consequences of the personhood amendment.
Worthy, for example, said that, as a health-care provider,
she was concerned that 26 “could keep a pregnant woman
with cancer from getting the care she needs.” Cristen
Hemmins, of Oxford, Mississippi, bravely shared her story
of being abducted and raped when she was a college
student. She noted that Initiative 26 would not allow
abortions for any reason, including for rape and incest, and
said it would be “bad for women and families.”
Their voices were part of a coordinated “No on 26”
campaign that united doctors, nurses, students, church
leaders, community organizations and reproductive rights
advocates in the “Mississippians for Healthy Families”
coalition. Even though supporters of the personhood
amendment said explicitly that their ultimate goal was to
outlaw abortion and cloning, the “No on 26” coalition did
not focus on abortion. Instead, their message emphasized
the extreme nature of 26. “You can be pro-life and still be
against 26” was something they said over and over again.
“A key part of our success was in crafting messages
that acknowledged the complexity of the issue,” says
Leola Reis, vice president for external affairs at Planned
Parenthood Southeast, which serves Mississippi. “Some
people were afraid 26 would rob families of the opportunity
to have children [by outlawing in-vitro fertilization]. For
others, it raised the question, ‘Do we want the government
interfering in these private matters?’ People from all
parts of the state came out against 26 from a multitude of
different perspectives.”
The coalition also did a lot of grassroots organizing.
Getting the public to understand or sympathize with its
message wasn’t enough; opponents of 26 also had to
turn out at the polls. Relying heavily on volunteers and
assistance from reproductive rights allies in other states,
the coalition set up phone banks and knocked on voters’
doors. By election day, “No on 26” had made more than
400,000 phone calls, knocked on 20,000 doors and sent
mailings to 140,000 households. Even more impressive
was the decisive defeat of Initiative 26. It lost by a 58-42
margin—and in the heart of the deep south, in the U.S.
state the Gallup poll ranks as “the most conservative” of all.
Even further south, an ongoing struggle
In Mexico, passage of the landmark 2007 law that legalized
abortion in Mexico City was a huge step forward for
reproductive rights—but it soon sparked backlash across
the country. Personhood amendments were subsequently
adopted in 17 states. In their wake, GIRE reports, dozens
of women have been subjected to arrest or investigation
for the crime of abortion—generally young women with
few economic resources. This has prompted GIRE to call
the personhood amendments “the perfect tool to persecute
and stigmatize women, to deprive them of their liberty
and punish them for making decisions regarding their
sexuality and reproduction.”
Regina Tamés, director of GIRE, says the amendments
not only have created fear and uncertainty among women
faced with unintended pregnancies, but also among
reproductive health-care providers. “Many physicians,
nurses, social workers and others involved in reproductive
health services are uncertain about whether or not they
can carry out their duties. They are fearful of ‘going
against the constitution,’” Tamés says. “Instead of
providing care, they end up saying to women, ‘We can’t
help you, go somewhere else.’ Providers might even
end up calling the police because they are not clear on
whether there is a crime or not.” This adds to the stigma
surrounding abortion and ultimately puts women’s health
and lives at even greater risk.
GIRE, Ipas and other organizations—including Population
Council, Catholics for the Right to Decide and Equidad—
are working to challenge this attack on women’s health
and human rights. Tamés says a key part of the effort
is to make sure that policymakers, the news media and
the public understand that the personhood amendments
U.S. states with
personhood bills
or initiatives pending
in 2012
Alabama
Arkansas
California
Colorado
Florida
Kansas
Montana
Nevada
Ohio
Oklahoma
Oregon
Virginia
Washington
Wisconsin
Because 7
violate international human rights standards. As
GIRE has noted, protection of prenatal life “should not
ignore women’s rights or be taken to such an extreme
that would allow women to die because they cannot
terminate a pregnancy if it places their health at risk…”
At the same time, the groups will be working to
advance what they call the real protection of prenatal
life—including better access to prenatal health care and
measures to protect pregnant women from violence.
A reinvigorated pro-choice
movement
In the meantime, the personhood movement and the
general onslaught of anti-abortion bills in the United
States have unintentionally reinvigorated the U.S.
pro-choice movement. Incensed by the thought that,
for example, women could be criminally investigated
or prosecuted after a miscarriage, women’s health
and reproductive rights advocates are speaking out
and raising funds at new levels. In Virginia, after
the widely publicized debate over personhood and
mandatory ultrasound bills, women political leaders
formed “Women’s Strike Force” to support pro-choice
politicians. They raised $100,000 in the first two weeks.
Initiative 26 photographs in this story courtesy
of the Mississippians for Healthy Families
Facebook page.
Some abortion rights advocates say the personhood
movement is not a real threat, that it will be defeated by
its own extreme nature. But as Patty Skuster, Ipas senior
advisor, says, whenever and wherever a constitution is
being reformed or new legislation is being introduced,
reproductive rights advocates should be vigilant. They
even need to be vigilant in the wake of victories, as the
backlash in Mexico has shown.
© Sara Gómez/Ipas
Whether it’s in Mississippi, Mexico or elsewhere,
women’s health and reproductive rights activists need
to be prepared to educate the public and policymakers,
mobilize grassroots activists, and mount public
education and media campaigns—because the health
and reproductive rights of women and girls is at stake.
8 www.ipas.org
‘Not separate battles’
By Jennifer Daw Holloway
Sometimes abortion rights and civil rights advocates
come together, often times they don’t. How do we
sustain a united movement?
Personhood USA, the anti-abortion group behind many
personhood ballot efforts, sometimes likens itself to
the civil rights movement. In fact, the group released a
video last year comparing its work to that of the fight to
end Jim Crow laws in the American south.
But this purported mission to bring civil rights to all
Americans through fetal personhood laws clearly
doesn’t jibe with many advocates—both those working
primarily in civil rights and those in abortion rights.
In fact, in Mississippi last year the NAACP got involved
to fight the personhood efforts. Mississippi NAACP
President Derrick Johnson said the ballot initiative
(known as 26) was “government gone too far.” At closer
look, he said, 26 was wrong because it would ban
birth control and would ultimately mean more children
growing up without the love of healthy families.
On March 29, the American Civil Liberties Union
(ACLU), the ACLU Oklahoma and the Center for
Reproductive Rights joined to file a suit against a similar
bill in Oklahoma. In a blog post on the ACLU site, the
organization said “It is one thing for people to conduct
their lives according to a code under which birth control
pills are immoral or even murderous. We are all entitled
to live by our own beliefs,
and the ACLU has stood
again and again against
forced contraception and
forced sterilization. But
it is quite another
thing for a state
to impose such
a regime on all
women and
men within its
borders, as this
new ballot measure
attempts to do in
Oklahoma.”
The personhood battle sparked collaboration amongst
abortion rights and civil rights activists. But, says Lynn
Roberts, assistant professor in the CUNY School of
Public Health at Hunter College and board member of
SisterSong, the civil rights and abortion rights activists
have not always joined forces and “this is exactly the
work of the reproductive justice movement, albeit still in
its most nascent stages.”
“For many of us involved in the reproductive justice
movement, civil rights and reproductive rights—that
includes, but is not limited to abortion rights—are not
separate battles since we have been involved in both
movements all along. The large question for those of us
who are active in both struggles (which is actually ONE
struggle for us) is how to get those who are not actively
engaged in both to do so,” she says.
She points in particular to what she calls a lost
opportunity—the fact that the personhood bill in
Mississippi was defeated but the voter ID bill was
not. “Clearly, the troops on the ground did not go far
enough to rally voters in the intersections of race, class
and gender; which is precisely where the reproductive
justice movement and all our constituents reside. We
have to create messaging that addresses all our issues
and we have to initiate or continue to have crossdialogues, recruit members across movements, and
mobilize folks, accordingly,” she says.
What is missing, she adds, is the ability of local chapters
of the NAACP and black faith-based organizations to
see fighting the war on women as just as “critical to civil
rights as the demand for an investigation and ultimate
repeal of Stand Your Ground laws that led to the coldblooded murder of a 17-year-old Black male, Trayvon
Martin, and perhaps countless others.”
“Whether we are talking about the shackling of
pregnant women in Georgia, access to contraception in
Arizona, or vaginal probes in Virginia, the bottom line is
that poor, black and brown women’s bodies are ground
zero in this current war against women and that makes
it a civil rights issue,” Roberts asserts. “On the other
hand, abortion rights organizations must recognize that
as long as significant numbers of people of color are
disenfranchised by anti-immigrant legislation and voter
ID laws, then all women’s right to choose will remain
under attack.”
Because 9
youth
RUN
“Young people have a right to
participate and a right to be heard,”
says Anna de Guzman, Ipas’s youth
program senior associate.
youth
APPROPRIATE
youth
APPROVED
Spotlight on
four innovative
programs
By
Jennifer
Colletti
Around the world, this firmly held conviction is the
driving force behind youth-run and youth-focused
organizations working to strengthen young people’s
voices and their ability to shape their own lives and
futures. In countries as varied as Ghana, Ethiopia,
Ecuador and Nepal, youth leaders and the adults
who support them agree that while societies have
traditionally ignored or undervalued the insight and
wishes of young people, things are beginning to
change. And with the largest youth population in
history—more than 1.7 billion young people aged 10–
24 worldwide according to the Population Reference
Bureau—change will be necessary to ensure the next
generation’s health and happiness.
“The societal perception of ‘adults are always right,’
which has been a major hindrance to the involvement
of young people in development planning, is slowly
giving way to an expanded space that accommodates
the views of young people in discussions,” says
Emmanuel Ashong, programmes officer for the awardwinning Ghana-based youth group Children and Youth
in Broadcasting – Curious Minds.
To increase the value societies place on young
people’s voices, many youth
organizations focus on building
advocacy skills. “More informed
and skilled youth leaders will
be better able to articulate
their own realities and identify
solutions to the problems they
face, which include challenges
to accessing appropriate, highquality sexual and reproductive
health care,” de Guzman says.
Young people have the right to reproductive health
Worldwide, unsafe
abortion affects girls
and young women
disproportionately:
+ A
dolescent girls aged
10–19 make up 70 percent
of all hospitalizations
from unsafe abortion
complications.
+ Y
oung women aged 10–24
account for approximately
46 percent of the deaths
from unsafe abortion
each year.
+ Y
oung women aged 10–24
are more likely to delay
seeking help for abortionrelated complications
than adults.
Sources:
Plan International’s report “Because
I am a girl: The state of the world’s
girls 2007” and the World Health
Organization.
In order for young people to have control over their own lives and
futures, they must be able to access accurate information and safe
sexual and reproductive health care—and make independent decisions about their own sexuality and reproduction.
Many young women now stay in school longer than in previous
decades, migrate farther away from their birth places, enter the
workforce in larger numbers and marry later. This means the time
period during which a young woman may be unmarried while
also able to become pregnant is expanding, explains a 2000 study
in the journal International Family Planning Perspectives. At the
same time, youth sexuality, pregnancy and motherhood outside
of marriage continue to be stigmatized in many societies, and
girls and young women experience higher rates of gender-based
violence. Because of all this, many girls and young women with
unwanted pregnancies seek abortions—and, due to myriad barriers, they often find no alternative than to resort to unsafe abortions,
even in settings where the procedure is legal.
Barriers for girls and young women who seek access to sexual
and reproductive health care—including safe abortion care—can
include gender and age discrimination, gender-based violence,
stigma attached to abortion and youth sexuality, lack of information, high cost of services, lack of confidentiality and judgmental
health-worker attitudes. Programs that rely on adult-generated
information to determine appropriate health-care options for young
people often do not take into account these barriers and consequently are unable to provide what young people need and want.
Organizations partnering with young people to define high-quality
sexual and reproductive health care are better able to meet girls’
and young women’s needs, ensuring that young people are not
just beneficiaries of services but also key stakeholders in their own
health care.
“We look for places where we can make an impact through partnerships with youth-led or youth-focused organizations,” de Guzman
explains. “It’s a conversation to discover our mutual strengths and
see how we can work together to ensure effective programs that
work with and reach young people from all walks of life.”
The ultimate goal is healthier, more just communities and societies in which young people are empowered and able to meaningfully participate in defining and shaping new realities. “Supporting young people to speak out will ensure they are able to
exercise their sexual and reproductive rights now and in the
future, leading to sustainable social change,” de Guzman says.
photos this page:© Richard Lord
photo opposite page: Top Photo Group/Thinkstock
Because 11
GHANA
Through radio, young people’s voices
reach a diverse audience
Across the West African nation of Ghana,
radio listeners of all ages tune in weekly to
hear educational and thought-provoking
programs on tough issues affecting youth,
such as abortion, HIV and AIDS, and violence against women. Just as impressive
as the enthusiasm of listeners is the fact
that young people themselves both host
and produce these influential broadcasts.
What started with one 30-minute weekly program 15 years ago has grown into a powerful
and award-winning young people’s development
and advocacy group called Children and Youth in
Broadcasting – Curious Minds. With the support of a
professional journalist, the youth-led organization now
produces six different radio programs—in English and
two local languages—catering to different groups and
interests, explains Cynthia Tawiah, who oversees Ipas
Ghana’s youth activities.
“The focus of Curious Minds over the last 15 years [has
been] to use the media, especially radio, to advocate
and represent the neglected perspective of young
people in the national discourse and [also] highlight the
development challenges of this group,” explains Curious
Minds Programmes Officer Emmanuel Ashong. Issues
affecting young people rarely gain coverage in Ghana’s
mainstream media, he says, and when young people
do make the headlines it’s usually negative and unproductive coverage of youth involved with crime or other
destructive behaviors. The young people who produce
Curious Minds radio programs are therefore responding
to the clear need for positive media coverage of youth
issues; they challenge and inspire Ghanaian society to
see young people as capable of offering solutions—not
causing problems.
Even though abortion is legal in Ghana under certain
circumstances* and the nation’s abortion law is one
of the African continent’s most progressive, women’s
access to safe services is extremely limited and unsafe
abortion continues to be a leading cause of maternal death. Young women are particularly vulnerable:
Stigma about youth sexuality and abortion in Ghana
12 www.ipas.org
puts younger women most at risk of terminating
a pregnancy unsafely. Ipas Ghana supports Curious Minds as part of its efforts “to educate and
inform young people on issues about their sexual and
reproductive health and rights, especially in the area of
unsafe abortion so as to prevent unnecessary deaths,”
Tawiah says.
Curious Minds can cite many tangible results from
its years of work: listeners who report a progressive
change in attitude on controversial topics, increased
knowledge among youth on national policies and
pressing issues, and prompt actions by local governments to address youth challenges discussed on the
radio programs, Ashong explains.
“The concept of young-people-led media advocacy has
proven very effective in Ghana despite the challenges,”
he asserts. “With regular capacity building and a
culturally sensitive and responsive approach to discussions, we believe this concept can work for others like
it has in Ghana.”
*Abortion is legal in Ghana for cases of incest or rape, when
necessary to preserve the physical and mental health of the
woman, or when there is risk of fetal abnormality.
photos this page: © Ipas; Hemera/Thinkstock
photo opposite page: © Richard Lord
ETHIOPIA
Innovative ‘Help Point’ system connects youth with
peer educators
Endalkachew is a third-year student and trained peer
educator at Ethiopia’s Bahir Dar University. “I’m proud
to be a peer educator and serve as a source of reproductive health information to my friends,” she confidently states.
“Young people are faced with reproductive health problems mainly due to lack of information and services
that are tailored to address their needs,” explains Ipas
Ethiopia Youth Consultant Blain Rezene. Consequently,
Help Points are so successful because young people
are involved in the design and dissemination of information to their peers. Trained peer educators staff the
Help Points, run informational sessions, render counseling services and learn leadership skills that allow
them to better engage their peers to make informed
choices about their bodies and lives.
Thanks to Endalkachew and 150 other peer educators
trained and deployed to serve
the two campuses of
Bahir Dar University,
students can access reproduc“A recent assessment showed that Help Points become
tive health
centers of discovery among young people with regard
information
to reproductive health,” Rezene says. “The number of
and servicstudents visiting the Help Points and benefiting from
es through
the services tends to increase over time.”
established
In addition, she says, Help Points have proven their
campus
worth to school administrators. “Now, there’s increased
“Help
commitment of university management in addressing
Points.” An
youth sexual and reproductive health issues for sucinnovative
cessful academic achievement.”
strategy to
provide EthioPartnerships with community organizations have been
pian high school
vital to implementing successful projects, as evidenced
and college students
by Ipas’s effective collaboration with Jerusalem Chilwith much-needed informadren and Community Development Organization since
tion on reproductive health, Help Points created by
2010 to bring Help Points to Bahir Dar University. After
Ipas Ethiopia and partner organizations now operate at documenting the success of Help Points in reaching
selected schools across the country and offer inforstudents, Ipas Ethiopia expanded its efforts to also reach
mation, counseling services, contraceptives, group
out-of-school youth through similar contact points, with
learning sessions, and mass “edutainment” activities
a focus on reaching rural youth by collaborating with
such as trivia sessions to engage young people on their community-based organizations, Rezene explains.
reproductive health needs and rights.
Whether the setting is urban or rural, however, the imAbortion is legal for a broad range of indications and
portant thing is that young people are empowered to
safe services are increasingly available for young
help each other. As second-year Bahir Dar University
women in Ethiopia, in part because the nation’s prostudent Meseret puts it: “Being a peer educator has
gressive abortion law specifically lists young age as
enabled me [to] discover new knowledge and informaa legal indication for having the procedure. However,
tion about reproductive health and build the confithe nation’s young people have long faced a lack of
dence to influence my peer[s].”
reproductive health information and contraceptives,
resulting in high rates of unintended pregnancy and
unsafe abortion.
Because 13
ECUADOR
Youth-run hotlines offer guidance—
and raise awareness
In Quito, Ecuador’s busy capital city, young
women with unwanted pregnancies face
a difficult situation: Abortion is illegal,
except in extreme cases, and highly
stigmatized. These young women
may feel helpless, ashamed, alone
and desperate. Without a reliable
source of support and guidance,
they are at risk of resorting to a
clandestine, unsafe abortion—like
more than 340 women in Ecuador
do every day.
But thanks to the confidential Women’s Health hotline (Salud Mujeres),
young women in Quito and other cities
have somewhere to turn. Created by the
youth-run nonprofit organization Youth Coordinator for Gender Equity (Coordinadora Juvenil por la
Equidad de Género), the hotline is based on the fundamental belief that all women have the right to freedom
of speech and the right to accurate, scientifically-proven
and secular information about their health.
Made up of young women and men aged 18–26, Youth
Coordinator aims to build a world where women—especially the youngest, poorest and most disadvantaged
women—can make safe decisions about their bodies
and their lives. Ipas works with Youth Coordinator to
support its hotline and related work raising awareness
throughout Ecuador of the need to have safe services.
Every woman who calls the hotline receives supportive
counseling and free, reliable information on sexual and
reproductive health, including information on contraception and on how to safely terminate an unwanted
pregnancy—if a woman so chooses—using misoprostol pills that are widely available in Ecuador.
“When we provide information about safe medical abortion, we know that we have contributed to allowing
one more woman to undergo a safe abortion without
risking her life,” explains Youth Coordinator’s Sarahí
Maldonado. “We don’t know whether she will choose
14 www.ipas.org
abortion and we don’t expect her to tell us, but we do
know that if she chooses the option of abortion, she will
have the information that will ensure her the best conditions, and that she clearly knows her rights as a woman.”
While women of all ages and backgrounds use the
hotline, a large portion of callers are young. In fact, 35
percent of callers are between the ages of 18 and 22,
Maldonado says. The women who answer the hotline’s
phones are also young: all under 34 years old.
Having identified a need amongst young people in
their society, these young women are working to meet
it. Accordingly, Maldonado and her colleagues like to
refer to their hotline work as a commitment by young
feminists to share information with women.
Across the broad spectrum of diverse women who
use the hotline, Maldonado says one thing is consistent: callers respond with gratitude, relief, and a
desire to help further disseminate the information
they have learned.
photos this page clockwise from top:
© Richard Lord; Purestock/Thinkstock; Creatas/Thinkstock
photo opposite page: © Ipas
NEPAL
Reproductive health classes come to Kathmandu
Valley
At a class for young women factory workers on sexual and reproductive health, one woman sat cradling
her week-old infant. The classes were so informative and interesting, she told the facilitator, that she
wouldn’t miss one for anything.
they are able to help their peers make informed decisions about their health care and lives.
In collaboration with two community partners in
Nepal, Ipas helped create a series of classes for factory workers.
Thousands of young women work in the brick,
“The young women factory workers increased
handicraft and textile factories scattered across
knowledge and skills in topics such as human
Nepal’s Kathmandu Valley. Multiple economic and
rights, gender, reproductive anatomy, pregnancy,
social barriers—such as the widely held beliefs that
contraception, HIV and abortion,” explains Ipas
young, unmarried women should not be sexually acNepal’s Madhabi Bajracharya. “In addition, the
tive and that reproductive health services are only for
young women built their capacity to be peer educaolder and married women—greatly limit the access
tors and conducted peer-to-peer outreach to other
these young women have to comprehensive informayoung women factory workers, as well as to friends
tion on sexual and reproductive health and rights,
and neighbors in their communities.”
including their right to a safe abortion.
Although abortion has been legally permitted in Nepal
since 2002, the risk of death or injury from unsafe
abortion persists—especially for young women and
women living in rural areas. So young women who
can share knowledge about reproductive health and
how to access safe services are uniquely positioned
to reduce the incidence of unsafe abortions. And
Bajracharya adds: “We worked with the Group for
Technical Assistance and Bhaktapur Youth Information Forum (BYIF), which is a local, youth-led
organization with experience effectively providing
young people with sexual and reproductive health
information.” In addition to BYIF, a new youth-led
organization, Thimi Youth Information Forum, is now
helping to run the classes.
Participants in the reproductive health classes talk
proudly of their improved ability to advise friends
and family members seeking information. One young
woman recalls a time in the past when a friend
confided that she had unprotected sex and needed
help. At the time, the young woman had believed
sex before marriage was a crime, so she scolded
her friend instead of offering
help. But the peer education
training changed her views.
Now she confidently says
she could offer guidance
in a positive and healthy
way to friends and others
who need it.
Because 15
It’s about women’s
EMPOWERMENT
Women hold up half the sky. We all know this.
And thanks to the New York Times’ Nicolas Kristoff, many more do as
well. Over the course of my 30-year career, just how true this is has
been better documented and more appreciated. Yet knowing this truth
makes our lack of progress when it comes to almost all of the indicators of women’s empowerment all the more embarrassing. We need to
advocate, more loudly than ever, to address the many health disparities
that continue to exist and that often do not look much better than they
did 30 years ago.
By Francine Coeytaux
Editor’s note: This article
has been adapted from Ms.
Coeytaux’s Lifetime Achievement
Award acceptance speech made
at the 2011 American Public
Health Association conference.
We have the tools, what is lacking is the political will. Nowhere
is that truer than in regard to abortion. As governments and policymakers rush to try to achieve the 5th Millennium Development
Goal—that of reducing maternal mortality—all seem to conveniently
overlook the fact that the fastest, most sure way to effectively do this
is by making abortion safe.
I recently traveled to India and Nigeria where I evaluated efforts to
prevent maternal deaths. I couldn’t help but notice that roughly a
third of the women in the hospital wards I visited were there not to
deliver but because they had attempted to abort their pregnancy.
This was as true in India, where abortion is now legal, as in Nigeria
where it is still restricted.
New technologies can be helpful but political will is still the
most important ingredient.
I remember, in the early 1980s, making a conscious decision about
which way to take my career. At the time, my decision was based
on what I now realize was a naïve faith in technology, tools and the
application of science.
I kept encountering what I refer to as the “Three As”—adolescence,
AIDS and abortion. These three topics were immense, intertwined
and were not easy to address. But when I weighed the opportunities
16 www.ipas.org
T
I decided to focus my work on reducing unsafe abortion, precisely because I knew that
we had all the required tools in hand—all we
needed was to make these very simple technologies available and show people (clinicians, governments, everyone) how effective
they were.
As for tackling the problem of AIDS—another scourge that was wiping out entire
populations at the time—I felt powerless to
do much, believing that the only tool we had
then was the condom and that its effective use would require large-scale behavior changes, something I knew to be very
difficult to achieve. Well, looking back now,
I think we’ve had much more success in addressing the spread of AIDS than we have in
improving access to safe abortion.
Why then, in spite of the advent of several
new contraceptive technologies like emergency contraception and abortion with pills,
do we still find ourselves looking at a map of
the world that does not look very different
from the world I was working in more than 30
years ago?
We still lack the political will.
Take medical abortion for example. We now
have a very simple, low-cost and easy-touse method, in the shape of pills that don’t
even really require a provider, which can
safely terminate an unwanted pregnancy. Yet
because of our many public policies, legal,
regulatory and administrative barriers, and
general discomfort with abortion, still today,
it is the disenfranchised, the poor, the young
and the powerless women who do not have
access to this truly lifesaving technology.
So I am giving up on trying to change
the political will from the top down and
going back to the women themselves.
I have come full circle, once again convinced
that it is all about women’s empowerment. After all, it was women in Brazil
who discovered the potential of misoprostol
(or cytoteca in their parlance). They did
so by taking initiative and circumventing
a system that, because of very restrictive
policies, did not allow them access to safe
services. They read the label on this readily available drug, learned that it in fact did
induce bleeding if taken during pregnancy,
and then, by word of mouth, they helped
other women, spreading the word about this
easily obtainable pill that could effectively
and safely terminate a pregnancy.
We in the public health world took what
they taught us, refined the technology and
developed what is now the gold standard—
mifepristone followed by misoprostol—a
hugely effective method of abortion which
is now, in most European countries as well
as our own, fast becoming the preferred and
most used method.
But what have we done for our sisters in the
rest of the world? Basically, for those living in
countries where abortion continues to be restricted, the availability of this new lifesaving
tool is largely non-existent. If I were to superimpose today’s map outlining where women
are still dying in significant numbers from
unsafe abortion on a map drawn up in 1980,
with the exception of two or three countries,
it would look the same. And as for Brazil,
strict policies (and strong political will from
the Catholic Church) have taken cytoteca off
the market and out of the hands of the very
women who discovered its use, leaving them
to once more fend for themselves.
We have
the tools,
what is
lacking
is the
political
will.
Nowhere is
that truer
than in
regard to
abortion.
We need to trust the power of women to help
themselves and help each other and believe
that they may ultimately be more effective in
influencing political will to address the problem of abortion than we have been.
Francine Coeytaux lives in Los Angeles, CA
and continues to work to improve women’s
health and rights.
Because 17
We have to trust women
Recently Because magazine had a
chance to sit down with Ms. Coeytaux
to discuss her current work and her
charge to empower women to make
their own reproductive health decisions, particularly by putting medical
abortion into their hands.
Can you talk more about your efforts to
expand misoprostol for abortion?
We’re in a very interesting time right now.
Medical abortion is cheap, easily available
and turns out to really help women. It’s effective, it’s safe. And women are talking to each
other about it.
At the Public Health Institute we’ve
launched an initiative to increase women’s
and pharmacists’ knowledge about and access to misoprostol in countries where abortion is restricted. We’ll provide support and
technical assistance to local women’s organizations, and award small grants to projects
proposed by these groups that demonstrate
the greatest potential to improve access to
misoprostol in communities.
What particular strategies will the
initiative use to reach women?
We think the success of the initiative will
hinge on new strategies and partnerships
that emerge from local organizations that
are working directly with women and adolescents. Medical abortion is safe enough
that we can really talk about empowerment,
not just the clinical aspects of the drug. We
want to partner with local women’s groups,
for example, whose mission is to empower
women. They are pragmatic and know
women want this. We will fund them so they
are able to do the work from the ground up
within their communities.
In Tanzania and Kenya, for example, we are
currently identifying women’s groups with
which we will partner. These groups can
come up with their own strategies and get
seed money for their efforts. We are also
hoping to work in Mexico and eventually
more countries.
18 www.ipas.org
In the public health field, particularly
around abortion care, there tends to be
a focus on the clinic delivery system:
Do you think we need to move away
from that?
There are really few health risks with
misoprostol. This is what you might call a
natural public health experiment—we have
evidence that it is used widely and that
women are doing this themselves. And this
has important public health implications; in
hospitals we don’t see as many terrible infections from clandestine abortion because
misoprostol is safe.
We need to help women so they can help
themselves—not stand in their way. We can’t
miss the opportunity to really put misoprostol in their hands. Unfortunately, as a field,
we decided to take this to a provider frame
instead. The bottom line is we don’t really
trust women with their own reproductive
health care—do we think they will misuse or
abuse misoprostol? We decide what’s effective; but have we really asked women what
they think?
What conclusions have you come to
about reproductive rights and abortion,
having worked for so long in this arena?
Looking back, it’s about gender and women’s
status really. So much is seen as a woman’s
problem and women don’t matter. Women
are still fighting for the right to vote or inherit
land in so many places in the world. Gender
is the real difference. We all read about how
important women are to society but sometimes we are just talking the talk. Are we
scared of empowering women for real?
I truly believe we need to empower local,
grassroots groups so that women can identify the issues and barriers around abortion,
particularly with misoprostol, and then help
them with what they say they need. Let
women be the shapers and the users, not the
beneficiaries of what we think they need.
Fact: Emergency contraception
doesn’t cause abortion
Emergency contraception, in particular, is widely misunderstood. Many
people believe emergency contraception causes abortion. In fact, it is birth
control that prevents pregnancy up to five
days after unprotected sex. The primary
and very likely only mechanism of action
is that emergency contraception stops or
disrupts ovulation. This means that no
mature egg is released from the ovary. If a
mature egg is not released, then it cannot
be fertilized and a woman cannot become
pregnant. This is similar to how hormonal
contraceptives work.
The most widely available form of emergency contraception is levonorgestrel-alone.
Emergency Contraceptive Pills (LNG-ECPs),
sometimes called “the morning after pill,”
are available under many brand names,
including Norlevo, Postinor and Plan B. This
is the regimen recommended by the World
Health Organization and available in most
countries. Research shows that making
emergency contraceptive pills more widely
available does not adversely affect regular
contraceptive use or increase risk-taking,
such as having unprotected sex.
No adverse effects on future fertility
Levonorgestrel, the active ingredient in
LNG-ECPs, has been widely used in various
formulations for more than 30 years and
has been extensively studied in women of
reproductive age. LNG-ECPs have been
found to be safe, including for use by adolescents. LNG-ECPs cannot harm a pregnant woman or a developing fetus if taken
early in pregnancy.
FACTsheet
Contraception has emerged as a
key issue in the 2012 U.S. presidential race—laden with emotion and
controversy, and the subject of much
misinformation. Some fact-checking
is in order.
Research shows that the use of hormonal
contraception, including ECPs, has no
adverse effect on future fertility and that
LNG-ECPs do not interrupt an established
pregnancy or harm a developing embryo.
Most brands of oral contraceptives can be
used as post-coital contraception. The website www.not-2-late.com has instructions,
including brand names of oral contraceptives and how many pills need to be taken
for them to serve as effective post-coital
emergency contraception. It is important
to have accurate information since the hormonal dosage varies by brand.
Adapted from Ipas’s The evidence speaks
for itself: Ten facts about abortion.
www.ipas.org/ten-facts
Because 19
A picture says
1,000 words
A video says even more
See what our videos have to say
about the 21 million women
who undergo an unsafe
abortion every year
about the effects of
abortion stigma on us all
about the bright futures
girls create for themselves
when given the chance
www.ipas.org/youtube
Protecting women’s health
Advancing women’s reproductive rights